Dislocation force of scleral flange-fixated intraocular lens haptics.

PURPOSE: To measure the dislocation forces in relation to haptic material, flange size and needle used. SETTING: Hanusch Hospital, Vienna, Austria. DESIGN: Laboratory Investigation. METHODS, MAIN OUTCOME MEASURES: 30 G (gauge) thin wall and 27 G standard needles were used for a 2 mm tangential scleral tunnel in combination with different PVDF (polyvinylidene fluoride) and PMMA (polymethylmethacrylate haptics). Flanges were created by heating 1 mm of the haptic end, non-forceps assisted in PVDF and forceps assisted in PMMA haptics. The dislocation force was measured in non-preserved cadaver sclera using a tensiometer device. RESULTS: PVDF flanges achieved were of a mushroom-like shape and PMMA flanges were of a conic shape. For 30 G needle tunnels the dislocation forces for PVDF and PMMA haptic flanges were 1.58 ± 0.68 N (n = 10) and 0.70 ± 0.14 N (n = 9) (p = 0.003) respectively. For 27 G needle tunnels the dislocation forces for PVDF and PMMA haptic flanges were 0.31 ± 0.35 N (n = 3) and 0.0 N (n = 4), respectively. The flange size correlated with the occurring dislocation force in experiments with 30 G needle tunnels (r = 0.92), when flanges were bigger than 384 micrometres. CONCLUSIONS: The highest dislocation forces were found for PVDF haptic flanges and their characteristic mushroom-like shape for 30 G thin wall needle scleral tunnels. Forceps assisted flange creation in PMMA haptics did not compensate the disadvantage of PMMA haptics with their characteristic conic shape flange.

Occurrence of Corneal Staining after Cataract Surgery with and without Chitosan-N-Acetylcysteine Eye Drops.

INTRODUCTION: The objective of this study was to evaluate the prevalence of ocular surface damage assessed by corneal staining scores right after cataract surgery and whether it can be prevented using chitosan-N-acetylcysteine (C-NAC) eye drops. METHODS: We included patients scheduled for routine cataract surgery. Each patient was randomly assigned to one of three groups. Patients in group 1 underwent routine cataract surgery with no additional eye drops. In group 2, patients received C-NAC eye drops after cataract surgery, and in group 3, C-NAC was applied both before and after surgery. Both groups continued the treatment once daily for 4 days. Ocular surface alteration was assessed using the National Eye Institute (NEI) score, and the visual analog scale (VAS) was used to evaluate subjective complaints. RESULTS: Thirty-six patients were included in the final analyses. One hour after cataract surgery, a statistically significant increase in corneal fluorescein staining was observed in all groups, which decreased again after 1 week. There was no significant difference between the groups 1 h after cataract surgery, though a tendency toward lower NEI scores was observed during this time point in group 3. DISCUSSION: Cataract surgery induced ocular surface staining and subjective complaints after 1 h. However, the increase in VAS score was small and probably not clinically relevant. The application of perioperative C-NAC eye drops did reduce the rate of corneal staining after cataract surgery in a clinically relevant manner.

Effect of Air Tamponade among Patients with Epiretinal Membranes and Intraretinal Cystoid Changes Undergoing Vitrectomy with Membrane Peeling - A Prospective Randomized Trial. / Effekt der Lufttamponade bei Patienten mit epiretinalen Membranen und intraretinalen zystoiden Veränderungen nach Vitrektomie mit Membrane Peeling ­ eine prospektive randomisierte Studie.

BACKGROUND: The effect of air tamponade among patients undergoing vitrectomy with membrane peeling for removal of epiretinal membranes (ERM) is controversially discussed. The aim of the present study was to analyze differences in outcomes between air tamponade and balanced salt solution (BSS) in a study population with preoperative intraretinal cystoid changes. PATIENTS AND METHODS: This randomized study included patients scheduled for pars plana vitrectomy with membrane peeling owing to ERM and intraretinal cystoid changes. Air tamponade or BSS at the end of surgery was applied according to preoperative randomization. Optical coherence tomography and best-corrected distance visual acuity (DCVA) measurements were performed before surgery, 5 days after surgery, and 3 months after surgery. RESULTS: From 96 patients included, 85 eyes had full follow-up and could be included for analysis. Median improvement of DCVA was + 16 EDTRS letters (IQR: 8 to 22) among patients with BSS, while it was + 13 EDTRS letters (IQR: 8 to 17) among patients with air tamponade. There was a trend for better improvement of DCVA when BSS was left at the end of surgery, compared to air tamponade, but not reaching statistical significance. CONCLUSIONS: There were no statistically significant differences concerning resorption of preoperative intraretinal cystoid changes, improvement of visual acuity, and final DVCA between air tamponade and BSS.

