Importance of different topographic, biometric, and retinal parameters for calculating IOL power.

The objective is to evaluate the parameters significantly related to calculating the power of the implanted lens and to determine the importance of different biometric, retina, and corneal aberrations variables. A retrospective cross-sectional observational study used a database of 422 patients who underwent cataract surgery at the Oftalvist Center in Almeria between January 2021 and December 2022. A random forest based on machine learning techniques was proposed to classify the importance of preoperative variables for calculating IOL power. Correlations were explored between implanted IOL power and the most important variables in random forests. The importance of each variable was analyzed using the random forest technique, which established a ranking of feature selections based on different criteria. A positive correlation was found with the random forest variables. Selection: axial length (AL), keratometry preoperative, anterior chamber depth (ACD), measured from corneal epithelium to lens, corneal diameter, lens constant, and astigmatism aberration. The variables coma aberration (p-value = 0,12) and macular thickness (p-value = 0,10) were almost slightly significant. In cataract surgery, the implanted IOL power is mainly correlated with axial length, anterior chamber depth, corneal diameter, lens constant, and preoperative keratometry. New variables such as astigmatism and anterior coma aberration and retina variables such as the preoperative central macular thickness could be included in the new generation of biometric formulas based on artificial intelligence techniques.

Geometry of Modern Presbyopia-Correcting Intraocular Lenses and Changes in Haptic-Capsular Bag Behavior According to Compression and Different Well Diameters: A Bench Study Using Computed Tomography.

INTRODUCTION: The geometry of an intraocular lens (IOL), the design of the haptics, and the optic-haptic junction play a role in initial and long-term visual outcome after cataract surgery. Knowledge of the behavior of an implant in the capsular bag and under compression is of major importance. Our laboratory experiment analyzed in-depth the geometry of acrylic, single-piece, premium, presbyopia-correcting intraocular lenses and changes in haptic-capsular bag relationships according to capsular bag size using a range of compression well diameters. METHODS: One hydrophilic (RayOne Trifocal® RAO603F) and three hydrophobic intraocular lenses (AcrySof IQ PanOptix®, Synergy DFR00V™, and AT ELANA 841P®) were scanned with computed tomography (CT) in a dry, uncompressed state for quantitative analyses of haptic and optic-haptic junction (OHJ) dimensions and qualitative assessment of geometry. In the second part of the experiment, CT was performed after sample placement into a series of compression wells (9.0, 10.0, 11.0, 11.5 mm) for analyses of length of contact (LoC) between the haptics and the wells. Axial alignment and haptic-capsular bag relationships were assessed. RESULTS: The qualitative and quantitative evaluations highlighted differences in haptic and OHJ geometry and dimensions across the samples. The mid-zone of the optic was thickest in the hydrophilic sample (RayOne Trifocal® RAO603F) with a maximum of 0.880 mm compared to the thinnest hydrophobic sample (AT ELANA 841P®) with 0.564 mm. The AT ELANA 841P® showed the largest OHJ surface area (3.86 mm2) and OHJ volume (0.60 mm3) of the hydrophobic samples. The TECNIS Synergy DFR00V™ showed the thickest OHJ (0.51 mm), while the AcrySof IQ PanOptix® showed the thinnest OHJ (0.21 mm). The LoC values decreased with increasing well size for all tested samples. The AT ELANA 841P® showed the largest LoC and largest contact zones of hydrophobic samples in all wells. CONCLUSION: The laboratory experiments highlight differences in the haptics, the OHJ geometric characteristics, and behavior of samples in different well diameters. The results support the idea that specific IOL designs may have advantages or disadvantages depending on anatomical dimensions. We cannot make any classification or rating (good versus bad) for clinical practice on the basis these experimental results, as many other factors play a role. However, knowledge of IOL geometry seems important to select the best option in each individual case.

Sir Harold Ridley as the Pioneer of Intraocular Lenses: His Inspiration Drawn From World War II Pilots.

