Influence of Capsular Tension Rings on the IOL-Capsule Complex in Patients With Long Axial Length: A Clinical Observation Based on SS-OCT.

PURPOSE: To evaluate the influence of a capsular tension ring (CTR) on the intraocular lens (IOL)-capsule complex after cataract surgery in patients with long axial length. METHODS: This was a prospective study. Patients underwent phacoemulsification and IOL implantation, with or without CTR implantation. Swept-source optical coherence tomography was performed at 1 day, 1 week, 1 month, and 3 months postoperatively to determine the postoperative aqueous depth (PAD), capsular bend index (CBI), and IOL tilt and decentration. Spherical equivalent values were obtained through subjective refraction and autorefraction. Root mean square was adopted to evaluate the indices listed above. RESULTS: Forty-three patients (56 eyes) were included in the study. Generalized estimating equation analysis of PAD showed a statistical difference between groups (P = .031). The RMS of the change in PAD was smaller in the CTR group than in the non-CTR group during the 3 months after surgery (P = .015). CBI in the CTR group increased more from 1 to 3 months after surgery than that in the non-CTR group (P = .025). The RMS of the change in vertical decentration was smaller in the CTR group than in the non-CTR group during the 3-month follow-up (P = .009). CONCLUSIONS: CTR implantation can stabilize the axial position of the IOL within the capsular bag after cataract surgery in patients with long axial length without affecting the refractive stability. The formation of capsular bend may be slightly delayed in the early stage after CTR implantation, but it accelerates from 1 to 3 months after surgery. [J Refract Surg. 2024;40(9):e654-e661.].

Accuracy of Modern Intraocular Lens Formulas in Highly Myopic Eyes Implanted With Plate-Haptic Intraocular Lenses.

PURPOSE: To evaluate the predictive accuracy of modern intraocular lens (IOL) formulas and axial length (AL) adjusted traditional IOL formulas, including Wang-Koch and Cooke-modified AL (CMAL) method, in long eyes with plate-haptic IOLs, and to compare refractive prediction error variances with C-loop IOLs. DESIGN: Retrospective consecutive case series study. METHODS: Data from 391 eyes with Zeiss 509 M and 302 eyes with Alcon SN6CWS implants in highly myopic patients, following cataract surgery from January 2019 to November 2023, were collected. One eye per patient was selected. Predictive outcomes of 15 modern formulas (Barrett Universal II (BU II), Cooke K6 (K6), Emmetropia Verifying Optical (EVO) 2.0, Hoffer-QST, Kane, Karmona, Ladas AI, Naeser 2, Olsen, Pearl-DGS, Radial Basis Function (RBF) 3.0, T2, VRF-G, Zhu-Lu, and Z-Calc) and 4 traditional IOL formulas (Haigis, Hoffer Q, Holladay 1, and SRK/T) with AL adjusted methods, were evaluated. The mean prediction error, mean absolute prediction error (MAE), root-mean-square absolute prediction error (RMSAE) and the proportions of eyes with PEs within ±0.25 Diopter (D), ±0.50 D, ±0.75 D, and ±1.00 D were analyzed. Top 10 RMSAE-ranked formulas underwent further subgroup analysis based on AL, anterior chamber depth (ACD), and keratometry (K). RESULTS: For the 509 M group, RMSAE ranking for the top 10 IOL formulas were the RBF 3.0 (0.432), Zhu-Lu (0.436), Olsen (0.436), EVO 2.0 (0.437), Pearl-DGS (0.447), K6 (0.452), VRF-G (0.454), Naeser 2 (0.464), Haigis-CMAL (0.465) and Karmona (0.477). Karmona and Naeser 2 showed poorer performance in the extremely long AL and steep K subgroups, respectively (p ≤ 0.042). Haigis-CMAL accuracy was significantly lower in shallow ACD and flat K subgroups (P ≤ .045). The SN6CWS group showed significantly lower MAE and RMSAE compared to the 509 M group for the BU II, EVO 2.0, Hoffer-QST, Kane, Pearl-DGS, and Zhu-Lu formulas (P ≤ .024). CONCLUSIONS: In long eyes with plate-haptic IOLs, RBF 3.0 performed best, closely followed by Zhu-Lu, Olsen, and EVO 2.0; Karmona and Naeser 2 are discouraged for extreme AL and steep K conditions, respectively; Haigis-CMAL is not suggested for shallow ACD and flat K cases. Refractive outcomes in eyes implanted with a C-loop design IOL were more accurate than for those implanted with a plate-haptic design, for most tested formulas.

Comparison of the effect of capsular bend on the rotational stability between 2 toric intraocular lenses.

