Early intraocular lens explantations: 10-year database analysis.

BACKGROUND: The aim of this study was to analyze the causes and characteristics of IOL explantation within the first year after primary implantation. METHODS: In this retrospective, cross sectional database study, a database consisting of over 2500 IOL explants sent from 199 national and international doctors over the past 10 years was analyzed. All IOLs explanted within the first year after implantation were included in this analysis. Explants with insufficient information as well as phakic and Add-on IOLs were excluded. Main outcome measures were the reason for explantation, the time between implantation and explantation, as well as IOLs' and patients' characteristics. Additionally, the explanted IOLs were microscopically and histologically analyzed, as required. RESULTS: Of all explanted IOLs from the database, 1.9% (n = 50) were explanted within the first year after implantation. The most frequent reasons for early IOL explantation were IOL dislocation (32%), visual intolerance (26%), opacification (20%), and intraoperative complications (16%). The time between implantation and explantation was the shortest in cases with intraoperative complications (1.5 ± 3.1 days), followed by IOL dislocation (90.9 ± 103.9 days), visual intolerance (98.3 ± 86.5 days), opacifications (253.5 ± 124.0 days) and other indications (249.7 ± 124.0 days). Calcification of hydrophilic IOLs was the main type of opacification (80%). Notably, seven IOLs required immediate intraoperative exchange due to an intraoperative crack in the optic or a torn off haptic. CONCLUSION: Indications for early IOL explantation were IOL dislocation, visual intolerance, opacification, and intraoperative complications. Especially intraoperative damages to the IOL and early calcification show a potential for improvement of affected IOLs and implantation systems.

Further characterization of ARSK-related mucopolysaccharidosis type 10.

Mucopolysaccharidosis type 10 is caused by biallelic variants in ARSK, which encodes for a lysosomal sulfatase. To date, seven patients with a mild phenotype resembling spondyloepiphyseal dysplasia or multiple epiphyseal dysplasia have been described. In this report, we present two novel ARSK variants and report clinical and radiological findings of three patients. The patients' initial complaints were hip or knee pain and a waddling gait. All patients showed normal intelligence, normal hearing and eye examinations, and none had organomegaly. While typical dysostosis multiplex findings were not observed, mild platyspondyly with anterior beaking of some vertebral bodies, irregular vertebral endplates, wide ribs, inferior tapering of the ilea with a poorly developed acetabulum, irregularity of the central part of the femoral head, delayed ossification of the carpals were noted. Remarkably, all patients showed metaphyseal striation of the long bones, a crucial diagnostic clue to identify ARSK-related MPS type 10. Interestingly, vertebral involvement regressed during follow-up. On the other hand, hip dysplasia progressed in all patients. In conclusion, this study provides valuable long-term results on a recently discovered form of MPS.

Management preferences of orthopedic surgeons in developmental dysplasia of the hip under 1 year of age in Türkiye: Results of a nationwide cross-sectional survey.

OBJECTIVE: This study aimed to evaluate the diagnosis and treatment preferences of orthopedic surgeons in developmental dysplasia of the hip (DDH) cases under the age of 1 in Türkiye with a higher incidence of DDH, estimated to be around 5-15 per 1000 live births. METHODS: This was a nationwide cross-sectional survey. A link for the online survey, including 16 multiple-choice questions, was sent to the email group of the National Orthopedic Society. RESULTS: Among 233 filled-out surveys, 211 met the inclusion criteria. Half of the participants had experience of <10 years as orthopedic surgeons, managed <25% of pediatric patients in daily practice, and treated <25 DDH cases per year before walking age. Ninety-seven percent used more than one method, hip ultrasound the most common, for exact diagnosis of DDH under 6 months. Pavlik harness was the most commonly preferred brace, but the use of Tübingen orthosis increased among experienced surgeons. The uppermost age limit for bracing was higher in surgeons dealing with more pediatric patients and treating more DDH cases. Dislocated hips and hips requiring closed/open reduction were more commonly referred to other surgeons by less experienced surgeons in terms of years, number of pediatric patients, and treated DDH cases per year. The lowest age limit for intervention under general anesthesia was lower in surgeons treating >25 DDH cases per year. Over one-third used both anterior and medial approach open reduction, but a trend to anterior open reduction alone was more evident in surgeons treating >50 DDH cases per year. More experienced surgeons were more prone to check the intraoperative reduction with postoperative computed tomography or magnetic resonance imaging. Diagnosis and treatment ages of DDH cases did not significantly change during the coronavirus disease 2019 pandemic. CONCLUSION: Management preferences of orthopedic surgeons in DDH before walking age primarily depend on the rate of pediatric patients in daily practice and the number of treated DDH cases per year.

