Long-term impact of low-energy femtosecond laser and manual cataract surgery on macular layer thickness: A prospective randomized study.

PURPOSE: To evaluate change in retinal layers 18 months after femtosecond laser-assisted cataract surgery (LCS) and manual cataract surgery (MCS) in a representative age-related cataract population using artificial intelligence (AI)-based automated retinal layer segmentation. METHODS: This was a prospective, randomized and intraindividual-controlled study including 60 patients at the Medical University of Vienna, Austria. Bilateral same-day LCS and MCS were performed in a randomized sequence. To provide insight into the development of cystoid macular oedema (CME), retinal layer thickness was measured pre-operatively and up to 18 months post-operatively in the central 1 mm, 3 mm and 6 mm. RESULTS: Fifty-six patients completed all follow-up visits. LCS compared to MCS did not impact any of the investigated retinal layers at any follow-up visit (p > 0.05). For the central 1 mm, a significant increase in total retinal thickness (TRT) was seen after 1 week followed by an elevated plateau thereafter. For the 3 mm and 6 mm, TRT increased only after 3 weeks and 6 weeks and decreased again until 18 months. TRT remained significantly increased compared to pre-operative thickness (p < 0.001). Visual acuity remained unaffected by the macular thickening and no case of CME was observed. Inner nuclear layer (INL) and outer nuclear layer (ONL) were the main causative layers for the total TRT increase. Photoreceptors (PR) declined 1 week after surgery but regained pre-operative values 18 months after surgery. CONCLUSION: Low-energy femtosecond laser pre-treatment did not influence thickness of the retinal layers in any topographic zone compared to manual high fluidic phacoemulsification. TRT did not return to pre-operative values 18 months after surgery. The causative layers for subclinical development of CME were successfully identified.

A Systematic Prospective Comparison of Fluid Volume Evaluation across OCT Devices Used in Clinical Practice.

Objective: Treatment decisions in neovascular age-related macular degeneration (nAMD) are mainly based on subjective evaluation of OCT. The purpose of this cross-sectional study was to provide a comparison of qualitative and quantitative differences between OCT devices in a systematic manner. Design: Prospective, cross-sectional study. Subjects: One hundred sixty OCT volumes, 40 eyes of 40 patients with nAMD. Methods: Patients from clinical practice were imaged with 4 different OCT devices during one visit: (1) Spectralis Heidelberg; (2) Cirrus; (3) Topcon Maestro2; and (4) Topcon Triton. Intraretinal fluid (IRF), subretinal fluid (SRF), and pigment epithelial detachment (PED) were manually annotated in all cubes by trained human experts to establish fluid measurements based on expert-reader annotations. Intraretinal fluid, SRF, and PED volume were quantified in nanoliters (nL). Bland-Altman plots were created to analyze the agreement of measurements in the central 1 and 6 mm. The Friedman test was performed to test for significant differences in the central 1, 3, and 6 mm. Main Outcome Measures: Intraretinal fluid, SRF, and PED volume. Results: In the central 6 mm, there was a trend toward higher IRF and PED volumes in Spectralis images compared with the other devices and no differences in SRF volume. In the central 1 mm, the standard deviation of the differences ranged from ± 3 nL to ± 6 nL for IRF, from ± 3 nL to ± 4 nL for SRF, and from ± 7 nL to ± 10 nL for PED in all pairwise comparisons. Manually annotated IRF and SRF volumes showed no significant differences in the central 1 mm. Conclusions: Fluid volume quantification achieved excellent reliability in all 3 retinal compartments on images obtained from 4 OCT devices, particularly for clinically relevant IRF and SRF values. Although fluid volume quantification is reliable in all 4 OCT devices, switching OCT devices might lead to deviating fluid volume measurements with higher agreement in the central 1 mm compared with the central 6 mm, with highest agreement for SRF volume in the central 1 mm. Understanding device-dependent differences is essential for expanding the interpretation and implementation of pixel-wise fluid volume measurements in clinical practice and in clinical trials. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Clinical prospective intra-individual comparison after mix-and-match implantation of a monofocal EDOF and a diffractive trifocal IOL.