PURPOSE: To compare the effect of capsular bend on the rotational stability between 2 toric intraocular lenses (IOLs). SETTING: Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China. DESIGN: Prospective study. METHODS: Patients with preexisting astigmatism received AcrySof IQ (SN6AT) or TECNIS (ZCT/ZMT) toric IOL during cataract surgery. CASIA2 was used to record the toric IOL axial orientation and capsular bend index (CBI) at the 1-day, 1-week, 1-month, and 3-month interval postoperatively. The postoperative rotational stability and CBI of both models were compared. RESULTS: A total of 58 eyes from 58 patients were enrolled in this study. The total misalignment of the TECNIS (ZCT/ZMT) group (6.96 ± 5.10 degrees, 7.41 ± 5.19 degrees, 6.93 ± 5.29 degrees, and 6.86 ± 5. 27 degrees) was significantly higher than that of the AcrySof IQ (SN6AT) group (3.55 ± 2.21 degrees, 4.00 ± 2.74 degrees, 3.72 ± 2.72 degrees, and 3.52 ± 2.50 degrees) at all follow-up intervals ( P < .05). The mean rotation of the TECNIS (ZCT/ZMT) group (2.66 ± 2.18 degrees) was significantly greater than that of the AcrySof IQ (SN6AT) group (1.65 ± 1.47 degrees) from 1 day to 1 week postoperatively ( P < .05). The capsular bend formation in the TECNIS (ZCT/ZMT) group was delayed compared with the AcrySof IQ (SN6AT) group ( P < .05, at the 1-week, 1-month, and 3-month interval). The TECNIS (ZCT/ZMT) group showed fibrosis in the peripheral anterior capsule, leading to its stretching away from the IOL surface, while the AcrySof IQ (SN6AT) group exhibited gentle adherence of the anterior capsule to the IOL surface. CONCLUSIONS: The AcrySof IQ toric IOL (SN6AT) exhibited greater rotational stability than the TECNIS toric IOL (ZCT/ZMT), which may partially result from the delay in capsular bend formation of TECNIS at the 1-day to 1-week follow-up postoperatively.

Fluid Supplementation Through Weakened Zonules via Side-Port Incision to Maintain Intraocular Pressure in High Myopic Eyes.

INTRODUCTION: During phacoemulsification, the infusion pressure can cause the liquefied vitreous fluid to escape through the ciliary fiber interspace in highly myopic eyes, leading to reduced vitreous cavity pressure similar to vitrectomized eyes. This study assessed the probability of low intraocular pressure (IOP) in high myopic eyes with different axial length (AL) group undergoing cataract surgery, as well as the impact of balanced salt solution (BSS) supplementation and the optimal IOP value for such supplementation. METHODS: The control group consisted of cataract eyes with normal AL (group 1: 22 mm ≤ AL < 24.5 mm), while cataract eyes with high axial myopia were categorized into three groups (group 2: 26 mm ≤ AL < 28 mm, group 3: 28 mm ≤ AL < 30 mm, group 4: AL ≥ 30 mm). IOP was measured using the iCare pro tonometer intraoperatively. BSS supplementation was performed to raise IOP in cases of low IOP, before intraocular lens (IOL) implantation and before the end of surgery. The probability of low IOP was calculated, and the IOP before and after supplementation were compared. RESULTS: Ninety-five eyes were included. The total probability of low IOP in groups 2, 3, and 4 was 56.52, 62.50, and 70.83%, respectively, significantly higher than that in group 1 (16.67%). Similarly, the probability of low IOP before IOL implantation was significantly higher in groups 2, 3, 4 (43.48, 41.67, and 62.50%) compared to group 1 (4.17%, P < 0.05). The IOP before and after the first BSS supplementation in three high myopia groups were statistically significant (P < 0.05), increasing from 12.10 mmHg (range, 6.0-24.9 mmHg) to 16.60 mmHg (range, 10.2-34.4 mmHg). After the second BSS supplementation before the end of surgery, the IOP of high myopia groups increased from 12.60 mmHg (range, 7.0-25.3 mmHg) to 14.60 mmHg (range, 9.8-25.3 mmHg). CONCLUSIONS: The condition of highly myopic eyes seems more likely to develop low IOP during cataract surgery. There is an observed correlation: as AL increases, the total probability of low IOP rises. In patients with IOP < 9.5 mmHg intraoperatively, fluid supplementation via a side-port incision can effectively raise IOP to about 16 mmHg before IOL implantation and about 14 mmHg after incision sealing, facilitating smoother IOL implantation and reducing the risk of postoperative low IOP. TRIAL REGISTRATION: NCT, NCT05201677. Registered 23 November 2021-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05201677 .