In vivo comparison of implantation behavior and laboratory analysis of two preloaded intraocular lens injectors.

PURPOSE: We evaluated implantation behavior and injector damage of two different IOL injector systems, the Multisert and the AutonoMe. DESIGN: Prospective, randomized, comparative study with laboratory investigation. METHODS: We examined used injectors from 48 bilateral cataract cases and assessed video recordings of each Implantation. All eyes were intraindividually randomized for treatment with one of the two IOL injectors. Implantation videos were reviewed for inadvertent events and the time for different implantation steps was determined. The injector nozzle tips were examined using light and scanning electron microscopy (SEM). Damage was graded using the Heidelberg Score for IOL injector damage (HeiScore). Three months postoperatively, IOLs were assessed for material changes. RESULTS: Implantation was without critical events in 96 of 96 eyes. Mean implantation time was 41.90 ± 7.11 s with the Multisert and 52.22 ± 12.06 s with the AutonoMe. In the AutonoMe group, we observed 4 eyes (8.3%) with a failed docking attempt, 28 eyes (58.3%) with a haptic adherence, one case (2.1%) of straight leading haptic and 2 cases (4.2%) of intrawound IOL manipulation. There were no events observed in the Multisert group. The mean HeiScore values were 0.87 ± 0.61 and 3.68 ± 0.47 for the AutonoMe and Multisert. 3 months postoperatively, IOL material changes were absent. CONCLUSIONS: Both injectors allowed safe and controlled implantation. Using Multisert, implantation behavior was more consistent. The injectors showed different damage profiles with a higher damage score for the Multisert.The study is registered at the German Clinical Trials Register (Deutsches Register Klinischer Studien; reference number: DRKS00007837).

Differential Diagnosis of Changes in Intraocular Lenses. / Differenzialdiagnostik von Veränderungen in Intraokularlinsen.

Differentiating between various intraocular lens (IOL) changes can be a challenge. In particular, certain IOL models carry the risk of late postoperative calcification. A major cause of IOL exchange surgery could be avoided if appropriate modifications were made during the IOL manufacturing process. The use of a hydrophilic acrylate carries the risk of IOL calcification, especially when a secondary procedure, such as a pars plana vitrectomy or other procedures using gas or air, is performed. In secondary IOL calcification, there is a wide range of opacification patterns, which are usually located in the centre on the anterior surface of the IOL or sometimes elsewhere. Often, granular deposits accumulate just below or on the surface of the IOL, leading to significant deterioration in visual quality and eventually requiring IOL exchange surgery. Therefore, in the case of eyes requiring secondary surgical intraocular intervention in the future, the use of hydrophilic IOLs should be critically evaluated. With regard to hydrophobic IOL materials, there are clear differences in the susceptibility to the formation of glistenings. Over time, there has been a significant decrease in glistening formation over the past 30 years due to optimisation of the material. With hydrophobic IOLs, special care should also be taken to avoid mechanical damage. In general, the only treatment option for functionally-impairing IOL opacification is surgical lens exchange, which carries potential risks of complications. In cases with a low degree of functional impairment, and especially in eyes with additional ocular diseases, it may be difficult to weigh the risk of additional surgery against the potential benefit. In some cases, it may be more appropriate not to perform an IOL exchange despite the IOL opacification. Recent visualisation methods that allow high-resolution analysis of the opacities in vivo and in vitro may be used in the future to estimate the functional effects of various IOL material changes on the optical quality.

Clinical Characteristics of Patients with Intraocular Lens Calcification after Pars Plana Vitrectomy.