This article underscores the monumental contributions of Sir Harold Ridley to the development of intraocular lenses (IOLs), which have revolutionized cataract surgery. Sir Harold Ridley, a British ophthalmologist and medical scientist, drew inspiration from the injuries of World War II pilots to pioneer the first successful IOL implantation in 1949 at St. Thomas's Hospital. The lens, made from Perspex CQ, marked the inception of modern cataract surgery. Despite facing considerable skepticism and resistance from the medical community throughout the 1950s and 60s, Ridley's perseverance led to the gradual acceptance of IOLs by the 1970s. Today, Ridley is rightfully recognized as the "father of the intraocular lens," with his groundbreaking work having profoundly impacted the field of ophthalmology and improved the quality of life for millions globally.

Secondary Intrascleral Intraocular Lens Fixation With Lens Capsule Preservation for Aphakic Eyes in Patients With Pseudoexfoliation Syndrome: A Case Series.

We describe three cases of pseudoexfoliation syndrome (PEX) in which good outcomes were achieved after secondary intrascleral intraocular lens (IOL) fixation with capsule preservation for aphakic eyes. Three Japanese patients with PEX underwent phacoemulsification and aspiration (PEA) owing to challenges in IOL intracapsular fixation caused by zonular weakness. Case 1 involved an 83-year-old man with PEX. Six weeks post-PEA, 30-gauge needles were inserted to exit between the capsule and the iris. The IOL was fixed intrasclerally using the double-needle technique. Case 2 involved a 90-year-old man with PEX. The same abovementioned double-needle intrascleral IOL fixation procedure was performed eight weeks post-PEA. Intraoperative vitreous prolapse into the anterior chamber was observed, and anterior vitrectomy was performed. Case 3 involved an 80-year-old man with PEX. Seven weeks post-PEA, the patient underwent the same double-needle intrascleral IOL fixation procedure. Good IOL fixation was achieved in all patients without postoperative iris capture. No serious complications, including retinal detachment and vitreous hemorrhage, were observed. Preserving the capsule during secondary IOL scleral fixation for aphakic eyes can effectively reduce intraoperative vitreous prolapse, minimize surgical invasiveness, suppress iris flutter, and prevent capture of the pupillary IOL, making it a meaningful and acceptable approach, although the long-term risks, such as potential lens capsule drop, should be studied further.

A case of delayed recurrent hyphema following Implantable Collamer Lens (ICL) surgery.

Purpose: To present a case of delayed recurrent hyphema following toric ICL implantation. Observations: This case reports a 24-year-old Asian female who presented with sudden decrease in vision in the right eye, accompanied by recurrent massive anterior chamber hemorrhage, six months after bilateral implantation of toric ICL with central holes for myopia correction. Despite initial conservative treatment with immobilization and intraocular pressure (IOP)-lowering medication at another hospital, the hyphema persisted. At our hospital, her corrected visual acuity (CDVA) in the right eye was counting fingers (CF) at 50 cm, with visible blood clots and hyphema in the anterior chamber, and an IOP of 40 mmHg. Ultrabiomicroscopy (UBM) indicated a large amount of hyphema in the anterior chamber. Initially, the patient was treated with a combination of three IOP-lowering medications: brimonidine eye drops, brinzolamide eye drops, and timolol eye drops, but the condition recurred. Two weeks later, we performed an anterior chamber hyphema evacuation and ICL removal surgery in the right eye. Postoperatively, the patient's IOP stabilized and her vision gradually recovered. One month after the surgery, a follow-up examination showed a CDVA of LogMAR 0.6 in the affected eye. Conclusion and importance: This case report is essential for characterizing a rare and serious complication following toric ICL implantation, highlighting the importance of close monitoring and timely intervention.

Current paradigms in refractive surgery.