Morphological changes in the meibomian gland in children with tic disorders.

Background: Since blinking accelerates meibomian gland (MG) expression, abnormal blinking in children with tic disorders may be associated with the morphological changes of the MGs. Our study aimed to quantitively evaluate the morphology of the MG in these children. Methods: In this prospective case-control study, we examined 68 eyes of 68 children with tic disorders, 47 eyes of 47 children with dry eye, and 45 eyes of 45 healthy children at the Hangzhou Branch of the Eye Hospital of Wenzhou Medical University from October 2020 to March 2021. We used an Oculus Keratograph 5M (K5M) to capture the MG images, noninvasive breakup time (NIBUT), and tear meniscus height (TMH). An automated method was used to analyze MG length, width, area, gland diameter deformation index (DI), and gland signal index (SI). Parameters across the three groups were assessed using Kruskal-Wallis test followed by Mann-Whitney test with Bonferroni correction for multiple comparisons. Results: The eyes in the tic disorders group exhibited lower MG length and area values compared with those of the other groups (all P values <0.001) and lower MG width values compared with those of children in the dry eye group (P=0.009). The tic disorder and dry eye groups both had a larger percentage of eyes with a U-shaped MG duct when compared with the control group (P<0.001 and P=0.017). The dry eye group had the lowest TMH and NIBUT values (both P values <0.001). The NIBUT values in the tic disorder group were lower than those in the control group (P<0.001). No significant correlations were detected between clinical tests and MG morphology in any of the groups. Conclusions: Blinking disorders have a significant impact on MG morphology. In children with tic disorders, more attention should be devoted to monitoring the MG over time.

Evaluation of optic nerve head vessels density changes after phacoemulsification cataract surgery using optical coherence tomography angiography.

AIM: To evaluate optic nerve head (ONH) vessel density (VD) changes after cataract surgery using optical coherence tomography angiography (OCTA). METHODS: This was a prospective observational study. Thirty-four eyes with mild/moderate cataracts were included. ONH scans were obtained before and 3mo after cataract surgery using OCTA. Radial peripapillary capillary (RPC) density, all VD, large VD and retinal nerve fiber layer thickness (RNFLT) in total disc, inside disc, and different peripapillary sectors were assessed and analyzed. Image quality score (QS), fundus photography grading and best-corrected visual acuity (BCVA) were also collected, and correlation analyses were performed between VD change and these parameters. RESULTS: Compared with baseline, both RPC and all VD increased in inside disc area 3mo postoperatively (from 47.5%±5.3% to 50.2%±3.7%, and from 57.87%±4.30% to 60.47%±3.10%, all P<0.001), but no differences were observed in peripapillary area. However, large VD increased from 5.63%±0.77% to 6.47%±0.72% in peripapillary ONH region (P<0.001). RPC decreased in inferior and superior peripapillary ONH parts (P=0.019, <0.001 respectively). There were obvious negative correlations between RPC change and large VD change in inside disc, superior-hemi, and inferior-hemi (r=-0.419, -0.370, and -0.439, P=0.017, 0.044, and 0.015, respectively). No correlations were found between VD change and other parameters including QS change, fundus photography grading, postoperative BCVA, and postoperative peripapillary RNFLT. CONCLUSION: RPC density and all VD in the inside disc ONH region increase 3mo after surgery in patients with mild to moderate cataract. No obvious VD changes are found in peripapillary area postoperatively.

Treatment of visual axis opacification and secondary membranes with Nd:YAG laser after pediatric cataract surgery under intranasal sedation.

Purpose: To describe neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser treatment of visual axis opacification and secondary membranes in pediatric patients with cataracts under intranasal dexmedetomidine sedation. Methods: Twenty eyes of 17 patients with secondary membrane formation after cataract extraction were enrolled in this study. Intranasal dexmedetomidine sedation (3 ug/kg) was administered, and Nd:YAG laser (Ellex Super Q, Adelaide, Australia) procedures were performed with children in the sitting position with their chin supported on a laser delivery slit lamp. Preoperative and postoperative visual acuities were documented, and medical records were reviewed. Results: The age of the patients ranged from 5 to 83 months (31.82 ± 27.73). Nineteen (95.0%) eyes had congenital cataracts and one (5.0%) had a traumatic cataract. Nd:YAG laser treatment of VAO with ten (50.0%) eyes, pupillary membranes with three (15.0%) eyes, pupillary cortical proliferation with six (30.0%) eyes, and anterior capsule contraction with one (5.0%) eye. Five (25.0%) eyes demonstrated visual acuity improvement, whereas six (30.0%) eyes remained unchanged after laser treatment. The recurrence rate was 30.0% and four eyes underwent a second Nd:YAG membranectomy. No side effects or tolerances due to sedative drugs were observed. Conclusion: Nd:YAG laser membranectomy under intranasal dexmedetomidine sedation was safely performed in children as young as 5 months old in a sitting position. This approach facilitates patient convenience, doctor proficiency, and cost reductions. Patients with recurrence can be treated by repeating the procedure.