ILM peeling with ILM flap transposition vs. classic ILM peeling for small and medium macula holes-a prospective randomized trial.

Background: The aim of the present study was to compare macular hole closure rates of patients with small and medium-sized macular holes who underwent vitrectomy with internal limiting membrane (ILM) peeling combined with ILM flap transposition over the macular hole, compared with classic ILM peeling. Methods: This prospective randomized trial was designed as a pilot study with two groups: ILM peeling with ILM flap transposition over the macular hole vs. classic ILM peeling. Results: Among 20 patients recruited, complete analysis could be performed for 16 patients. The macular hole closure rates were 100% in both groups, without significant differences with respect to postsurgical subfoveal hyporeflective zones (p = 1.0, Fisher's exact test), postsurgical visual acuity (p = 0.7, t-test), and postsurgical irregularities of the ellipsoid zone (p = 1.0, Fisher's exact test). Conclusion: Vitrectomy with ILM peeling combined with ILM flap transposition over the macular hole and classic ILM peeling are both successful methods for the repair of macular holes of small and medium size and are associated with comparable outcomes.

Intraoperative optical coherence tomography guided corneal sweeping for removal of remnant Interface fluid during ultra-thin Descemet stripping automated endothelial keratoplasty.

BACKGROUND: Remnant interface fluid following Descemet stripping automated endothelial keratoplasty (DSAEK) is associated with postoperative detachments. The aim of this study was to assess outcomes of intraoperative optical coherence tomography (iOCT) guided meticulous peripheral corneal sweeping for removal of interface fluid during ultra-thin (UT) DSAEK. METHODS: This retrospective study included all eyes underwent iOCT guided UT-DSAEK from October 2016 to February 2018 at the Hanusch Hospital, Vienna, Austria. Peripheral meticulous corneal sweeping was performed to remove excess fluid. Central graft thickness (CGT) was measured prior to surgery, after graft bubbling and after corneal sweeping. Remnant interface fluid rates were compared between eyes that underwent rebubbling and those that did not. RESULTS: Overall, 28 eyes of 28 patients with a mean age of 73.9 ± 10.0 years were included. An iOCT guided meticulous peripheral sweeping was performed in 89.3% (n = 25) of the cases. Following 84% (n = 21) of the peripheral sweeping performed, remnant fluid was no longer identified. Following peripheral sweeping the interface fluid height was reduced from 17.31 ± 15.96 µm to 3.46 ± 9.52 µm (p < 0.001) and CGT was reduced by 7% (p < 0.001). Rebubbling was performed in 17.9% (n = 5) of the cases. The rebubbling group had a greater proportion of patients that had remnant fluid identified with iOCT at the end of surgery despite meticulous peripheral sweeping (60.0% versus 4.4%, p = 0.01). CONCLUSION: The iOCT identified subclinical remnant fluid in nearly 90% of UT-DSAEK cases. An iOCT guided peripheral corneal sweeping led to resolution of interface fluid in a majority of cases. Eyes with persistent remnant fluid despite peripheral corneal sweeping are more likely to require subsequent rebubbling.

Computer-Based Tutorial to Enhance the Informed Consent Process for Cataract Surgery in Serbian- or Turkish-Speaking Patients.

