Visual outcomes following bilateral implantation of a non-diffractive extended depth of focus toric intraocular lens using a mini-monovision approach.

PURPOSE: To evaluate the clinical outcomes following bilateral implantation of the AcrySof™ IQ Vivity™ toric extended depth of focus (EDOF) intraocular lens (IOL). DESIGN: Prospective interventional case series. METHODS: Patients with bilateral significant cataracts and pre-existing corneal astigmatism underwent cataract surgery and implantation with the AcrySof™ IQ Vivity™ toric IOL. Dominant eyes were targeted at emmetropia and non-dominant eyes at -0.50D. Primary endpoints were binocular uncorrected distance (UDVA), intermediate (UIVA at 66 cm) and near (UNVA at 40 cm) acuities at 3 months. Secondary outcomes were corrected distance (CDVA), distance corrected intermediate (DCIVA) and distance corrected near (DCNVA), refractive predictability, rotational stability, binocular defocus curve, contrast sensitivity, Questionnaire for Visual Disturbances (QUVID) and Visual Function Index (VF-14) questionnaire scores. All visual acuities were converted to logarithm of minimum angle of resolution (logMAR) for analysis. RESULTS: 30 patients underwent uneventful phacoemulsification. The mean binocular UDVA, UIVA and UNVA were 0.06 ± 0.12, 0.11 ± 0.10 and 0.26 ± 0.10 respectively. The mean refractive spherical equivalent (MRSE) for dominant and non-dominant eyes were - 0.07D ± 0.27 and - 0.12D ± 0.54 respectively. 92.4% of dominant eyes and 84.6% of non-dominant eyes within 0.50D of target. The mean IOL rotation was 3.85° ± 5.09 with 86.7% of eyes with less than 5° of rotation. 26.7%, 20% and 36.7% of patients reported starbursts, haloes and glare respectively. The mean VF-14 score was 91.77. CONCLUSION: Bilateral implantation of the AcrySof™ IQ Vivity™ Toric IOL resulted in very good unaided visual acuities for far and intermediate distance with functional near vision. Dysphotopsias were reported but despite this, a high level of visual function was achieved.

Use of the perceptual point-spread function to assess dysphotopsias.

Nowadays many patients are choosing EDOF or multifocal lenses for replacement of natural lens in cataract surgery. This can result in issues such as presence of dysphotopsias, namely halo and glare. In this work, we propose a new perimetry method to describe dysphotopsias in far-field region in a presence of bright, point-like light source. We constructed a custom device and designed measurement procedure for quantitative measurement of dysphotopias in the center of visual field and used it to examine patients with mild cataracts or implanted IOLs. Our approach may help in establishing an objective method to study and compare dysphotopsias.

[First experience of implantation of extended depth of focus intraocular lenses in patients with glaucoma]. / Pervyi opyt implantatsii intraokulyarnykh linz s uvelichennoi glubinoi fokusa u patsientov s glaukomoi.

PURPOSE: This study evaluates the effectiveness of implantation of extended depth of focus (EDOF) intraocular lenses (IOL) in patients with cataract and glaucoma. MATERIAL AND METHODS: The study included 13 patients (16 eyes) who underwent implantation of the Lentis Comfort EDOF IOL (Teleon Surgical BV, Netherlands). Standard phacoemulsification cataract surgery with IOL implantation was performed in a planned manner after the hypotensive surgery stage in two eyes; a combined procedure was performed in 14 cases. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), near visual acuity, and intraocular pressure (IOP) measured with a Maklakov tonometer were assessed preoperatively, on the first day, and 3-6 months after surgery. Computer perimetry using the 30-2 program and spatial contrast sensitivity (SCS) assessment were also performed preoperatively and at the same follow-up time points. RESULTS: On the first day after surgery, UCVA was 0.53±0.65, BCVA was 0.85±0.45. Near UCVA (at 40 cm) was 0.5±0.14 on the first day after surgery and 0.56±0.18 at 3-6 months. According to computer perimetry data, retinal light sensitivity values increased in all patients in the long-term (-3.1±2.9 dB). SCS values increased for objects of all sizes compared to preoperative values. CONCLUSION: Implantation of EDOF IOL contributes to improved vision without reducing contrast sensitivity and retinal light sensitivity in patients with concomitant cataract and glaucoma.

