Repeatability and reproducibility of a new method for centration analysis via optical zone tangent points after corneal refractive surgery.

PURPOSE: To investigate the repeatability and reproducibility of a new method for centration analysis after small incision lenticule extraction (SMILE) and femtosecond laser-assisted LASIK (FS-LASIK). METHODS: This study comprised 29 eyes treated with SMILE and 24 with FS-LASIK. Decentrations were analyzed using tangential and pachymetry difference maps respectively. Both difference maps were generated with a Scheimpflug tomographer (Pentacam) for each eye, using preoperative and 3-month postoperative scans. Repeatability and reproducibility were evaluated by calculating the intraclass correlation coefficient (ICC), within-subject standard deviation (Sw), and coefficient of repeatability (CR). RESULTS: ICC, Sw, and CR showed good to excellent repeatability in locating the coordinates of the optical zone (OZ) center on both maps, with values ranging from 0.84 to 0.96, 0.03 to 0.13, and 0.08 to 0.36 respectively. The repeatability of the total decentration from the preoperative corneal vertex on the tangential curvature difference maps( d TC ) and the pachymetry difference maps( d PC ) were moderate and good, respectively. The ICC, Sw, and CR of d TC were 0.63, 0.09, and 0.25, respectively. The ICC, Sw, and CR of d PC were 0.77, 0.10, and 0.28, respectively. The reproducibility of the OZ center measurements was excellent for the tangential difference maps (ICC ≥ 0.97 ) and good for the pachymetry difference maps (ICC ≥ 0.86). ICC, Sw, and CR showed excellent reproducibility of d TC , with values of 0.95, 0.03, and 0.08, respectively. ICC, Sw, and CR showed good reproducibility of d PC , with values of 0.89, 0.06, and 0.17, respectively. CONCLUSION: The centration analysis method used in this study showed good to excellent repeatability and reproducibility in locating the coordinates of the center of the OZ on the tangential and pachymetry difference maps.

Effect of corneal curvature on optical zone decentration and its impact on astigmatism and higher-order aberrations in SMILE and LASIK.

PURPOSE: To determine the association between anterior corneal curvature and optical zone centration as well as its impact on aberration profiles in small-incision lenticule extraction (SMILE) and laser in situ keratomileusis (LASIK). METHODS: Seventy-eight eyes of 78 patients treated with SMILE (45 eyes) and LASIK (33 eyes) were included. The centration of the optical zone was evaluated on the instantaneous curvature difference map between the preoperative and 3-month postoperative scans using a superimposed set of concentric circles. The correlation between optical zone decentration and anterior keratometry values was evaluated. The effect of optical zone decentration on vector components of astigmatic correction and induction of higher-order aberrations (HOA) was assessed. RESULTS: The mean decentration distance was 0.21 ± 0.11 mm for SMILE and 0.20 ± 0.09 mm for LASIK (p = 0.808). There was a significant correlation between anterior keratometric astigmatism and decentration distance (r = 0.653, p < 0.001) for SMILE but not for LASIK (r = - 0.264, p = 0.138). Astigmatic correction was performed in 67 eyes. Optical zone decentration and the vector components of astigmatic correction were not correlated (p ≥ 0.420). Significant correlation was demonstrated between the decentration distance and the induced total coma (SMILE: r = 0.384, p = 0.009; LASIK: r = 0.553, p = 0.001) as well as the induced total HOA (SMILE: r = 0.498, p = 0.001; LASIK: r = 0.555, p = 0.001). CONCLUSION: Anterior cornea astigmatism affected the treatment centration in SMILE but not LASIK. Subclinical decentration was associated with the induction of total coma and total HOA, but it did not affect the lower-order astigmatic correction.

Glenoid retroversion is an important factor for humeral head centration and the biomechanics of posterior shoulder stability.