INTRODUCTION: This study analyses if a translated version of the CatInfo tool increases the knowledge of Serbian- and Turkish-speaking patients about cataract surgery. METHODS: In total, 61 cataract patients, literate in Serbian or Turkish, were randomly allocated into two groups. Via an interactive computer-based tool ("CatInfo"), patients either saw a detailed audio-visual presentation about cataract surgery (study group) or a "placebo" video (control group). Afterwards, all participants had a face-to-face discussion with an ophthalmologist. Immediately after the interview and on the day of surgery, all patients had to fill out a questionnaire including knowledge and demographic questions. Patients in the study group were further asked about their satisfaction with the CatInfo tool and the usefulness of such a device before other interventions. RESULTS: Patients in the study group answered significantly more questions correctly compared to the control group, and this information gain remained stable over a 1-week period. There was a significant low negative correlation between educational level and the test results, whereas age and computer habits of the participants did not have an influence on correct answers. Satisfaction with the CatInfo tool was high in the Serbian and the Turkish group (96% and 84%, respectively), and 92% of Serbian patients as well as 62% of the Turkish patients rated that they could imagine to use such a device before any other surgery. DISCUSSION/CONCLUSION: The translated version of the CatInfo tool improved patients' knowledge, and this information gain remained stable until the day of the surgery.

Fourier-Transform Infrared Spectroscopy of Epiretinal Membranes and Internal Limiting Membranes after Pars Plana Vitrectomy with Membrane Peeling.

INTRODUCTION: Fourier-transform infrared imaging (FTIRI) enables examination of protein secondary structure in the analyzed tissues. The aim of our study was to examine the distribution of secondary structures in epiretinal membranes (ERMs) and internal limiting membranes (ILMs), and to explore possible associations to other diagnostic variables. METHODS: This prospective pilot study included patients scheduled for pars plana vitrectomy with membrane peeling. ERMs and ILMs were harvested during surgery and placed on a BaF2 window for postsurgical FTIRI analysis. Infrared hyperspectral images were subjected to second and fourth derivative analysis to obtain information of the protein secondary structures present in the tissues. RESULTS: Samples of 43 patients were analyzed, with the triple helical domain showing the highest prevalence in the examined tissues. The other secondary structures (beta-sheet, random coil, and beta-turn) showed a heterogenous distribution in the examined samples, without specific associations to indication of surgery, comorbidities, outcomes from optical coherence tomography, and intrasurgical findings. CONCLUSIONS: FTIRI enables analysis of the spatial distribution of protein secondary structures in the examined tissues; thus, it is a useful analytical technique for the analysis of ERMs and ILMs.

Caffeine Uptake into the Vitreous after Peroral Coffee Consumption.

INTRODUCTION: Caffeine and its metabolites have antioxidant activity, scavenging reactive oxygen species. The aim of our study was to measure caffeine concentrations in vitreous samples after peroral caffeine intake. METHODS: This prospective study included patients scheduled for 23-G pars plana vitrectomy with membrane peeling due to epiretinal membranes. The study was performed in two parts: in the first part, patients were recruited into three different groups: group A consisted of habitual coffee drinkers who agreed to drink coffee containing 180 mg caffeine 1 h before surgery (n = 10), group B consisted of habitual coffee drinkers who were not offered coffee before surgery (n = 5), and group C consisted of non-habitual coffee drinkers, forming the control group (n = 5). In the second part (group D) patients (habitual coffee drinkers) agreed to give additional blood serum samples for measurement of caffeine concentration. Harvested samples of vitreous (groups A-D), epiretinal membranes (groups A-C), and blood serum samples (group D) were examined for concentrations of caffeine with gas chromatography-mass spectrometry. RESULTS: Samples of 40 eyes of 40 patients were harvested. The concentrations of caffeine in the vitreous samples were 1,998 ± 967 ng/mL in group A and 1,108 ± 874 ng/mL in group B. In group C, caffeine concentrations were below 176 ng/mL in all vitreous samples. Both groups A and B had significantly higher concentrations of caffeine in the vitreous samples than group C (p < 0.002, p < 0.01, Mann-Whitney U test). Caffeine concentrations in epiretinal membranes were below the limits of detection. Correlation of caffeine concentrations between blood serum samples and vitreous samples in group D was high, with significantly higher caffeine concentrations in the blood serum. CONCLUSION: Coffee consumption leads to significant caffeine levels in the vitreous compared to patients in the control group, and caffeine concentrations in the vitreous showed a high correlation to blood serum concentrations of caffeine after peroral coffee consumption.