OBJECTIVES: To assess intra-individually visual acuity (VA) and subjective outcome after mix-and-match implantation of a monofocal EDOF IOL and a diffractive trifocal IOL. METHODS: The monofocal EDOF Isopure IOL was implanted in the dominant eye and the trifocal FineVision HP IOL in the non-dominant eye. Postoperative evaluation included VA at various distances, contrast acuity, monocular defocus curves, decentration and tilt, wavefront aberrometry, VF-7 questionnaire and a halo and glare simulator. RESULTS: 50 eyes of 25 subjects were enroled. The trifocal IOL performed better at monocular DCNVA (p < 0.01) and at defocus levels of -1.5D to -4.0D (p < 0.01), the monofocal EDOF IOL was better at -0.5D (p = 0.013). No differences in monocular BCDVA, DCIVA, contrast acuity, decentration or tilt were observed (p > 0.05). Wavefront analysis revealed lower HOAs in the trifocal group at 5 mm (p < 0.01) and no difference (p = 0.107) at 3 mm pupil aperture. The monofocal EDOF IOL displayed increased negative SA at 5 mm (p < 0.01) and 3 mm (p < 0.01) pupil diameter. Low values of optical phenomena and satisfying results of the VF-7 questionnaire were obtained. CONCLUSION: Excellent visual performance and low rates of optical phenomena were achieved after mix-and-match implantation of the monofocal EDOF Isopure IOL and the trifocal FineVision HP IOL. Trifocal IOL implantation in the non-dominant eye may decrease optical disturbing phenomena. Similar results were observed for monocular distance, intermediate and contrast VA. The trifocal IOL provided better monocular near VA. Decentration and tilt and HOAs were low.

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.

Best fit formula approach in delayed sequential bilateral cataract surgery.

BACKGROUND: We evaluated whether the best-fit intraocular lens (IOL) power formula for the first operated eye (BF1) was also the most accurate formula for the second eye. METHODS: This was a retrospective study of 152 patients who underwent uncomplicated delayed bilateral cataract surgery with a minimum delay of 3 weeks using only one 1-piece IOL (HOYA, Vivinex) at the Medical University of Vienna, Austria. Seven different formulae (Barrett Universal II, Castrop, Haigis, Hoffer Q, Holladay 1, Kane, and SRK/T) were investigated to test the formula selection approach with regard to the calculated mean and median absolute prediction errors (MAE/MedAE). RESULTS: The mean intraindividual difference in axial length was 0.2 mm (±0.3 mm). BF1 coincided with the best-fit formula for the second eye (BF2) in 56% of patients (p < 0.05). Using BF1 for the second eye led to a lower MedAE (0.22 dioptre, D) than using a formula at random (0.33 D) and was less accurate than using the best-fit formula for each eye separately (0.1 D). The MedAEs of all formulae were generally low, ranging from 0.28 to 0.35 D. CONCLUSION: Using BF1 for the second eye led to a lower MedAE than the random selection of a formula. Therefore, BF1 can be used for the second eye if the surgeon is unsure of the choice of formula.