PURPOSE: Glenoid retroversion is a known independent risk factor for recurrent posterior instability. The purpose was to investigate progressive angles of glenoid retroversion and their influence on humeral head centration and posterior translation with intact, detached, and repaired posterior labrum in a cadaveric human shoulder model. METHODS: A total of 10 fresh-frozen human cadaveric shoulders were investigated for this study. After CT- canning, the glenoids were aligned parallel to the floor, with the capsule intact, and the humerus was fixed in 60° of abduction and neutral rotation. Version of the glenoid was created after wedge resection from posterior and fixed with an external fixator throughout the testing. Specimens underwent three conditions: intact, detached, and repaired posterior labrum, while version of the glenoid was set from + 5° anteversion to - 25° retroversion by 5° increments. Within the biomechanical setup, the glenohumeral joint was axially loaded (22 N) to center the joint. At 0° of glenoid version and intact labrum, the initial position was used as baseline and served as point zero of centerization. After cyclic preloading, posterior translation force (20 N) was then applied by a material testing machine, while start and endpoints of the scapula placed on an X-Y table were measured. RESULTS: The decentralization of the humeral head at glenoid version angles of 5°, 10°, 15°, and 20° of retroversion and 5° of anteversion was significantly different (P < 0.001). Every increment of 5° of retroversion led to an additional decentralization of the humeral head overall by (average ± SD) 2.0 mm ± 0.3 in the intact and 2.0 mm ± 0.7 in the detached labrum condition. The repaired showed significantly lower posterior translation compared to the intact condition at 10° (P = 0.012) and 15° (P < 0.01) of retroversion. In addition, CT measured parameters (depth, diameter, and native version) of the glenoid showed no correlation with angle of dislocation of each specimen. CONCLUSION: Bony alignment in terms of glenoid retroversion angle plays an important role in joint centration and posterior translation, especially in retroversion angles greater than 10°. Isolated posterior labrum repair has a significant effect on posterior translation in glenoid retroversion angles of 5° and 10°. Bony correction of glenoid version may be considered to address posterior shoulder instability with retroversion > 15°.

Rehabilitation of an ocular defect with intraorbital implant and custom-made prosthesis using digital photography and gridded spectacle.

Accidental trauma involving the eye may necessitate surgical removal of the eye ball. Immediate management should consider future prosthetic rehabilitation. Insertion of eye ball implant after enucleation or evisceration preserves socket anatomy, maintains sulcus and fornix which ensures proper retention of ocular prosthesis in future. Placement of intraorbital ball implant also reduces the weight as well as enhances motility of the prosthesis, thus imparting life-like appearance. Custom-made acrylic prosthesis has been shown to deliver superior functional and esthetic result. Exact positioning of the iris disc on a custom-made scleral blank is critical from esthetic point of view. This clinical report describes prosthetic rehabilitation of an anophthalmic socket where intraorbital ball implant was inserted during evisceration. Custom-made acrylic ocular prosthesis with a prefabricated iris button was used. Here, digital photography and a specially fabricated spectacle gridded with mm scale were used for positioning iris button on the ocular prosthesis. These two methods of centration of iris button may be used to reduce chairside time and increase patient cooperation with a positive clinical outcome.

Low Concentration of Exogenous Carbon Monoxide Modulates Radiation-Induced Bystander Effect in Mammalian Cell Cluster Model.

During radiotherapy procedures, radiation-induced bystander effect (RIBE) can potentially lead to genetic hazards to normal tissues surrounding the targeted regions. Previous studies showed that RIBE intensities in cell cluster models were much higher than those in monolayer cultured cell models. On the other hand, low-concentration carbon monoxide (CO) was previously shown to exert biological functions via binding to the heme domain of proteins and then modulating various signaling pathways. In relation, our previous studies showed that exogenous CO generated by the CO releasing molecule, tricarbonyldichlororuthenium (CORM-2), at a relatively low concentration (20 µM), effectively attenuated the formation of RIBE-induced DNA double-strand breaks (DSB) and micronucleus (MN). In the present work, we further investigated the capability of a low concentration of exogenous CO (CORM-2) of attenuating or inhibiting RIBE in a mixed-cell cluster model. Our results showed that CO (CORM-2) with a low concentration of 30 µM could effectively suppress RIBE-induced DSB (p53 binding protein 1, p53BP1), MN formation and cell proliferation in bystander cells but not irradiated cells via modulating the inducible nitric oxide synthase (iNOS) andcyclooxygenase-2 (COX-2). The results can help mitigate RIBE-induced hazards during radiotherapy procedures.

Pupil versus 1st Purkinje capsulotomy centration with femtosecond laser: Long term outcomes with a sinusoidal trifocal lens.

