Bilateral Implantation of Multifocal Intraocular Lenses: 10-Year Follow-Up.

PURPOSE: To evaluate and compare the long-term results after bilateral implantation of different multifocal intraocular lenses (MIOLs). METHODS: This retrospective comparative study included 42 patients who underwent cataract surgery with bilateral MIOL implantation. Patients were divided into 5 groups: Group 1 received a refractive ReZoom NGX1 IOL (AMO), Group 2 a diffractive Acrysof ReSTOR SA60D3 IOL (Alcon), and Group 3 a diffractive Tecnis ZM900 IOL (AMO). Group 4 and Group 5 were implanted using the mix and match approach with refractive ReZoom-diffractive ReSTOR IOL and refractive ReZoom-diffractive Tecnis ZM900 IOL, respectively. Primary outcome measures were distance, near, and intermediate distance visual acuity measured 6 months (T0) and 10 years (T1) after surgery. Secondary outcomes were defocus curves, contrast sensitivity, patients' satisfaction, and spectacle independence. RESULTS: All patients achieved best-corrected distance visual acuity (BCDVA) greater than 0.11 logMAR and uncorrected distance visual acuity (UCDVA) greater than 0.14 logMAR at both time points. A decrease in contrast sensitivity was evident, particularly at high spatial frequencies; at T1, Group 4 reported statistically higher values than Group 2 at 12 cycles/degree and 18 cycles/degree and statistically higher values than Group 3 at 18 cycles/degree. Great overall satisfaction was reported even in the presence of dysphotopsia. Tecnis ZM900 IOL showed the lowest incidence of posterior capsular opacification. CONCLUSION: MIOLs could provide adequate functional vision and patient satisfaction, despite the incidence of side effects, in carefully selected patients desiring spectacle independence.

Changes in Anterior Segment Morphology and Intraocular Pressure after Cataract Surgery in Non-glaucomatous Eyes.

BACKGROUND: It is known that cataract extraction is associated with a significant reduction in intraocular pressure, especially in narrow angled eyes; however, the modifications of anterior segment parameters associated with this phenomenon have still not been completely defined. The purpose of this study was to evaluate changes in anterior segment anatomy and intraocular pressure after cataract surgery in non-glaucomatous eyes. METHODS AND MATERIAL: This retrospective case series study included 64 eyes of 64 consecutive patients who underwent phacoemulsification with intraocular lens implantation. Anterior segment parameters and intraocular pressure were assessed and compared before and 6 months after surgery. Anterior segment imaging was performed using Casia SS-1000 anterior segment optical coherence tomography (Tomey, Nagoya, Japan). Anterior segment measurements included anterior chamber depth, anterior chamber width, anterior chamber volume, angle opening distance at 500 µm anterior to the scleral spur, angle recess area 750 µm from the scleral spur, lens vault, trabecular iris space area at 500 µm from the scleral spur, and trabecular iris angle at 500 µm from the scleral spur. Intraocular pressure was measured using the Goldmann applanation tonometer (Model AT 900 C/M, Haag-Streit, Bern, Switzerland). Anterior segment parameters and the relationship of changes in intraocular pressure were also evaluated. RESULTS: All anterior segment parameters increased significantly after surgery (p < 0.05). Both angle opening distance at 500 µm anterior to the scleral spur and anterior chamber depth changes were positively correlated with the preoperative lens vault. The mean intraocular pressure significantly decreased from 14.91 mmHg (± 2.8 SD) to 12.91 mmHg (± 3.13 SD) (p < 0.001). Changes in intraocular pressure correlated negatively with values for the width of the preoperative anterior chamber (r = - 0.533; p = 0.001). CONCLUSION: Cataract surgery led to significant widening of the anterior chamber angle and lowering of intraocular pressure. Further investigations are needed to better understand whether anterior chamber width may be a new independent predictive factor for reduction in postoperative intraocular pressure.

Profile of a new extended range-of-vision IOL: a laboratory study.

