Anatomic changes in asymptomatic pachychoroid spectrum diseases after cataract surgery.

Pachychoroid spectrum disease (PSD) involves various chorioretinal pathologies associated with increased choroidal blood flow. Theoretically, PSD could worsen after cataract surgery since the choroidal thickness tends to increase after surgery. Therefore, we evaluated the prevalence of asymptomatic PSD in patients who underwent cataract surgery and compared the clinical characteristics according to the presence of PSD. The subretinal fluid (SRF) development risk was evaluated using the Cox proportional hazard model. Of 924 eyes, 184 (19.9%) showed asymptomatic PSD. Patients with asymptomatic PSD were older, predominantly male, hyperopic, and showed thicker choroid (P < 0.001, 0.001, < 0.001, and < 0.001). Seven (3.8%) of 184 eyes with asymptomatic PSD developed SRF. The Cox proportional hazard model showed that the flat, irregular pigment epithelial detect (FI-PED; HR 37.337, 95% CI 3.880-359.9300, P = 0.002) was the sole indicator for the SRF development after adjustment of age, sex, and axial length. The SRF-developed PSD group experienced a profound and prolonged increase in the choroidal thickness (P = 0.001, 0.002, and 0.002 at 1, 3, and 12 months). Meticulous preoperative evaluation for FI-PED and postoperative monitoring for choroidal thickness would predict SRF development after cataract surgery in eyes with asymptomatic PSD.

Comparison of Keratometry and Total Corneal Power, as measured by a swept-source OCT-based optical biometer, for IOL power calculation in Asian eyes.

PURPOSE: To investigate whether standard keratometry (K) or total corneal power (TCP) lead to more accurate refractive outcomes for intraocular lens (IOL) power calculation. SETTING: Public hospital. DESIGN: Retrospective evaluation of a diagnostic test instrument. METHODS: Preoperatively all patients underwent optical biometry with the Anterion (Heidelberg), a swept-source optical coherence tomographer providing both K and TCP. The same IOL model was implanted in all cases. The whole sample was divided into a training dataset, used to optimize the formula constants, and a testing dataset, used to investigate the spherical equivalent prediction error (SEQ-PE) of 8 IOL power formulas. Trueness, precision and accuracy were evaluated by means of the robust two-sample t-test. Cochran's Q test was performed to assess whether the percentage of eyes with an SEQ-PE within each threshold was significantly different; in such an event, the McNemar test was then applied. RESULTS: Both the training and testing datasets included 317 eyes. No significant differences were detected for trueness, due to constant optimization. Precision and accuracy were better when K was entered, although a statistically significant difference was observed only with the EVO (precision: p = 0.02 and accuracy: p = 0.03) and Haigis formula (p <0.01 for both precision and accuracy). No significant differences were observed for the percentage of eyes with an absolute SEQ-PE within any threshold. CONCLUSIONS: With most formulas, IOL power calculation is not more accurate when TCP is used instead of K.

The Effect of Blue-light Filtering Intraocular Lenses on the Development and Progression of Macular Atrophy in Eyes With Neovascular Age-related Macular Degeneration.