Femtosecond Laser-Assisted Cataract Surgery versus Conventional Phacoemulsification Surgery: Clinical Outcomes with EDOF IOLs.

In this study, we evaluate and compare the outcomes of conventional phacoemulsification cataract surgery (CPS) and femtosecond laser-assisted cataract surgery (FLACS) with the implantation of an extended depth of field (EDOF) intraocular lens (IOL). A prospective, consecutive cohort study was conducted. Patients were given the option to choose FLACS or CPS and were implanted with an EDOF IOL. Refractive data, visual acuity data, ocular aberration measured with a wavefront aberrometer, and optical quality measured with an optical quality analysis system II were collected at one month postoperatively. A total of 92 eyes of 64 patients were enrolled in this study; 35 eyes of 26 patients were treated with FLACS, whereas 57 eyes of 38 patients were treated with CPS. Uncorrected visual acuity at far, intermediate, and near distance and best-spectacle-corrected visual acuity were not statistically significantly different between the groups (all p > 0.05), nor were the mean cylinder and mean spherical equivalent refraction (both p > 0.05). The FLACS group had a lower ocular trefoil than the CPS group (p = 0.033), and there was no significant difference between the two groups considering other aberration parameters, whether ocular or internal (all p > 0.05). Optical-quality-related parameters showed also no significant difference between the two groups (all p > 0.05). In conclusion, there was no significant difference between FLACS and CPS with implantation of EDOF IOLs in postoperative ocular parameters, refractive outcomes, ocular aberration, optical quality, and aberration parameters, except a lower ocular trefoil in the FLACS group. In terms of these indicators, FLACS does not provide an additional clinical benefit for patients over CPS.

Capsulotomy opening diameter outcomes in aphakic eyes after primary congenital cataract removal and its association.

Aim: To observe the change of capsulotomy opening diameter (COD) in aphakic eyes after primary congenital cataract removal and investigate its influencing factors. Methods: Ocular parameters, including corneal diameter (CD), axial length (AL), anterior and posterior COD (ACOD, PCOD), and age at surgery were recorded at primary congenital cataract removal and secondary intraocular lens implantation. The concentrations of 15 kinds of cytokines in aqueous humor samples collected at the primary surgery were detected. The change (Δ) of COD between two surgeries were described, and its association was analyzed. Results: Fifty eyes from 33 patients with congenital cataract who underwent primary and secondary surgery were enrolled. The changes in ACOD and PCOD were not statistically significant on the whole. ΔACOD was positively correlated with ΔCD and the concentrations of PDGF-AA, VEGF and TGF-ß1. The concentration of FGF-2 and the interval between two surgeries showed negative correlations with ΔACOD and ΔPCOD. Conclusion: COD in aphakic eyes kept changing after primary surgery. The positive correlation between ΔACOD and ΔCD manifested the enlargement of ACOD was influenced by lateral eye growth. Meanwhile, ΔACOD was also associated with cytokines, indicating postoperative inflammation promoted the ACOD constriction.

Efficacy of Toric Intraocular Lens Implantation in Patients Older Than 80 Years with Cataracts and Corneal Astigmatism.

INTRODUCTION: This study analyzed the visual outcome following cataract surgery with toric intraocular lenses (IOLs) in patients older than 80 years with corneal astigmatism. METHODS: A total of 159 patients (159 eyes) older than 80 years with corneal astigmatism (≥ 0.75 D) were included. Fifty-three eyes received Acrysof IQ® toric IOLs (SN6AT2-5), while the others received non-toric IOLs: 51 eyes received Acrysof IQ® IOLs (SN60WF) and 55 eyes received A1-UV IOLs. The uncorrected distance visual acuity, corrected distance visual acuity, and refraction (spherical equivalent, refractive cylinder) were assessed at 3 months postoperatively. The prediction error of refractive outcome and percentages of eyes within ± 0.50 D and ± 1.00 D in the toric IOL group obtained using five toric IOL formulas (Barrett predicted posterior corneal astigmatism (PCA), Barrett measured PCA, Kane, EVO 2.0 and Næser-Savini) were compared. RESULTS: At 3 months postoperatively, the average uncorrected distance visual acuity was better in the toric IOL group than the non-toric IOL group (p < 0.001). The mean residual refractive cylinder was lower in the toric IOL group than the non-toric IOL group (p < 0.001). The Næser-Savini formula achieved the lowest mean absolute error (0.39 D) and had the highest percentages of eyes within an absolute error of 0.50 D and 1.00 D (72% and 98%) compared to the other formulas. CONCLUSION: The results demonstrate the efficacy of toric IOL implantation in patients older than 80 years with corneal astigmatism and provide strong evidence for cataract surgeons to encourage such patients to choose toric IOLs.