PURPOSE: To evaluate the surface profile of a new-generation extended range-of-vision intraocular lens (IOL) and to compare it with that obtained for a monofocal IOL based on the same platform. METHODS: Prospective, experimental, laboratory study comparing the surface profile of the DFT015 (AcrySof IQ Vivity; Alcon Laboratories, Inc.), a new-generation presbyopia-correcting IOL, with the profile of the SN60WF (AcrySof IQ; Alcon Laboratories, Inc.), an aspheric monofocal IOL based on the same platform. Raw profiles were obtained using contact profilometry. The best-fit form was then subtracted from each raw profile to highlight potential differences. RESULTS: No significant differences were appreciated in raw profiles. On the contrary, after form removal, the new extended range-of-vision IOL showed a peculiar profile characterized by the presence of two altitudinal symmetrical changes in the order of 1 µm, localized in the central portion of the optic. CONCLUSIONS: The new-generation extended range-of-vision IOL evaluated showed a smooth change of its surface compared to the same platform monofocal IOL. The altitudinal changes blended in the central design of the new presbyopia-correcting IOL, although micrometric, might play a crucial role in creating a continuous focal range while minimizing visual disturbances.

Global multi-site, prospective analysis of cataract surgery outcomes following ICHOM standards: the European CAT-Community.

PURPOSE: To evaluate in a large sample of patients from 10 different European centers the results of cataract surgery, characterizing the relationship between patient-reported outcomes (PROMs) and clinician-reported outcome measures (CROMs). METHODS: Prospective non-interventional multicenter observational descriptive study analyzing the clinical outcomes of a total of 3799 cases undergoing cataract surgery (mean age: 72.7 years). In all cases, the cataract surgery standard developed by the International Consortium for Health Outcomes Measurements (ICHOM) was used to register the clinical data. Three-month postoperative visual acuity and refraction data were considered CROMs, whereas Rasch-calibrated item 2 (RCCQ2) and total Catquest-9SF score (CQ) were considered PROMs. RESULTS: Postoperative corrected distance visual acuity (CDVA) was 0.3 logMAR or better in 88.7% (2505/2823) of eyes. Mean differences between preoperative and postoperative RCCQ2 and CQ scores were -3.09 and -2.39, respectively. Visual function improvement with surgery was reported by 91.5% (2163/2364) of patients. Statistically significant, although weak, correlations of postoperative CDVA with postoperative refraction, PROMs, and complications were found (0.133 ≤ r ≤0.289, p < 0.001). A predictive model (R2: 0.254) of postoperative CDVA considering 10 variables was obtained, including preoperative CDVA, different ocular comorbidities, age, gender and intraoperative complications. Likewise, another predictive model (R2: 0.148) of postoperative CQ considering a total of 14 variables was obtained, including additionally preoperative CQ, target refraction and previous surgeries. CONCLUSIONS: Cataract surgery provides an improved functional vision in most of patients although this improvement can be limited by ocular comorbidities and complications. The relationship between PROMs and CROMs is multifactorial and complex.

VITREOUS PROSTAGLANDIN E2 CHANGES AFTER TOPICAL ADMINISTRATION OF DICLOFENAC 0.1%, INDOMETHACIN 0.5%, NEPAFENAC 0.3%, AND BROMFENAC 0.09.

PURPOSE: To evaluate the vitreous concentration of different nonsteroidal anti-inflammatory drugs (NSAIDs) after topical administration and the related prostaglandin E2 (PGE2) levels in patients undergoing pars plana vitrectomy. METHODS: A prospective, randomized, investigator-masked study was performed. One hundred four patients scheduled for a pars plana vitrectomy for an epiretinal membrane or a macular hole were randomized to receive topical diclofenac 0.1%, indomethacin 0.5%, nepafenac 0.3%, bromfenac 0.09%, or placebo 3 days before surgery. At the beginning of surgery, a sample of undiluted vitreous was collected in each patient to assess NSAIDs concentration and PGE2 levels. RESULTS: The median vitreous concentrations were 203.35 (interquartile range 146.54-264.18) pg/mL for diclofenac, 243.45 (interquartile range 156.96-365.37) pg/mL for nepafenac, 438.21 pg/mL (interquartile range, 282.52-645.87) for its active metabolite amfenac, 350.14 (interquartile range, 290.88-481.95) pg/mL for indomethacin, and 274.59 (245.43-358.25) pg/mL for bromfenac. Vitreous PGE2 levels were significantly lower for all the NSAIDs groups compared with the control group (P < 0.001). A statistically significant higher vitreous PGE2 level was found in the diclofenac group compared with the other NSAIDs groups (P < 0.05). CONCLUSION: Topical NSAIDs achieve sufficient vitreous concentration to decrease vitreous PGE2 levels compared with the control group. The different efficacy in reducing PGE2 concentration may affect the management of posterior segment inflammation.