PURPOSE: To assess the role of femtosecond laser-assisted capsulotomy centration in the long-term intraocular positioning of a multifocal intraocular lens. DESIGN: Prospective comparative study. METHODS: A total of 60 eyes of 30 patients underwent femtosecond laser-assisted Refractive Lens Exchange (RLE). For every patient, capsulotomy centration was randomly performed according to pupil centre (PC) in one eye and first Purkinje reflex (FPR) in the other. The intraocular lens (IOL) positioning, visual acuities, spherical equivalent, internal aberrometry and quality of vision were assessed and compared at 3 years' follow-up between groups (PC and FPR). RESULTS: Intraocular lens positioning showed a statistically significant difference between groups, with a closer centration to the visual axis in the FPR patients (p < 0.001). Internal aberrometry showed higher values in the PC capsulotomy centration group (p < 0.01). CONCLUSIONS: FPR centered capsulotomy is associated to a closer centration of the IOL to the visual axis.

Amelioration: An Innovative Approach to Behavior Management Based on Cognitive Process.

Aim: The study aimed to determine the applicability of psychological traits identified by Piaget sixty years ago to children in the current generation and to utilize these traits clinically for behavior modification. Methods: A cross-sectional study was conducted with 200 participants aged 4-7, divided into four groups. Three tests were administered to evaluate the manifestation of preoperational features. Based on the most noticeable aspect of cognitive development, tailored behavior management strategies were applied to help improve cooperation among the children. The study utilized Frankl's behavior rating scale both before and after the intervention, and statistical analysis was performed to assess the outcomes. Results: Contrary to Piaget's findings, the study revealed that 94% of children displayed egocentrism and centration at the age of four, with these traits gradually decreasing from four to seven years old. Moreover, better patient cooperation was observed when cognitive-based behavior management techniques were employed clinically, and the improvement was statistically significant at P < 0.001. Conclusion: The study concluded that the Amelioration, a cognitive feature-based behavior modification technique, represented the most effective way to elicit cooperative responses from children. This technique can be considered a novel and pioneering behavior management strategy for enhancing patient cooperation.

Honey Bee Products as Bio Indicator of Heavy Metals Pollution and Health Risk Assessment Through the Consumption of Multifloral Honey Collected in Azad Kashmir, Pakistan.

The study assessed the health risks associated with heavy metal ingestion and explored the use of honey bee products as a bio-indicator for heavy metal pollution. All honey bee products tested showed heavy metals, but some honey samples had concentrations exceeding permissible limits for Cd, Pb, Ni, and Cr. The mean concentrations of heavy metals (mg/kg) in the honey, propolis, bee wax, and bee pollen were Fe (1.32) > Zn (1.31) > Pb (0.46) > Ni (0.18) > Cr (0.16) > Cu (0.14) > Co (0.12) > Mn (0.05) > Cd (0.03), Fe (8) > Zn (1.13) > Mn (0.59) > Pb (0.13) > Ni (0.07) > Cu (0.06) > Co (0.05) > Cr (0.03) > Cd (0.02), Fe (1.31) > Pb (0.41) > Ni (0.407) > Zn(0.25) > Mn (0.12) > Co(0.10) > Cu (0.07) > Cr (0.05) > Cd (0.002), and Fe (2.2) > Zn (0.75) > Ni (0.25) > Pb (0.16) > Cu (0.05) > Mn (0.045) > Co (0.04) > Cr (0.01) > Cd(0.002), respectively. Similarly, the mean concentration of heavy metals (mg/kg) in the soil, flowers and pine pollen was Fe (539.08) > Zn (89.53) > Mn (66.91) > Ni (58.5) > Co (19.2) > Cr (11.42) > Pb (6.58) > Cu (5.71) > Cd (0.19), Fe (3.12) > Zn (0.95) > Mn (0.72) > Ni (0.29) > Cu (0.16) > Cr (0.14) > Pb (0.059) > Co (0.057) > Cd (0.003) and Fe (2.59) > Zn (1.75) > Mn (0.43) > Pb (0.34) > Co (0.1) > Cr (0.07) > Cu (0.06) > Cd (0.039) > Ni (0.03), respectively. The atomic absorption spectrophotometry procedure was validated through a recovery study and achieved accuracy through the limit of detection (LOD) and limit of quantification (LOQ). The mean Bio concentration factor (BCF) indicated that the transfer from soil to honey was higher than from soil to flower. The metal pollution index (MPI) of the selected indicators was in descending order: soil > honey > flowers > propolis > pine pollen > beeswax > bee pollen. The hazard quotient (HQ) and hazard index (HI) were below one, showing no chronic health risk. The carcinogenic risk (CR) of Cd, Cr, and Ni in honey for children, male and female adults for the consumers exceeds the acceptable level, making Cd, Cr, and Ni the most concerning heavy metals in honey. The study suggests that regular monitoring of heavy metal pollution is essential.