Cav 1.3 channels play a crucial role in the formation of paroxysmal depolarization shifts in cultured hippocampal neurons.

OBJECTIVE: An increase of neuronal Cav 1.3 L-type calcium channels (LTCCs) has been observed in various animal models of epilepsy. However, LTCC inhibitors failed in clinical trials of epileptic treatment. There is compelling evidence that paroxysmal depolarization shifts (PDSs) involve Ca2+ influx through LTCCs. PDSs represent a hallmark of epileptiform activity. In recent years, a probable epileptogenic role for PDSs has been proposed. However, the implication of the two neuronal LTCC isoforms, Cav 1.2 and Cav 1.3, in PDSs remained unknown. Moreover, Ca2+ -dependent nonspecific cation (CAN) channels have also been suspected to contribute to PDSs. Nevertheless, direct experimental support of an important role of CAN channel activation in PDS formation is still lacking. METHODS: Primary neuronal networks derived from dissociated hippocampal neurons were generated from mice expressing a dihydropyridine-insensitive Cav 1.2 mutant (Cav 1.2DHP-/- mice) or from Cav 1.3-/- knockout mice. To investigate the role of Cav 1.2 and Cav 1.3, perforated patch-clamp recordings were made of epileptiform activity, which was elicited using either bicuculline or caffeine. LTCC activity was modulated using the dihydropyridines Bay K 8644 (agonist) and isradipine (antagonist). RESULTS: Distinct PDS could be elicited upon LTCC potentiation in Cav 1.2DHP-/- neurons but not in Cav 1.3-/- neurons. In contrast, when bicuculline led to long-lasting, seizure-like discharge events rather than PDS, these were prolonged in Cav 1.3-/- neurons but not in Cav 1.2DHP-/- neurons. Because only the Cav 1.2 isoform is functionally coupled to CAN channels in primary hippocampal networks, PDS formation does not require CAN channel activity. SIGNIFICANCE: Our data suggest that the LTCC requirement of PDS relates primarily to Cav 1.3 channels rather than to Cav 1.2 channels and CAN channels in hippocampal neurons. Hence, Cav 1.3 may represent a new therapeutic target for suppression of PDS development. The proposed epileptogenic role of PDSs may allow for a prophylactic rather than the unsuccessful seizure suppressing application of LTCC inhibitors.

Attaining the optimal flange technique for transscleral capsular bag stabilization using iris hooks.

PURPOSE: To investigate the flange properties of different iris hooks. SETTING: Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria. DESIGN: Laboratory study. METHODS: The flanging properties of 4 different iris hooks made from polypropylene (PP), elastic polymer (EP), and nylon were investigated with different heating distances and both with and without forceps gripping. The maximum diameter of the flanges was measured, and the shape of the flanges was evaluated. RESULTS: Although both nylon and EP iris hooks had too small flange diameters for intrascleral fixation, PP iris hooks had a sufficient flange diameter (>330 µm) and mushroom-like shape. Furthermore, in PP hooks, heating distance was directly proportional to flange diameter. CONCLUSIONS: The findings of this study suggest that only PP iris hooks are suitable for flanged intrascleral fixation, which is off-label, to secure adequate fixation.

Influence of Sutureless Scleral Fixation Techniques With 3-Piece Intraocular Lenses on Dislocation Force.

PURPOSE: To compare 4 different secondary intraocular lens (IOL) fixation techniques regarding the least required force to dislocate a scleral fixated 3-piece IOL in human corneoscleral donor tissue. DESIGN: Experimental laboratory investigation. METHODS: The least required dislocation force (LRDF) of 4 different secondary IOL fixation techniques, namely, the techniques using transscleral tunnels (TTs; as described by Scharioth), glued haptics (GHs; Agarwal), flanged haptics (FHs; Yamane), and bent haptic ends (BH; Behera/Bolz), were investigated using 40 three-piece IOLs (Sensar AR40) fixated to human scleral tissue. The main outcome of the study, dislocation force between different techniques, was measured with a tensiometer. RESULTS: The force needed to dislocate the haptics was highest with the FH technique and was significantly higher than with all the other techniques (GH vs FH: -1.02±0.02 N, P < .001; TT vs FH: -1.08±0.21 N, P < .001; BH vs FH: -1.00±0.25 N, P = .044). There was no significant difference regarding the dislocation force between the other techniques: GH vs TT (-0.06±0.100 N, P = .988), GH vs BH (-0.02±0.03 N, P = .60), TT vs BH (-0.08±0.04 N, P > .99). CONCLUSIONS: The FH technique as described by Yamane proved to be the strongest form of secondary IOL fixation regarding dislocation force in this in vitro study. The other fixation techniques showed significantly less resistance to axial traction.