AIM: To determine the clinical risk factors that may increase the occurrence of intraocular lens (IOL) calcification in patients who had undergone pars plana vitrectomy (PPV). METHODS: The medical records of 14 patients who underwent IOL explantation due to clinically significant IOL opacification after PPV were reviewed. The date of primary cataract surgery, technique and implanted IOL characteristics; the time, cause and technique of PPV; tamponade used; additional surgeries; the time of IOL calcification and explantation; and IOL explantation technique were investigated. RESULTS: PPV had been performed as a combined procedure with cataract surgery in eight eyes and solely in six pseudophakic eyes. The IOL material was hydrophilic in six eyes, hydrophilic with a hydrophobic surface in seven eyes and undetermined in one eye. The endotamponades used during primary PPV were C2F6 in eight eyes, C3F8 in one eye, air in two eyes and silicone oil in three eyes. Two of three eyes underwent subsequent silicone oil removal and gas tamponade exchange. Gas in the anterior chamber was detected in six eyes after PPV or silicone oil removal. The mean interval between PPV and IOL opacification was 20.5 ± 18.6 months. The mean BCVA in logMAR was 0.43 ± 0.42 after PPV, which significantly decreased to 0.67 ± 0.68 before IOL explantation for IOL opacification (p = 0.007) and increased to 0.48 ± 0.59 after the IOL exchange (p = 0.015). CONCLUSIONS: PPV with endotamponades in pseudophakic eyes, particularly gas, seems to increase the risk for secondary IOL calcification, especially in hydrophilic IOLs. IOL exchange seems to solve this problem when clinically significant vision loss occurs.

Reversible Multifocality Achieved Through Polypseudophakia. / Reversible Multifokalität durch Polypseudophakie.

Simultaneous implantation of a monofocal or monofocal toric intraocular lens (IOL) into the capsular bag and a multifocal IOL into the ciliary sulcus, referred to as duet procedure, allows us to create multifocality that is more easily reversible than the implantation of a capsular bag-fixated multifocal IOL. The optical quality and results after the duet procedure are equivalent to those of a capsular bag-fixated multifocal IOL. Patients who cannot tolerate the side effects of multifocal optics or who develop an ocular condition leading to loss of function such as age-related macular degeneration (AMD) or glaucoma in the course of their lives may benefit from the reversibility of the procedure.

[Hydrophobic surface properties of hydrophilic acrylic lenses do not protect against calcification]. / Hydrophobe Oberflächeneigenschaften hydrophiler Acryllinsen schützen nicht vor Kalzifikation.

BACKGROUND: Opacification through calcification of hydrophilic acrylic intraocular lenses is a serious complication of cataract surgery, which usually results in explantation of the lens. In the process of calcification, the intraocular lens material plays a crucial role: calcification only occurs in hydrophilic acrylic lenses. Hydrophobic acrylic lenses show no crystal formation within the polymer. Hydrophilic acrylic lenses from some manufacturers have hydrophobic surface properties. The question arises as to what influence these surface properties have on the risk of calcification. OBJECTIVE: The present study investigated whether the hydrophobic surface properties of hydrophilic acrylic lenses can prevent calcification. MATERIAL AND METHODS: Using an electrophoretic in vitro model of calcification, two hydrophilic lenses with hydrophobic surface properties were compared to two hydrophilic lenses and a hydrophobic negative control to determine the risk of calcification. The lenses were then analyzed by optical microscopy, Alizarin Red and Von Kossa staining, scanning electron microscopy (SEM) and energy dispersive X­ray spectroscopy (EDX). RESULTS: All four hydrophilic lens models showed calcification within the polymer. No difference was found between the hydrophilic lenses and the hydrophilic lenses with hydrophobic surface properties in terms of crystal formation. The hydrophobic negative control showed no calcification. CONCLUSION: The investigation conducted in this study under standardized conditions could show that hydrophobic surface properties of hydrophilic acrylic lenses do not protect against calcium phosphate crystal formation within the polymer. There also is a risk of calcification in these lens models.

Refractive outcomes after DMEK: meta-analysis.

In this meta-analysis and systematic literature review of refractive outcomes after Descemet membrane endothelial keratoplasty (DMEK), the extent of the refractive shift and an overview of reasons for refractive shift after DMEK are provided. The PubMed library was screened for articles containing the terms "Descemet membrane endothelial keratoplasty," "DMEK," "Descemet membrane endothelial keratoplasty combined with cataract surgery," "triple-DMEK" combined with "refractive outcomes," "refractive shift," and "hyperopic shift." The refractive outcomes after DMEK were analyzed and compared using a fixed and random effects model. The overall mean change of the spherical equivalent outcome when compared with the preoperative value in cases of DMEK or when compared with the preoperative target refraction in cases of DMEK combined with cataract surgery was +0.43 diopters (D) (95% CI, 0.31-0.55). When DMEK is combined with cataract surgery, a target refraction of -0.5 D is recommended to achieve emmetropia. Changes in the posterior corneal curvature are identified as the main cause of the refractive hyperopic shift.

