Discordance between Anterior Segment Anatomy and Axial Length in Cataract Surgery Candidates in France.

INTRODUCTION: The aims of this study were to study ocular biometric data and their association with age and sex in a population of cataract surgery candidates and to assess the proportion of inhomogeneous eyes and the ratio anterior segment (AS) to axial length (AL). Multicentric cross-sectional analysis was conducted between April 2008 and May 2021 in public and private ophthalmic institutions in Montpellier, France. Individuals ≥40 years old who underwent ocular biometry before cataract surgery were included. METHODS: Right phakic eyes were included. Ocular biometrics were measured by using the Lenstar LS900 device. We defined AS as anterior chamber depth (ACD) plus lens thickness (LT) and calculated the ratio of AS to AL. We defined inhomogeneous eyes as those with deep AS (≥4th quartile) and short AL (≤1st quartile) (AS+) or with short AS and high AL (AL+). RESULTS: We included 11,650 individuals (11,650 eyes) (mean [SD] age 71.64 [10.50] years; 54.51% women). Older age was associated with shorter AL (p < 0.01), shallower ACD (p < 0.01), thinner central corneal thickness (p < 0.01), and larger LT (p < 0.001). Women had shorter AL, shallower ACD, and thinner central corneal thickness than men (p < 0.001). In total, 778 (6.68%) eyes were inhomogeneous (3.22% AS+ and 3.46% AL+), for a mean (SD) AS/AL ratio of 0.36 (0.01) and 0.28 (0.01), respectively, as compared with 0.32 (0.02) for homogeneous eyes (p < 0.001). CONCLUSION: The AS/AL ratio could be useful to screen inhomogeneous eyes before cataract surgery and justify the use of new generation formulas in these eyes to avoid the risk of refractive error.

Evisceration with autogenous scleral graft and bioceramic implantation within the modified scleral shell: 133 cases over 17 years.

INTRODUCTION: To present long-term follow-up data on evisceration performed with autogenous scleral grafting and ceramic implantation in a modified scleral shell. METHODS: This was a retrospective analysis of all consecutive eviscerations performed in the Department of Ophthalmology, Montpellier University Hospital, France, between February 1998 and October 2015. For all patients, the technique used was a conventional anterior evisceration after total keratectomy, disinsertion of the medial rectus muscle, sectioning of the optic nerve and excision of sclera centered on the papilla. The scleral graft was then sutured just behind the sutured keratectomy, and the bioceramic implant was inserted by posterior way in the scleral shell. Demographic characteristics, implant size and type, cosmetic results from pictures of all patients and complications were recorded. This study was performed with Ethics Review Committee Approval, and in compliance with the Declaration of Helsinki. RESULTS: In total, 133 patients (36.6% women) were identified during the study period. The mean (SD) implant size was 17.32 (1.84) mm. The median follow-up after evisceration was 57.43 (24.7, 68.3) months. Two cases of implant exposure (1.5%) were recorded. For 24 patients (17.9%), additional surgeries were performed for ptosis (2.2%), conjunctival cyst (1.5%), or post-evisceration socket syndrome (6.7%). Cosmetics results were excellent for 50.1% of cases, good for 33.3% and fair for 16.6%; using a grading scale based on the superior sulcus deformity. CONCLUSION: Evisceration with autogenous scleral grafting and ceramic implantation can result in a high volume of restoration, good cosmetic results, and low risk of exposure of the implant.

Clinical and biometric determinants of actual lens position after cataract surgery.

PURPOSE: To evaluate the preoperative clinical and biometric determinants associated with the actual lens position after cataract surgery. SETTING: Department of Ophthalmology, University Hospital of Montpellier, France. DESIGN: Prospective longitudinal cohort study. METHODS: The data collected included clinical factors (age, sex, history of vitrectomy) and biometry factors (axial length [AL], anterior chamber depth [ACD], lens thickness, white-to-white [WTW] distance) that might affect actual lens position. Each patient had optical low-coherence reflectometry biometry (Lenstar) preoperatively and 1 month postoperatively. The actual lens position was measured as the postoperative position of the center of the intraocular lens (IOL). Patients were stratified into 3 groups by type of IOL: Acrysof SN60WF or SN6AT (Group 1), Tecnis ZCB00 or ZCT (Group 2), and Asphina 409 MV (Group 3). RESULTS: The study comprised 168 eyes (mean age 73.3 years ± 9.8 [SD]). The mean actual lens position was 4.88 ± 0.29 mm, 5.01 ± 0.29 mm, and 5.05 ± 0.32 mm in Group 1 (n = 67 eyes), Group 2 (n = 52 eyes), and Group 3 (n = 49 eyes), respectively. In the overall population, AL, ACD, anterior segment depth, and WTW distance were correlated with actual lens position (r = 0.48, P < .0001; r = 0.64, P < .001; r = 0.58, P < .0001; r = 0.39, P < .001, respectively). CONCLUSIONS: The AL, ACD, anterior segment depth, and WTW distance correlated with actual lens position after cataract surgery. The integration of these data in IOL formulas could help improve refractive outcomes after the surgery.