Moderate COVID-19 Disease Is Associated With Reduced Bone Turnover.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection has been associated with musculoskeletal manifestations, including a negative effect on bone health. Bone formation was found to be reduced in coronavirus disease 2019 (COVID-19) patients. The aim of this case-control study was to determine whether bone metabolism is coupled or uncoupled in COVID-19 patients with moderately severe disease, the latter expressed by the requirement of hospitalization but not intensive care treatment, no need for mechanical ventilation, and a C-reactive protein level of (median [quartiles], 16.0 [4.0; 52.8]) mg/L in serum. Besides standard biochemical markers, serum levels of C-terminal telopeptide of type 1 collagen, tartrate-resistant acid phosphatase, osteocalcin, bone-specific alkaline phosphatase, sclerostin, dickkopf-1, and osteoprotegerin were evaluated in COVID-19-infected patients at the time of hospital admission, along with those of age- and sex-matched noninfected controls. The median age of the 14 female and 11 male infected patients included in the matched-pair analysis was (67 [53; 81]) years. C-terminal telopeptide of type 1 collagen was significantly lower in COVID-19 patients (0.172 [0.097; 0.375] ng/mL) than in controls (0.462 [0.300; 0.649] ng/mL; p = 0.011). The patients' osteocalcin levels (10.50 [6.49; 16.26] ng/mL) were also lower than those of controls (15.33 [11.85, 19.63] ng/mL, p = 0.025). Serum levels of sclerostin and dickkopf-1 were significantly higher in infected patients relative to controls. The remaining parameters did not differ between cases and controls. A limitation of the study was that patients and controls were recruited from different hospitals. Nevertheless, due to the geographical proximity of the two centers, we assume that this fact did not influence the results of the study. Given this limitation, the investigation showed that bone metabolism is altered but remains coupled in patients with moderately severe COVID-19. Therefore, it is important to evaluate bone turnover markers and fracture risk in these patients during the postinfection period. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Rotational Stability, Decentration, and Tilt of a New Hydrophobic Acrylic Intraocular Lens Platform.

PURPOSE: To evaluate rotational stability, decentration and tilt of the monofocal intraocular lens (IOL) Nanex (NC1-SP; HOYA Surgical Optics). DESIGN: Prospective interventional case series. METHODS: The study was performed at the Department of Ophthalmology, Medical University of Vienna. The study population comprised 130 eyes of 68 patients with age-related cataract who underwent cataract surgery with implantation of a Nanex IOL. Baseline image for rotational stability evaluation was obtained at the end of surgery (EoS) and compared to retroillumination images taken at 1 hour, 1 week, 1 month, and 6 months after surgery. Axis alignment was assessed using nonmovable landmarks on the sclera and the optic-haptic junctions of the IOL. Anterior segment OCT images were performed to evaluate decentration and tilt. The main outcome measure was absolute rotation from EoS to 6 months postoperatively. RESULTS: Median IOL rotation of all eyes from EoS to 6 months was 1.9° (interquartile range 0.1°-37.5°). Ten eyes (9.71%) rotated more than 5° and 2 eyes (1.94%), more than 10°. IOL rotation did not correlate with axial eye length (Spearman r = -0.042, P = .46), crystalline lens thickness (Spearman r = 0.134, P = .19), and crystalline lens equatorial diameter (Spearman r = 0.101, P = .325). IOL rotation positively correlated with anterior fibrosis severity (Spearman r = 0.321, P = .002). Preoperative decentration (0.2 ± 0.12 mm) and tilt (5.7 ± 1.6°) did not change significantly after surgery (0.22 ± 0.12 mm and 5.62 ± 1.49°, respectively). CONCLUSION: The investigated IOL presented good rotational stability and low decentration and tilt values. Nevertheless, anterior capsule fibrosis development led to a higher tendency of IOL rotation after 1 week.

Prediction of individual graft for anterior cruciate ligament reconstruction using anthropometric data.

