Visual Acuity Outcomes and Complications after Intraocular Lens Exchange: An IRIS® Registry (Intelligent Research in Sight) Analysis.

PURPOSE: To assess risk factors for worse visual acuity (VA) outcomes after intraocular lens (IOL) exchange, and the most common postsurgical complications. DESIGN: Retrospective cohort study. PARTICIPANTS: Eyes from patients 18 years of age and older in the IRIS® Registry (Intelligent Research in Sight) that underwent IOL exchange in the United States between 2013 and 2019. METHODS: Vision improvement compared with baseline was determined at 1 year after surgery. A multivariable generalized estimating equation model adjusting for demographic factors and baseline vision was used to identify factors associated with VA worse than 20/40 at 1 year. MAIN OUTCOME MEASURES: Visual outcomes and postoperative complications after lens exchange. RESULTS: A total of 46 063 procedures (n = 41 925 unique patients) were included in the analysis. Overall, VA improved from a mean ± standard deviation (SD) of 0.53 ± 0.58 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/70) before surgery to a mean ± SD of 0.31 ± 0.40 logMAR (Snellen equivalent, 20/40) at 1 year. Among eyes with VA recorded at both baseline and 1 year after surgery, 60.5% achieved VA of 20/40 or better at 1 year. Vision of worse than 20/40 at 1 year was associated with greater age (odds ratio [OR], 1.16 per 5-year increase; 95% confidence interval [CI], 1.14-1.18) and higher logMAR baseline VA (OR, 1.14 per 0.1-logMAR increase; 95% CI, 1.14-1.15), as well as Black or African American (OR, 1.96; 95% CI, 1.68-2.28), Hispanic (OR, 1.82; 95% CI, 1.59-2.08), and Asian (OR, 1.48; 95% CI, 1.21-1.81) race or ethnicity versus White race, Medicaid (OR, 1.78; 95% CI, 1.40-2.25) versus private insurance, smoking history (OR, 1.22; 95% CI, 1.11-1.35), and concurrent anterior (OR, 1.65; 95% CI, 1.51-1.81) and posterior (OR, 1.53; 95% CI, 1.41-1.66) vitrectomy versus no vitrectomy. Female sex was associated with better VA at 1 year. At 1 year, epiretinal membrane (10.9%), mechanical lens complication (9.4%), and dislocation of the replacement lens (7.1%) were the most common complications. CONCLUSIONS: In this large national cohort, the annual number of IOL exchanges rose steadily over time. Vision improved in 60.2% of patients; worse visual outcomes were associated with greater age, worse baseline vision, Black race, Hispanic ethnicity, Medicaid insurance, smoking, and concurrent vitrectomy. Epiretinal membrane was the most common complication. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Toric Monofocal Intraocular Lenses for the Correction of Astigmatism during Cataract Surgery: A Report by the American Academy of Ophthalmology.

PURPOSE: To review the published literature evaluating the visual and refractive outcomes and rotational stability of eyes implanted with toric monofocal intraocular lenses (IOLs) for the correction of keratometric astigmatism during cataract surgery and to compare those outcomes with outcomes of eyes implanted with nontoric monofocal IOLs and other astigmatism management methods performed during cataract surgery. This assessment was restricted to the toric IOLs available in the United States. METHODS: A literature search of English-language publications in the PubMed database was last conducted in July 2022. The search identified 906 potentially relevant citations, and after review of the abstracts, 63 were selected for full-text review. Twenty-one studies ultimately were determined to be relevant to the assessment criteria and were selected for inclusion. The panel methodologist assigned each a level of evidence rating; 12 studies were rated level I and 9 studies were rated level II. RESULTS: Eyes implanted with toric IOLs showed excellent postoperative uncorrected distance visual acuity (UCDVA), reduction of postoperative refractive astigmatism, and good rotational stability. Uncorrected distance visual acuity was better and postoperative cylinder was lower with toric IOLs, regardless of manufacturer, when compared with nontoric monofocal IOLs. Correcting pre-existing astigmatism with toric IOLs was more effective and predictable than using corneal relaxing incisions (CRIs), especially in the presence of higher magnitudes of astigmatism. CONCLUSIONS: Toric monofocal IOLs are effective in neutralizing pre-existing corneal astigmatism at the time of cataract surgery and result in better UCDVA and significant reductions in postoperative refractive astigmatism compared with nontoric monofocal IOLs. Toric IOLs result in better astigmatic correction than CRIs, particularly at high magnitudes of astigmatism. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Influence of a Capsular Tension Ring on Capsular Bag Behavior of a Plate Haptic Intraocular Lens: An Intraindividual Randomized Trial.