Accuracy of newer generation intraocular lens power calculation formulas in pediatric cataract patients.

PURPOSE: To evaluate the accuracy of newer generation intraocular lens (IOL) power calculation formulas (EVO 2.0 and Kane) with established formulas (Barrett Universal II, Haigis and SRK/T) in pediatric cataract patients. METHODS: Retrospective study. We enrolled 110 eyes (110 patients) in Eye Hospital of Wenzhou Medical University. All patients underwent uneventful cataract surgery and implanted with posterior chamber IOL in the bag. We calculate the mean prediction errors (PE) and percentage within 1 diopter (D) at 1 month to assess the accuracy, and percentage > 2D was defined as prediction accident. Then, we performed subgroup analysis according to age and axial length (AL). RESULTS: The mean age and AL were 37.45 ± 23.28 months and 21.16 ± 1.29 mm. The mean PE for all patients was as follows: Barrett (- 0.30), EVO (0.18), Haigis (- 0.74), Kane (- 0.36), and SRK/T (0.58), p < 0.001. In addition, EVO and SRK/T formulas were relatively accurate in patients younger than 24 months and with AL ≤ 21 mm, while EVO got lower prediction accident rate than SRK/T (3/41 vs 8/41, 4/52 vs 5/52). Moreover, Barrett, EVO, and Kane formulas achieved better accuracy and lower prediction accident rate in patients older than 24 months and with AL > 21 mm (both > 51/69 and 43/58, and < 3/69 and 3/58). CONCLUSIONS: In patients older than 24 months and with AL > 21 mm, Barrett, EVO, and Kane formulas were relatively accurate, while in patients younger than 24 months and with AL ≤ 21 mm, EVO was more accurate, followed by SRK/T formula.

Accuracy of new-generation intraocular lens calculation formulas in eyes with variations in predicted refraction.

PURPOSE: To investigate the characteristics of eyes with large variations in predicted refraction using four traditional intraocular lens (IOL) formulas and evaluate the accuracy of new-generation intraocular lens power calculation formulas. METHODS: Eyes that had variation in predicted refraction (≥ 0.75 D) using four traditional formulas (SRK/T, Holladay 1, Hoffer Q, and Haigis formulas) were included. Axial length (AL), anterior chamber depth (ACD), average keratometry (AK), and the ratio of axial length to corneal radius (AL/CR) were measured. New-generation formulas (Barrett Universal II, Emmetropia Verifying Optical 2.0, Kane, and Pearl-DGS formulas) and traditional formulas were compared. The median absolute error (MedAE) was the main parameter to evaluate the accuracy of formulas. RESULTS: A total of 79 participants (79 eyes) who had variation in predicted refraction of (≥ 0.75 D) using four traditional formulas out of 510 eyes (510 patients) underwent uncomplicated cataract surgeries. The Barrett Universal II (0.29 D), EVO 2.0 (0.31 D), Kane (0.30 D), and Pearl-DGS (0.33 D) formulas produced significantly lower median absolute errors (MedAEs) than the Hoffer Q (0.61 D) and Holladay 1 (0.59 D) formulas (P < 0.01). The Wang-Koch (WK) adjustment significantly improved the accuracy of the Holladay 1 formula in long eyes (P < 0.001). CONCLUSIONS: Abnormal AL, ACD, and AK are more likely to lead to prediction errors using traditional formulas. New-generation formulas and traditional formulas with WK adjustment showed satisfactory prediction accuracy.

Comparison of Three-Dimensional Surgical System Versus Binocular Microscope for Clear Corneal Incision in Cataract Surgery.