Randomized multicenter trial to assess posterior capsule opacification and glistenings in two hydrophobic acrylic intraocular lenses.

To evaluate the long-term posterior capsule opacification (PCO) formation, and glistening rate of the HOYA Vivinex (XY1) IOL compared to Alcon AcrySof (SN60WF). In this prospective, multicentric, randomized, paired-eye, open-label study, we included 87 subjects that underwent cataract surgery with IOL implantation, with 67 patients completing the 3-year follow-up. The completer population consisted of 32 subjects implanted with XY1 and 35 implanted with SN60WF. Primary endpoints consisted of the evaluation of glistenings and measurement of PCO. Secondary outcomes included Best Corrected Distance Visual Acuity (BCVA), Contrast Acuity (CA), uncorrected visual acuities, subjective refraction, medical and lens complication rates, adverse events, and optical/visual symptoms. Follow-up visits occurred at 6-months, 1-, 2- and 3-years. At 3-years follow-up, mean PCO score was 0.121 ± 0.193 for eyes implanted with Vivinex versus 0.239 ± 0.463 for AcrySof (p = 0.026). The Vivinex IOL showed statistically significantly lower glistening occurrence through 3-years postoperatively (0.14 ± 0.26) compared to AcrySof (1.79 ± 1.43; p < 0.0001). Postoperative visual acuities improved from baseline in both IOL groups (p < 0.0001), and remained stable through the 3-year follow-up period. Eyes implanted with a HOYA Vivinex IOL exhibited significantly lower occurrence of glistening at 3-years versus Alcon AcrySof (p < 0.0001). Incidence of PCO was very low and comparable in both Vivinex and AcrySof eyes.

Natural history and genetic spectrum of the Turkish metaphyseal dysplasia cohort, including rare types caused by biallelic COL10A1, COL2A1, and LBR variants.

BACKGROUND: Metaphyseal chondrodysplasias are a heterogeneous group of diseases characterized by short and bowed long bones and metaphyseal abnormality. The aim of this study is to investigate the genetic etiology and prognostic findings in patients with metaphyseal dysplasia. METHODS: Twenty-four Turkish patients were included in this study and 13 of them were followed for 2-21 years. COL10A1, RMRP sequencing and whole exome sequencing were performed. RESULTS: Results: Seven heterozygous pathogenic variants in COL10A1 were detected in 17 patients with Schmid type metaphyseal chondrodysplasia(MCDS). The phenotype was more severe in patients with heterozygous missense variants (one in signal peptide domain at the N-terminus of the protein, the other, class-1 group mutation at NC1 domain) compared to the patients with truncating variants. Short stature and coxa vara deformity appeared after 3 and 5 years of age, respectively, while large femoral head resolved after the age of 13 years in MCDS group. Interestingly, one patient with severe phenotype also had a biallelic missense variant in NC1 domain of COL10A1. Three patients with biallelic mutations in RMRP had prenatal onset short stature with short limb, and typical findings of cartilage hair hypoplasia (CHH). While immunodeficiency or recurrent infections were not observed, resistant congenital anemia was detected in one. Biallelic mutation in LBR was described in a patient with prenatal onset short stature, short and curved limb and metaphyseal abnormalities. Unlike previously reported patients, this patient had ectodermal findings, similar to CHH. A biallelic COL2A1 mutation was also found in the patient with lower limb deformities and metaphyseal involvement without vertebral and epiphyseal changes. CONCLUSION: Long-term clinical characteristics are presented in a metaphyseal dysplasia cohort, including rare types caused by biallelic COL10A1, COL2A1, and LBR variants. We also point out that the domains where mutations on COL10A1 take place are important in the genotype-phenotype relationship.

Evolution of the angular deformity and limb length discrepancy of congenital posteromedial bowing of the tibia over time.