PURPOSE: To evaluate the influence of a capsular tension ring (CTR) on rotational stability, decentration, tilt, and axial stability of an 11.0-mm plate haptic intraocular lens (IOL). DESIGN: Intraindividual, randomized, double-masked, controlled clinical trial. PARTICIPANTS: Patients scheduled for sequential same-day bilateral cataract surgery. METHODS: All patients were randomized to receive a CTR and a plate haptic IOL in one eye and a plate haptic IOL in the fellow eye only. Intraocular lens axis assessment was performed at the end of surgery, 1 hour, 1 week, 1 month, and 6 months using a high-precision evaluation method. Decentration and tilt of the crystalline and pseudophakic lenses were assessed before surgery and at 1 week and 6 months using an anterior segment OCT. MAIN OUTCOME MEASURES: Rotational stability from the end of surgery to 6 months and at all follow-up visits, decentration and tilt at 6 months, and differences in axial shift between 1 week and 6 months. RESULTS: One hundred thirty eyes of 65 patients were included in the study. Absolute rotation from the end of surgery to 6 months was 2.8 ± 3.9° and 3.2 ± 5.3° for the CTR and control groups, respectively (P = 0.613). Intraocular lens decentration and IOL tilt at 6 months were 0.29 ± 0.1 mm and 0.24 ± 0.1 mm and 6.7 ± 2.8° and 5.6 ± 1.6° for the CTR and control groups, respectively (P = 0.058; P < 0.01). A posterior IOL shift of 0.31 ± 0.31 mm and 0.19 ± 0.14 mm was observed in the CTR and control groups, respectively. CONCLUSIONS: Concomitant implantation of a CTR and a plate haptic IOL did not improve the overall rotational stability of the IOL compared with the control group. Against expectations, higher values of decentration, tilt, and axial shift were observed in the CTR group. The simultaneous use of a CTR and a plate haptic IOL in the absence of zonular weakness at the time of cataract surgery should be considered with caution. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

A 3D in vitro model for assessing the influence of intraocular lens: Posterior lens capsule interactions on lens epithelial cell responses.

Posterior Capsule Opacification (PCO), the most frequent complication of cataract surgery, is caused by the infiltration and proliferation of lens epithelial cells (LECs) at the interface between the intraocular lens (IOL) and posterior lens capsule (PLC). According to the "no space, no cells, no PCO" theory, high affinity (or adhesion force) between the IOL and PLC would decrease the IOL: PLC interface space, hinder LEC migration, and thus reduce PCO formation. To test this hypothesis, an in vitro hemisphere-shaped simulated PLC (sPLC) was made to mimic the human IOL: PLC physical interactions and to assess their influence on LEC responses. Three commercially available IOLs with different affinities/adhesion forces toward the sPLC, including Acrylic foldable IOL, Silicone IOL, and PMMA IOL, were used in this investigation. Using the system, the physical interactions between IOLs and sPLC were quantified by measuring the adhesion force and interface space using an adhesion force apparatus and Optical Coherence Tomography, respectively. Our data shows that high adhesion force and tight binding between IOL and sPLC contribute to a small interface space (or "no space"). By introducing LECs into the in vitro system, we found that, with small interface space, among all IOLs, acrylic foldable IOLs permitted the least extent of LEC infiltration, proliferation, and differentiation (or "no cells"). Further statistical analyses using clinical data revealed that weak LEC responses are associated with low clinical PCO incidence rates (or "no PCO"). The findings support that the in vitro system could simulate IOL: PLC interplays and predict IOLs' PCO potential in support of the "no space, no cells, no PCO" hypothesis.

Optical characterization and through-focus performance of two advanced monofocal intraocular lenses.