PURPOSE: To assess the effect of blue-light filtering (BLF) intraocular lenses (IOLs) on the development and progression of macular atrophy (MA) in eyes with neovascular age-related macular degeneration (nAMD). DESIGN: Retrospective, clinical cohort study. METHODS: The study included patients with nAMD with anti-vascular endothelial growth factor (VEGF) injections who underwent uneventful cataract surgery between 2007 and 2018 with follow-up until June 2023. Subsequent MA rates were compared between subjects who received a BLF IOL or a non-BLF IOL. All optical coherence tomography scans were manually reviewed in a masked manner regarding patient baseline variables and IOL status by an experienced research technician. By using Heidelberg software, the area of MA was manually evaluated and calculated (mm2) by the program. The overall risk of developing new-onset MA and the effect of IOL type on disease progression were assessed. Death was included as a censoring event. RESULTS: Included were 373 eyes of 373 patients (mean age, 78.6 ± 6.7 years at surgery; 67.4% were female). BLF IOLs were implanted in 206 eyes, and non-BLF IOLs were implanted in 167 eyes with comparable follow-up times (3164 ± 1420 days vs 3180 ± 1403 days, respectively, P = .908) and other baseline parameters (age, gender, corrected distance visual acuity, macular thickness, cumulative number of anti-VEGF injections). Nine preexisting and 77 new-onset MA cases were detected, with similar distribution between BLF and non-BLF eyes (P = .598 and P = .399, respectively). Both univariate Kaplan-Meier (P = .366) and multivariate Cox regression analyses adjusted for age and gender showed that BLF-IOLs were comparable to non-BLF IOLs regarding hazard for new-onset MA (hazard ratio [HR], 1.236; 95% CI, 0.784-1.949; P = .363). Final MA area at the last visit was 5.14 ± 4.71 mm2 for BLF IOLs and 8.56 ± 9.17 mm2 for non-BLF IOLs (P = .028), with the mean annual MA area increase of 0.78 ± 0.84 mm2 and 1.26 ± 1.32 mm2, respectively (P = .042). CONCLUSIONS: BLF IOLs did not show added benefit over non-BLF IOLs in terms of MA-free survival but were associated with less progression over time in a cohort of patients with nAMD.

Ultra-Widefield-Guided Swept-Source OCT Findings of Peripheral Vitreoretinal Abnormality in Young Myopes.

PURPOSE: To evaluate the ultra-widefield fundus photography (UWF-FP)-guided swept-source OCT (SS-OCT) images of peripheral vitreoretinal abnormality (PVRA) in young asymptomatic myopes. DESIGN: Cross-sectional, single-center study. PARTICIPANTS: A total of 1966 eyes of 983 consecutive patients aged 18 to 42 years with refractive error in the spherical equivalent of < 0 diopters (D) who visited KEYE Eye Center, Seoul, Republic of Korea, for refractive surgery. METHODS: The prevalence of PVRA and their characteristics, including shape, location, presence of pigmentation, membrane, retinal breaks, and detachment, were evaluated. A logistic regression analysis was done to evaluate the risk factors of PVRA and the risk of retinal breaks or detachment among eyes with PVRA. RESULTS: Among 1966 eyes, 317 (16.1%) had PVRA, and 182 (57.4%) and 135 (42.6%) had focal and linear lesions, respectively. The risk of PVRA was increased with axial length of the eyes (odds ratio [OR], 1.238, 95% confidence interval [CI], 1.112-1.379, P < 0.001), corneal astigmatism (OR, 1.320, 95% CI, 1.148-1.519, P < 0.001), presence of discrete margins of different retinal reflectivity (DMDRR; indicating outer retinal disruption from abnormal vitreoretinal traction) (OR, 1.751, 95% CI, 1.334-2.300, P < 0.001), and posterior vitreous detachment (PVD) at the posterior pole of the retina (OR, 1.833, 95% CI, 1.352-2.485, P < 0.001). Among eyes with PVRA, patient age (OR, 1.063, 95% CI, 1.008-1.121, P = 0.025), linear lesions (OR, 15.234, 95% CI, 7.891-29.407, P < 0.001), and multiple lesions (OR, 3.432, 95% CI, 1.780-6.620, P < 0.001) were independently associated with the presence of retinal breaks or detachment. CONCLUSIONS: The follow-up for PVRA among young myopes should be personalized on the basis of their ocular characteristics, including asymmetric ocular expansion (axial length and astigmatism) and vitreoretinal interface status. The treatment plan for PVRA eyes should emphasize the greater risk of retinal breaks and detachment with increasing age and the presence of linear and multiple lesions. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

A wearable colorimetric sweat pH sensor-based smart textile for health state diagnosis.