Face-specific identification impairments following sight-providing treatment may be alleviated by an initial period of low visual acuity.

Identifying faces requires configural processing of visual information. We previously proposed that the poor visual acuity experienced by newborns in their first year of life lays the groundwork for such configural processing by forcing integration over larger spatial fields. This hypothesis predicts that children treated for congenital cataracts late in life will exhibit persistent impairments in face- but not object-identification, because they begin their visual journey with higher than newborn acuity. This would not be the case for patients whose pretreatment condition has allowed for initial low acuity vision, like that of a newborn. Here, we test this prediction by assessing the development of facial identification skill in three groups: patients treated for congenital cataracts whose pretreatment visual acuity was worse than that of a newborn, patients whose pretreatment acuity was better than that of a newborn, and age-matched controls. We find that while both patient groups show significant gains in object-identification, the emergence of face identification is determined by pretreatment acuity: patients with pre-operative acuity worse than a newborn did not show any improvements on face-identification tasks despite years of visual experience, whereas those with pretreatment acuity comparable to a newborn improved on both the object- and face-identification tasks. These findings not only answer our research question but also provide new insights into the role of early visual acuity in facial identification development. We discuss these results in the context of both typical and atypical visual development.

Aging of the eye: Lessons from cataracts and age-related macular degeneration.

Aging is the greatest risk factor for chronic human diseases, including many eye diseases. Geroscience aims to understand the effects of the aging process on these diseases, including the genetic, molecular, and cellular mechanisms that underlie the increased risk of disease over the lifetime. Understanding of the aging eye increases general knowledge of the cellular physiology impacted by aging processes at various biological extremes. Two major diseases, age-related cataract and age-related macular degeneration (AMD) are caused by dysfunction of the lens and retina, respectively. Lens transparency and light refraction are mediated by lens fiber cells lacking nuclei and other organelles, which provides a unique opportunity to study a single aging hallmark, i.e., loss of proteostasis, within an environment of limited metabolism. In AMD, local dysfunction of the photoreceptors/retinal pigmented epithelium/Bruch's membrane/choriocapillaris complex in the macula leads to the loss of photoreceptors and eventually loss of central vision, and is driven by nearly all the hallmarks of aging and shares features with Alzheimer's disease, Parkinson's disease, cardiovascular disease, and diabetes. The aging eye can function as a model for studying basic mechanisms of aging and, vice versa, well-defined hallmarks of aging can be used as tools to understand age-related eye disease.

Clinical results with a multifocal intraocular lens with a novel optical design.

BACKGROUND: To evaluate the optical performance and safety of a new multifocal lens with a novel optical design featuring two additional foci (or intensifiers) in patients with cataract and presbyopia. METHODS: In this single-center, non-randomized prospective observational study, 31 patients underwent implantation of the new multifocal IOL between March 2020 and November 2021 at a tertiary clinical center in Buenos Aires and Ramos Mejia, Argentina. Postoperative examinations with emphasis on uncorrected and corrected visual acuity at distance and near and at two different intermediate distances (80 cm and 60 cm) were performed during the 3 postoperative months. RESULTS: Of the 31 patients who underwent implantation of the new IOL, 30 underwent bilateral surgery (61 eyes in total). At 3 months, all 61 eyes had an uncorrected distance visual acuity (UCDVA) of at least 0.15 logMAR; 57 eyes (93%) had an uncorrected distance visual acuity (UCDVA) of 0.1 logMAR and 27 eyes (44%) had an UCDVA of 0.0 logMAR. At 80 cm, 60 eyes (98%) had an uncorrected intermediate visual acuity (UCIVA) of at least 0.1 log MAR and 48 eyes (79%) had an UCIVA of 0.0 logMAR. CONCLUSION: The new multifocal IOL with a novel optical concept (5 foci) showed a wide range of visual acuity especially at intermediate and near distances in patients undergoing cataract surgery. Uncorrected visual acuity was excellent at all tested distances, monocularly and binocularly, spectacle independence and patient satisfaction were high.

Development of a postoperative visual function rehabilitation compliance assessment scale for children with congenital cataract: a reliability and validity study.