PURPOSE: To compare the refractive power profile, subjective depth-of-field and objective optical quality of two advanced monofocal intraocular lenses (IOLs) designed to improve intermediate vision. METHODS: This prospective study evaluated forty-six eyes of twenty-three patients, aged 54-68 years, binocularly implanted with two monofocal enhanced intraocular lenses (IOLs), the Tecnis Eyhance and the Physiol Isopure. Subjective through-focus visual acuity curves were obtained by placing trial lenses in front of the eye while wearing its best spherical-cylindrical correction for distance. Objective optical quality was defined as the area under the modulation transfer function, calculated from the wavefront maps measured with a high-resolution aberrometer. The optical design of both lenses was compared based on their refractive power profiles measured with the lenses immersed in saline solution. RESULTS: Both lenses have progressive aspherical geometries, in which the sagittal power decreases rapidly from the center to the edge of the optical zone. Mean monocular through-focus curves show a best corrected distance visual acuity of - 0.02 logMAR with both lenses. Through-focus visual acuity was marginally higher for the Eyhance, with a difference of 1 letter at the defocus position of - 0.5D and 3 letters between - 1.0D and - 2.0D. Objective assessment of optical quality revealed only a difference of about 2 points in MTF area at distance. CONCLUSION: Both IOLs use a similar approach to improve intermediate vision. The Eyhance showed marginally better subjective performance than the Isopure at the target vergences between - 1.00D and - 2.00D, although these results did not reach statistical significance and were not replicated by the objective findings.

Tolerance to residual astigmatism of an isofocal intraocular lens.

PURPOSE: To evaluate the impact of residual astigmatism on the optical and visual performance of an enhanced-monofocal isofocal intraocular lens (EM Isopure, BVI medical, Belgium) compared to a monofocal one (Micropure, BVI medical, Belgium). METHODS: Laboratory investigation and prospective, comparative and randomized clinical study. Optical quality was assessed on an optical bench for 2.0, 3.0, and 4.5 mm pupils. The effect of residual astigmatism was investigated from through-focus images recorded with increasing amounts of regular positive astigmatism induced with a deformable mirror. To evaluate the impact of residual astigmatism, 28 eyes of 28 patients were randomly assigned to either group. Residual astigmatism was induced with positive and negative cylinder lenses at 90 and 180°. Visual acuity (VA) was measured at each step. RESULTS: The optical performance of both IOLs was quite similar for 2.0 and 3.0 mm pupils. For 4.5-mm pupil, the EM Isopure showed a significant reduction of its optical quality in comparison with the monofocal IOL. When visual performance was evaluated, no statistically significant differences were found for any power of induced astigmatism. More differences were found when positive induced astigmatism was compared within each group, and VA was better when the astigmatism was induced at 180° vs. 90°. The greatest differences were found for and induced positive astigmatism of + 1.50D (p = 0.009 for Isopure and p = 0.023 for Micropure). CONCLUSIONS: The tolerance to residual astigmatism of the EM Isopure lens is similar to that of a reference monofocal lens with pupils up to 3.5 mm.

Effect of intraocular lens material and haptic design on anterior capsule contraction after cataract surgery: A systematic review and meta-analysis.

PURPOSE: To compare anterior capsule contraction (ACC) after cataract surgery with implantation of intraocular lens (IOLs) of different materials and designs. METHODS: We searched three electronic databases for relevant studies published up to January 1, 2023. Five randomized controlled trails (RCTs) and three cohort studies involving 1,221 eyes were included in quantitative synthesis. We extracted data, assessed their quality independently, and calculated standard mean difference (SMD) using a random-effects model. Six RCTs and one retrospective cohort were included in information summary. RESULTS: The contraction of the anterior capsule opening area in the hydrophilic group was larger than that of the hydrophobic group from one month to one year postoperatively (P < 0.001 and P < 0.001, respectively). Specifically, the hydrophilic group showed greater contraction of the anterior capsule opening area at one month postoperatively (Standardized mean difference [SMD] = -0.73, 95% confidence interval [CI] = -0.93 to -0.52), three months (SMD = -1.04, 95% CI = -1.32 to -0.75), six months (SMD = -0.99, 95% CI = -1.24 to -0.74) and one year (SMD = -1.33, 95% CI = -2.50 to -0.16). As of one year postoperatively, the anterior capsular opening area showed a trend of decreasing over time in both groups (P = 0.046 and P = 0.050, respectively). In information summary, three studies indicated no relationship between haptic design and ACC, while the other four studies reported that the number and shape of haptic would affect ACC. CONCLUSION: This meta-analysis suggested that the postoperative ACC after the implantation of hydrophobic IOLs was less than that induced by hydrophilic IOLs. Haptic design may also affect the degree of ACC.

Comparison of the axial growth with multifocal and monofocal intraocular lenses in unilateral pediatric cataract surgery.