Quality assurance via telephone interviews after cataract surgery: An explorative study.

INTRODUCTION: Cataract surgery is a relatively safe procedure with satisfactory postoperative results in most patients. However, in rare cases severe complications can occur shortly after the intervention. Therefore, patients are advised to undergo an ophthalmological examination postoperatively, which should be performed as soon as possible in case of emergencies. However, exactly when these follow-up visits should take place is still discussed. A time- and cost-saving alternative to this could be short-term postoperative telemedical approaches. The aim of this study was to analyze patient complaints as well as satisfaction with and the best timepoint to perform telephone calls after cataract surgery. METHODS: Patients scheduled for cataract surgery received a telephone call on the surgery day or the day after (study group) during which they were asked about complaints or additional examination visits. Patients without telephone calls served as control group. All patients had a follow-up visit one week after the intervention during which a questionnaire was filled out and the study group was asked about their satisfaction with the telephone calls. RESULTS: 181 patients were recruited in this study. Ocular surface problems were the most common postoperative symptom. More than 80% of the patients were very satisfied with the telephone calls, with patients being contacted on the day of surgery being more calmed than those called on the next day. No difference in additional and planned follow-up visits was found between the study and the control group (P > .40). Postoperative patient complaints (Phi 0.372, P < .001) and additional prescribed therapy (Phi 0.480, P < .001) were moderately associated with additional visits. CONCLUSION: Satisfaction with telephone reviews shortly after cataract surgery was very high and contacting patients on the evening of the day of the procedure could be a time- and cost-saving alternative to short-term in-house follow-up visits.

Repeatability of biometry in patients with meibomian gland dysfunction before and after vectored thermal pulsation therapy: A randomized, controlled trial.

PURPOSE: To evaluate the effect of vectored thermal pulsation therapy (VTPT) on the repeatability of biometry readings of two different optical biometers in patients with meibomian gland dysfunction (MGD). METHODS: Patients affected by MGD were included in this prospective, randomized, controlled, investigator-masked study. One eye was randomized to VTPT (LipiFlow®, Johnson & Johnson), and the contralateral eye served as a control. Three visits were scheduled at baseline, 2 weeks and 3 months after the treatment. The main outcome parameter of the study was the repeatability of three calculations of emmetropic intraocular lens power (EIOLP) at the 3 months visit as compared to baseline using an optical biometer (IOLMaster® 700, Carl Zeiss Meditec AG). Repeatability of different keratometry values obtained by the optical biometer and a Placido-disc topographer (MS-39®, CSO) served as secondary outcome parameters. RESULTS: Twenty-nine patients were included in the final analysis. While tear film parameters improved in the study eyes, there were no significant differences regarding the repeatability of three EIOLP measurements between baseline and 3-months-visit in both eyes (p > 0.05) and keratometry measurements in both the optical biometer and the Placido-disc topographer. Remarkably, throughout all study visits, there were some outliers regarding the repeatability of measurements. CONCLUSION: While both devices showed high repeatability regarding EIOLP and keratometry, future studies are needed to detect high-risk patients for poor repeatability.

Differences Between Keratometry and Total Keratometry Measurements in a Large Dataset Obtained With a Modern Swept Source Optical Coherence Tomography Biometer.