Scanning electron microscopy study of different one-piece foldable acrylic intraocular lenses after injection through microincisional cataract surgery cartridges.

PURPOSE: To evaluate possible surface alterations of different models of one-piece foldable acrylic intraocular lenses (IOLs) after folding and ejecting process through 2.2-mm microincisional cataract surgery (MICS) cartridges. METHODS: In this experimental laboratory study, the following IOLs were studied: Johnson&Johnson PCB00, HOYA iSert 251, Alcon AcrySof IQ SN60WF, Bausch&Lomb enVISTA MX-60. A total of 80 IOLs were analyzed. Twenty intraocular lenses of each type were studied: ten with a power of + 21 D ± 1 and ten with a power of + 28 D ± 1. IOLs were injected through a dedicated 2.2-mm MICS cartridge into a 50-mL vial containing 10 mL of deionized water. After rinsing and metallization process, scanning electron microscopy images were acquired. RESULTS: All IOLs presented high-quality construction biomaterials. Some IOLs showed superficial scratches and tears on the optic surface, mainly positioned according to the direction of the stress induced by the folding process. In other cases, small superficial tears were seen in a more peripheral position. CONCLUSIONS: All lenses showed excellent surface quality. After folding and injection process some superficial scratches and tears of the IOL optic were detected in some models. Further studies are needed to assess the possible effects of those superficial damages on the optical quality of the IOLs.

LONG-TERM INTRAOCULAR PRESSURE AFTER UNCOMPLICATED PARS PLANA VITRECTOMY FOR IDIOPATHIC EPIRETINAL MEMBRANE.

PURPOSE: To investigate long-term intraocular pressure trends after uncomplicated pars plana vitrectomy for idiopathic epiretinal membrane. METHODS: Three hundred and sixty-eight eyes of 368 consecutive patients were enrolled. Changes in intraocular pressure 1, 3, 6, and 12 months after surgery and during the final follow-up visit were evaluated in vitrectomized eyes and nonvitrectomized fellow eyes. RESULTS: The median follow-up period was 36 months (range 12-92 months). Longitudinal data analysis evidenced a 2.5-mmHg (2.2 mmHg; 2.7 mmHg, 95% confidence interval) statistically significant difference in intraocular pressure 30 days after surgery between treated and fellow untreated eyes, gradually recovering to a not significant 0.2-mmHg (-0.1 mmHg; 0.4 mmHg, 95% confidence interval) difference within 26 months. The incidence of late-onset ocular hypertension was 5.7% (21 over 347, 2%; 12%, 95% confidence interval) without difference between the treated eyes and the group control. No significant difference in the incidence of late-onset ocular hypertension and sex, lens status, or gauge of vitrectomy instruments was detected. Only patient's age was significantly higher (mean difference 4.2 years; 0.1-8.0 years, Monte Carlo, 95% confidence interval) in those who developed late-onset ocular hypertension in the vitrectomized eye. CONCLUSION: Uncomplicated pars plana vitrectomy for idiopathic epiretinal membrane seems not to increase the risk of late-onset ocular hypertension or open-angle glaucoma development.

Diagnostic Accuracy of Digital Retinal Fundus Image Analysis in Detecting Diabetic Maculopathy in Type 2 Diabetes Mellitus.