PURPOSE: To compare axial growth in pediatric cataract patients who underwent multifocal intraocular lens (IOL) implantation without anterior vitrectomy (AV) with that in pediatric patients who underwent monofocal IOL implantation with or without AV. METHODS: Patients who had unilateral pediatric cataracts and underwent surgery at 3-6 years of age from June 6, 2019, to June 30, 2020, at our institution were prospectively analyzed. The patients were categorized into Group A: multifocal IOL implantation with optic capture in Berger's space without AV; Group B: monofocal IOL implantation with optic capture in Berger's space without AV; and Group C: bag-in-the-lens monofocal IOL implantation with AV. Groups A', B' and C' consisted of the fellow eyes from the respective groups. Axial growth and monthly growth rates were compared among the 3 treatment groups, as well as between the treated eyes and the fellow eyes. RESULTS: Thirty-one, 23, and 14 children fulfilling the inclusion criteria, respectively, were included in the final analysis. There were no significant differences in patient age at the time of surgery or preoperative axial length (P > 0.05). After a mean follow-up of 35.57 ± 3.78 months, significant differences in the axial growth and the monthly growth rate were observed (P < 0.05), and Group A had the least axial elongation. Comparing treated eyes with fellow eyes, the amount and rate of axial growth were lower in Group A than in Group A' (P < 0.05), no significant differences were found in Group B (P > 0.05), and Group C had greater growth than did Group C' (P < 0.05). CONCLUSIONS: The implanting multifocal intraocular lenses and maintenance of vitreous body integrity may be protective factors against excessive axial growth in pediatric cataract patients. Clinical trial registration (prospective study): chiCRT1900023155; 2019-05-14.

Effect of decentration and tilt on the in vitro optical quality of monofocal and trifocal intraocular lenses.

PURPOSE: To evaluate and compare the effect of decentration and tilt on the optical quality of monofocal and trifocal intraocular lenses (IOL). METHODS: Optical quality of a monofocal IOL (AcrySof IQ SN60WF; Alcon Laboratories, Inc., USA) and a trifocal IOL (AcrySof IQ PanOptix; Alcon Laboratories, Inc., USA) was assessed using an in vitro optical bench (OptiSpheric IOL R&D; Trioptics GmbH, Germany). At apertures of 3.0 mm and 4.5 mm, modulation transfer function (MTF) at spatial frequency of 50 lp/mm, MTF curve and the United States Air Force (USAF) resolution test chart of the two IOLs were measured and compared at their focus with different degrees of decentration and tilt. Optical quality at infinity, 60 cm and 40 cm and the through-focus MTF curves were compared when the two IOLs were centered at apertures of 3.0 mm and 4.5 mm. Spectral transmittance of the two IOLs was measured by the UV-visible spectrophotometer (UV 3300 PC; MAPADA, China). RESULTS: The SN60WF and the PanOptix filtered blue light from 400 to 500 nm. Both IOLs at the far focus and the PanOptix at the intermediate focus showed a decrease in optical quality with increasing decentration and tilt. The PanOptix demonstrated enhanced optical quality compared to the previous gradient at the near focus at a decentration range of 0.3-0.7 mm with a 3.0 mm aperture, and 0.5 mm with a 4.5 mm aperture, whereas other conditions exhibited diminished optical quality with increasing decentration and tilt at the focus of both IOLs. When the two IOLs were centered, the SN60WF had better optical quality at infinity, while the PanOptix had better optical quality at 60 cm and 40 cm defocus. The optical quality of the SN60WF exceeded that of the PanOptix at far focus, with a 3 mm aperture decentration up to 0.7 mm and a 4.5 mm aperture decentration up to 0.3 mm; this observation held true for all tilts, irrespective of aperture size. As both decentration and tilt increased, the optical quality of the SN60WF deteriorated more rapidly than that of the PanOptix at the far focal point. CONCLUSIONS: The SN60WF showed a decrease in optical quality with increasing decentration and tilt. Optical quality of the PanOptix at the near focus increased in some decentration conditions and decreased in some conditions, while it showed a decrease at the other focuses with increasing decentration. While tilt only had a negative effect on optical quality. When both IOLs were centered, the PanOptix provided a wider range of vision, while the SN60WF provided better far distance vision. At the far focus, the SN60WF has better resistance to tilt than the PanOptix, but the optical quality degrades more quickly when decentered and tilted.

Predicting the postoperative intraocular lens position based on IOL Master 700 biometry, compared with results from the anterior segment analysis system.