OBJECTIVES: This study aims to assess the natural history of congenital posteromedial bowing of the tibia (CPMBT) deformity during growth and to evaluate the outcomes of lengthening by an Ilizarov frame in CPMBT patients with limb length discrepancy (LLD). PATIENTS AND METHODS: Between January 2000 and December 2019, a total of 22 patients (12 males, 10 females; mean age: 10.5±4.4 years; range, 6 to 19 years) with the diagnosis of CPMBT and followed closely from birth until skeletal maturity were retrospectively analyzed. The radiographic evaluation included the anteroposterior and lateral interphyseal angle and full leg standing radiographs. Limb lengthening by an Ilizarov frame was performed for an estimated LLD over 40 mm. RESULTS: The age of the patients ranged from six days to 10 months at the time of presentation, while the mean age at the final follow-up was 10.5±4.4 years. Posterior medial bowing was satisfactorily remodeled in 13 (59%) patients those were not operated either for deformity or LLD. The mean LLD was 21±4.1 mm in 13 nonoperated CPMBT patients. Nine of 22 (41%) patients underwent lengthening for LLD. Five of the nine CPMBT patients were operated under the age of 10 years, while four were operated over the age of 10 years. CONCLUSION: According to the results of the current study, CPMBT was satisfactorily remodeled in more than half of the patients, and the majority of patients did not undergo surgery for angular deformity and LLD within 10 years of their lives. Based on these findings, although most of the patients' deformities remodeled, it should be kept in mind that some may require lengthening surgery.

Automatic Quantitative Assessment of Lens Opacities Using Two Anterior Segment Imaging Techniques: Correlation with Functional and Surgical Metrics.

The purpose of this study is to quantitatively assess lens opacity, using a swept-source optical coherence tomography (SS-OCT) device for anterior segment assessment, and establish the correlation with Scheimpflug imaging, corrected distance visual acuity (CDVA) and cumulative dissipated energy (CDE). This prospective cross-sectional single-center study enrolled 51 patients (51 eyes) with crystalline lens opacity. Patients with previous ocular surgery, pathologies or general disorders affecting vision were excluded. Eyes were scanned with an SS-OCT device, and lens densitometry was automatically analyzed using a custom MATLAB script which examined lens density, nuclear density and linear density. The same analyses were performed on Scheimpflug images. Preoperative CDVA and CDE during phacoemulsification were recorded. Spearman's (ρ) and Pearson's (r) correlation coefficients were assessed according to data normality. Statistically significant correlations were established between SS-OCT and Scheimpflug imaging using lens analysis (ρ = 0.47, p < 0.001), nuclear analysis (ρ = 0.73, p < 0.001) and linear analysis (r = 0.44, p < 0.001). A significant correlation with CDE was found with all the SS-OCT methods (r = 0.57, p < 0.001). Only the nuclear analysis of the SS-OCT scans (Tb = −0.33, p < 0.01) and Pentacam Nucleus Staging (Tb = −0.26, p < 0.05) showed a statistically significant correlation with CDVA. Good inter-device agreement in lens densitometry was found. However, SS-OCT yielded improved lens imaging compared with the Scheimpflug device and a higher correlation with clinical parameters. Thus, high-resolution SS-OCT has the potential to become a preferable option for automatic cataract grading and preoperative planning.

Ophthalmic viscosurgical device interaction with two hydrophobic acrylic intraocular lenses of different equilibrium water content.

Ophthalmic viscosurgical device (OVD) is used during intraocular surgery to protect ocular tissue. It requires complete removal from the eye by the end of surgery to avoid postoperative complications. This study compares the interaction of a cohesive OVD with two different intraocular lenses (IOLs) of different equilibrium water content. In this laboratory study on porcine cadaver eyes, the capsular bags and anterior chambers of each eye were filled with fluorescein-stained OVD. Following implantation of 10 IOLs each of Clareon CNA0T0 and AcrySof SN60WF (Alcon Laboratory, Fort Worth, USA) IOLs, the OVD was removed using the irrigation/aspiration mode. The OVD removal was timed and differences between the both IOL groups were compared. OVD removal time ranged from 18 to 40 s (mean ± SD, 26.4 ± 6.8 s) and from 16 to 39 s (mean ± SD, 23.6 ± 6.6 s) for eyes implanted with a CNA0T0 and a SN60WF IOL, respectively, without a statistically significant difference between the groups, P > 0.05. Cohesive OVD removal times were similar between the CNA0T0 and SN60WF groups. Surgeons should experience no differences regarding the interaction between cohesive OVDs and IOLs made from the new Clareon material compared to the established AcrySof material.

Risk factors related reduction loss in nonoperatively treated Type II supracondylar humerus fractures.