BACKGROUND: Digital retinal imaging is the gold standard technique for diabetic retinopathy (DR) and diabetic macular oedema (DME) assessment during DR screening. OBJECTIVES: To evaluate the diagnostic accuracy of digital retinal fundus image (DRFI) analysis in detecting DME using three manual grading systems (MGS) and comparing it with optical coherence tomography (OCT) findings. METHOD: A total of 287 DRFI of 287 eyes were analysed. Non-stereoscopic 45° images were acquired using a Kowa VX-20 camera and were graded according to three MGS: Early Treatment Diabetic Retinopathy Study (ETDRS), International Clinical Diabetic Retinopathy (ICDR), and United Kingdom National Screening Committee (UKNSC). The two graders were masked to the patient's clinical DR status. DME characteristics were analysed using OCTs. RESULTS: A very good agreement in detecting DME was found with Cohen's κ = 0.83 (ICDR vs. ETDRS), κ = 0.83 (ICDR vs. UKNSC), and κ = 0.82 (ETDRS vs. UKNSC). Sensitivity and specificity of DRFI analysis in DME assessment were 70.0 and 69.6% for UKNSC, 71.9 and 67.4% for ETDRS, and 70.9 and 65.2% for ICDR, respectively. Positive and negative predictive values were 91.7 and 32.7% for UKNSC, 91.4 and 33.3% for ETDRS, and 90.7 and 31.9% for ICDR, respectively. On OCT scans, micro-architectural damages of both inner and outer retinal layers and mean ganglion cell layer thickness showed a significant association with the presence of DME detected with DRFI analysis. CONCLUSIONS: Despite the low negative predictive value, the good specificity and sensitivity of DRFI in detecting DME make it a useful tool in a routine clinical setting, and its potential in diabetic eye screening is yet to be realized.

Autologous neurosensory retinal free patch transplantation for persistent full-thickness macular hole.

PURPOSE: To evaluate anatomical and functional outcomes after autologous neurosensory retinal free patch (ANRFP) transplantation for persistent idiopathic full-thickness macular hole (iFTMH). METHODS: A 65-year-old woman with persistent macular hole in her right eye after previous 27-gauge pars plana vitrectomy with internal limiting membrane peeling and long-acting gas tamponade underwent ANRFP transplantation. Before surgery, best corrected visual acuity in her right eye was 20/800. Optical coherence tomography (OCT) showed a 715-micron-diameter FTMH. To treat the persistent FTMH, a small autologous neurosensory retinal patch was transplanted and placed inside the macular hole under perfluorocarbon liquids (PFCL). PFCL-air exchange was performed, and long-acting gas tamponade was carried out. Clinical features of the macular area, visual acuity (VA), fundus autofluorescence, microperimetry and OCT were recorded during the 10-month follow-up. RESULTS: The macular hole appeared successfully closed with retinal patch stable and well plugged into the hole during the whole follow-up. VA improved to 20/100 and microperimetry revealed an increase in mean retinal sensitivity from 14.7 dB at 1 month to 15.6 dB at 10 months postoperatively. OCT showed a well-distinguishable retinal patch into the hole 1 month after surgery and a completely integrated retinal patch between the retinal layers 10 months postoperatively. No intra- and postoperative complications were noticed. CONCLUSIONS: ANRFP transplantation may represent an innovative technique for persistent iFTMH treatment.

Controlled drainage of subretinal fluid during scleral buckling surgery for rhegmatogenous retinal detachment: the pigment stream sign.

PURPOSE: To describe the macroscopic characteristics of the subretinal fluid (SRF) and its spilling modality during evacuative puncture in scleral buckling (SB) surgery for rhegmatogenous retinal detachment. METHODS: We retrospective reviewed all the SB surgeries performed over a period of 26 months at the University Eye Clinic of Trieste, Italy. We selected a cohort of 102 patients in which SRF drainage by means of evacuative puncture was performed. A high-definition video was recorded during the whole duration of the procedures, and the macroscopic characteristics of the SRF leakage were assessed. RESULTS: Pigmented dark-brownish deposits spilling in the fluid outcoming from the evacuative puncture was observed during the surgeries. In all cases, this macroscopic feature was detected during the late phases of the drainage. Moreover, indirect ophthalmoscopic evaluation showed the almost complete SRF drainage and a flattened retina at that moment. CONCLUSIONS: The pigment stream sign, easily detectable by the surgeon, allows to understand, during the evacuative puncture, when the SRF has been drained almost completely and that the drainage procedure is therefore close to the end.

The Combination of Trypan Blue and Brilliant Blue G-Assisted Vitrectomy for Macular Pucker: Histopathological Findings.