PURPOSE: Predict intraocular lens position after cataract surgery using the IOL Master 700 and explore the associated ocular parameters compared with the results obtained from the anterior segment analysis system (Sirius, CSO Inc, Florence, Italy). METHODS: A total of 98 patients (106 eyes) were included in the retrospective study. The postoperative intraocular lens position was obtained using the IOL Master 700 and measured using Adobe Illustrator software. Correlation analysis and linear regression analysis were applied to study the correlation between the actual position of the postoperative intraocular lens (ALP) and the ocular parameters. In addition, Bland-Altman consistency analysis was used to compare the consistency between any two among the predicted intraocular lens position (ALPi) obtained using IOL Master 700 biometry, the predicted artificial lens position (ALPs) calculated using the anterior segment analysis system, or the ALP. RESULTS: Ocular parameters, including preoperative anterior chamber depth, lens thickness, axial length, white-to-white, and postoperative refractive error were all correlated with ALP after cataract surgery (P < 0.05) using univariate analysis. However, in multivariate linear regression, only the first three variables were correlated with ALP. Compared with the equation obtained by the anterior segment analysis, the equation from IOL Master 700 biometry provided a better fit. The results of the consistency analysis showed that ALP, ALPi, and ALPs were in good agreement. CONCLUSION: IOL Master 700 biometry can help predict intraocular lens position after surgery, and its accuracy is better than that provided by the anterior segment analysis system.

Chord mu and chord alpha as postoperative predictors in multifocal intraocular lens implantation.

PURPOSE: With the aging population, the prevalence of presbyopia and the popularity of multifocal intraocular lenses is also growing worldwide. Unfortunately, in some cases, they are still associated with postoperative visual disturbances. Recent literature started to evaluate angle kappa- and angle alpha-derived metrics of chord mu and chord alpha as possible predictive values for visual outcomes after multifocal intraocular lens implantation but the published results are inconsistent between studies. Thus, this article aims to review the role of chord mu and chord alpha as postoperative predictors after multifocal intraocular lens implantation and lay the foundation for further research. METHODS: Relevant articles were identified using the following keywords: "presbyopia," "multifocal intraocular lens," "angle kappa," "angle alpha," "Chord mu," and "Chord alpha" up to June 2022. An attempt was made to present the majority of publications that addressed the topic. CONCLUSIONS: Chord mu and chord alpha have a predictive role on the outcomes after multifocal intraocular lens implantation but to a different extent. Cataract surgeons should take them into consideration and avoid implanting a multifocal intraocular lens for patients with speculated critical values of chord mu and alpha above 0.5-0.6 mm, depending on the device used for measurement and the multifocal intraocular lens implanted. Currently, chord alpha seems to be a more stable, more widely applicable, and reliable determinant in predicting postoperative outcomes and in patient selection prior to multifocal intraocular lens implantation when compared to chord mu. To draw conclusions on the topic, a controlled study is needed.

Accuracy of 14 intraocular lens power calculation formulas in extremely long eyes.

PURPOSE: To compare the accuracy of 14 formulas in calculating intraocular lens (IOL) power in extremely long eyes with axial length (AL) over 30.0 mm. METHODS: In this retrospective study, 211 eyes (211 patients) with ALs > 30.0 mm were successfully treated with cataract surgery without complications. Ocular biometric parameters were obtained from IOLMaster 700. Fourteen formulas were evaluated using the optimized A constants: Barrett Universal II (BUII), Kane, Emmetropia Verifying Optical (EVO) 2.0, PEARL-DGS, T2, SRK/T, Holladay 1, Holladay 2, Haigis and Wang-Koch AL adjusted formulas (SRK/Tmodified-W/K, Holladay 1modified-W/K, Holladay 1NP-modified-W/K, Holladay 2modified-W/K, Holladay 2NP-modified-W/K). The mean prediction error (PE) and standard deviation (SD), mean absolute errors (MAE), median absolute errors (MedAE), and the percentage of prediction errors (PEs) within ± 0.25 D, ± 0.50 D, ± 1.00 D were analyzed. RESULTS: The Kane formula had the smallest MAE (0.43 D) and MedAE (0.34 D). The highest percentage of PE within ± 0.25 D was for EVO 2.0 (37.91%) and the Holladay 1NP-modified-W/K formulas (37.91%). The Kane formula had the highest percentage of PEs in the range of ± 0.50, ± 0.75, ± 1.00, and ± 2.00 D. There was no significant difference in PEs within ± 0.25, ± 0.50 ± 0.75 and ± 1.00 D between BUII, Kane, EVO 2.0 and Wang-Koch AL adjusted formulas (P > .05) by using Cochran's Q test. The Holladay 2modified-W/K formula has the lowest percentage of hyperopic outcomes (29.38%). CONCLUSIONS: The BUII, Kane, EVO 2.0 and Wang-Koch AL adjusted formulas have comparable accuracy for IOL power calculation in eyes with ALs > 30.0 mm.