OBJECTIVE: To develop a comprehensive compliance assessment scale for postoperative visual function rehabilitation in children with congenital cataracts and to assess its reliability and validity. METHOD: Drawing on the Interactive Model of Health Behavior, we conducted a literature review and semi-structured interviews to create a pool of 36 items. The items underwent rigorous evaluation through the Delphi method, face validity checks, and item analysis, leading to a reduction to 18 items. To assess the scale's reliability and validity, we collected data from 225 parents of children with congenital cataracts. We employed SPSS version 25.0 for data analysis and evaluated construct validity using exploratory factor analysis, content validity, internal consistency reliability, and test-retest reliability. RESULTS: The compliance scale for postoperative visual function rehabilitation in children with congenital cataracts comprises 5 dimensions and 18 items. Exploratory factor analysis extracted 5 common factors, with a cumulative variance contribution rate of 68.178%. Item-level content validity index ranged from 0.730 to 1.000, and the content validity index of the scale was 0.963. The total Cronbach's alpha coefficient, split-half reliability, and test-retest reliability of the scale were 0.855, 0.778, and 0.859, respectively. CONCLUSIONS: The compliance assessment scale for postoperative visual function rehabilitation in children with congenital cataracts demonstrates acceptable reliability and validity. It serves as a valuable reference for developing standardized nursing programs for these children in clinical practice.

Noise Sensitivity in Cataract Patients: A Retrospective Study.

BACKGROUND: Noise sensitivity results from a series of variables and processes, and it can be used to predict the annoyance caused by noise and health-related outcomes. This study aimed to compare the noise sensitivity between cataract patients and healthy subjects and explore the effect of high noise sensitivity on cataract patients. METHODS: A retrospective analysis was conducted on the clinical data of 100 cataract patients and 78 healthy subjects who underwent physical examination in Jiaozhou Central Hospital of Qingdao from February 2020 to February 2023. Noise sensitivity was evaluated by adopting the 8-Item Weinstein Noise Sensitivity Scale (WNSS-8). Comparisons were conducted on the psychological state scores, blood pressure (BP), and heart rate (HR) of the high- (HG) and low-noise-sensitivity (LG) groups. RESULTS: Cataract patients exhibited lower visual acuity (P < 0.001) and higher WNSS-8 scores than the healthy subjects (P < 0.05). On the basis of the median of WNSS-8, the cataract patients were divided into HG (n = 42) and LG (n = 58). Compared with the LG, the HG presented higher Generalized Anxiety Disorder-7 scores, Beck Depression Inventory scores, systolic BP, diastolic BP and HR (P < 0.05). CONCLUSIONS: High noise sensitivity in cataract patients may be associated with vision disorders, and it may affect their BP and HR and damage physical and mental health.

Animal model for in-vivo Nuclear Cataract. Lens hardness and elasticity assessment.

Age-related cataract is the most frequent cause of blindness in the world being responsible for 48% of blindness and affecting more than 10% of the working population. Currently there is no objective data of the lens biomechanical properties so the process by which the cataract affects the lens's properties (e.g. hardness and elasticity) is still unclear. A modified animal model was produced to create different severities of nuclear cataract. Different doses of sodium selenite were injected in two different moments of the rat' eyes maturation resulting in 12, 13 and 11 rats with incipient, moderate and severe cataract, respectively. The nucleus and cortex's hardness and the stiffness were measured using NanoTest™. Statistically significant differences were found between healthy and cataractous lenses. Statistically significant differences were also found between the different nuclear cataract degrees (p = 0.016), showing that the lens' hardness increases with cataract formation. The nucleus shows a higher hardness increase with cataract formation (p = 0.049). The animal model used in this study allowed for the first time the characterization of the lens's hardness and elasticity in two regions of the lens, in healthy and cataractous lenses.

Association Between Preoperative Ocular Parameters and Myopic Shift in Children Undergoing Primary Intraocular Lens Implantation.