INTRODUCTION: To compare surgical outcomes of 2.2 mm clear corneal incision (CCI) between a three-dimensional (3D) visualization system and traditional binocular microscope (BM) for phacoemulsification and intraocular lens implantation surgery. METHODS: In this randomized controlled clinical study, 60 eyes with age-related cataracts were divided into two groups receiving cataract surgery using either a 3D vision system (n = 30 eyes) (3D group) or a binocular microscope (n = 30 eyes) (BM group). We recorded and statistically analyzed surgical parameters and pre- and postoperative ocular parameters. Primary outcomes included the change in endothelial cell density (ECD) and CCI architecture, and secondary outcomes comprised other ocular parameters and surgical parameters. All procedures complied with the tenets of the Declaration of Helsinki. RESULTS: Of the 60 eyes randomly assigned between January 5, 2021, and May 9, 2021, 55 (26 eyes in the 3D group and 29 eyes in the BM group) were analyzed. The ECD loss rate was 8.1% in the 3D group and 12.3% in the BM group, but the difference was not statistically significant. Local detachment of Descemet's membrane was seen in 50% (13 eyes, 3D group) and 51.6% (15 eyes, BM group), wound gaping at the endothelial side in 15.4% (four eyes, 3D group) and 10.3% (four eyes, BM group), gaping at the epithelial side in 11.5% (three eyes, 3D group) and 6.9% (two eyes, BM group), and misalignment of the incision in 3.4% (one eye, BM group) 1 day after surgery. These abnormalities improved with time. There was no difference between the 3D group and BM group in terms of other ocular parameters or surgical parameters before and after surgery. CONCLUSIONS: Using the 3D surgical system for phacoemulsification and IOL implantation surgery seems to result in similar ECD and CCI conditions as using a conventional binocular microscope. TRIAL REGISTRATION: The protocol was registered on ClinicalTrials.gov (NCT04839250).

Posterior Capsular Outcomes of Pediatric Cataract Surgery With In-The-Bag Intraocular Lens Implantation.

Aim: To investigate the change of posterior capsular outcomes of pediatric cataract surgery with primary in-the-bag intraocular lens (IOL) implantation. Methods: We conducted a case series of pediatric cataract children who underwent cataract extraction with primary in-the-bag IOL implantation, posterior capsulorhexis or vitrectorhexis, and limited anterior vitrectomy at the Eye Hospital of Wenzhou Medical University between 2016 and 2019. Digital retro-illumination photographs of pediatric eyes were obtained at baseline and 6 months, 12 months, and the last visit postoperatively. Capsular outcomes of the posterior capsular opening area (PCOA) and lens reprolifration area at those time points were compared. Correlations between the PCOA and influential factors, such as age at surgery, axial growth, and follow-up duration, were analyzed. The study was registered at register.clinicaltrials.gov (NCT04803097). Results: Data of 23 patients (27 eyes) were used in the final analysis. During follow-up, the PCOA enlarged at a rate of 0.29-0.32 mm2/month during the first six months postoperatively and 0.05-0.08 mm2/month over the next 1-2 years. Six months postoperatively, the PCOA enlargement statistically and positively correlated with the follow-up duration and axial growth. The area of lens reprolifration was 0.46 ± 1.00 mm2 at six months postoperatively and then remained stable. Conclusion: The PCOA enlarged rapidly within the first six months after the pediatric cataract surgery with primary IOL implantation. Six months postoperatively, the enlargement of PCOA was positively correlated with follow-up duration and axial growth. Posterior capsulorhexis or capsulectomy should be performed with a diameter of 3.0 to 4.0 mm for good visual axis transparency and the protection of in-the-bag IOL.

A Retrospective Study on the Eye-Related Quality of Life, Functional Vision, and Their Determinants Among Children Following Congenital and Developmental Cataracts Surgery and Its Impact on Their Families Using the PedEyeQ.

Objectives: To evaluate the eye-related quality of life (ER-QOL), functional vision, and their determinants in children following congenital and developmental cataract surgery, as the impact on their families, using the Pediatric Eye Questionnaire (PedEyeQ). Materials and Methods: This was a retrospective cross-sectional study involving 107 children (aged 0-11 years) with congenital and developmental cataracts who had undergone surgery, as well as 59 visually healthy controls (aged 0-11 years). One parent for each child completed either the Proxy 0-4 PedEyeQ, the Proxy 5-11 PedEyeQ, or the Parent PedEyeQ, depending on their child's age. Mann-Whitney U and Kruskal-Wallis tests were then conducted to compare the differences between groups and to analyze their determinants. Results: PedEyeQ scores were found to be lower in postoperative children with congenital and developmental cataracts compared with the control group across all study domains. The PedEyeQ Proxy 0 to 4 years' greatest mean difference was 27 points worse in the Functional Vision domain (95% CI -34 to -19; p < 0.001). We also found that the occurrence of nystagmus (p < 0.005) and strabismus (p < 0.005) were the major factors affecting participants' functional vision. The PedEyeQ Proxy 5 to 11 years' greatest mean difference was 23 points worse in this same domain (95% CI -30 to -15; p < 0.001), with nystagmus (p < 0.05) being the main determinant herein. Parent PedEyeQ 0 to 4 years' greatest difference was 46 points worse on the Worry about their Child's Eye Condition domain (95% CI -57 to -36; p < 0.001). Similarly, parents of children with ophthalmologic abnormalities, including nystagmus (p < 0.001) and strabismus (p < 0.05), were significantly more worried about their children's eye condition. Parent PedEyeQ 5 to 11 years' greatest difference was also found to be 30 points worse on the Worry about their Child's Eye Condition domain (95% CI -43 to -17; p < 0.005). Conclusions: Children who have undergone congenital and developmental cataract surgery experience a lower quality of life and reduced functional vision. Their families are also significantly and adversely affected herein. Thus, more attention is needed on these groups, with more focused measures being administered to both children and their families.