BACKGROUND: Controversies continue about the optimal treatment method for extension Type II supracondylar humerus fractures (SCHFs). Although most patients are successfully treated with closed reduction and plaster casting, in some patients, the reduction initially obtained is lost during the time in the plaster cast. The aim of this study was to determine the risk factors causing reduction loss. METHODS: A retrospective examination was made of the data of 103 patients with Type II extension SCHF treated with closed reduction and plaster cast fixation between 2012 and 2018. Reduction loss was evaluated in respect of patient variables, fracture characteristics as obliquity and metaphyseal fragmentation, fixation method, and plaster cast parameters. RESULTS: The 103 patients evaluated comprised 62 males and 41 females with a mean age of 5.4±2.5 years (2-11.6 years). Successful treatment was achieved with closed reduction and plaster cast fixation in 81 (79%) patients and reduction loss was observed in 22 (21%) patients. The reduction loss of fractures showing high oblique in the sagittal plane was 3.17-fold higher than low sagittal oblique fractures (95% CI: 0.99-10.03, p<0.05). The risk of reduction loss in fractures with metaphyseal fragmentation was found to be 6.5-fold higher (95% CI: 1.6-26.5, p<0.01). No statistically significant relationship was determined between reduction loss and Gartland subtype, age, gender, the presence of rotation initially, plaster cast angle, and the soft-tissue/inner cast width ratio. CONCLUSION: According to our study group, 79% of extension Type II fractures can be successfully treated with closed reduction and plaster casting. Sagittal plane obliquity and metaphyseal fragmentation are risk factors for reduction loss independent of Gartland subtype.

Development of a standardized in vitro model to reproduce hydrophilic acrylic intraocular lens calcification.

Opacification through calcification of hydrophilic acrylic intraocular lenses (IOL) is a severe complication after cataract surgery. Causing symptoms that range from glare through to severe vision loss, the only effective therapy is explantation of the opacified IOL so far. Although IOL calcification is a well-described phenomenon, its pathogenesis is not fully understood yet. The purpose of the current study was to develop a laboratory model to replicate IOL calcification. Calcification could be reproduced using a horizontal electrophoresis and aqueous solutions of calcium chloride and disodium hydrogen phosphate. The analysis of the in vitro calcified IOLs was performed using light microscopy, Alizarin Red and Von Kossa staining, scanning electron microscopy, energy dispersive x-ray spectroscopy and electron crystallography using transmission electron microscopy and electron diffraction. The presented laboratory model could be used to identify hydrophilic IOLs that are at risk to develop calcification and to assess the influence of associated risk factors. In addition, it can serve as a research tool to further understand this pathology.

Multivariate analysis of the predictive value of asymmetric skin creases in diagnosis of decentralized developmental dysplasia of the hip.

The aim of this study was to investigate the relationship of developmental dysplasia of the hip (DDH) with asymmetrical skin crease (ASC) in the inguinal, gluteal and thigh regions and to determine which ASC has the most predictive value for the diagnosis of hip dislocation in infants. This study was planned as a prospective, observational study and conducted between 1 October 2020 and 1 June 2021. Asymmetric distribution of skin creases was evaluated separately in three regions (inguinal, gluteal and thigh). Then, hip ultrasonography (USG) was performed and the Graf method was used to classify the cases as 'centralized' [Graf types I, IIa (-), IIb and IIc] and 'decentralized' (Graf types IId, III and IV). The relationship between the groups was evaluated using univariate and then multivariate analyses. A total of 241 patients were included in the study. The number of patients with ASC was 49 (21%). While 36 of these 49 patients had centralized hips, 13 had decentralized hips ( P < 0.001). Sixty-five percent (13/20) of 20 infants with decentralized hips had ASC in at least one of the inguinal, gluteal or thigh regions. The presence of ASC in the inguinal ( P < 0.001) and gluteal ( P < 0.014) regions increased the risk of the decentralized hip in the child, whereas the presence of ASC in the isolated thigh region did not increase the risk of the dislocated hip ( P = 0.534). Inguinal ASC and gluteal ASC are reliable findings in DDH screening, but the relationship of isolated thigh ASC with DDH could not be demonstrated statistically. Level of Evidence: Level II - diagnostic study.

Development and Verification of an Adjustment Factor for Determining the Axial Length Using Optical Biometry in Silicone Oil-Filled Eyes.