Refractive surgeries have evolved from the archaic incisional corneal procedures to the use of sophisticated femtosecond lasers and new-generation phakic intraocular lenses (pIOL) for surgical correction of refractive errors. The armamentarium of modern-day refractive surgery includes corneal-based procedures such as photorefractive keratectomy, laser-assisted in situ keratomileusis and keratorefractive lenticule extraction, as well as lensbased pIOL implantation. The current procedures are associated with a high index of efficacy and predictability, with enhanced safety and a significant reduction in sight-threatening complications. Patient counselling and case selection is imperative to achieve optimal visual outcomes and patient satisfaction. This review article provides a comprehensive overview of current refractive surgery procedures, with an emphasis on decision-making. Evolving frontiers in refractive surgeries like customised corneal ablation and presbyopia correcting pIOL are also discussed.

A Retrospective Study of Visual Outcomes When Using a Cloud-Based Surgical Planning Platform and the Barrett Universal II Formula.

Purpose: To evaluate the efficacy of a cloud-based surgical planning platform with regards to refractive target accuracy. Methods: This was a retrospective chart review of consecutive cases from January 2022 through December 2023. Surgical planning was performed using the SMARTCataract platform, eyes were implanted with Clareon monofocal IOLs, and power calculations were done using the Barrett Universal II formula. Data were collected for the percentage of eyes within ±0.5 D of target refraction, mean absolute error (MAE), and postoperative visual acuity. Results: A total of 148 eyes were identified that met the inclusion/exclusion criteria. The percentage of eyes within ±0.5 D of the planned target was 94%. The MAE was 0.25 ± 0.17 D. In addition, 57%, 93%, 98%, and 100% of eyes had MAE ≤ 0.25 D, ≤ 0.5 D, ≤ 0.75 D, and ≤ 1.0 D, respectively. Conclusion: The results of this study suggest high refractive accuracy when using the SMARTCataract planning platform with the Barrett Universal II formula and excellent distance visual acuity.

When the natural lens inside the eye develops a cataract (becomes opaque) it can be replaced with a clear artificial intraocular lens (IOL). Good visual outcomes after surgery are heavily reliant on implanting the optimal lens power. A new cloud-based surgical planning tool (SMARTCataract) aims to automatically use patient data, surgeon preferences, favored IOL power calculation formulas, and desired IOL type to guide surgical planning. However, to date there are no data on the refractive outcomes when using the SMARTCataract platform. The purpose of this study was to evaluate the efficacy of the SMARTCataract platform with regards to refractive target accuracy. The results of this study suggest high refractive accuracy when using the SMARTCataract platform with the Barrett Universal II formula and excellent distance visual acuity.

Incidence of Acute Endophthalmitis after Secondary Intraocular Lens Implantation: A Nationwide Cohort Study.

INTRODUCTION: In this study, we aimed to analyze the incidence of acute endophthalmitis after secondary intraocular lens (IOL) implantation in South Korea. METHODS: This study used information from the National Health Insurance Service (NHIS)-National Health Information Database (NHID). We identified patients who underwent secondary IOL implantation or IOL exchange surgeries during 2002-2021 due to diagnoses of IOL dislocation or mechanical complication of IOL. Postoperative endophthalmitis (POE) was defined as patients having received intravitreal antibiotic injection or vitrectomy for acute endophthalmitis diagnosed within 42 days after the claim for secondary IOL surgeries. All statistical analyses were performed with a significance level p < 0.05, and we used the univariate and multivariate Cox proportional hazard model to identify risk factors. RESULTS: From 2002 to 2021, 39,364 patients received secondary IOL implantation, and acute POE was diagnosed in 62 patients. The overall incidence of acute POE was 0.16% during the 20-year period. More than half of the patients were diagnosed with POE within the first week after surgery. In the univariate analysis, there was a higher incidence of endophthalmitis in the group with pre-existing glaucoma (hazard ratio [HR], 1.945; 95% confidence interval [CI], 1.036-3.652; p = 0.0385) and the group undergoing concurrent vitrectomy (hazard ratio [HR], 2.329; 95% confidence interval [CI], 1.003-5.405; p = 0.0491). CONCLUSIONS: The incidence of acute endophthalmitis after secondary IOL implantation in South Korea was similar to that of other countries. This is the largest retrospective claims data-based study of acute endophthalmitis after secondary IOL implantation in patients in South Korea.