PURPOSE: To report on the combined use of trypan blue (TB) and brilliant blue G (BBG) for staining the epiretinal membrane (ERM) and internal limiting membrane (ILM) during vitrectomy and to describe the histopathological findings. METHODS: 10 surgical specimens were removed from 10 eyes with macular pucker during vitrectomy using a commercially available combination of TB and BBG for ERM and ILM staining and peeling. Specimens were evaluated using light and transmission electron microscopy. RESULTS: In all cases the combination of TB and BBG was useful for identifying and delineating ERM and ILM. No complications related to the use of the dye were observed during or after surgery. Glial cells were present in all specimens. Hyalocytes were observed in 6 cases and myofibroblasts in 3 of them. In 7 cases native vitreous collagen fibrils were found on the ILM, while in 5 specimens newly formed collagen was present. No clinical evidence of toxicity was observed during the 3-month follow-up. CONCLUSION: The combined use of TB and BBG appeared to be very useful intraoperatively to improve the visualization of ERM and ILM, thus facilitating their complete removal. Anatomical and histopathological findings demonstrated the safety and the efficacy of this vital dye.

Comparative analysis of 23-, 25-, and 27-gauge forceps stiffness and related displacement.

PURPOSE: To test the stiffness and displacement of different vitreous forceps. Physical features and deformation after multiple procedures were also measured. METHODS: Eleven different 23-, 25-, and 27-gauge vitreous forceps were studied. The measurements were repeated loading the probe at different distances from the tip: at the top of the tip and 10 and 20 mm from the tip, respectively. For each probe, 10 successive identical bending tests were performed. The total length and the internal and external diameters of each forceps were also measured. RESULTS: A total of 330 successive identical bending tests were performed. No progression in deformation after the repeated measurements was recorded (p > 0.05). In each gauge group, displacement differences were detected according to the manufacturing metal properties, the total length, and the thickness of the shaft wall. A minimal adequate model to describes forceps displacements in terms of their significant predictors, such as gauge, model, and load distance from the tip, was created. CONCLUSION: We provided a precise assessment of the stiffness and displacement of different vitreous forceps to enable surgeons to select the optimal instrument according to the benefits and limitations of each forceps.

Impact of Epiretinal Membrane on Optical Coherence Tomography Tools Used for Monitoring Glaucoma.

BACKGROUND: Retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) measurements can be influenced by many factors including the presence of concomitant retinal diseases. The aim of this study it to assess the impact of epiretinal membrane (ERM) on RNFL and GCL assessment using optical coherence tomography (OCT). METHODS: GCL, peripapillary RNFL (pRNFL), and Bruch's Membrane Opening Minimum Rim Width (BMO-MRW) thicknesses were analysed using an SD-OCT (Spectralis OCT) in eyes with idiopathic ERM and compared with a control group. RESULTS: 161 eyes were included, 73 eyes in the control group and 88 eyes with idiopathic ERM. The pRNFL analysis revealed a statistically significant difference between the two groups in overall and temporal sector thicknesses. For GCL thickness report, the percentage of scans in which the GCL was erroneously segmented by automatic segmentation was assessed for each eye. A statistically significant difference was found in all sectors (p < 0.001), with the exception of external nasal sector. A statistically significant difference (p < 0.001) in the GCL total volume report was found in ERM group compared to the control group. For MRW at BMO analysis, there was no statistically significant difference in MRW thickness in any sector. CONCLUSION: In eyes with ERM, the GCL and pRNFL analysis seemed affected by the morphological retinal layers' modification. MRW-BMO did not appear to be directly affected by the presence of ERM.

Cataract standard set for outcome measures: An Italian tertiary referral centre experience.

PURPOSE: Implementation of the International Consortium for Health Outcomes Measurements (ICHOM) standard for cataract surgery into clinical practice at an Italian tertiary referral centre. METHODS: Prospective, observational, descriptive study consisting of the registry and analysis of cataract surgeries performed during a 6-month enrolment period at the University Eye Clinic of Trieste, Trieste, Italy. Outcomes were recorded and analysed according to the ICHOM Cataract Standard Set version 2.0.1. Records included clinician-reported outcome measures (CROMs) - visual outcome and complications - and patient-reported outcome measures (PROMs) - self-assessed vision with the Catquest-9SF questionnaire. Correlations between PROMs and CROMs were evaluated. A multiple linear regression was used for predicting the change in PROMs with surgery. RESULTS: A total of 218 eyes (of 218 patients) were analysed. Postoperative corrected distance visual acuity (CDVA) was ⩾0.3 in 89.0% (194/218) of eyes. There was a statistically significant improvement of the post-operative Catquest-9SF global average score. (p < 0.001). The change in the Catquest-9SF score significantly correlated with the change in Item 2 score (related to intermediate vision) (r = 0.634, p < 0.001). A predictive model of the change in the Catquest-9SF score was found (p < 0.001, R2: 0.527) based on preoperative Catquest-9SF total score, presence or not of macular degeneration, presence or not of intraoperative complications, age >75 years old, and preoperative CDVA. CONCLUSIONS: Cataract surgery improves the functional vision, with some factors limiting the outcomes such as comorbidities. Self-perceived improvement in intermediate vision significantly influenced the improvement in self-assessed vision.