Switching from weak to strong cortical attachment of microtubules accounts for the transition from nuclear centration to spindle elongation in metazoans.

The centrosome is a major microtubule organizing center in animal cells. The position of the centrosomes inside the cell is important for cell functions such as cell cycle, and thus should be tightly regulated. Theoretical models based on the forces generated along the microtubules have been proposed to account for the dynamic movements of the centrosomes during the cell cycle. These models, however, often adopted inconsistent assumptions to explain distinct but successive movements, thus preventing a unified model for centrosome positioning. For the centration of the centrosomes, weak attachment of the astral microtubules to the cell cortex was assumed. In contrast, for the separation of the centrosomes during spindle elongation, strong attachment was assumed. Here, we mathematically analyzed these processes at steady state and found that the different assumptions are proper for each process. We experimentally validated our conclusion using nematode and sea urchin embryos by manipulating their shapes. Our results suggest the existence of a molecular mechanism that converts the cortical attachment from weak to strong during the transition from centrosome centration to spindle elongation.

Variations of pupil centration and their effects on video eye tracking.

PURPOSE: To evaluate measurement errors that are introduced in video eye tracking when pupil centration changes with pupil size. METHODS: Software was developed under Visual C++ to track both pupil centre and corneal centre at 87 Hz sampling rate at baseline pupil sizes of 4.75 mm (800 lux room illuminance) and while pupil constrictions were elicited by a flashlight. Corneal centres were determined by a circle fit through the pixels detected at the corneal margin by an edge detection algorithm. Standard deviations for repeated measurements were ± 0.04 mm for horizontal pupil centre position and ± 0.04 mm for horizontal corneal centre positions and ±0.03 mm for vertical pupil centre position and ± 0.05 mm for vertical corneal centre position. Ten subjects were tested (five female, five male, age 25-58 years). RESULTS: At 4 mm pupil sizes, the pupils were nasally decentred relative to the corneal centre by 0.18 ± 0.19 mm in the right eyes and -0.14 ± 0.22 mm in the left eyes. Vertical decentrations were 0.30 ± 0.30 mm and 0.27 ± 0.29 mm, respectively, always in a superior direction. At baseline pupil sizes (the natural pupil sizes at 800 lux) of 4.75 ± 0.52 mm, the decentrations became less (right and left eyes: horizontal 0.17 ± 0.20 mm and -0.12 ± 0.22 mm, and vertical 0.26 ± 0.28 mm and 0.20 ± 0.25 mm). While pupil decentration changed minimally in eight of the subjects, it shifted considerably in two others. Averaged over all subjects, the shift of the pupil centre position per millimetre pupil constriction was not significant (right and left eyes: -0.03 ± 0.07 mm and 0.03 ± 0.04 mm nasally per mm pupil size change, respectively, and -0.04 ± 0.06 mm and -0.05 ± 0.12 mm superiorly). Direction and magnitude of the changes in pupil centration could not be predicted from the initial decentration at baseline pupil sizes. CONCLUSIONS: In line with data in the literature, the pupil centre was significantly decentred relative to the corneal centre in the nasal and superior direction. Pupil decentration changed significantly with pupil size by 0.05 mm on average for 1 mm of constriction. Assuming a Hirschberg ratio of 12° mm(-1) , a shift of 0.05 mm is equivalent to a measurement error in a Purkinje image-based eye tracker of 0.6°. However, the induced measurement error could also exceed 1.5° in some subjects for only a 1 mm change in pupil size.

Using a smartphone app in the measurement of posture-related pupil center shift on centration during corneal refractive surgery.