Purpose: To evaluate the association between preoperative ocular parameters and myopic shift following primary intraocular lens (IOL) implantation in pediatric cataracts. Methods: Eyes from pediatric patients undergoing bilateral cataract surgery with primary IOL implantation were included. Eyes were grouped by age at surgery and subdivided into three axial length (AL) subgroups and three keratometry subgroups. Mixed-effects linear regression was utilized to assess the trend in myopic shift among subgroups. Multivariable analysis was performed to determine factors associated with myopic shift. Results: A total of 222 eyes were included. The median age at surgery was 4.36 years (interquartile range [IQR], 3.16-6.00 years) and the median follow-up was 4.18 years (IQR, 3.48-4.64 years). As preoperative AL increased, a decreased trend was observed in myopic shift and rate of myopic shift (P = 0.008 and P = 0.003, respectively, in the 4 to <6 years old group; P = 0.002 and P < 0.001, respectively, in the ≥6 years old group). Greater myopic shift and rate of myopic shift were associated with younger age at surgery (P = 0.008 and P = 0.008, respectively). Both myopic shift and rate of myopic shift were negatively associated with AL. Conclusions: Age at surgery and preoperative AL were associated with myopic shift in pediatric cataracts following primary IOL implantation. Adjusting the target refraction based on preoperative AL could potentially improve patients' long-term refractive outcome. Translational Relevance: This study may help to guide the selection of postoperative target refraction according to age at surgery and preoperative ocular parameters for pediatric cataracts.

Comparison of macular changes and visual outcomes between femtosecond laser-assisted cataract surgery and conventional phacoemulsification surgery for high myopic cataract patients.

BACKGROUND: To evaluate differences in log MAR best-corrected visual acuity (BCVA) improvement and postoperative central foveal thickness (CFT) and choroidal thickness (CT) changes between conventional phacoemulsification surgery (CPS) and femtosecond laser-assisted cataract surgery (FLACS) for high-myopia cataracts. METHODS: This was a retrospective and observational study. One hundred and two eyes of 102 patients with high-myopia cataracts were examined. CPS was performed in 54 eyes, and FLACS was performed in 48 eyes. All eyes underwent logMAR BCVA, CFT and CT of three different sectors preoperatively and one week and six months postoperatively. RESULTS: The logMAR BCVA improved significantly after surgery in both groups (both P < 0.001), but no difference was observed in BCVA improvement between the groups (P = 0.554). Moreover, no significant differences were reflected in the changes in CFT, nasal 1 mm CT or temporal 1 mm CT between the two groups, and only subfoveal choroidal thickness (SFCT) in the CPS group decreased significantly compared with that in the FLACS group at any postoperative time (P = 0.003 and 0.026). AL, preoperative logMAR BCVA, and CT of the three regions exhibited a notable correlation with postoperative BCVA (all P < 0.05) according to univariate logistic regression analysis. However, only the AL, preoperative logMAR BCVA and SFCT remained significant in the multivariate model. Postoperative logMAR BCVA revealed a positive correlation with AL and preoperative logMAR BCVA but a negative correlation with SFCT. CONCLUSIONS: FLACS was not superior to CPS in improving BCVA but had less impact on SFCT in the treatment of high-myopia cataracts. Eyes with a longer AL, worse preoperative logMAR BCVA and thinner SFCT had a high risk of worse postoperative BCVA.

[Evaluation of the accuracy of modern intraocular lens calculation formulas when optical biometry is not possible]. / Otsenka tochnosti sovremennykh formul rascheta intraokulyarnykh linz pri nevozmozhnosti vypolneniya opticheskoi biometrii.

PURPOSE: This study evaluates the accuracy of modern intraocular lens (IOL) calculation formulas using axial length (AL) data obtained by ultrasound biometry (UBM) compared to the third-generation SRK/T calculator. MATERIAL AND METHODS: The study included 230 patients (267 eyes) with severe lens opacities that prevented optical biometry, who underwent phacoemulsification (PE) with IOL implantation. IOL power calculation according to the SRK/T formula was based on AL and anterior chamber depth obtained by UBM (Tomey Biometer Al-100) and keratometry on the Topcon KR 8800 autorefractometer. To adapt AL for new generation calculators - Barrett Universal II (BUII), Hill RBF ver. 3.0 (RBF), Kane and Ladas Super Formula (LSF) - the retinal thickness (0.20 mm) was added to the axial length determined by UBM, and then the optical power of the artificial lens was calculated. The mean error and its modulus value were used as criteria for the accuracy of IOL calculation. RESULTS: A significant difference (p=0.008) in the mean IOL calculation error was found between the formulas. Pairwise analysis revealed differences between SRK/T (-0.32±0.58 D) and other formulas - BUII (-0.16±0.52 D; p=0.014), RBF (-0.17±0.51 D; p=0.024), Kane (-0.17±0.52 D; p=0.029), but not with the LSF calculator (-0.19±0.53 D; p=0.071). No significant differences between the formulas were found in terms of mean error modulus (p=0.238). New generation calculators showed a more frequent success in hitting target refraction (within ±1.00 D in more than 95% of cases) than the SRK/T formula (86%). CONCLUSION: The proposed method of adding 0.20 mm to the AL determined by UBM allows using this parameter in modern IOL calculation formulas and improving the refractive results of PE, especially in eyes with non-standard anterior segment structure.