Sweat pH is an important indicator for diagnosing disease states, such as cystic fibrosis. However, conventional pH sensors are composed of large brittle mechanical parts and need additional instruments to read signals. These pH sensors have limitations for practical wearable applications. In this study, we propose wearable colorimetric sweat pH sensors based on curcumin and thermoplastic-polyurethane (C-TPU) electrospun-fibers to diagnose disease states by sweat pH monitoring. This sensor aids in pH monitoring by changing color in response to chemical structure variation from enol to di-keto form via H-atom separation. Its chemical structure variation changes the visible color due to light absorbance and reflectance changes. Furthermore, it can rapidly and sensitively detect sweat pH due to its superior permeability and wettability. By O2 plasma activation and thermal pressing, this colorimetric pH sensor can be easily attached to various fabric substrates such as swaddling and patient clothing via surface modification and mechanical interlocking of C-TPU. Furthermore, the diagnosable clothing is durable and reusable enough to neutral washing conditions due to the reversible pH colorimetric sensing performance by restoring the enol form of curcumin. This study contributes to the development of smart diagnostic clothing for cystic fibrosis patients who require continuous sweat pH monitoring.

Long-term Clinical Outcomes After Trifocal Intraocular Lens Implantation: A Retrospective Observational Study.

PURPOSE: To evaluate the long-term stability of the AcrySof IQ PanOptix TFNT00 intraocular lens (IOL) (Alcon Laboratories, Inc). METHODS: This was a retrospective review of 1,065 eyes (745 patients) who underwent implantation of a PanOptix IOL. A total of 296 eyes (mean age: 58.62 ± 5.63 years and preoperative refractive error: -0.68 ± 3.01 diopters [D]) met inclusion criteria for this study. The objective refraction, uncorrected distance and near visual acuity (UDVA and UNVA), and corrected distance visual acuity (CDVA) were evaluated at postoperative months 1, 2, 6, 12, 24, and 36. RESULTS: The refractive error was -0.20 ± 0.36 D at 1 month, -0.20 ± 0.35 D at 2 months (P = .503), -0.10 ± 0.37 D at 6 months (P < .001), -0.02 ± 0.38 D at 12 months (P < .001), 0.00 ± 0.38 D at 24 months (P < .001), and 0.03 ± 0.39 D at 36 months (P < .001). Multivariate analysis showed long-term, independent associations for young age (beta = -0.122; P = .029) and changes in mean keratometry (beta = -0.413; P < .001). A greater refractive change was associated with a greater change in UNVA (r = 0.134; P = .026) but not with UDVA (r = -0.029; P = .631) or CDVA (r = -0.010; P = .875). CONCLUSIONS: Implantation of the PanOptix IOL yields stable clinical outcomes for visual acuity and refractive error for the first 3 years. A slight hyperopic shift, causing decreased near visual acuity, is anticipated for younger patients. [J Refract Surg. 2023;39(4):236-241.].

Accuracy of Nine Formulas to Calculate the Powers of an Extended Depth-of-Focus IOL Using Two SS-OCT Biometers.

PURPOSE: To evaluate the accuracy of nine formulas to calculate the power of a new extended depth-of-focus intraocular lens (EDOF IOL), the AcrySof IQ Vivity (Alcon Laboratories, Inc), using measurements from two optical biometers, the IOLMaster 700 (Carl Zeiss Meditec AG) and Anterion (Heidelberg Engineering GmbH). METHODS: After constant optimization, the accuracy of these formulas was analyzed in 101 eyes: Barrett Universal II, EVO 2.0, Haigis, Hoffer Q, Holladay 1, Kane, Olsen, RBF 3.0, and SRK/T. Both standard and total keratometry from the IOLMaster 700 and standard keratometry from the Anterion were used for each formula. RESULTS: Constant optimization provided slightly different values for the A-constant, which ranged between 118.99 and 119.16, depending on the formula and the optical biometer. According to the heteroscedastic test, within each keratometry modality the standard deviation of the SRK/T was significantly higher compared to that of the Holladay 1, Kane, Olsen, and RBF 3.0 formulas. The SRK/T formula provided less accurate results also when the absolute prediction errors were compared by Friedman test. According to McNemar's test with Holm corrections, statistically significant differences were found within each keratometry modality between the percentage of eyes with a prediction error within ±0.25 diopters obtained with the Olsen formula compared to the Holladay 1 and Hoffer Q formulas. CONCLUSIONS: Constant optimization remains a mandatory step to achieve the best outcomes with the new EDOF IOL: the same constant should not be used for all formulas and for both optical biometers. Different statistical tests revealed that older IOL formulas have lower accuracy compared to newer formulas. [J Refract Surg. 2023;39(3):158-164.].