Orbital metastasis as presenting symptom from a prostatic adenocarcinoma.

PURPOSE: To report a 72-year-old man with orbital metastasis as presenting symptoms from a prostatic adenocarcinoma. METHODS: A complete ophthalmological evaluation with ultrasonography examination, kinetic perimetry, fluorescein angiography, and visually evoked potentials were performed. The patient underwent computed tomography, magnetic resonance imaging of the orbit, and blood test for confirmation of the diagnosis. Bone infiltration rate of the cancer was evaluated with bone scintigraphy. Type of the tumor was assessed with orbital incision biopsy and histological analysis. The patient received systemic chemotherapy. Due to poor patient compliance, radiotherapy was not performed. RESULTS: Ultrasonography showed a hypoechoic retrobulbar lesion. At computed tomography examination of the orbit an expansive oval intraconical solid lesion with enhancement after medium contrast was found. Biopsy findings revealed a moderately differentiated adenocarcinoma with immunohistochemical profile supporting prostate as the primary tumor site: negative for cytokeratin-7 and cytokeratin-20 and positive for prostate-specific antigen, prostate-specific acid phosphatase, and alpha-methylacyl-CoA-racemase. CONCLUSIONS: Ocular signs and symptoms as first clinical presentation of a prostate cancer are relatively rare. Despite its very poor prognosis, a correct management and therapy can improve visual acuity, ocular symptoms, and median survival of cancer patients.

Rethinking Elective Cataract Surgery Diagnostics, Assessments, and Tools after the COVID-19 Pandemic Experience and Beyond: Insights from the EUROCOVCAT Group.

The progressive deterioration of the visual function in patients on waiting lists for cataract surgery has a negative impact on their quality of life, especially in the elderly population. Patient waiting times for cataract surgeries in many healthcare settings have increased recently due to the prolonged stop or slowdown of elective cataract surgery as a result of coronavirus disease 19 (COVID-19). The aim of this review is to highlight the impact of such a "de-prioritization" of cataract surgery and to summarize some critical issues and useful hints on how to reorganize cataract pathways, with a special focus on perioperative diagnostic tools during the recovery phase and beyond. The experiences of a group of surgeons originating from nine different countries, named the European COVID-19 Cataract Group (EUROCOVCAT), have been combined with the literature and recommendations from scientific ophthalmic societies and healthcare institutions. Key considerations for elective cataract surgery should include the reduction of the number of unnecessary visits and examinations, adoption of precautionary measures, and implementation of telemedicine instruments. New strategies should be adopted to provide an adequate level of assistance and to guarantee safety conditions. Flexibility will be the watchword and regular updates would be necessary following scientific insights and the development of the pandemic.

Macular Hole in Myopic Eyes: A Narrative Review of the Current Surgical Techniques.

Macular hole (MH) in myopic eyes is a disease arising from complex tractional forces exerted by vitreomacular interface, epiretinal tissue, and progressive scleral ectasia of the posterior ocular globe wall. This retinal disease requires vitreoretinal treatment for its repair, and the surgical intervention remains a challenge also for experienced surgeons. The aim of this review is to describe the current knowledge regarding the pathogenesis of MH in myopic eyes and to detail novel surgical techniques and technological advancements in its surgical management.

Surface properties of commercially available hydrophobic acrylic intraocular lenses: Comparative study.