Purpose: Pupil center is an important anchor point in corneal refractive surgery, which may affect by body position. This study investigated the feasibility of using a smartphone application in measurement of posture-related pupil center shifts. Methods: Images of undilated eyes were captured for 25 participants (age: 18-38 years) at a distance of 40 cm in four body positions (seated, supine, right lateral, and left lateral) under controlled lighting conditions. During taking images, a smartphone application was used to guide positioning without head rotation and tilt. From the images, the location of the pupil center and pupil diameter with respect to the limbus boundary were measured. Results: According to the data obtained by the smartphone application, pupil center was located slightly nasal and superior to the limbus center in the seated position, and it shifted more nasally and superiorly (p < 0.001, OD 0.54 ± 0.11 mm, OS 0.57 ± 0.14 mm) in the supine position. When body position switched between left and right lateral positions, the pupil centers of both eyes shifted along the direction of gravity (p < 0.05), and no significant shift occurred along the longitudinal axis. Moreover, pupil constriction was observed when the body position changed from seated to supine position (p < 0.001, OD 0.64 ± 0.57 mm, OS 0.63 ± 0.58 mm). Conclusion: Posture-related pupil center shift may be larger than the error tolerance of centration in corneal refractive surgery, which might be difficult to measure by the existing instruments. An accessible application is necessary for evaluating the shift of pupil center and guiding centration during the surgery.

Centration assessment of an extended depth of focus contact lens for myopic progression control.

PURPOSE: To evaluate the accuracy and the inter and intra-observer reliability of the centration assessment of extended depth of focus (EDOF) contact lenses (CL) using corneal topography. METHOD: EDOF soft CLs (Mylo, Mark'Ennovy) were fitted on thirty-three myopic students (25 females), aged 19-28 years (22.7 ± 2.0 years). For any EDOF CL, a topography over the CL and a slit lamp (SL) digital picture were taken in random order. For the topographic images, the position of the EDOF CL centre, with respect to the pupil centre, was detected by two different practitioners (one newly graduated and one with more than 20 years of clinical experience respectively) and repeated after 15 days. This measurement was compared to the one taken through the SL, considered as the gold standard, and assessed using the instrument software. RESULTS: EDOF CLs resulted decentred inferiorly and temporally ranging, in the case of slit lamp assessment, between -0.27 ± 0.19 and 0.22 ± 0.23 mm horizontally and between -0.12 ± 0.31 and -0.17 ± 0.34 mm vertically, for the right and left eye respectively. The accuracy of the topographic assessment in determining EDOF CL centration was found to be very good compared to the SL assessment. No differences were found for the left eye, whereas in the right eye, a less temporally decentred position of the CL was detected by the topographical method (p < 0.05). However, this difference appeared clinically negligible (0.14 ± 0.22 mm). Inter-observer reliability (the differences between the two practitioners in assessing the EDOF centre) resulted significant only for the vertical coordinates of the centre position (p < 0.05). Concerning intra-observer reliability, better coefficient of precision and reliability between measurements within the same session were achieved by the more experienced practitioner, as well as a better level of the intraclass correlation coefficient in test-retest. CONCLUSION: The centration of the EDOF CL investigated in this study can be accurately detected by a corneal topography performed over CLs. Inter-observer reliability resulted good whereas the intra-observer reliability resulted partially affected by the level of clinical experience of the practitioner.

Changes of intraocular lens position induced by Nd:YAG capsulotomy.

AIMS: The aim of this study was to evaluate the changes in IOL position (axial shift, tilt and decentration) in the capsular bag after Nd:YAG laser capsulotomy and to create a user-friendly software that is optimized for the output of available imaging technology, then verify the relationship between the biometric parameters of the eye and the extent of changes in the IOL position. PATIENTS AND METHODS: The study included 35 artephakic eyes that underwent laser capsulotomy. Before and at least one hour after capsulotomy, all patients underwent the following assessments: optical biometry (Lenstar LS900), OCT with anterior segment module (Optovue Avanti) and IOL photography in infrared mode using reference unit (Verion). The original software solution was designed for the graphical evaluation of the differences between centering, axial displacement and tilt of IOL. Changes in IOL position were evaluated as simple differences before and after the laser procedure and as differences in absolute values (abs). RESULTS: The following results show the average differences in IOL position: ACD=0.02±0.23 mm (abs=0.11±0.20 mm), IOL decentration in x-axis = -0.001±0.091 mm (abs=0.065±0.063 mm), IOL decentration in y-axis =0.012±0.119 mm (abs=0.048±0.53 mm), tilt in horizontal plane TILT-H=0.11±0.83° (abs=0.51±0.66°) and tilt in vertical plane TILT-V = -0.14±0.49° (abs=0.26±0.44°). All changes were insignificant (P>>0.05). In total, 74.29% of IOLs showed a hypermetropic shift. A moderate positive correlation was found between the absolute differences in horizontal tilt and keratometry (r=0.45). Relationship with other changes and parameters were weak. CONCLUSION: In conclusion, the use of the original software solution developed by the authors showed that changes in IOL centering, axial displacement and tilt occur after Nd:YAG capsulotomy, but average differences were insignificant. In almost 3/4 cases, there was a hypermetropic axial displacement of the IOL.