Accuracy of IOL Power Calculation Formulas for Quadrifocal Acrysof IQ PanOptix TFNT Implantation in Patients With Previous Corneal Refractive Surgery: Comparison of SS-OCT-Based Biometers.

PURPOSE: To evaluate the accuracy of intraocular lens (IOL) power calculation formulas from two biometers using swept-source optical coherence tomography for quadrifocal Acrysof IQ Panoptix TFNT IOL (Alcon Laboratories, Inc) implantation in patients with visually significant cataract with previous corneal refractive surgery. METHODS: This retrospective study comprised 50 eyes from 50 patients with a history of corneal refractive surgery and TFNT IOL implantation. Candidate formulas were Shammas-PL and Barrett True-K in the Argos (Movu, Inc), Barret True-K and Haigis-L in the IOLMaster 700 (Carl Zeiss Meditec AG), and Haigis using the total keratometry (TK) mode in the IOLMaster 700. The main outcome measure was the mean absolute error (MAE) detected at postoperative 6 months. The refractive accuracy was also evaluated as number and percentage of eyes within ±0.25, ±0.50, and ±0.75 diopters (D) of the prediction error. RESULTS: The uncorrected distance and near visual acuity were 0.32 ± 0.34 and 0.46 ± 0.20 logMAR at baseline, and significantly improved to 0.04 ± 0.07 and 0.03 ± 0.06 logMAR at postoperative 6 months (P < .001 for all analysis) with a mean spherical equivalent of -0.20 ± 0.39 D. The MAE was smallest for the Barrett True-K formula in the IOLMaster 700 (0.36 ± 0.26 D) and largest for the Shammas-PL formula in the Argos (0.59 ± 0.37 D). The Barrett True-K formula from both devices showed that 90% of eyes were within ±0.75 D of MAE. CONCLUSIONS: The visual and refractive outcomes of TFNT IOL implantation in patients with previous corneal refractive surgery were favorable. The Barrett True-K formula in the IOLMaster 700 showed the best refractive outcome for TFNT IOL implantation. [J Refract Surg. 2021;37(11):836-841.].

Accuracy of Total Corneal Power Calculation for Multifocal Toric Intraocular Lens Implantation: Swept-Source OCT-Based Biometer vs Scheimpflug Tomographer.

PURPOSE: To evaluate the accuracy of total corneal power calculation from a swept-source optical coherence tomography-based biometer and a rotating Scheimpflug tomographer for the Acrysof IQ Panoptix toric TFNT intraocular lens (IOL) (Alcon Labroatories, Inc). METHODS: A retrospective study was undertaken on 145 eyes implanted with the TFNT IOL. The accuracy of total corneal power calculation from a SS-OCT-based biometer (IOLMaster 700; Carl Zeiss Meditec AG; total keratometry [TK]) and a rotating Scheimpflug tomographer (Oculus Optikgeräte GmbH; total corneal refractive power at 3 mm [TCRP3] and at 4 mm [TCRP4]) were compared. The surgically induced astigmatism vector, difference vector, angle of vector, correction index, index of success, coefficient of adjustment, and flattening index were analyzed using the VectrAK analysis program (ASSORT). RESULTS: The index of success showed a significant difference between the three methods (P = .035, analysis of variance test). The mean ± standard deviation of the index of success was the best in TK (0.43 ± 0.20), followed by TCRP4 (0.47 ± 0.24, P = .400, Bonferroni HSD test) and TCRP3 (0.50 ± 0.22, P = .030, Bonferroni HSD test). The preoperative refractive astigmatism prediction error was within ±0.50 diopters (D) in 62 eyes (42.8%) when using TCRP4 and in 66 eyes (45.5%) when using TK. CONCLUSIONS: These study results suggest that the refractive accuracy of TFNT implantation using total corneal power from TCRP4 and TK was favorable. [J Refract Surg. 2021;37(10):686-692.].