PURPOSE: To analyze and compare the surface properties of commercially available hydrophobic acrylic intraocular lenses (IOLs). SETTING: Eye Clinic, University of Trieste, Italy. DESIGN: Experimental study. METHODS: The following 6 single-piece hydrophobic acrylic IOL models with the same dioptric power were studied and compared: Clareon SY60WF, Tecnis PCB00, enVista MX60, CT Lucia 601P, Vivinex iSert XY1, and iSert 251. Topography of the IOL surface was analyzed using atomic force microscopy (AFM). Surface contact angle measurements using the sessile drop method were performed to assess IOL wettability. RESULTS: The AFM analysis showed that the Vivinex iSert XY1 IOL and Clareon SY60WF IOL had the lowest surface roughness (P < .05); there was no statistically significant difference in surface roughness between the those 2 IOL models (P > .05). Surface contact angle measurements showed that the iSert 251 IOL had the highest hydrophobicity. The CT Lucia 601P IOL had the lowest contact angle of all IOL models. CONCLUSIONS: The AFM analysis and surface contact angle measurements of all IOLs tested showed that the Vivinex iSert XY1 IOL and Clareon SY60WF IOL had the best topographic features. The smoother, more regular surface of these new IOL models might reduce cell adhesion and therefore lower the incidence of posterior capsule opacification.

Intraocular Pressure Changes during Femtosecond Laser-Assisted Cataract Surgery: A Comparison between Two Different Patient Interfaces.

PURPOSE: The aim of this retrospective cohort study was to evaluate intraocular pressure (IOP) changes during femtosecond laser-assisted cataract surgery (FLACS) using two different patient interface systems. METHODS: 116 eyes of 116 patients scheduled for cataract surgery were divided into 2 groups: group 1 (61 eyes) and group 2 (55 eyes) underwent FLACS using Catalys Laser with fluid interface (liquid optics interface, LOI) and LenSx Laser with curved interface and soft contact lens (SoftFit), respectively. IOP was assessed using a portable rebound tonometer (Icare®) preoperatively, after docking, immediately after surgery, at one and seven days postoperatively. RESULTS: In group 1, the mean IOP (±SD) was 14.1 ± 0.4 mmHg before surgery, 33.2 ± 1.1 mmHg after docking, and 21.4 ± 0.9 mmHg immediately after surgery. In group 2, the mean IOP was 13.8 ± 0.4 mmHg before surgery, 24.2 ± 1.4 mmHg after docking, and 20.2 ± 1.2 mmHg immediately after surgery. After the docking procedure, a statistically significant increase in IOP from the baseline was found in both groups (p < 0.001). Moreover, no statistically significant difference in IOP measured at 1 and 7 days postoperatively was observed compared with the preoperative values (p > 0.05) using both laser platforms. No intraoperative and postoperative complications were observed. CONCLUSIONS: FLACS suction phase resulted in a transient increase of IOP in both groups, especially with the LOI system, and it is probably related to the greater pressure of a suction ring and suction generated through the vacuum, independently from the effect of femtosecond laser itself.

Swept-Source Optical Coherence Tomography Biometer as Screening Strategy for Macular Disease in Patients Scheduled for Cataract Surgery.

The aim of this study was to assess the central macular imaging captured with an optical biometer based on full-eye-length Swept-Source OCT (SS-OCT) scan as a screening strategy for identifying macular diseases in patients scheduled for cataract surgery. 1,114 eyes of 749 consecutive patients underwent a biometrical examination with IOLMaster 700 SS-OCT technology (Carl Zeiss) and conventional Spectral-Domain OCT (SD-OCT) (Spectralis OCT, Heidelberg) device analysis on the same day. Seven examiners graded the scans individually in a full-masked mode. Twenty-five eyes were excluded for media opacities. Among the 1,089 included eyes, statistical analysis revealed a mean Kendall's Coefficient of 0.83 (range 0.76-0.89). A logistic regression model demonstrated a highly significant correlation (p < 0.001) between the coefficient of concordance and SD-OCT imaging. Intraobserver reproducibility was 0.89 (range 0.86-0.91). Optical biometer SS-OCT scans showed a mean sensitivity of 0.81 and a mean specificity of 0.84. The positive and negative predictive value detected was 0.78 and 0.86, respectively. In order to predict the risk of reduced visual recovery, especially in cases of retinal pathology, optical biometer with SS-OCT scan has proven to be a useful modality for detecting macular structural abnormalities in patients undergoing cataract surgery. Conventional SD-OCT remains mandatory to confirm the presumed diagnosis.