[Outcomes of extended depth of focus intraocular lenses implantation]. / Rezul'tat implantatsii intraokulyarnykh linz s rasshirennoi glubinoi fokusa.

Extended depth of focus (EDOF) intraocular lenses (IOLs) are the latest IOL designs. In recent years, several models of EDOF IOLs have become available in Russia, two of which (Tecnis Symfony and Acrysof IQ Vivity) are implanted in our clinic. Comparative studies devoted to the results of implantation of the new EDOF IOLs are rare in the available literature. PURPOSE: This article compares the outcomes of implantation of two EDOF IOLs in patients with presbyopia and/or cataract. MATERIAL AND METHODS: The prospective study included 60 patients (81 eyes) after implantation of EDOF IOL Tecnis Symfony (32 patients, 45 eyes; group 1) or EDOF IOL AcrySof IQ Vivity (28 patients, 36 eyes; group 2). The mean follow-up period was 3.9±1.3 months. RESULTS: All groups showed a significant (p<0.05) increase in uncorrected near visual acuity (UCNVA), intermediate visual acuity (UCIVA), and distance visual acuity (UCDVA) at the maximum follow-up time compared to preoperative values. In group 1, the best corrected near visual acuity (BCNVA) increased from 0.61±0.10 to 0.82±0.16 at the maximum follow-up time, and in group 2 - from 0.58±0.08 to 0.67±0.12 (p>0.05). Both groups showed a significant increase in best corrected intermediate and distance visual acuity (BCIVA and BCDVA) at the maximum follow-up time. The increase in the indicator compared to the preoperative period was not significant in both groups (p>0.05). The frequency of side optical phenomena was low in both groups. No significant differences were found between the groups (p>0.05). CONCLUSION: This study presents a comparative analysis of the results of implantation of two different EDOF IOLs. Both lenses were comparable in most of the studied parameters, including providing good distance and intermediate vision, functional near vision, as well as a low frequency of side optical phenomena. In all cases the patients were satisfied with the results of the surgical intervention.

Cataract surgery outcomes in children and adolescents with type 1 diabetes mellitus.

PURPOSE: To report the outcomes of cataract surgery in children and adolescents with type 1 diabetes mellitus. METHODS: The medical records of all pediatric patients (<18 years of age) with a diagnosis of type 1 diabetes mellitus who had undergone surgery for cataract between January 2000 and December 2019 at a tertiary care center were reviewed retrospectively. RESULTS: A total of 27 eyes of 15 patients who met the inclusion criteria were included. Median age at cataract surgery was 13 (IQR, 9.5-16) years, and median follow-up was 3.8 (IQR, 1.25-7.2) years, with 11 eyes followed for more than 5 years. Visual acuity improved from a median preoperative value of 0.8 (IQR, 0.55-1.3) logMAR to 0.15 (IQR, 0-0.45) logMAR at final follow-up. Posterior capsular visual axis opacification in 40.7% and diabetic retinopathy in 14.8% were the common complications requiring additional intervention, including laser capsulotomy and panretinal photocoagulation, respectively. CONCLUSIONS: Cataract surgery in children and adolescents with type 1 diabetes leads to improvement in visual acuity. Proliferative diabetic retinopathy can lead to poor visual outcomes in these children. Visual axis opacification occurs at similar rates with or without primary posterior capsulorhexis.

Clinical Outcomes of a New Hydrophobic Trifocal Intraocular Lens with Hydroxyethyl Methacrylate in Cataract Surgery: A Prospective Multicenter Study.