Behavior of biometric parameters during clinical hours.

PURPOSE: To evaluate and quantify variation of biometric parameters - axial length (AL), anterior chamber depth (ACD), central corneal thickness (CCT) and white-to-white (WTW). METHODS: A population-based retrospective cohort study was performed on patients who underwent a biometry test prior to cataract surgery using the IOL Master 700 (Carl Zeiss Meditec, Jena, Germany) between the years 2017-2021. Differences in these parameters were evaluated between scans executed at different times of the day. RESULTS: 21,975 examinations of 8611 patients were included. Mean age was 70.50±12.56years. The mean time of the biometry exams was 10:52±1:23 AM. Measurements of AL, ACD, CCT and WTW were tested hourly and grouped between 7:00-9:00 AM and 12:00-03:00 PM. All the parameters showed a diurnal increase with a significance of P<0.001 (AL from 23.64±1.5 to 24.01±1.76mm; ACD from 3.29±0.67 to 3.35±0.64mm; CCT from 0.52±0.04 to 0.53±0.04µm and WTW from11.83±0.46 to 11.90±0.51mm). The most significant change was seen in AL. The difference between time groups remained significant in a generalized linear mixed model (P<0.001). CONCLUSIONS: There are fluctuations in AL, ACD, CCT, WTW measurements during office hours. These results raise questions about the significance of timing of the biometry exam and the effect on the ELP calculation.

The Surgical Outcomes of Modified Intraocular Lens Suturing with Forceps-Assisted Haptics Extraction: A Clinical and Basic Evaluation.

Background/Objectives: Postoperative intraocular lens (IOL) tilt is a risk associated with IOL scleral fixation. However, the cause of IOL tilt during IOL suturing remains unclear. Therefore, this study aimed to evaluate the surgical outcomes of a modified IOL suturing technique and investigate the factors contributing to postoperative IOL tilt and decentration. Methods: We included 25 eyes of 22 patients who underwent IOL suturing between April 2018 and February 2020. A modified IOL suturing technique that decreased the need for intraocular suture manipulation was used. Factors contributing to IOL tilt and decentration were investigated using an intraoperative optical coherence tomography (iOCT) system. Results: The mean postoperative best-corrected visual acuity improved from 0.15 ± 0.45 to -0.02 ± 0.19 (p = 0.02). The mean IOL tilt angle at the last visit after surgery was 1.84 ± 1.28 degrees. The present study reveals that the distance of the scleral puncture site from the corneal limbus had a stronger effect on IOL tilt; meanwhile, the suture position of the haptics had a greater effect on IOL decentration. Conclusions: The modified IOL suturing technique, which avoids intraocular suture handling, had favorable surgical outcomes with improved postoperative visual acuity and controlled IOL tilt and decentration. Accurate surgical techniques and careful measurement of distances during surgery are crucial for preventing postoperative IOL tilt and decentration.

Optimizing IOL Calculators with Deep Learning Prediction of Total Corneal Astigmatism.

