Rotational stability and capsular bag performance of a hydrophobic acrylic open-loop single-piece intraocular lens.

PURPOSE: To evaluate the rotational stability and capsular bag performance of a blue light-absorbing hydrophobic acrylic open-loop single-piece intraocular lens (IOL) with a blast-finished anchor wing haptic design during the first 6 postoperative months. METHODS: In this prospective clinical study, patients with age-related cataract and potential postoperative corrected distance visual acuity (CDVA) of 0.2 logMAR or better were included. The patients received a non-toric hydrophobic acrylic single-piece IOL with an axis mark (YST0.00; Nidek Co. Ltd, Japan). Surgeries were video-taped. Retroillumination images were acquired 1 h, 1 week and 6 months postoperatively. Rotational stability was assessed by precise image overlay. At 6 months, Purkinje meter measurements were performed to evaluate tilt and decentration. RESULTS: In total, 100 eyes of 77 patients were included in the analysis. Mean absolute rotation was 2.1 ± 1.7° (median 1.7, range: 0-7.9) at 6 months (1 h - 6 months postoperatively). IOL rotation was ≤3° and ≤6° in 74 (74%) and 98 (98%) eyes, respectively. Mean absolute IOL rotation from the end of surgery to 6 months was 2.5 ± 2.2° (median 2.3, range: 0-15.6; n = 78). Mean tilt (pupillary axis) and decentration were 4.1 ± 1.9° (median 4.0, range: 0.5-8.2) and 0.35 ± 0.17 mm (median 0.32, range: 0.06-0.91) respectively (n = 84). Postoperatively, 98 (98%) eyes achieved a CDVA of 0.2 logMAR or better, 95 (95%) of ≤0.1 and 81 (81%) of ≤0.0. CONCLUSIONS: This hydrophobic acrylic single-piece IOL showed an excellent rotational stability and capsular bag position with low tilt and decentration values.

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.

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.

Anterior chamber depth variability between 2 hydrophobic acrylic 1-piece intraocular lenses: randomized trial.

PURPOSE: To analyze the difference in anterior chamber depth (ACD) after uneventful cataract surgery between 2 hydrophobic acrylic 1-piece intraocular lenses (IOLs) with different material properties. SETTING: Hanusch Hospital, Vienna, Austria. DESIGN: Single-center, bilateral randomized paired-eye controlled study. METHODS: Patients scheduled for bilateral cataract surgery were randomized to receive the Clareon IOL in 1 eye and the AcrySof IQ IOL (both Alcon Laboratories, Inc.) in the contralateral eye. Preoperatively, a slitlamp examination, optical biometry (IOLMaster 700, Carl Zeiss Meditec AG), refraction, and visual acuity measurements were performed. ACD was assessed 1 hour and 1 week postoperatively and with additional measurement of uncorrected (UDVA) and corrected distance visual acuity (CDVA) 6 months postoperatively. RESULTS: 80 eyes of 40 patients were analyzed in this study. ACD at the 6-month follow-up was 3.94 ± 0.30 mm for the Clareon IOL and 3.91 ± 0.32 mm for the AcrySof IQ IOL (P = .08). Statistically significant differences in the ACD shift between both IOLs were detected between 1 week and 6 months (P = .04) and 1 hour and 6 months (P = .04). There were no statistically significant differences between both IOLs in UDVA (P = .78), CDVA (P = .59), and spherical equivalent (SE, P = .39) at the 6-month visit. The mean absolute error between the measured and the aimed SE was not significant (P = .97). CONCLUSIONS: There was no clinically relevant difference in ACD between the Clareon IOL and the AcrySof IQ IOL in patients after uneventful cataract surgery. Both IOLs yielded good refraction and visual acuity outcomes.

Repeatability of 2 swept-source OCT biometers and 1 optical low-coherence reflectometry biometer.

AIM: To compare the repeatability of 2 swept-source optical coherence tomography (SS-OCT) biometers, IOLMaster 700 (biometer A, Carl Zeiss Meditec AG) and ANTERION (biometer B, Heidelberg Engineering GmbH) and 1 optical low-coherence reflectometry (OLCR) device (biometer C, LENSTAR, LS900; Haag-Streit AG). SETTING: Department of Ophthalmology, Hanusch Hospital, Vienna Institute for Research in Ocular Surgery-Karl Landsteiner Institute, Vienna, Austria. DESIGN: Prospective study that included patients scheduled for cataract surgery. METHOD: Three consecutive measurements were performed with 2 SS-OCT devices and 1 OLCR device. The repeatability of the following biometry variables was compared: keratometry, central corneal thickness, anterior chamber depth (ACD), lens thickness (LT), and axial eye length (AL). To assess the repeatability of each parameter, the within-subject SD (Sw) and coefficient of variation (CoV) were calculated. RESULT: Fifty eyes of 50 patients were included. The CoV values were below 0.5 for all variables, except for ACD and LT for biometer C. The Sw values for mean keratometry were 0.018 for biometer A, 0.083 for biometer B, and 0.137 for biometer C. For the ACD, the Sw values were 0.039 and 0.004 for biometer A and biometer B, respectively, and 0.134 for biometer C. For the AL, the values were 0.006 for biometer A, 0.008 for biometer B, and 0.012 for biometer C. CONCLUSIONS: All biometry devices included in the analysis presented a high repeatability. The SS-OCT devices showed a higher repeatability performance compared with the OLCR device.