PURPOSE: To investigate the clinical outcomes of new hydrophobic trifocal intraocular lens with hydroxyethyl methacrylate in the Korean population. METHODS: This prospective, multicenter, and observational study evaluated the clinical outcomes of 80 eyes of 40 patients with age-related cataract underwent cataract surgery using CNWT (Clareon PanOptix). Assessment included monocular and binocular uncorrected distance visual acuity, corrected distance visual acuity, uncorrected intermediate visual acuity (at 60cm), near visual acuity (at 40 and 33 cm), uncorrected defocus curves, questionnaires evaluating photic phenomena, spectacle independence, and spectacle free satisfaction. RESULTS: At postoperative 3 months, mean uncorrected binocular visual acuities were 0.04, 0.04, 0.03 logarithm of the minimum angle of resolution (logMAR) at far, intermediate, and near distances, respectively. All patients achieved uncorrected binocular visual acuity of 0.2 logMAR or better. Monocular and binocular defocus curve indicated a mean visual acuity of 0.2 logMAR or better at the defocus range of +1.0 to - 3.0 diopters (100 to 33 cm) and +1.0 to - 3.5 diopters (100 to 28 cm). High spectacle independence was observed at all distances, with 37.5% patients reporting photic phenomena. CONCLUSIONS: The Clareon PanOptix intraocular lens has shown positive clinical outcomes, providing a viable option for cataract surgery. These lenses effectively address patients' visual needs, especially in intermediate and near distance tasks, reducing dependence on glasses.

Patching in Children With Unilateral Congenital Cataract and Child Functioning and Parenting Stress.

Importance: Parents may be concerned about the adverse outcomes of occlusion therapy in children treated for unilateral congenital cataract (UCC). Objective: To determine whether occlusion therapy in children treated for UCC with poor visual outcomes is negatively associated with poorer child and/or family functioning. Design, Setting, and Participants: This cohort study was conducted in 2023 using data collected between 2006 and 2016 in the Infant Aphakia Treatment Study (IATS). IATS participants with a visual acuity (VA) of 20/200 or worse were included. Statistical analysis was performed from July 2022 to October 2023. Exposure: Caregivers reported the mean daily minutes of patching during the 12 months prior to the VA assessment at 4.5 years of age. Patching was categorized as minimal (<15 minutes per day), moderate (15 to <120 minutes per day), or extensive (≥120 minutes per day). Main Outcome Measures: At 4.25 and 10.5 years of age, caregivers reported stress associated with the parenting role using the Parenting Stress Index and the Ocular Treatment Index and child behavior problems using the Achenbach Child Behavior Checklist. Motor skills were assessed at age 54 months using the Movement Assessment Battery for Children-Second Edition. Children completed the Harter Self-Perception Profile for Children at age 10.5 years. One-way analysis of variance and χ2 tests were used to compare outcomes by amount of patching. Results: Patching data were available for 47 of 53 children (88.7%) with a VA of 20/200 or worse. Among these 47 children with patching data included in the study, 20 (42.5%) were female, 27 (57.5%) were male, 12 (25.5%) were reported to have been patched fewer than 15 minutes per day, 11 (23.4%) were patched 16 to 119 minutes per day, and 24 (51.1%) were patched at least 120 minutes per day. Parenting stress, child behavior problems, motor functioning, and child self-perception were similar in all groups. For example, after adjusting for gender and insurance status, there was a nonsignificant difference between mean stress scores of 11.0 (95% CI, -4.5 to 26.5) points for parents who reported minimal patching vs parents who reported patching at least 120 minutes per day, and there was no significant difference in children's report of their global self-worth (0.0 [95% CI, -0.4 to 0.3] points). Conclusions and Relevance: Occlusion therapy was not negatively associated with family or child functioning. Although the sample size was limited, these results do not support changes to the current practice guidelines.

Observation on the tilt and decentration of multifocal intraocular lens with optic capture in Berger space for pediatric cataract.