INTRODUCTION: Multiple options for individual anterior cruciate ligament (ACL) reconstruction exist; still, there are no guidelines for the preoperative preparation. The aim of this study was to assess the correlation between patients' anthropometric data (height, weight, and age) and measurements of potential tendons (quadriceps-, patella, hamstrings tendon) for an anterior cruciate ligament reconstruction. MATERIAL AND METHODS: MR images of 102 patients have been analyzed. Measurements of the ACL were performed with respect to its length and angle. The diameter and length as well as width of the quadriceps and patella tendon, the cross-sectional area (CSA) and diameter of the hamstring tendons have been assessed. Patients' height, weight, BMI, sex and age have been recorded. The correlations of these measurements with the patients' anthropometric data have been calculated. Inter-rater and intra-rater reliability based on intra-class correlation (ICC) was evaluated. RESULTS: The mean lengths of the ACL were 29.8 ± 3.5 mm, tibial insertion sites 15.8 ± 2.5 mm and femoral insertion sites 15.2 ± 3.0 mm. Thickness of the quadriceps tendons was 4.7 ± 1.1 mm and patella tendon 3.2 ± 0.7 mm. The patients' height showed significant positive correlations with the CSA of the hamstring tendon measurements, the length of the ACL, and the insertion sites of the ACL. Patients' weight showed significant positive correlations with patella tendon thickness, the CSA of the hamstring tendons, the length of the ACL, and the tibial and femoral insertion sites. Patients' age showed a significant positive correlation with patella tendon thickness. The ICCs for intra- and inter-rater reliability were 0.98 (95% CI 0.95-0.99, p < 0.001) and 0.94 (95% CI 0.88-0.99, p < 0.001). CONCLUSION: Anthropometric data with respect to height, weight, and sex can help to predict the dimension of tendons for ACL reconstruction and do correlate with ACL tendon. Patients at risk for small graft dimensions and failure are younger than 20 years and physically active. MRIs of patients at risk for small graft dimensions should be analyzed on tendon length and cross section areas preoperatively to determine the appropriate tendon harvest and fixation technique.

Similarity of eyes in a cataractous population-How reliable is the biometry of the fellow eye for lens power calculation?

BACKGROUND: In some situations it is necessary to use biometry from the fellow eye for lens power calculation prior to cataract surgery. The purpose of this study was to analyse the lateral differences in biometric measurements and their impact on the lens power calculation. METHODS: The analysis was based on a large dataset of 19,472 measurements of 9736 patients prior to cataract surgery with complete biometric data of both left and right eyes extracted from the IOLMaster 700. After randomly indexing the left or right eye as primary (P) and secondary (S), the differences between S and P eye were recorded and analysed (Keratometry (RSEQ), total keratometry (TRSEQ) and back surface power (BRSEQ)), axial length AL, corneal thickness CCT, anterior chamber depth ACD, lens thickness LT). Lens power was calculated with the Castrop formula for all P and S eyes, and the refraction was predicted using both the P and S eye biometry for the lens power calculation. RESULTS: Lateral differences (S-P, 90% confidence interval) ranged between -0.64 to 0.63 dpt / -0.67 to 0.66 dpt / -0.12 to 0.12 dpt for RSEQ / TRSEQ / BRSEQ. The respective difference in AL / CCT / ACD / LT ranged between -0.46 to 0.43 mm / -0.01 to 0.01 mm / -0.20 to 0.20 mm / -0.13 to 0.14 mm. The resulting difference in lens power and predicted refraction ranged between -2.02 to 2.00 dpt and -1.36 to 1.30 dpt where the biometry of the S eye is used instead of the P eye. The AL and RSEQ were identified as the most critical parameters where the biometry of the fellow eye is used. CONCLUSION: Despite a strong similarity of both eyes, intraocular lens power calculation with fellow eye biometry could yield different results for the lens power and finally for the predicted refraction. In 10% of cases, the lens power derived from the S eye deviates by 2 dpt or more, resulting in a refraction deviation of 1.36 dpt or more.

Ultrasound energy consumption and macular changes with manual and femtolaser-assisted high-fluidics cataract surgery: a prospective randomized comparison.