Early results of circularity and centration of capsulotomy prepared by three different methods.

AIM: To compare the difference of capsulotomy produced by precision pulse capsulotomy (PPC), manual (M-CCC), and femtosecond laser assisted capsulotomy (FLAC) in relation to intraocular lens (IOL) centration, circularity and its effect on visual outcomes. METHODS: Prospective, non-randomized comparative study conducted at LV Prasad Eye Institute, Hyderabad, India. Sixty eyes of 52 patients were grouped into 3 (FLAC, PPC and M-CCC) based on capsulotomy techniques used. Twenty consecutive eyes with uneventful phacoemulsification and with no comorbidities affecting the capsulotomy or visual outcome were included in each group. The main outcome measure was IOL centration in relation to capsulotomy and pupil. Secondary outcome measures were post-operative visual acuity, manifest refraction and aberration profile between groups. RESULTS: At 5wk the visual, refractive outcomes and endothelial cell density were comparable between the 3 groups. The median circularity index of FLAC was statistically significantly different to M-CCC or PPC (1-10) groups (P<0.01) but PPC (11-20) was comparable to FLAC. Decentration of IOL center in relation to capsulotomy was seen only between the PPC (1-10) group and FLAC group (P=0.02). The IOL was well centered in relation to the pupil in all the groups (P=0.46). The quality of vision parameters like the higher order aberrations, spherical aberration, coma, trefoil, modular transfer function, and Strehl ratio were comparable between the groups. CONCLUSION: Our study shows that despite differences in the morphology of capsulotomy produced by PPC, M-CCC, FLAC a well-centered IOL can be achieved. The measured capsular morphology parameters do not affect visual outcomes.

Evaluation of Decentration, Tilt and Angular Orientation of Toric Intraocular Lens.

PURPOSE: The aim of this study was to develop software for the universal objective evaluation of factors influencing intraocular correction of astigmatism, such as decentration, tilt, axial position and angular orientation the toric intraocular lens (IOL). PATIENTS AND METHODS: Software was developed using the MS Visual Studio environment. The analysis was presented using images of 67 eyes with an implanted IOLs of the SN6ATx model series. Decentration and angular position of the lens were obtained from images of the anterior segment of the eye, using a Visucam unit. Tilt was measured on tomographic images from OCT Avanti (in meridian of highest tilt and perpendicular meridian) and preoperative biometry parameters of eye (axial length, anterior chamber depth - ACD, ocular lens thickness - LT, limbus diameter and mean keratometry value) including postoperative anterior chamber depth (pACD) were measured using Lenstar LS900. RESULTS: Applying the software methodology to the evaluation of individual toric IOL parameters, the following results were obtained: mean decentration 0.25 ± 0.17 mm which was observed in 61.19% of eyes, mean misalignment to the planned axis equal to 3.8 ± 3.6 degrees, mean highest inclination equal to 3.7 ± 1.2 degrees and mean difference of pACD and ACD was equal to 1.46 ± 0.31 mm. There was only a weak nonsignificant correlation between preoperative ACD versus decentration and tilt of IOL or a weak significant correlation between preoperative LT and both decentration and misalignment of IOL. CONCLUSION: The use of the presented methodology for determining the positional parameters of the toric IOL provided comparable results with the results of recent studies. Software design can be considered as a suitable alternative to previously published techniques, with the significant advantage of the possibility of using universal input images, their graphical editing and especially the possibility of comprehensive analysis of all parameters.