Background/Objectives: This study aims to identify the most accurate regression model for predicting total corneal astigmatism (TCA) from anterior corneal astigmatism (ACA) and to fine-tune the best model's architecture to further optimize predictive accuracy. Methods: A retrospective review of 19,468 eyes screened for refractive surgery was conducted using electronic medical records. Corneal topography data were acquired using the Pentacam HR. Various types (7) and subtypes (21) of regression learners were tested, with a deep neural network (DNN) emerging as the most suitable. The DNN was further refined, experimenting with 23 different architectures. Model performance was evaluated using root mean squared error (RMSE), R2, average residual error, and circular error. The final model only used age, ACA magnitude, and ACA axis to predict TCA magnitude and axis. Results were compared to predictions from one of the leading TCA prediction formulas. Results: Our model achieved higher performance for TCA magnitude prediction (R2 = 0.9740, RMSE = 0.0963 D, and average residual error = 0.0733 D) compared to the leading formula (R2 = 0.8590, RMSE = 0.2257 D, and average residual error = 0.1928 D). Axis prediction error also improved by an average of 8.1° (average axis prediction error = 4.74° versus 12.8°). The deep learning approach consistently demonstrated smaller errors and tighter clustering around actual values compared to the traditional formula. Conclusion: Deep learning techniques significantly outperformed traditional methods for TCA prediction accuracy using the Pentacam HR. This approach may lead to more precise TCA calculations and better IOL selection, potentially enhancing surgical outcomes.

Preparation and Stability Study of an Injectable Hydrogel for Artificial Intraocular Lenses.

Currently available intraocular lenses (IOLs) on the market often differ significantly in elastic modulus compared to the natural human lens, which impairs their ability to respond effectively to the tension of the ciliary muscles for focal adjustment after implantation. In this study, we synthesized a polyacrylamide-sodium acrylate hydrogel (PAH) through the cross-linking polymerization of acrylamide and sodium acrylate. This hydrogel possesses excellent biocompatibility and exhibits several favorable properties. Notably, the hydrogel demonstrates high transparency (94%) and a refractive index (1.41 ± 0.07) that closely matches that of the human lens (1.42). Additionally, it shows strong compressive strength (14.00 kPa), good extensibility (1400%), and an appropriate swelling ratio (50 ± 2.5%). Crucially, the tensile modulus of the hydrogel is 2.07 kPa, which closely aligns with the elastic modulus of the human lens (1.70-2.10 kPa), enabling continuous focal adjustment under the tension exerted by the ciliary muscles.

Efficacy and comfort following the implantation of extended depth of focus, multifocal, and monofocal intraocular lenses in cataract patients.

BACKGROUND: Extended depth of focus (EDOF) and multifocal (Multi) intraocular lenses (IOL) can provide a fixed distance of near vision, which may result in some discomfort for patients who prefer different near distances. The aim of this study was to compare the vision, comfortable near distance (CND) and visual comfort in patients who underwent implantation of EDOF, Multi, and monofocal (Mono) IOLs. METHODS: A total of 100 eyes were implanted with Tecnis ZXR00, ZMB00 or ZCB00 IOLs. Uncorrected distance, intermediate, and near visual acuity (UDVA, UIVA, and UNVA, respectively), corrected distance visual acuity (CDVA), the fluctuations of CND, the ability to see at comfortable or standard near distance and visual comfort were evaluated at 3-month postoperative. RESULTS: At 3 months postoperative, the EDOF and Multi groups showed non-inferiority compared to the Mono group in the UDVA (P > 0.05) and CDVA (P > 0.05) but superiority in the UNVA (P < 0.001). The UIVA was better in the EDOF group, with comparable results for the Multi and Mono groups. There was no difference in preoperative and postoperative CND in the three groups. The CND visual acuity (CNDVA) was lower than the UNVA in the three groups, especially in the EDOF and Multi groups (P < 0.05). The CND effectively improved patients' near visual comfort and visual clarity, except for one patient in the Multi group who complained of severe fatigue and was unable to tolerate the experience at month 3. CONCLUSION: The EDOF and Multi IOLs achieved excellent visual quality and superior UNVA compared to the Mono IOL, but the CNDVA was significantly inferior to the UNVA. Patients' near visual experience can be effectively improved at their CND.

Cross-Sectional Survey of Vitreoretinal Surgery Fellowship Training in Secondary Intraocular Lens Placement.