PURPOSE: The purpose of the study was to compare ultrasound (US) consumption and central macular thickness (CMT) and volume changes with manual and femtosecond laser (FSL)-assisted cataract nucleus workup. METHODS: Sixty patients scheduled for immediate sequential bilateral surgery underwent a prospective randomized intraindividual comparison of nucleus sector fragmentation performed manually in one eye and with low-energy FSL assistance in the partner eye, followed by high-fluidics phacoaspiration with a maximum US power of 30%. Ultrasound (US) energy consumption and macular thickness and volume were compared as measured by intraoperative effective phacoemulsification time (EPT) and high-resolution spectral domain optical coherence tomography pre- and 1 week, 3 weeks and 6 weeks postoperatively. Results are presented as means ± SD or medians [min; max]. RESULTS: Fifty-two patients completed the full follow-up. For the manual and FSL-assisted groups, nuclear hardness was almost identical with a mean LOCS III grade of 2.44 ± 1.08 and 2.50 ± 1.00 (p = 0.371). Median EPT was 1.40 [0.2; 8.3] and 1.25 [0.2; 9.4] seconds. Median preoperative CMT was 276.50 [263.25; 289.75] µm and 276.00 [262.00; 290.00] µm. Median postoperative CMT was 278.00 [260.50; 288.00] versus 275.50 [264.00; 290.50] µm at 1 week, 279.50 [266.75; 292.25] versus 280.00 [266.50; 294.50] µm at 3 weeks and 280.50 [268.00, 293.75] versus 279.50 [264.75; 295.25] µm at 6 weeks. Differences in CMT and total macular volume between the groups were not statistically significant at any point in time. CONCLUSION: Femtosecond laser (FSL) prefragmentation of the nucleus into six sectors did not reduce US energy consumption compared with manual splitting of the nucleus into four quadrants in this particular surgical setting. Sectorial FSL-prechopping with the low-energy FSL used had no additional impact on postoperative macular thickness and volume.

Comparison of Axis Determination With Different Toric Intraocular Lens Power Calculation Methods.

PURPOSE: To compare the axis position of the measured total corneal astigmatism (TCA) with the axis of the anterior keratometry and the calculated axis position of different toric intraocular lens (IOL) calculators. METHODS: A total of 163 astigmatic eyes of 163 patients were retrospectively analyzed. The axis of the actual TCA, measured with anterior segment optical coherence tomography, was compared to the anterior keratometric value (Group I) and three different methods of TCA calculation for toric IOL power determination: Abulafia-Koch regression formula (Group II), Barrett Toric Calculator V2.0 (Group III), and Barrett Toric Calculator V2.0 including measured posterior keratometric value (Group IV). Eyes were assigned to three subgroups: with-the-rule, against-the-rule, and oblique astigmatism. RESULTS: The mean deviation calculated from measured TCA was +0.56° (Group I), -0.32° (Group II), -0.37° (Group III), and -1.00° (Group IV). For with-the-rule astigmatism, the TCA axis agreed most with Group I (6.5% outliers > 5° deviation). For against-the-rule astigmatism, Group IV and Group II were closest to the measured TCA axis (1.5% and 3% outliers with > 5° deviation). CONCLUSIONS: The means of the calculated axis were similar to the measured TCA, but the proportion of outliers with an axis deviation of greater than 5° showed remarkable differences. Isolated anterior keratometric value measurements showed the fewest outliers in with-the-rule astigmatism. In against-the-rule astigmatism, Abulafia-Koch calculation should be used for axis determination. [J Refract Surg. 2021;37(9):642-647.].

Rotational Stability of Intraocular Lenses: A Standardized Method for More Accurate Measurements in Future Studies.

PURPOSE: To assess the reliability and reproducibility of a new semiautomated evaluation method, "Rotix," for intraocular lens (IOL) rotation and to define a standardized evaluation method for future toric IOL studies. DESIGN: Reliability and reproducibility study. METHODS: Setting: Department of Ophthalmology, Medical University of Vienna. PATIENT POPULATION: A dataset of 25 patients with 2 consecutive follow-up visits was created to test the intra- and interrater reliability. A data test set of 10 patients including 30 pictures taken 5 minutes apart was created to test the short-term reproducibility. INTERVENTION: Evaluation of IOL rotational stability using nontoric implants in 25 × 2 consecutive follow-up visits. Two experienced graders performed axis evaluation 3 times in a randomized order. One experienced grader performed axis evaluation for the short-term reproducibility study. Reference landmarks at the end of operation were used to assess the IOL axis. MAIN OUTCOME MEASURES: Intra- and interrater reliability and short-term reproducibility of axis measurements. RESULTS: Mean standard deviation for intrarater reliability was 0.16 degrees. The intraclass correlation coefficients were 0.97 for grader 1 and 0.96 for grader 2. A very high interrater correlation of 0.95 was found. The mean individual difference between grader 1 and grader 2 was 0.061 ± 0.28 degrees. Short-term reproducibility showed a mean standard deviation of 0.22 ± 0.14 degrees. CONCLUSION: The novel semiautomated evaluation method showed an accurate inter- and intrarater reliability. Short-term reproducibility was below 0.25 degrees. The method of using nonmovable reference landmarks showed reliable results and should be used as a standard in future toric IOL studies.