Risk factors for onset or progression of epiretinal membrane after cataract surgery.

While the precise diagnosis of early stage epiretinal membrane (ERM) at the time of cataract surgery and evaluation of risk factors for development or progression of ERM after cataract surgery is increasingly important, there is only limited information. In the present study, we evaluated the risk factors for onset or progression of ERM on spectral domain optical coherence tomography (SD-OCT) after cataract surgery. The univariate analysis showed that eyes with partial posterior vitreous detachment (PVD; p < 0.001), hyper-reflective foci (HF) on the inner retinal surface (p < 0.001), vitreoschisis (p = 0.014), and discrete margin of different retinal reflectivity (DMDRR; p = 0.007) on ultra-widefield fundus photography (UWF-FP) had significant risk for the onset or progression of ERM after cataract surgery. The multivariate analysis showed that partial PVD (HR, 3.743; 95% confidence interval [CI], 1.956-7.162; p < 0.001), HF (HR, 2.330; 95% CI, 1.281-4.239; p = 0.006), and DMDRR on UWF-FP (HR, 3.392; 95% CI, 1.522-7.558; p = 0.003) were the independent risk factors for the onset or progression of ERM after cataract surgery after adjustment for other confounding factors. Our study shows that the onset or progression of ERM after cataract surgery depends on an abnormal vitreoretinal interface (VRI) represented by partial PVD, HF on SD-OCT, and DMDRR on UWF-FP, not on age, axial length, or presence of ERM at the time of surgery. A meticulous funduscopic evaluation of the VRI would help to predict the ERM risk before cataract surgery.

Clinical Characteristics of Eyes Showing a Discrete Margin of Different Retinal Reflectivity.

BACKGROUND AND OBJECTIVE: To evaluate the clinical characteristics of discrete margins of different retinal reflectivity (DMDRR) in ultra-widefield fundus photography. PATIENTS AND METHODS: This DMDRR comprises a discrete border, with differing patterns of reflectivity on either side. Spectral-domain optical coherence tomography was performed on both the macula and the margin. The incidences of epiretinal membrane (ERM) and peripheral retinal pathologies of patients with a DMDRR (n = 36) were compared with a control group (n = 41). RESULTS: An ellipsoid zone (EZ) defect at the DMDRR was detected in 34 eyes (92.2%), and vitreous traction was detected in 20 eyes (55.6%). A significantly higher proportion of eyes in the DMDRR group had an ERM, retinal hole, and cystic retinal tuft compared with the control group (P = .022, P = .010, and P < .001, respectively). CONCLUSIONS: The DMDRR indicates EZ disruption that may originate from vitreous traction. Meticulous observation for vitreoretinal interface diseases is mandatory for these patients. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:273-280.].

Effect of Capsular Tension Ring on Refractive Outcomes in Patients With Implantation of the Quadrifocal Acrysof PanOptix TFNT00 IOL.