Purpose: To assess current trends in vitreoretinal surgical fellowship training for placement of secondary intraocular lenses (IOLs). Methods: A cross-sectional survey was administered to vitreoretinal surgical fellowship graduates who completed their program between 2019 and 2023. Results: Completed responses were obtained from 70 (22.5%) of 311 eligible recipients. Training settings included academic (80%), hybrid academic/private practice (15%), and private practice (5%). During their fellowship, the majority of respondents reported 10 or fewer cases using anterior chamber (AC) IOLs (69%), 5 to 50 cases using scleral-sutured IOLs (64%), and 5 to 25 cases using sutureless scleral-fixated IOLs (52%). Most fellows (79%) did not have exposure to iris-fixated IOL placement during fellowship training. The Akreos AO60 (78%) and Envista MX60 (10%) IOLs were the most common choice for scleral-sutured placement. Most fellows (67%) placed fewer than 10 secondary IOLs through scleral tunnels. Overall, scleral-sutured IOL placement (Akreos Gore-Tex [polytetrafluoroethylene] sutured, 49%) and scleral-fixated IOLs (modified Yamane, 45%) were the preferred and most comfortable surgical techniques for recent graduates after completing training. There was a significant association between surgical case volume during fellowship training and self-reported competency for each type of secondary IOL (P ≤ .005). Conclusions: The majority of vitreoretinal surgical fellows receive limited training in the placement of AC IOLs or construction of scleral tunnels during their fellowship. Aligned with their experience during fellowship, recent graduates generally prefer implanting scleral-fixated or scleral-sutured IOLs. Analysis of trainees' exposure to various techniques and postgraduate surgical preferences may identify areas for improvement in surgical education.

[On the issue of diagnostic accuracy of methods for analyzing the parameters of regular astigmatism]. / K voprosu o diagnosticheskoi tochnosti metodov indikatsii pokazatelei regulyarnogo astigmatizma.

Accurate measurement of astigmatism parameters is the basis for prescribing modern means of optical correction. In recent years, another direction for correcting astigmatism has emerged - implantation of toric intraocular lenses (TIOL). PURPOSE: This study evaluates the diagnostic accuracy of various methods for measuring the parameters of regular astigmatism. MATERIAL AND METHODS: The study included 83 patients (122 eyes) with regular astigmatism exceeding 1.0 D. Three groups were formed depending on the type of astigmatism. Spherical and cylindrical (power and axis) components of refraction were determined using automatic refractometry. The results were refined with subjective tests: power and axis tests with a cross-cylinder. The criterion for diagnostic accuracy was the level of corrected visual acuity. To assess the impact of cylinder position on visual acuity, discrete deviations of the axis of trial astigmatic lenses from the correct position (determined based on subjective tests) were modeled at 5, 10, and 15 degrees in both clockwise and counterclockwise directions. RESULTS: In the overall sample of observations, coincidence of results was found only in one-third of cases, with a tendency for discrepancies in data between the two methods in nearly 70% of cases. Statistical processing revealed significant differences only in the magnitude of the cylinder in the group with against-the-rule astigmatism (p<0.0005). An increase in maximum visual acuity corrected based on subjective test data was noted. With a deviation of the cylinder axis from the correct position by 10-15 degrees, regardless of the type of astigmatism, a significant tendency for a decrease in visual acuity was identified. At the same time, with a deviation of the cylinder axis within 5 degrees, a significant decrease in visual acuity was noted only in with-the-rule astigmatism and counterclockwise deviation. CONCLUSION: To achieve maximum visual acuity in the correction of regular astigmatism, objective method data must be refined with subjective tests. The results of modeling the deviation of the axis of the corrective lens from the proper position can be considered when evaluating the functional outcomes of TIOL implantation.