Influence of lens opacities and cataract severity on quantitative fundus autofluorescence as a secondary outcome of a randomized clinical trial.

The aim of this study is to investigate the impact of age-related lens opacities and advanced cataract, quantified by LOCS III grading, on quantitative autofluorescence (qAF) measurements in patients before and after cataract surgery. Images from a randomized controlled trial evaluating the impact of femtosecond-laser assisted cataract surgery (FLACS) on retinal thickness were analyzed post-hoc. One-hundred and twenty eyes from 60 consecutive patients with age-related cataract were included and assessed with qAF and optical coherence tomography (OCT) before, 1, 3 and 6 weeks after cataract surgery (randomized 1:1 to FLACS or phacoemulsification). LOCS III grading was performed before surgery. Pre- to post-surgical qAF values, as well as the impact of LOCS III gradings, surgery technique, gender, axial length and age on post-surgery qAF values was investigated using generalized linear mixed models. For this analysis, 106 eyes from 53 patients were usable. No difference in qAF was found between FLACS and phacoemulsification (p > 0.05) and results were pooled for the total cohort. Mean pre-surgical qAF was 89.45 ± 44.9 qAF units, with a significant mean increase of 178.4-191.6% after surgery (p < 0.001). No significant difference was found between the three follow-up visits after surgery (p > 0.05). Higher LOCS III cortical opacity quantifications were associated with a significantly greater increase in qAF after surgery (estimate: 98.56, p = 0.006) and nuclear opacities showed a trend toward an increased change (estimate: 48.8, p = 0.095). Considerable interactions were identified between baseline qAF and cortical opacities, nuclear opacities and posterior subcapsular opacities, as well as nuclear opacities and cortical opacities (p = 0.012, p = 0.064 and p = 0.069, respectively). Quantitative autofluorescence signals are significantly reconstituted after cataract surgery and LOCS III gradings are well associated with post-surgical qAF values. Careful consideration of age-related lens opacities is vital for the correct interpretation of qAF, especially in retinal diseases affecting the elderly.ClinicalTrials.gov Identifier: NCT03465124.

Rotational Stability of a New Hydrophobic Acrylic IOL With Modified C-loop Haptics.

PURPOSE: To assess rotational stability, axial stability, decentration, and tilt of the Rayner RAO800C single-piece hydrophobic acrylic intraocular lens (IOL) (Rayner Intraocular Lenses Ltd) from end of surgery to 4 to 7 months postoperatively. METHODS: Surgeries were performed at the Department of Ophthalmology at the Medical University of Vienna. A total of 130 eyes of 68 patients received an aspheric hydrophobic Rayner RAO0800C IOL. IOLs were randomly implanted to the 0 ± 10, 45 ± 10, 90 ± 10, or 135 ± 10 degree axis. Baseline measurement was performed with the patient still supine on the operating table. Axis alignment after 1 hour, 1 week, 1 month, and 4 months was evaluated by retroillumination pictures. Postoperative IOL decentration, tilt, and aqueous depth at 4 months were assessed using an anterior segment swept-source optical coherence tomography. RESULTS: Absolute median IOL rotation from end of surgery to 4 months was 2.4 degrees (range: 0.0 to 85.0 degrees). Median IOL rotation from end of surgery to 1 hour, 1 hour to 1 week, 1 week to 1 month, and 1 month to 4 months was 1.6 (range: 0.0 to 86.2), 1.1 (range: 0.0 to 28.8), 0.6 (range: 0.0 to 5.2), and 0.7 (range: 0.0 to 2.6) degrees. Respective proportions of IOLs rotating more than 5, 10, and 20 degrees from end of surgery to 4 months were 23.9%, 11.0%, and 6.4%. Horizontal and vertical decentration at 4 months was -0.09 ± 0.14 and 0.09 ± 0.14 mm, respectively. Horizontal and vertical tilt at 4 months was -4.78 ± 1.36 and -1.58 ± 1.10 degrees, respectively. A posterior axial shift of 0.052 ± 0.055 mm was observed from 1 week to 4 months. CONCLUSIONS: Although median IOL rotation appeared to be low, a significant proportion of IOLs rotated postoperatively. Decentration and tilt values were generally low. A minimal posterior optic shift was observed after 1 week. [J Refract Surg. 2021;37(2):112-118.].