Effect of Posterior Keratometry on the Accuracy of 10 Intraocular Lens Calculation Formulas: Standard Keratometry versus Total Keratometry.

PURPOSE: To investigate the effect of posterior keratometry (PK) on the accuracy of 10 intraocular lens (IOL) power calculation formulas using standard keratometry (K) and total keratometry (TK). METHODS: This is a retrospective consecutive case-series study. The IOL power was calculated using K and TK measured by IOLMaster 700 in 6 new-generation formulas (Barrett Universal II, Emmetropia Verifying Optical (EVO) 2.0, RBF Calculator 3.0, Hoffer QST, Kane, and Ladas Super Formula) and 4 traditional formulas (Haigis, Hoffer Q, Holladay 1, and SRK/T). The arithmetic prediction error (PE) and mean absolute PE (MAE) were evaluated. The locally-weighted scatterplot smoothing was performed to assess the relationship between PE and PK. RESULTS: A total of 576 patients (576 eyes) who underwent cataract surgery were included. Compared with using K, all formulas using TK showed a hyperopic shift in the whole group. Specifically, for eyes with PK exceeding -5.90 D, all formulas using TK exhibited a hyperopic shift (all P < 0.001), while eyes with PK less than -5.90 D showed a myopic shift (all P < 0.001). The MAE of new-generation formulas calculated with TK and K showed no statistical differences, while the MAE of traditional formulas with TK was larger (TK: 0.34 ~ 0.43 D; K: 0.33 ~ 0.42 D, all P < 0.05). CONCLUSIONS: The prediction bias of formulas with TK increased as PK deviated from -5.90 D. TK did not improve the prediction accuracy of new-generation formulas, and even performed worse in traditional formulas.

Assessing the predictability of five intraocular lens calculation methods in eyes with prior myopic keratorefractive lenticule extraction.

PURPOSE: To evaluate and compare the predictability of five methods of intraocular lens (IOL) calculation in eyes with prior keratorefractive lenticule extraction (KLEx) for the treatment of myopia. METHODS: A retrospective case study included 100 eyes of 52 patients who underwent myopia and myopia with astigmatism treatment with small incision lenticule extraction (SMILE). Preoperative and 3-month postoperative measurements of optical biometry and corneal tomography were obtained. The spherical equivalent of the refractive change induced by surgery was converted to the corneal plane (SMILE-dif). A physically well-defined method was developed in which the same IOL model was implanted before and after SMILE. IOL power was calculated using ray-tracing (RT-Sirius), and several IOL power calculation formulas (Kane, EVO 2.0, Barrett Universal II Formula, Hoffer QST) before surgery. After surgery, IOL power was calculated with RT-Sirius, Kane using Mean Pupil Power at 5.5 mm by ray tracing, EVO 2.0 Post Myopic LASIK/PRK, Barrett True K and Hoffer QST Post Myopic LASIK/PRK after surgery. The difference between the refractive error induced by the IOL before and after SMILE in the corneal plane (IOL-dif) was compared with SMILE-dif. The predicted error (PE) was calculated as the difference between SMILE-dif and IOL-dif. RESULTS: The PE obtained was 0.26 ± 0.55 diopters (D), 0.10 ± 0.45 D, 0.40 ± 0.37 D, -0.03 ± 0.36 D, 0.02 ± 0.51 D, with RT-Sirius, Kane, EVO 2.0, Barrett True K, and Hoffer QST respectively. PE was not statistically significantly different between Barrett True K and Hoffer QST, with differences being more homogeneous with Barrett, (variance σ2 = 0,13). The absolute EP obtained with Barrett True K achieved 84% of cases within ± 0.5 D, followed by Kane (72%), Hoffer QST (65%), EVO (61%) and RT-Sirius (59%). CONCLUSIONS: Barrett True K formula was the most accurate method for IOL calculation in eyes that had undergone SMILE for the correction of myopia. KEY MESSAGES: What is known The literature regarding IOL power calculation after SMILE is sparse, and the methods used to estimate corneal power following LASIK/PRK may not be applicable to SMILE procedures. The most common approach to investigating the predictability of IOL calculation formulas involves a theoretical model encompassing the virtual implantation of an IOL. What is new The Hoffer QST formula, Kane formula using Mean Pupil Power at 5.5 mm, EVO 2.0, and Sirius' Ray Tracing software had not been previously evaluated using this approach. The Barrett True K formula was the most accurate method for IOL calculation in eyes that had undergone SMILE for myopia correction, outperforming Ray Tracing.