PURPOSE: To evaluate the effect of a capsular tension ring (CTR) on refractive outcomes in eyes undergoing implantation of the quadrifocal Acrysof PanOptix TFNT00 intraocular lens (IOL) (Alcon Laboratories, Inc). METHODS: A retrospective case-control study was undertaken of 91 eyes implanted with the TFNT00 IOL. Of these 91 eyes, a CTR was implanted in 33 and these eyes were compared to the 58 eyes in which a CTR was not implanted. The main outcome measure was the mean absolute error (MAE) of the refractive prediction error. To evaluate the consistency of refractive outcomes, variance of MAE was measured. Using a swept-source optical coherence tomography device, postoperative aqueous depth (AQD) was measured to estimate the position of the IOL. RESULTS: Eyes with a CTR showed a significantly smaller MAE when compared with eyes without a CTR (P = .038 at 1 m, P = .003 at 2 m, and P = .001 at 6 m). There was a lower variance of MAE in the eyes implanted with a CTR, with higher precision of refraction (P = .058 at 1 m, P = .007 at 2 m, and P = .001 at 6 m). There was a significant difference in the percentage of the eyes showing more than 0.50 D from the estimated target of the Barrett Universal II formula (P = .007 at 1 m, P = .064 at 2 m, and P = .004 at 6 m, respectively). AQD was significantly shallower in eyes with a CTR than in eyes without a CTR (P = .006). CONCLUSIONS: Use of the CTR enhanced the accuracy of postoperative refractive outcomes after TFNT00 IOL implantation by preventing the posterior bowing of the optic-haptic junction. [J Refract Surg. 2021;37(3):174-179.].

Digital technology, tele-medicine and artificial intelligence in ophthalmology: A global perspective.

The simultaneous maturation of multiple digital and telecommunications technologies in 2020 has created an unprecedented opportunity for ophthalmology to adapt to new models of care using tele-health supported by digital innovations. These digital innovations include artificial intelligence (AI), 5th generation (5G) telecommunication networks and the Internet of Things (IoT), creating an inter-dependent ecosystem offering opportunities to develop new models of eye care addressing the challenges of COVID-19 and beyond. Ophthalmology has thrived in some of these areas partly due to its many image-based investigations. Tele-health and AI provide synchronous solutions to challenges facing ophthalmologists and healthcare providers worldwide. This article reviews how countries across the world have utilised these digital innovations to tackle diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration, glaucoma, refractive error correction, cataract and other anterior segment disorders. The review summarises the digital strategies that countries are developing and discusses technologies that may increasingly enter the clinical workflow and processes of ophthalmologists. Furthermore as countries around the world have initiated a series of escalating containment and mitigation measures during the COVID-19 pandemic, the delivery of eye care services globally has been significantly impacted. As ophthalmic services adapt and form a "new normal", the rapid adoption of some of telehealth and digital innovation during the pandemic is also discussed. Finally, challenges for validation and clinical implementation are considered, as well as recommendations on future directions.

Risk Factors for Onset or Progression of Posterior Vitreous Detachment at the Vitreomacular Interface after Cataract Surgery.

PURPOSE: To study the incidence and risk factors for onset or progression of posterior vitreous detachment (PVD) at the vitreomacular interface (VMI) after cataract surgery. DESIGN: Retrospective case series. PARTICIPANTS: Patients with a history of phacoemulsification from April 2018 through April 2019 at the Keye Eye Center, Seoul, Korea, and postoperative monitoring for more than 2 months. METHODS: Cox proportional hazard ratios for the onset or development of PVD after cataract surgery in the presence of selected risk factors and demographic data were calculated. To evaluate the ocular risk factors, various ocular metrics, including spherical equivalent (SE), axial length (AL), anterior chamber depth, lens thickness, central subfield thickness, PVD status at macula and optic nerve head (ONH), peripapillary retinal nerve fiber layer thickness, and ONH parameters from OCT scans, were used for the analysis. MAIN OUTCOME MEASURES: Onset or development of PVD at the VMI. RESULTS: Among 988 eyes without PVD at baseline, 174 eyes (17.6%) showed changes in the VMI. Univariate analysis showed that age, SE, AL, PVD status at macula and ONH, and average and vertical cup-to-disc ratios (CDRs) were associated significantly with PVD onset or development (P = 0.046, P = 0.004, P = 0.040, P < 0.001, P < 0.001, P = 0.008, and P = 0.042, respectively). In a multivariate analysis, PVD status at the macula and ONH and smaller CDR were associated with PVD onset or progression after cataract surgery after adjustment for age, SE, and AL (P < 0.001, P < 0.001, and P = 0.005, respectively). CONCLUSIONS: The risk of PVD onset or progression was dependent on PVD status and the CDR detected on OCT scans, not on age or AL, in a large patient cohort. Patients who show risk factors on OCT should be monitored carefully during the postoperative period.