Influence of Artificial Tears on Keratometric Measurements in Cataract Patients.

PURPOSE: To assess the influence of artificial tears of different viscosity on K-readings prior to cataract surgery. DESIGN: Prospective randomized crossover, before-and-after clinical study. METHODS: Setting: Department of Ophthalmology, Medical University of Vienna. PATIENT POPULATION: A total of 123 eyes of 80 patients prior to cataract surgery were assigned to 2 groups based on normal and dry eyes. INTERVENTION: Two native baseline keratometries were followed by instillation of either high- or low-viscosity eye drops. Keratometry was repeated 30 seconds, 2 minutes, and 5 minutes after instillation. MAIN OUTCOME MEASURES: Influence of eye drops of different viscosity in normal and dry eyes on short time K-readings. RESULTS: Repeatability between native baseline measurements was high (standard deviation = 0.02 mm in normal and in dry eyes). In normal and dry eyes, a statistically significant increase in measurement variability after instillation of both low-viscosity and high-viscosity eye drops was observed (P < .01). Measurement variability was most pronounced between baseline measurement and 30 seconds and diminished over time. Variability of K-readings appeared higher in dry eyes compared with normal eyes. Astigmatism changed more than 0.5 diopters in 13.2% of normal eyes and 34.4% in dry eyes using eye drops of high viscosity. CONCLUSION: Tear film-stabilizing eye drops prior to keratometry measurements influenced K-readings significantly, especially in dry eyes. A time period of more than 5 minutes should be allowed to pass after instillation of eye drops. The higher the viscosity of the eye drops, the stronger the influence and the longer its persistence.

One-Year Results of Arcuate Keratotomy in Patients With Low to Moderate Corneal Astigmatism Using a Low-Pulse-Energy Femtosecond Laser.

PURPOSE: To investigate corneal astigmatism (CA) reduction and corneal optical quality after surface-penetrating femtosecond laser arcuate keratotomies (Femto AK) considering anterior (CAant) and posterior corneal curvature (CApost), total corneal refractive power astigmatism (CAtot), and corneal higher-order aberrations (HOAs) through 1 year. DESIGN: Prospective interventional case series. METHODS: Setting: Department of Ophthalmology, Medical University of Vienna. PatientPopulation: Forty-three eyes of 43 patients with age-related cataract and CAtot between 1 and 3 diopters (D). INTERVENTION: Paired keratotomies were created with a low-energy femtosecond laser (LDV Z8; Ziemer Ophthalmic Systems, Port, Switzerland) and combined with an astigmatic neutral manual posterior-limbal cataract incision. CA and HOAs measurements were obtained preoperatively and after 1 month, 3 months, and 1 year. MainOutcomeMeasure: Change of CA and HOAs after low-energy Femto AK through 1 year. RESULTS: Mean preoperative CAant and CAtot (1.62 ± 0.49 D and 1.58 ± 0.44 D) were significantly reduced, to 0.66 ± 0.38 and 0.50 ± 0.30 D (P < .001) 1 year after surgery, respectively. CApost showed no significant change, from 0.31 ± 0.19 D preoperatively to 0.31 ± 0.13 D (P = .732) at the 1-year follow-up period. Astigmatism as calculated by vector astigmatism analysis stayed stable at 1 month, 3 months, and 1 year. Corneal wavefront HOAs significantly improved at 1 month, 3 months, and 1 year. CONCLUSIONS: Paired surface-penetrating keratotomies created by a low-energy femtosecond laser showed efficient and stable CA reduction within 1 year after surgery. The optical quality of the cornea was preserved with lower HOAs than preoperatively.