PURPOSE: This study aimed to explore the concept of total keratometry (TK) by analyzing extensive international datasets representing diverse ethnic backgrounds. The primary objective was to quantify the disparities between traditional keratometry (K) and TK values in normal eyes and assess their impact on intraocular lens (IOL) power calculations using various formulas. DESIGN: Retrospective multicenter intra-instrument reliability analysis. METHODS: The study involved the analysis of biometry data collected from ten international centers across Europe, the United States, and Asia. Corneal power was expressed as equivalent power and astigmatic vector components for both K and TK values. The study assessed the influence of these differences on IOL power calculations using different formulas. The results were analyzed and plotted using Bland-Altman and double angle plots. RESULTS: The study encompassed a total of 116,982 measurements from 57,862 right eyes and 59,120 left eyes. The analysis revealed a high level of agreement between K and TK values, with 93.98% of eyes exhibiting an absolute difference of 0.25 D or less. Astigmatism vector differences exceeding 0.25 D and 0.50 D were observed in 39.43% and 1.08% of eyes, respectively. CONCLUSIONS: This large-scale study underscores the similarity between mean K and TK values in healthy eyes, with rare clinical implications for IOL power calculation. Noteworthy differences were observed in astigmatism values between K and TK. Future investigations should delve into the practicality of TK values for astigmatism correction and their implications for surgical outcomes.

Web-based Telemonitoring of Visual Function and Self-reported Postoperative Outcomes in Cataract Care: an International Multicenter RCT.

PURPOSE: Comparing web-based, self-administered follow-up after cataract surgery to conventional face-to-face follow-up. SETTING: Eye clinics in the Netherlands, Austria and Germany. DESIGN: Randomized controlled trial with an embedded method comparison study [ClinicalTrials.gov: NCT04809402]. METHODS: Routine cataract patients were randomized into two groups: the 'telemonitoring' group undertook web-based vision self-assessments and questionnaires from home, while the 'usual care' group received conventional care. All participants had a 4-6 week post-surgery clinic visit for safety and validation purposes. Outcomes included: the web-test's accuracy for assessing postoperative visual acuity (VA) and refractive error; adverse event rates; and patient reported outcome measurements (PROMs). RESULTS: 94 participants (188 eyes) were enrolled. Web-based uncorrected distance VA testing demonstrated a negligible mean difference (-0.03±0.14 logMAR) when compared to conventional ETDRS chart testing, with 95% limits-of-agreement ranging from -0.30 to 0.24 logMAR. The web-based refraction assessment overestimated the postoperative refractive error (mean difference 0.15±0.67 diopters), resulting in a poorer corrected distance VA compared to subjective refraction (mean 0.1 vs. -0.1 logMAR). Rates of adverse events and unscheduled consultations were minimal across both groups. Preoperative and postoperative PROMs questionnaires had a 100% response rate. Visual functioning (Catquest-9SF and NEI-VFQ-25) improved after surgery (mean improvement -0.80 and 16.70 respectively) and did not significantly differ between the two groups. CONCLUSION: The cataract patients in this study effectively provided postoperative outcome data via a web-interface. Both conventional and web-based follow-ups yielded similar PROMs and adverse event rates. Future developments should reduce the variability in the web-based VA test and yield representative refraction outcomes.

Assessing the astigmatism-reducing effect of toric intraocular lenses in eyes with low astigmatism: randomized masked bilateral comparison.

PURPOSE: To evaluate the astigmatism-reducing effect of toric intraocular lenses (IOLs) for low amounts of corneal astigmatism. SETTING: Hanusch Hospital, Vienna, Austria. DESIGN: Randomized, masked, controlled trial with bilateral comparison. METHODS: Patients scheduled for bilateral cataract surgery and a corneal astigmatism in both eyes between 0.75 diopters (D) and 1.5 D were included in this study. The first eye was randomized to receive either a toric IOL or a nontoric IOL, and the contralateral eye received the other type of IOL. At the follow-up visits, optical biometry, corneal measurements with tomography and topography, autorefraction, subjective refraction, corrected and uncorrected distance visual acuity (CDVA/UDVA) with ETDRS charts and a questionnaire were performed. RESULTS: 58 eyes were included in the study. Postoperative median UDVA was 0.00 (logMAR) in the toric eyes and 0.10 in the nontoric eyes ( P = .03). The median CDVA was 0.00 in both groups ( P = .60). Median residual astigmatism determined by subjective refraction and autorefraction in the toric eyes was 0.25 D and 0.50 D, respectively ( P = .04), and 0.50 D and 1.00 D in the nontoric eyes, respectively ( P < .001). CONCLUSIONS: The use of a toric IOL appears to be appropriate from a threshold value of approximately 0.75 D preoperative corneal astigmatism. Further studies in a larger patient population are needed to confirm these results.