Ultra-Widefield Fluorescein Angiography Findings in Patients with Macular Edema Following Cataract Surgery.

Purpose: To evaluate the ultra-widefield fluorescein angiography (UWFA) findings in patients with macular edema (ME) following cataract surgery.Methods: Thirty-three eyes from patients who showed greater than a 30% increase in the central subfield thickness following cataract surgery were included. UWFA scored according to a system suggested by the Angiography Scoring for Uveitis Working Group (ASUWG). Factors associated with a high ASUWG score were evaluated.Results: Thirty-three (100.0%) of the 33 eyes showed abnormal UWFA findings, including optic disc staining (81.8%), capillary leakage (100.0%), pinpoint leakage (84.8%), peripheral retinal vascular leakage (24.2%) and retinal staining (6.1%). Multiple regression analysis reveals that following adjustment for other factors, younger age was independently associated with a higher ASUWG score (R2 = 0.476, p = .001).Conclusions: Patients with ME following cataract surgery show generalized inner and outer blood-retinal barrier breakage. Particular attention is required during cataract surgery in young patients.

Application of a four-flanged intrascleral fixation technique for toric and multifocal intraocular lenses.

PURPOSE: To report clinical outcomes of a four-flanged intrascleral fixation technique using toric and multifocal intraocular lens. OBSERVATIONS: We describe two cases of premium intraocular lens (IOL) implantation after which the patients fully recovered their visual function following a four-point sutureless scleral fixation technique via a 2.8-mm corneal incision. In the first case, a monofocal toric hydrophobic lens consisting of two haptic plates with four holes for suturing was fixated with 5-0 polypropylene monofilament. In the second case, a bifocal hydrophobic lens with the same haptic design was fixated. No conjunctival or scleral sutures, glue, or flap formation was required during the surgery. There were no complications related to the surgical process. CONCLUSIONS AND IMPORTANCE: A four-flanged intrascleral fixation technique may benefit patients with poor zonular support who have high expectations for postoperative visual quality.

Systemic Factors Related to Intraocular Levels of Interleukin-6 and Vascular Endothelial Growth Factor in Diabetic Retinopathy.

This study is for identifying systemic factors correlating with intraocular levels of interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) in diabetic retinopathy. Forty-two consecutive patients undergoing pars plana vitrectomy (PPV) for PDR were included in this cross-sectional study. The aqueous humor was sampled just prior to PPV for assay of IL-6 and VEGF. One day before PPV, patient characteristics were recorded and a number of systemic markers were amassed, including fasting and postprandial glucose, homeostasis model assessment- (HOMA-) IR, HOMA-beta, C-peptide, insulin, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, apolipoprotein- (Apo-) A, Apo-B, and lipoprotein A (Lp-A). Relationships between systemic determinants and intraocular cytokine levels were analyzed by regression analysis. Mean levels of IL-6 and VEGF were 15.3 pg/mL (range, 2.4-10124.5 pg/mL) and 21.1 pg/mL (range, 3.2-766.1 pg/mL), respectively. After adjustment for age, gender, duration of diabetes, and BMI, multivariate analysis showed significant association of smoking (p=0.002) and HOMA-IR (p=0.003) with intraocular IL-6 levels, while intraocular VEGF and systemic Lp-A levels correlated significantly (p=0.032). Insulin resistance and smoking status impacted intraocular levels of IL-6, while intraocular VEGF levels were influenced by Lp-A. An appreciation for the relationship between systemic factors and intraocular cytokines may help elucidate the complex pathophysiology of diabetic retinopathy.