PURPOSE: This study aimed to observe the tilt and decentration of multifocal intraocular lens (IOL) with optic capture in Berger space within 2 years after pediatric cataract surgery. METHODS: This is a prospective observational study. The implantation of multifocal IOL (Tecnis ZMB00) with optic capture in Berger space was performed on 33 patients (48 eyes) with pediatric cataract at Qingdao Eye Hospital. Tilt and decentration of IOL was measured using Scheimpflug system (Pentacam) at 1 month and 2 years postoperatively. RESULTS: All the multifocal IOLs were successfully implanted in Berger space with optic capture and no visually significant complications were detected during the follow-up. The mean tilt of IOLs was 2.779° ± 0.950° in the vertical plane and 2.399° ± 0.898° in the horizontal plane at 1 month postoperatively, and the mean length of the decentration was 0.207 ± 0.081 mm in vertical plane and 0.211 ± 0.090 mm in the horizontal plane. Compared with 1 month after surgery, the angle of tilt decreased by a mean of 0.192° and decentration increased by a mean of 0.014 mm at the vertical meridian at 2 years postoperatively (P = 0.37 and P = 0.27, respectively), meanwhile, tilt increased by 0.265° and decentration increased by 0.012 mm at the horizontal meridian (P = 0.11 and P = 0.22, respectively). CONCLUSIONS: The follow-up results suggest the tilt and decentration of multifocal IOL implantation with optic capture in Berger space remain stable in an acceptable range within 2 years after cataract surgery in children above the age of 5. TRIAL REGISTRATION: The study was approved by the Ethics Committee of Qingdao Eye Hospital, and registered on Chinese Clinical Trial Registry (ChiCTR identifier: 1900023155).

The LISA-PPV Formula: An Ensemble Artificial Intelligence-Based Thick Intraocular Lens Calculation Formula for Vitrectomized Eyes.

PURPOSE: To investigate the relationship between effective lens position (ELP) and patient characteristics, and to further develop a new intraocular lens (IOL) calculation formula for cataract patients with previous pars plana vitrectomy (PPV). DESIGN: Cross-sectional study. METHODS: A total of 2793 age-related cataract patients (group 1) and 915 post-PPV cataract patients (group 2) who underwent phacoemulsification with IOL implantation were included. The ELP of 2 groups was compared and the association between ELP and patient characteristics was further evaluated using standardized multivariate regression coefficients. An ensemble artificial intelligence-based ELP prediction model was developed using a training set of 810 vitrectomized eyes, and a thick-lens IOL formula (LISA-PPV) was constructed and compared with 7 existing formulas on an external multi-center testing set of 105 eyes. RESULTS: Compared to eyes with age-related cataract, vitrectomized eyes showed a similar ELP distribution (P = .19), but different standardized coefficients of preoperative biometry for ELP. The standardized coefficients also varied with the type of vitreous tamponade, history of scleral buckling, and ciliary sulcus IOL implantation. The LISA-PPV formula showed the lowest mean and median absolute prediction error (MAE: 0.63 D; MedAE: 0.44 D), and the highest percentages of eyes within ±0.5 D of prediction error (57.14%) in the testing dataset. CONCLUSIONS: The ELP prediction required optimization specifically for vitrectomized eyes based on their biometric and surgical characteristics. The LISA-PPV formula is a useful and accurate tool for determining IOL power in cataract patients with previous PPV (available at http://ppv-iolcalculator.com/).

External Validation of a Model to Predict Postoperative Globe Axial Length in Children After Bilateral Cataract Surgery.

PURPOSE: To perform the external validation of a model to predict postoperative axial length (AL) in children over 2 years of age who were undergoing bilateral cataract surgery with primary intraocular lens (IOL) implantation. DESIGN: Validation study using a retrospective case series. METHODS: Using a population different from the one that created the model, but with the same characteristics regarding age, bilateral cataract, primary IOL implantation, and follow-up assessment, AL was estimated. The AL values estimated by the model were compared with the AL measured in the follow-ups. RESULTS: In all, 55 eyes of 30 children were selected for this study; in 5 children with bilateral cataracts, only 1 eye was included. The median age at the time of surgery was 5.01 years. Follow-up AL measurements were obtained for 179 visits. The median age at the final follow-up visit was 10.15 years. The median AL measured and estimated by the model in all visits were 22.37 mm and 22.16 mm, respectively (Pearson coefficient: 0.9534; Lin correlation: 0.9258). In the Bland-Altman analysis, the 95% limit of agreement between the 2 methods (measured and estimated AL) was 0.71 to -1.19. In 3 eyes (1.68%) with AL shorter than 21.2 mm, the difference was >0.71, and in 9 eyes with AL longer than 22.5 (5.03%), it was less than -1.19. The median AL measured and estimated at the final visit were 22.69 mm and 22.43 mm, respectively. CONCLUSION: Our previously developed prediction model for globe AL growth demonstrated good external validity by accurately predicting measured AL changes with growth in the validation cohort.