Clinical outcomes and optical performance of a new segmental refractive extended depth-of-focus intraocular lens.

BACKGROUND: The visual performance and the optical quality of a segmental refractive extended depth-of-focus (EDoF) intraocular lens (IOL) were evaluated in a prospective, single-arm, single-center study. METHODS: A total of 20 patients (40 eyes) after bilateral implantation of the refractive segmental EDoF Acunex Vario AN6V were included. Assessment procedure: refraction outcome, monocular and binocular uncorrected (UCVA) and distance-corrected visual acuity (DCVA), defocus curve, contrast sensitivity (CS), higher-order aberrations (HOAs) and patient satisfaction were evaluated 1 and 3 months after surgery. RESULTS: At 3-month follow-up, mean spherical equivalent was - 0.23 ± 0.32 D. Binocular uncorrected distance visual acuity (VA) at distance, intermediate and near was - 0.08 ± 0.06 logMAR at 4 m, -0.03 ± 0.06 logMAR at 66 cm and 0.16 ± 0.06 logMAR at 40 cm, respectively. The binocular defocus curve showed a VA better than 0.20 logMAR over a range from + 1.50 to - 2.45 D. Contrast sensitivity aligned with monofocal lenses, highlighting the lens's clinical value. Aberrometry showed minimal changes in corneal aberrations. NEI-RQL-42-Questionnaire showed a high patient satisfaction for daily activities and revealed reduced dependence on glasses, particularly for near and intermediate vision. The Acunex Vario AN6V demonstrated minimal dysphotopsias, making it a promising option for those seeking spectacle independence. CONCLUSION: This segmental refractive EDoF IOL provides a high degree of spectacle independence for far and intermediate distances with functional near VA. Although inducing residual coma aberrations, it showed subjectively good results with little dysphotopsias. TRIAL REGISTRATION: This study protocol was reviewed and approved by ethics committee of Charité University, Berlin, Germany, with approval number EA4/126/20.

Comparing clinical outcomes of trifocal intraocular lens in patients with and without prior history of laser in situ keratomileusis for myopia.

BACKGROUND: To compare clinical outcomes of trifocal intraocular lens in patients with and without prior history of laser in situ keratomileusis (LASIK). METHODS: A retrospective study included patients who underwent bilateral cataract surgery and PanOptix trifocal intraocular lens (IOLs) implantation. Patients were grouped: Group A for patients with history of LASIK and Group B for patients without history of LASIK. Postoperative outcome measures comprised distance, intermediate, and near visual acuity, manifest refraction, defocus curve, contrast sensitivity, visual quality, patient satisfaction, and the rate of spectacle independence. RESULTS: A total of 288 eyes (144 patients) were included: 132 eyes in Group A and 156 eyes in Group B. At 6 months post-surgery, patients of both groups achieved a continuous satisfying visual acuity from 33 cm to distance. 73% of eyes in Group A and 75% of eyes in Group B were within ± 0.50 D of emmetropia (P > 0.05). The percentages of eyes within ± 1.00 D of emmetropia were 98% for Group A and 96% for Group B (P > 0.05). The total scores of satisfaction were 52.58 ± 3.46 for Group A and 53.23 ± 3.46 for Group B (P > 0.05). Most of patients (98% for Group A, 99% for Group B) were able to be spectacle independence for daily living. 53% of patients in Group A and 51% in Group B experiencd mild to moderate negative visual symptoms, which made it a little or moderate difficult to drive at night. CONCLUSIONS: Cataract patients with and without history of LASIK could safely undergo implantation of the PanOptix IOLs, which results in precise refractive outcomes and satisfactory visual acuity. Although contrast sensitivity decreased and some negative visual symptoms were observed, patients' satisfaction was generally high due to the high rate of spectacles independence. There were no statistically significant differences between the study groups.

Comparison of complications of intrascleral fixation according to the extent of vitrectomy.

BACKGROUND: Intraocular lens (IOL) fixation is performed after intraoperative anterior or total vitrectomy. This study aimed to compare the intraoperative and postoperative complications of these two techniques. METHODS: This retrospective study included 235 eyes that underwent intrascleral fixation surgery at our hospital between July 2014 and January 2021. The eyes were classified into the anterior vitrectomy group (A-vit group; 134 eyes) and the pars plana vitrectomy group (PPV group; 101 eyes). The age, preoperative and postoperative best-corrected visual acuity, observation period, preoperative and postoperative intraocular pressure, and the incidence of intraoperative and postoperative complications were assessed. RESULTS: Intrascleral fixation was performed more frequently in the PPV group, and a significant difference was observed between the eyes with a history of vitrectomy and eyes with scleral buckles (p = 0.00041). In terms of the incidence of postoperative complications following intrascleral fixation, the incidence of low intraocular pressure postoperative was higher in the PPV group than that in the A-vit group, and a significant difference was observed between the two groups (p = 0.01). CONCLUSIONS: The visual outcome and complications following intrascleral fixation did not differ according to the extent of vitreous excision.