The aim of this prospective clinical study was to establish and verify an adaptation for axial length (AL) measurement in silicone oil (SO)-filled pseudophakic eyes with a Scheimpflug and partial coherence interferometry (PCI)-based biometer. The AL was measured with a Pentacam AXL (OCULUS Optikgeräte GmbH, Wetzler, Germany) and IOLMaster 700 (Carl Zeiss Meditec, Jena, Germany). The coefficients of variation (CoV) and the mean systematic difference (95% confidence interval (CI)) between the devices were calculated. After implementing a setting for measuring AL in tamponaded eyes with a Pentacam based on data of 29 eyes, another 12 eyes were examined for verification. The mean AL obtained with the Pentacam was 25.53 ± 1.94 mm (range: 21.70 to 30.76 mm), and with IOLMaster, 24.73 ± 1.97 mm (ranged 20.84 to 29.92 mm), resulting in a mean offset of 0.80 ± 0.08 mm (95% CI: 0.77, 0.83 mm), p < 0.001. The AL values of both devices showed a strong linear correlation (r = 0.999). Verification data confirmed good agreement, with a statistically and clinically non-significant mean difference of 0.02 ± 0.04 (95% CI: -0.01, 0.05) mm, p = 0.134. We implemented a specific adaptation for obtaining reliable AL values in SO-filled eyes with the Pentacam AXL.

Laboratory and Clinical Experience With a Diffractive Trifocal Intraocular Lens Sutured to an Artificial Iris.

PURPOSE: To determine in vitro, using a translational research approach before realizing the procedure in a patient with iatrogenic aphakia and partial aniridia, whether suturing a trifocal intraocular lens (IOL) to an artificial iris degrades the IOL's optical quality. METHODS: Optical quality was analyzed by measuring the modulation transfer function (MTF) at a 3-mm aperture and at 50 and 100 lp/mm spatial frequencies. The FineVision Pod F GF IOL (PhysIOL) was assessed in two powers: two +20.00 diopters (D) (20A and 20B IOLs) and two +30.00 D (30A and 30B IOLs). The IOLs' decentration in relation to the artificial iris's center was evaluated. The laboratory results provided empirical evidence in the informed consent for surgical intervention in a patient with iatrogenic aphakia and iris defect in one eye. Clinical results were measured using the parameter of corrected distance visual acuity plus a patient self-assessment of the cosmetic appearance of the operated eye. RESULTS: The 20A and 20B IOLs demonstrated a mean MTF reduction of up to 1.1%, whereas the 30A and 30B IOLs showed a decrease of up to 5.2% for both spatial frequencies. All lenses showed good centration levels. In the clinical case, the patient showed corrected distance visual acuity, distance-corrected near visual acuity, and distance-corrected intermediate visual acuity of 0.20, 0.20, and 0.22 logMAR, respectively. The patient was satisfied with the cosmetic outcome. CONCLUSIONS: There was merely a slight reduction in trifocal IOL optical quality after it was sutured to an artificial iris. Clinically, the combined implantation of the artificial iris and FineVision IOL provided good functional and cosmetic outcomes. [J Refract Surg. 2022;38(1):61-68.].

Pupil dynamics after in-the-bag versus anterior and retropupillary iris-fixated intraocular lens implantation.

An Intraocular Lens (IOL) fixated on the iris either anteriorly, as a phakic IOL, or posteriorly, as an aphakic IOL, can influence pupil motility. In this interventional case series study, we evaluated pupil size under different levels of illumination (scotopic = 0.04 lx, low-mesopic = 0.4 lx and high-mesopic = 4 lx) for anterior iris-claw IOL fixation for correcting myopia or hyperopia (IFPH), retropupillary iris-claw IOL fixation to correct aphakia or as treatment for late in-the-bag IOL dislocation/subluxation (IFRP), and capsular-fixation IOL in-the-bag implantation (IB). Pupil size was measured preoperatively for the IFPH- and IB-group as well as 6 months after surgery for all groups. We analyzed a total of 70 eyes: 22 eyes of 11 patients with phakic IOLs, 22 eyes of 20 patients in the IFRP group and 26 eyes of 13 patients in the IB group. Both IFPH and IB showed a smaller postoperative scotopic pupil size, compared with the preoperative values. When compared to postoperative values of IB and IFPH, IFRP showed a significantly smaller postoperative scotopic pupil size (IFPH: 5.89 ± 0.83 mm, IFRP: 4.37 ± 0.83 mm, IB: 5.34 ± 0.98 mm, p < 0.001) while no differences were seen at high-mesopic lighting. Neither of the surgical techniques seems to impair the constriction of the pupil.