Rotational stability of a new toric intraocular lens with an advanced optical profile.

PURPOSE: To examine the rotational stability of a new toric intraocular lens (IOL), the TECNIS Eyhance Toric II, over a course of 3 months. SETTING: Vienna Institute for Research in Ocular Surgery, Hanusch Hospital, Vienna, Austria. DESIGN: Prospective unmasked single-center study. METHODS: 50 eyes of 50 patients with cataract and regular corneal astigmatism ≥0.75 diopters (D) were included. The TECNIS Eyhance Toric II IOL was implanted in 1 eye of each study patient. Images of the alignment axis of the IOL were taken intraoperatively, as well as at 1 hour, 1 week, and 3 months postoperatively. For the measurement of toric IOL rotation, images were superimposed on the basis of ocular landmarks. Uncorrected and corrected distance (4 m) and intermediate (66 cm) visual acuities were assessed at the 3-month visit. RESULTS: There was no significant difference in the rotational position between the intraoperative and 3 month timepoints, with a mean rotation of 1.34 ± 1.46 degrees, in 27 examined eyes. ( P = 0.313). No patients had to undergo repositioning of the toric IOL. A significant reduction of refractive cylinder occurred from preoperatively 1.8 ± 1.1 to 0.40 ± 0.42 D at the 3-month visit ( P = .001; n = 43). The corrected distance visual acuity improved significantly from 0.28 ± 0.16 logMAR preoperatively to -0.01 ± 0.13 logMAR at 3 months postoperatively ( P = .001; n = 43). CONCLUSIONS: The TECNIS Eyhance Toric II showed a good visual performance with no significant rotation over a course of 3 months and, therefore, an excellent rotational stability. The intraocular lens showed a good safety profile with no adverse events.

Comparison of corneal aberrations from anterior segment swept source OCT versus Placido-topography combined spectral domain OCT in cataract patients.

BACKGROUND: To comprehensively evaluate the agreement of component corneal aberrations from the newly updated wavefront analysis software of a swept-source optical coherence tomographer (SS-OCT) and a referential Placido-topography combined OCT device in elderly cataract patients. METHODS: Retrospective study including 103 eyes from 103 elderly patients scheduled for cataract surgery that were measured on the same day with a SS-OCT (Heidelberg Engineering, Germany) device and a Placido-topography combined OCT device (CSO, Italy). Anterior, total, and posterior corneal wavefront aberrations were evaluated for their mean differences and limits of agreement (LoA) via Bland-Altman plots. Vector analysis was additionally employed to compare corneal astigmatism measurements in dioptric vector space. RESULTS: Mean differences of all corneal aberrometric parameters did not exceed 0.05 µm. Total corneal aberrations were not significantly different from 0 except for vertical coma (- 0.04 µm; P = 0.003), spherical aberration (- 0.01 µm, P < 0.001), and root mean square (RMS) higher-order aberration (HOA) (0.03 µm, P = 0.04). The 95% LoA for total corneal aberration parameters between both devices were - 0.46 to 0.42 µm for horizontal astigmatism, - 0.37 to 0.41 µm for oblique astigmatism, - 0.19 to 0.17 µm for oblique trefoil, - 0.33 to 0.25 µm for vertical coma, - 0.20 to 0.22 µm for horizontal coma, - 0.22 to 0.20 µm for horizontal trefoil, - 0.11 to 0.08 µm for spherical aberration, and - 0.22 to 0.28 µm for RMS HOA. Vector analysis revealed no statistically significant mean differences for anterior, total, and posterior corneal astigmatism in dioptric vector space. CONCLUSION: In eyes undergoing cataract surgery with a regular elderly cornea, corneal wavefront analysis from the SS-OCT device showed functional equivalency to the reference device. Nevertheless, clinically relevant higher order aberration parameters should be interpreted with caution for surgical decision-making.