The Effect on Post-Operative Intraocular Lens Centration by Manual Intraoperative Centration versus Auto-Centration.

INTRODUCTION: To determine if intraoperative manual centration of the intraocular lens (IOL) during cataract surgery results in better early post-operative centration. It is common practice for cataract surgeons to align intraocular lens centration to the visual axis by manual intraoperative manipulation of the intraocular lens. We aim to compare post-operative intraocular lens centration between intraocular lenses that were allowed spontaneous positioning in the capsular bag and IOLs that were manually centred during implantation. MATERIALS AND METHODS: One hundred and twenty-five consecutive eyes that underwent either femtosecond laser-assisted cataract surgery (FLACS) or phacoemulsification and IOL (monofocal/toric/multifocal) implantation by a single surgeon were included. Post-operative IOL centration at 4 weeks was assessed and measured on a slit-lamp by a masked observer. RESULTS: A total of 17 (13.6%) IOLs were off-centered to some extent at 4 weeks post-operatively. All the decentered IOLs were graded as minimal or mild (<0.5mm) decentration. There was no statistically significant difference in the proportion of decentered IOLs between the manual centration group and non-centration group (p = 0.59). CONCLUSION: The final position of the IOL is not dependent on manual centration but rather on the design and symmetry of the IOL, as well as the integrity of the capsular bag.

Accuracy, inter-observer and intra-observer reliability in topography assessment of multifocal contact lens centration.

PURPOSE: To evaluate the accuracy and reliability (inter and intra-observer) of a method to assess multifocal contact lenses (MCLs) centration using a corneal topography unit. METHOD: Daily-disposable MCLs (Fusion 1 day Presbyo) were fitted on both eyes of the subjects. For each lens fit a slit lamp digital picture and videokeratograph image were taken in a rapid but randomised sequence. Photo-editing software was used to assess the position of the MCL centre with respect to pupil centre as taken from the slit lamp photograph. The position of the MCL centre was automatically detected as the point of maximum curvature from the videokeratography. Three further manual and qualitative procedures to detect MCL centre, comparing a template of CLs optic zones to the videokeratographic image were performed by 4 practitioners using 3 different algorithms to represent the topographic map. Each manual reading was repeated 3 times. RESULTS: Twenty-two subjects (11 males) aged 22.8 ± 1.9 years (range 20.8-27.0 years) were recruited. The accuracy of the 4 topographic assessments in determining the centre coordinates of the MCL with respect to SL assessment was good: no differences were found in the left eyes and although in the right eyes a more temporal and superior position of MCLs was determined (paired t-test, p < 0.05) the difference was clinically negligible (0.16 ± 0.36 mm horizontally, 0.23 ± 0.48 vertically). Amongst the 4 practitioners one-way Anova for repeated measures showed no differences for any of the 3 manual assessments. Intra-class correlation coefficient was calculated among the 3 readings for each manual procedure and was very good (between 0.75 and 0.98) in 3 practitioners and moderate (between 0.49 and 0.92) in the fourth. CONCLUSIONS: The assessment of MCL centration by performing corneal topography over the MCL is an accurate method. Furthermore, inter and intra-practitioner reliability showed by manual procedures appeared very good.

Patient selection to optimize near vision performance with a low-addition trifocal lens.

PURPOSE: To assess the impact of ocular biometric variables on the visual performance achieved with a low addition trifocal intraocular lens (MIOL). METHODS: Retrospective observational study including 34 eyes. Preoperative measured variables included mean corneal power (Km), corneal regular astigmatism (RA), anterior chamber depth (ACD), axial length (AXL), total irregular astigmatism (IA), spherical aberration (SA) and distance from pupil center to vertex normal (µ). Same variables were retrieved from the three month visit follow-up in addition to the actual lens position (ALP), the calculated effective addition (EA), the IOL centration from vertex normal (d), and the visual acuity defocus curve. The area under the defocus curve was computed along the total curve (TAUC) and ranges for far (FAUC), intermediate (IAUC) and near vision (NAUC). The sample was split in two groups of 17 eyes with TAUCs above and below the mean, and the differences among groups for different ocular parameters were assessed. RESULTS: The group of eyes above TAUC of 2.03 logMAR*m-1 showed significantly lower Km and greater AXL and SA. Km was negatively correlated with TAUC and NAUC. NAUC was negatively correlated with IA and positively with d. A multiple lineal regression model including Km, d, and IA predicted NAUC (r-square = 34%). No significant differences between IA and SA were found between preoperative and postoperative values but µ significantly decreased after surgery. CONCLUSIONS: The mean corneal power, irregular astigmatism, and centration from vertex normal should be considered for optimizing the near visual performance with this MIOL.