Application of modified Yamane technique in intrascleral intraocular lens fixation combined with or without iris reconstruction.

AIMS: To explore the application and long-term clinical effects of modified Yamane technique in intrascleral intraocular lens (IOL) fixation combined with or without iris reconstruction. SETTINGS AND DESIGN: The data of patients receiving IOL fixation with modified Yamane technique in an ophthalmology department between December 2021 and August 2023 were analyzed retrospectively. The longest follow-up duration was > 12 months. METHODS AND MATERIAL: The trailing haptic was fixed with the needle before the leading haptic. The silicone haptic stoppers were used to stabilize the IOL when iris reconstruction was combined. Preoperative and postoperative best-corrected visual acuity (BCVA), corneal endothelial cells (CECs), postoperative intraocular pressure (IOP), surgical indications and methods, and postoperative complications were recorded. Anterior segment optical coherence tomography (OCT) was used to evaluate IOL decentration and tilt. The paired sample t-test or Wilcoxon rank sum test were used to compare the results of the same index before and after the operation. RESULTS: Twelve patients (12 eyes) were included in this cohort. There were 1 case of IOL dislocation, eight cases of lens dislocation or subluxation, and three cases of aphakia. Traumatic lens dislocation was the main cause of aphakia. Primary lens extraction was performed in previous surgeries, and all three were combined with pars plana vitrectomy (PPV). Four of 12 patients underwent IOL fixation and iris reconstruction. The mean age of participants was 63 ± 10.61 years. The mean BCVA increased from 0.89 ± 0.72 logMAR to 0.39 ± 0.56 logMAR at the last visit (p < 0.05). The postoperative relative refractive error was - 0.13 ± 0.42 D (-0.60 D to + 0.57 D). The OCT showed that the IOLs were well centered, with a mean decentration of 0.20 ± 0.13 mm and a mean tilt of 2.31°±0.93°. Ten patients did not experience any complications. CONCLUSIONS: The modified Yamane technique in IOL fixation surgery, especially combined with iris reconstruction, reduces operation difficulty, increases operational stability and safety, and improves postoperative visual acuity without serious intra- or postoperative complications. The long-term improvement effect was remarkable.

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.

Safety, efficacy, and clinical outcomes of transconjunctival intrascleral fixation of an intraocular lens.

BACKGROUND: Implantation of intraocular lens in the capsular bag has become the standard of care in aphakic state. However, in the absence of capsular support, several techniques and intraocular lenses are available. Our study aims to report the safety, efficacy, and clinical outcomes of transconjunctival intrascleral intraocular lens fixation with Yamane's double-needle technique and flanged haptics. METHODS: Prospective, observational study with some retrospective data collection. The study enrolled 13 patients (16 eyes) who underwent transconjunctival intrascleral fixation of an intraocular lens with Yamane's technique between June 2017 and April 2019 at Dhahran Eye Specialist Hospital and King Fahd University Hospital. All patients underwent preoperative and postoperative comprehensive evaluation, including uncorrected and best-corrected vision, intraocular pressure, slit-lamp examination, dilated fundus examination, and ultrasound biomicroscopy. We excluded patients with visually significant coexistent pathology such as retinal diseases, glaucoma, follow-up less than three months, and combined surgery such as keratoplasty. RESULTS: The mean preoperative uncorrected visual acuity was 1.50 logMAR, and it improved to 0.60 logMAR. The mean preoperative best-corrected visual acuity was 0.70 logMAR, and it improved to 0.40 logMAR. The median safety index was 2.0, and the median efficacy index was 1.58. The postoperative complications included iris capture by the intraocular lens in one eye (7.7%), haptic extrusion in one eye (7.7%), and transient cornea edema in one eye (7.7%). There were no detected reports during the follow-up period of postoperative retinal detachment, choroidal detachment, elevation of the intraocular pressure (> 25 mmHg), hypotony, hyphema, vitreous hemorrhage, or endophthalmitis. CONCLUSIONS: The transconjunctival intrascleral fixation of an intraocular lens is safe and effective with a short learning curve and was not associated with significant intraoperative or postoperative complications.