Accuracy of common IOL power formulas in 611 eyes based on axial length and corneal power ranges.

AIMS: To provide clinical guidance on the use of intraocular lens (IOL) power calculation formulas according to the biometric parameters. METHODS: 611 eyes that underwent cataract surgery were retrospectively analysed in subgroups according to the axial length (AL) and corneal power (K). The predicted residual refractive error was calculated and compared to evaluate the accuracy of the following formulas: Haigis, Hoffer Q, Holladay 1 and SRK/T. Furthermore, the percentages of eyes with ≤±0.25, ≤±0.5 and 1 dioptres (D) of the prediction error were recorded. RESULTS: The Haigis formula showed the highest percentage of cases with ≤0.5 D in eyes with a short AL and steep K (90%), average AL and steep cornea (73.2%) but also in long eyes with a flat and average K (65% and 72.7%, respectively). The Hoffer Q formula delivered the lowest median absolute error (MedAE) in short eyes with an average K (0.30 D) and Holladay 1 in short eyes with a steep K (Holladay 1 0.24 D). SRK/T presented the highest percentage of cases with ≤0.5 D in average long eyes with a flat and average K (80.5% and 68.1%, respectively) and the lowest MedAE in long eyes with an average K (0.29 D). CONCLUSION: Overall, the Haigis formula shows accurate results in most subgroups. However, attention must be paid to the axial eye length as well as the corneal power when choosing the appropriate formula to calculate an IOL power, especially in eyes with an unusual biometry.

Posterior Capsule Opacification With Two Hydrophobic Acrylic Intraocular Lenses: 3-Year Results of a Randomized Trial.

PURPOSE: To compare the incidence and intensity of posterior capsule opacification (PCO) and neodymium-yttrium-aluminum-garnet (Nd:YAG) capsulotomy rates between 2 similar open-loop single-piece hydrophobic acrylic intraocular lenses (IOLs) that differ in the proprietary material characteristics and design features, over a period of 3 years. DESIGN: Randomized, prospective, patient- and examiner-masked clinical trial with intraindividual comparison. METHODS: Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. PATIENT POPULATION: Eighty patients (160 eyes) had bilateral cataract surgery and received a Vivinex XY1 IOL in 1 eye and an AcrySof SN60WF IOL in the other eye. OBSERVATION PROCEDURES: Follow-up examinations were performed 3 years after surgery. Digital retroillumination images were taken of each eye. The amount of PCO (score: 0-10) was assessed subjectively at the slit lamp and objectively using automated image analysis software (AQUA). MAIN OUTCOME MEASURE: PCO score (scale, 0-10). RESULTS: The mean objective PCO score of the Vivinex XY1 IOLs was 0.9 ± 0.8 compared to the PCO score of 1.4 ± 1.1 for the AcrySof SN60WF IOLs (P < .001). Three years postoperatively, 11.4% of patients had an Nd:YAG capsulotomy in the Vivinex XY1 eye and 18.6% had a capsulotomy in the AcrySof SN60WF eye (P = .23). CONCLUSION: The new hydrophobic acrylic Vivinex XY1 IOL showed significantly lower PCO rates and lower YAG rates compared to the AcrySof SN60WF IOL. The interaction of various factors such as hydrophobic material, smooth optic surface, and sharp posterior optic edge plays a key role in PCO development.