Comparative Analysis of LASIK Flap Diameter and its Centration Using Two Different Femtosecond Lasers.

The aim of this study was to compare the diameter, accuracy, variability, and centration with respect to the limbus of corneal flaps created by two femtosecond lasers, the VisuMax, and Wavelight FS200, for laser in situ keratomileusis (LASIK) and how these flaps affect visual outcomes. This is a retrospective chart review of flap morphology created during LASIK Surgery. Overall, 168 eyes underwent flap creation using the WaveLight FS200 laser, and on 189 eyes, the VisuMax laser was used. Of these total number, flap morphology was analyzed in a random sample of 158 eyes; 80 with the Visumax laser and 78 with the WaveLight FS200 laser. Intraoperative photos of the flaps taken by the Wavelight Allegretto EX500 were analyzed. Flap diameters and centration were measured using Adobe Acrobat Pro. All patients had visual acuity measurements including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent refraction (SE) and refractive astigmatism recorded three months postoperatively. Greater than 90% of patients in both groups achieved a UDVA of 20/20 postoperatively. The mean difference between targeted and achieved flap diameter was 0.50 +/- 0.15 mm in the VisuMax group and 0.35 +/- 0.15 millimeters (mm) in the FS200 group (P<0.01). The flap diameters of the VisuMax group were more precise with a variance of 0.024 mm compared to a variance of 0.038 mm in the FS200 group (P<0.05). VisuMax flaps were more nasally displaced (log(NA/TA) = -0.21 +/- 0.10 mm) compared to the FS200 flaps (log(NA/TA) = 0.03 +/- 0.10 mm), (P< 0.01). We concluded that both the VisuMax and FS200 created flaps larger than the preoperative targeted diameter. VisuMax created corneal flaps that had a greater degree of deviation from the targeted diameter when compared to flaps from the FS200. However, there was less variance in the VisuMax flap diameter. In addition, VisuMax flaps were more nasally displaced. There were no statistically significant differences in visual outcomes when comparing the two femtosecond lasers.

Biometric Factors Associated with the Visual Performance of a High Addition Multifocal Intraocular Lens.

Purpose/Aim: To evaluate the impact of ocular parameters on the visual performance achieved with the multifocal intraocular lens (IOL) Bi-Flex M 677MY. MATERIALS AND METHODS: About 26 subjects were included in the current study. Several physiological variables were retrieved from the 3-month follow-up visit, including pupil diameter and distance from pupil center to the vertex normal of the anterior cornea (µ). These variables were also obtained in the preoperative visit. Binocular and monocular visual acuity defocus curves were measured at 1 and 3 months after surgery, respectively. The monocular Area Under the Curve (AUC) was computed along the total range (Total Area Under the Curve (TAUC), +1.00 to -4.00 D) and for the ranges of Far (Far Area Under the Curve (FAUC), +0.50 to -0.50 D), (Intermediate Area Under the Curve (IAUC), -1.00 to -1.50 D) and Near vision (Near Area Under the Curve (NAUC), -2.00 to -4.00 D). Correlations between these areas and the postoperative physiological variables were assessed. RESULTS: The mean µ was reduced from 0.21 to 0.10 mm after surgery, as well as pupil diameters, either photopic (-7.4%) or mesopic (-8.1%) (p < 0.05). The mean AUCs were 2.08 ± 0.74 for TAUC, 0.57 ± 0.17 for FAUC, 0.16 ± 0.09 for IAUC, and 0.81 ± 0.29 for NAUC. Significant correlations were found between NAUC and corneal power  (r = -0.39, p = 0.05) as well as between IAUC and temporal decentration of the lens from vertex normal (ρ = -0.41, p = 0.04). CONCLUSIONS: The visual performance at near distance with the IOL evaluated improved in eyes with less corneal power. On the other hand, a slight temporal IOL decentration from vertex normal also improved intermediate visual acuity. The binocular defocus curve was similar to other trifocal IOLs.