Glaucoma and risk factors three years after congenital cataract surgery.

BACKGROUND: This study aimed to identify the incidence of and risk factors for postoperative glaucoma-related adverse events at various time points after congenital cataract surgery. METHODS: This retrospective cohort study enrolled 259 eyes from 174 patients (surgical age ≤ 7 years) who underwent congenital cataract surgery. All surgical procedures were conducted at the Eye Hospital of Wenzhou Medical University between May 2011 and March 2019. Patients were classified into group 1 [primary intraocular lens (IOL) implantation, N = 111 eyes], group 2 (secondary IOL implantation, N = 85 eyes), and group 3 (no IOL implantation, N = 63 eyes). We recorded demographic factors and incidence and risk factors for glaucoma-related adverse events. RESULTS: Glaucoma-related adverse events occurred in 21 (8.1%) eyes, whereas 27 (10.4%) eyes developed steroid-induced ocular hypertension. The percentage of glaucoma-related adverse events was 0%, 1.2%, 1.2%, 1.6%, 4.0%, and 8.9% at 1 month, 6 months, 1 year, 2 years, 3 years and 4 years after surgery, respectively. Sixteen (18.8%), five (7.9%), and zero eyes developed glaucoma-related adverse events in groups 2, 3, and 1, respectively. Family history of congenital cataract [hazard ratio (HR), 50.463; 95% confidence interval (CI), 7.051-361.139; P < 0.001], preoperative central corneal thickness (CCT) [HR, 1.021; 95% CI, 1.009-1.034; P = 0.001], preoperative horizontal corneal diameter (HCD) [HR, 3.922; 95% CI, 1.558-9.804; P = 0.004], and preoperative lens thickness (LT) [HR, 3.745; 95% CI, 1.344-10.417; P = 0.012] were identified as predictors of postoperative glaucoma-related adverse events. CONCLUSIONS: Family history of congenital cataract, thicker preoperative CCT, smaller preoperative HCD, and thinner preoperative LT are the main risk factors of postoperative glaucoma-related adverse events. Regular monitoring of children after cataract surgery with these risk factors may help ophthalmologists detect susceptible individuals and provide timely interventions in the clinic.

Meibomian Gland Morphology Changes After Cataract Surgery: A Contra-Lateral Eye Study.

Purpose: To evaluate the morphology changes of meibomian glands (MGs) after cataract surgery. Setting: Hangzhou Branch of the Eye Hospital of Wenzhou Medical University, Zhejiang, China. Methods: In this contra-lateral eye study, 40 patients received unilateral cataract surgery for age-related cataract. All the patients underwent the evaluation of non-invasive break-up time (NIBUT) and lower tear meniscus height (TMH) before the surgery and 6 months post-operatively. The MGs were evaluated via ImageJ and Meibomian Gland Bio-image Analyzer. MG dropout, length, width, area, gland diameter deformation index (DI), and gland signal index (SI) were recorded. Results: MG length, width, area, DI, and SI were significantly decreased after cataract surgery in the study group (operated eyes, P < 0.001, P = 0.003, P < 0.001, P = 0.001, and P < 0.001, respectively) and showed no significant changes in the control group (non-operated eyes) (all P > 0.05). MG loss increased more in the study group (P = 0.030), and the changes in TMH and NIBUT were not significantly different between the two eyes (both P > 0.05). Conclusion: Cataract surgery aggravated meibomian gland morphology, such as MG loss, MG length, width, area, and SI, and produced no change in NIBUT and TMH at 6 months post-operatively.

Assessment of anterior chamber angle changes after phacoemulsification with swept-source OCT.