Size variability and fitting of 30-gauge thin-wall needles and 3-piece intraocular lens haptics for the flanged intrascleral fixation technique.

PURPOSE: To assess the diameter of different 30-gauge thin-wall needles and 3-piece intraocular lens (IOL) haptics readily used for the flanged-haptic intrascleral fixation technique. SETTING: Hanusch Hospital, Vienna, Austria. DESIGN: Laboratory investigation. METHODS: 5 30-gauge thin-wall needles and 5 3-piece IOLs were assessed. An upright light microscopy was used for measurements. The inner and outer diameters of the needles and the end thickness of the haptics were analyzed and compared for haptic fitting into the needle. RESULTS: Among the needles, the inner diameter of the T-lab needle was significantly wider compared with all the others (mean 209.3 ± 8.0 µm, P < .001), followed by TSK (194.8 ± 5.0 µm), MST (194.7 ± 5.8 µm), Sterimedix (187.5 ± 9.0 µm) and significantly narrower Meso-relle (mean 178.7 ± 7.0 µm, P < .05). The outer diameter of the T-lab needle was significantly larger of all (mean 316.0 ± 2.0 µm, P < .001). Concerning the IOLs, the AvanseePreset Kowa's haptic was significantly thinner (mean 127.2 ± 0.7 µm) than all the others, such as the TecnisZA900 Johnson & Johnson (143.5 ± 3.1 µm), the CTLucia202 Zeiss (143.8 ± 1.3 µm), and the AcrysofMA60AC Alcon (143.9 ± 1.4 µm). The only haptic that was thicker than all the others assessed was that of SensarAR40 Johnson & Johnson (170.7 ± 1.7 µm, P < .001). CONCLUSIONS: Most of the analyzed haptics would fit into most of the measured needles, with the exception of the Sensar AR40 in combination with the Meso-relle or Sterimedix needles. The combination of a larger needle lumen and a thinner haptic could result in more ease of insertion during surgery. If the dimensions of the needle and IOL haptics used are unknown, we recommend trying insertion before beginning surgery.

Role of vascular endothelial growth factor polymorphisms in the treatment success in patients with wet age-related macular degeneration.

PURPOSE: Along with environmental risk factors such as smoking, hypertension, and atherosclerosis, genetic susceptibility is a primary contributor to the development and progression of exudative age-related macular degeneration (AMD). Vascular endothelial growth factor (VEGF) is a central angiogenic regulator and there has been general agreement now that it is an important trigger for the progression of exudative AMD. In the present study, we tested the hypothesis that VEGF gene polymorphisms play a role in the treatment success with VEGF inhibitors in patients with exudative AMD. DESIGN: Prospective cohort study. PARTICIPANTS: We included 185 eyes of 141 patients with exudative AMD who were scheduled for their first treatment with intravitreally administered bevacizumab in this trial. METHODS: All patients were aged >50 years and had angiographically verified exudative AMD. Blood from the finger pad was collected on blood cards for genotyping for the VEGF polymorphisms rs1413711, rs3025039, rs2010963, rs833061, rs699947, rs3024997, and rs1005230. At each follow-up visit, visual acuity was reassessed and an ophthalmic examination was carried out. Visual acuity outcome, number of retreatments, and overall time of treatment were analyzed in dependence of the VEGF polymorphisms. MAIN OUTCOME MEASURES: Mean change in visual acuity at the end of the treatment period. RESULTS: The included patients were reinjected with bevacizumab 1 to 15 times, resulting in a total treatment period of 42 to 1182 days. In univariate analysis only the G/G genotypes of rs3024997 and rs2010963 compared with all other 5 single nucleotide polymorphisms (SNPs) showed a significantly lower visual acuity at the end of treatment. In multivariate analysis including parameters such as time, baseline visual acuity, and number of reinjections, none of the SNPs showed a significant correlation. CONCLUSIONS: The current study indicates that VEGF polymorphisms are not major predictors of anti-VEGF treatment success in patients with exudative AMD.