Repeatability of intraoperative Hartmann-Shack wavefront sensing in cataract surgery.

PURPOSE: To evaluate the repeatability of aphakic intraoperative wavefront aberrometry and compare it with preoperative and postoperative aberrometry. SETTING: Department of Ophthalmology, Hanusch Hospital, Vienna, Austria. DESIGN: Prospective case series. METHODS: Patients scheduled for cataract surgery were each measured 3 consecutive times using Hartmann-Shack wavefront sensing (HS-WFS) preoperatively, intraoperatively in aphakia, and 2 months postoperatively after intraocular lens implantation by a single examiner. Intraclass correlation coefficients (ICCs) of spherical equivalent (SE) values were evaluated for each timepoint. Intrasubject standard deviation (Sw) as repeatability (Sr) with corresponding repeatability limit () and mean SE differences with corresponding limits of agreement (LoA) were calculated for comparison. RESULTS: A high consistency of repeated measurements was found with ICCs above 0.9 for each of the 3 timepoints. Intraobserver repeatability (Sr) and repeatability limit (r) of intraoperative aberrometry SE measurements (30 eyes of 30 patients) were 0.34 diopters (D) and 0.95 D, respectively. The LoA for intraoperative aphakic SE across 3 consecutive measurements were -0.71 to +0.85 D. For comparison, Sr and r for phakic preoperative measurements in the cataractous state (30 eyes of 30 patients) and postoperative measurements in the pseudophakic state (24 eyes of 24 patients) were 0.33 D and 0.93 D and 0.23 D and 0.64 D, respectively. Similarly, the LoA for preoperative and postoperative SE measurements were -0.66 to +0.60 D and -0.27 to +0.45 D, respectively. CONCLUSIONS: HS-WFS test-retest reliability was high for all 3 timepoints, but the intraoperative setting resulted in a lower repeatability and broadened the agreement range.

Comparison of 2 swept-source optical coherence tomography-based biometry devices.

PURPOSE: To compare 2 swept-source optical coherence tomography (SS-OCT) biometers, IOLMaster 700 (biometer A), and ANTERION (biometer B). SETTING: Department of Ophthalmology, Vienna Institute for Research in Ocular Surgery, Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria. DESIGN: Retrospective study. METHOD: Biometric measurements of cataract patients performed between June and July 2019 were reviewed. Patients scheduled for cataract surgery were measured with both SS-OCT devices on the same day. The following biometry parameters were compared: keratometry, central corneal thickness, anterior chamber depth (ACD), lens thickness (LT), and axial length (AL). RESULT: In total, 389 eyes of 209 subjects were measured with both devices. The mean absolute difference between the keratometry data of the 2 devices was 0.04 ± 0.05 mm (7.80 ± 0.26 mm for biometer A and 7.82 ± 0.26 mm for biometer B; P < .0001) for the steep keratometry readings and 0.04 ± 0.04 mm (7.63 ± 0.26 mm and 7.65 ± 0.25 mm; P < .0001) for the flat keratometry readings. For ACD and LT, the mean absolute difference was 0.07 ± 0.04 mm and 0.07 ± 0.04 mm. The mean absolute difference for AL was 0.02 ± 0.03 mm (23.55 ± 1.18 mm for biometer A and 23.54 ± 1.18 mm for biometer B; P < .0001). CONCLUSIONS: Good agreement was found between the 2 devices, with a minor offset for ACD and LT measurements. Although differences were found to be small, the devices should not be used interchangeably.

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.

NONICHEMIC CENTRAL RETINAL VEIN OCCLUSION ASSOCIATED WITH HEREDITARY THROMBOPHYLIA.

Retinal vein occlusion (RVO) is the second most common retinal vein disease with significant visual loss via thrombus or compression of vein wall. Thrombophilia is the predisposition to vascular thrombosis with the existence of genetic defect that leads to blood hypercoagulability. This report describes the case of a 55 year old male patient, with an active life who presented himself at the emergency room with acute visual lose, insidious and progressive visual field constriction, without any known history of neurological or vascular diseases. The examinations revealed unilateral optic nerve head edema, the fluorescein angiography was specific for nonischemic central retinal vein occlusion CRVO complicated with macular edema. Blood examinations has emphasized the presence of the heterozygous mutation A1298C in the methylenetetrahydrofolate reductase gene (MTHFR), the only one presented from the thrombophilia screen panel and a slightly elevated cholesterol level. During the follow-up period, the patient received anti-VEGF treatment (Bevacizumab, 3x 0.1 ml intravitreal injections) with improved visual acuity and amendment of macular edema. The complex etiology calls for interdisciplinary approach to determine better the cause of this ophthalmological disease. Although studies have found a correlation between some thrombophilia mutations and retinal vein occlusion, more studies that contain a larger number of patients are necessary in order to determine the final role of these gene variants.