AIM: To assess the changes of anterior chamber angle in patients with shallow anterior chamber after phacoemulsification combined with intraocular lens (IOL) implantation, based on anterior segment swept-source optical coherence tomography (AS-SS-OCT) measurements. METHODS: This was a prospective case control study; sixty eyes of sixty case were scheduled for cataract surgery with normal intraocular pressure (IOP). Based on anterior chamber depth (ACD) and gonioscopy findings, the eyes were divided into two groups: group of shallow anterior chamber and narrow angle (SAC group, 30 eyes); and group of normal anterior chamber group with wide angle (NAC group, 30 eyes). Measurements of ACD, anterior chamber volume (ACV), iris volume (IV), lens vault (LV), angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), and trabecular iris angle (TIA) were conducted in each group before and 3mo after surgery. RESULTS: There was no significant difference in age, axial length (AL), corneal curvature, corneal diameter, intraocular pressure, and IV between two groups before surgery, except for the LV (P=0.000). ACD and ACV were prominently larger in the NAC group than the SAC group 3mo after operation (3.69±0.38 vs 3.85±0.39 mm, P=0.025; 161.37±19.47 vs 178.26±20.30 mm3, P=0.002). AOD750, ARA750 in nasal and inferior quadrants, TISA750 in all quadrants except temporal, and TIA750 in all quadrants in SAC group were significantly smaller than those in NAC group after operation (all P<0.05). CONCLUSION: Cataract surgery can deepen anterior chamber and increase the width of anterior chamber angle in Chinese subjects, but the angle related parameters including AOD750, ARA750, TISA750, TIA, TISA750, and ACV in patients with shallow anterior chamber and narrow angle do not reach the normal level.

The Relationship Between the Change of Intraocular Lens Position and Capsular Bend After Cataract Surgery.

PURPOSE: To explore the relationship between the change in intraocular lens (IOL) position and capsular bend after cataract surgery. METHODS: Patients underwent phacoemulsification and IOL implantation (Alcon Laboratories, Inc). Patients were divided into two groups based on preoperative axial length: long axial length group (axial length ⩾ 26 mm) and normal axial length group (axial length > 22 but < 26 mm). Swept-source optical coherence tomography was performed at 1 day, 1 week, 1 month, and 3 months after mydriasis to obtain postoperative aqueous depth (PAD) and capsular bend index (CBI). The relationship between CBI and PAD changes was analyzed. RESULTS: Eighty patients (80 eyes) were included in the study. PAD decreased gradually from 1 day to 1 week and increased from 1 week to 3 months. Mean CBI was moderately positively correlated with PAD changes (r = 0.586, P < .001). The IOL moved forward gradually when the CBI was less than 2.30 and the IOL gradually moved backward when the CBI was 2.30 or greater. The root mean square of the change in PAD was smaller in the long axial length group (0.08 ± 0.04 mm) than in the normal axial length group (0.09 ± 0.05 mm) during the 3 months after surgery (P = .036). CONCLUSIONS: The position of the IOL was almost stable 1 month after operation, and postoperative capsule adhesion mainly occurred within 1 month. The change in PAD was related to capsule adhesion. The postoperative position of the IOL was relatively stable and capsular bend was relatively slow for the long axial length group over 3 months. [J Refract Surg. 2021;37(5):324-330.].

Accuracy of Constant C for Ray Tracing: Assisted Intraocular Lens Power Calculation in Normal Ocular Axial Eyes.

OBJECTIVE: To evaluate the effect of constant C for ray tracing-assisted intraocular lens (IOL) power calculation in patients with different refractive power, we compared the refractive outcome of the ray tracing method based on constant C and conventional IOL calculation. METHODS: 215 eyes which underwent phacoemulsification and IOL implantation were enrolled in the study. According to the average corneal power, patients were divided into 3 groups: high corneal power (K >45 D) group, medium corneal power (43 ≤ K ≤ 45 D) group, and low corneal power (K <43 D) group. The predicted sphero-equivalent refractive outcome for the IOL power implanted at surgery was calculated using the ray tracing method, SRK/T, and Haigis formulas. RESULTS: On the basis of the corneal refractive power, there were 65 eyes of K >45 D (30.23%), 96 eyes of 43 ≤ K ≤ 45 D (44.65%), and 54 eyes of K <43 D (25.12%). In general, the ray tracing group had the smallest value of mean absolute error (MAE) and mean error, and the proportions of eyes with absolute error (AE) <0.50 and <0.75 D were significantly higher than those of the other 2 formulas (p = 0.010). In each group, the value of MAE was smallest in the ray tracing group; for the proportions of AEs <0.50 and <0.75 D, the values in the ray tracing group were higher than those in the SRK/T and Haigis groups. Especially in the high and low corneal refractive groups, the proportion of AE <0.25 D was also obviously higher, but only in the low corneal refractive power group, and the difference was statistically significant (p = 0.006). CONCLUSIONS: Compared with the conventional formulas, C constant of the ray tracing-assisted IOL power calculation has more accuracy for the patients with different corneal refractive powers. Ray tracing could provide better guidance for IOL selection clinically.