[Efficacy of drainage implants in combined cataract and glaucoma surgery]. / Effektivnost' primeneniya drenazhei v kombinirovannoi khirurgii katarakty i glaukomy.

The combination of glaucoma and cataract occurs in 14.6-76% of cases, according to various sources. The goal of surgical treatment for these patients is to improve visual function while simultaneously reducing intraocular pressure. Due to the wide variety of proposed surgical methods, there is no consensus on the optimal management strategy for such patients. PURPOSE: This study evaluates the hypotensive effect and visual function outcomes of combined surgery for complicated cataract and glaucoma using the mesh drain made of digeland the xenocollagen drain. MATERIAL AND METHODS: Patients in Group 1 (n=43; 48.3%) underwent combined cataract and glaucoma surgery with implantation of the digel drainage implant, while patients in Group 2 (n=46; 51.7%) underwent an identical operation with the xenocollagen implant. Preoperative tonometric pressure was 27.2±1.7 and 27.3±1.9 mm Hg; best corrected visual acuity was 0.35±0.21 and 0.33±0.18, respectively. The following surgical technique was employed. At 3.0-4.0 mm from the limbus, an intrascleral tunnel was created using a 2.2 mm sclerotome through the conjunctiva in the anteroposterior direction, exiting into the anterior chamber. Capsulorhexis and phacoaspiration were performed. The scleral tunnel was widened to 3 mm, and the intraocular lens was implanted. Penetrating basal coloboma of the iris was formed. The deep flap of the scleral tunnel was dissected from the flat part of the ciliary body and removed. The digel implant was shaped into a T-configuration, while the xenocollagen implant was used without modification. Each drainage was implanted into the intrascleral tunnel (one end directed into the anterior chamber, the other exiting the scleral tunnel). The conjunctiva was sutured with 10/0 stitches, and the paracenteses were hydrated. RESULTS: Over a 24-month follow-up period, the tonometric intraocular pressure in Groups 1 and 2 was 18.8 and 18.5 mm Hg, respectively, and the best corrected visual acuity was 0.51 and 0.58. CONCLUSION: The use of both drainages in the proposed combined surgery for complicated cataract and glaucoma results in similarly stable hypotensive outcomes and high visual function.

Short-term outcomes of implanting a retropupillary iris-claw intraocular lens in patients with lens and intraocular lens drops.

Lens drop and intraocular lens (IOL) drop can occur after cataract or phacoemulsification surgery, where the IOL is dislocated from the capsular bag into the vitreous cavity. The aim of this study was to investigate the short-term outcomes of implanting a retropupillary iris-claw in patients with IOL drop and lens drop after phacoemulsification. A cross-sectional study was conducted at Santosa Hospital, Bandung, West Java, Indonesia, from January 2020 to December 2023. Patients were divided into two groups: IOL drop and lens drop groups. Total sampling was used, involving 51 patients in the present study, with 27 patients in the IOL drop group and 24 patients in the lens drop group. Data collected included age, sex, eye laterality, the onset of IOL drop or lens drop, intraocular pressure (IOP), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), record of astigmatism change preoperative and postoperative, and postoperative pars plana vitrectomy (PPV) complications. Our data indicated that the UDVA significantly improved in both IOL drop and lens drop groups after PPV surgery (p<0.001). However, there were no significant changes in IOP or astigmatism following the surgery in either group. Over one month, both groups showed improved UDVA, decreased IOP, and changes in astigmatism, with no significant differences between groups. Similarly, there was no significant difference in CDVA between IOL drop and lens drop groups. Only four complications were recorded in the present study. Comparing IOL drop and lens drop groups, only an increase in IOP showed a significant difference (p=0.018). Corneal edema, IOL decentration, and pupil ovalization were not significantly different. In conclusion, retropupillary iris-claw IOL implantation is safe and effective for aphakic patients with complications from phacoemulsification, regardless of whether it is lens drop or IOL drop.

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 measurements and calculated lens power using three biometers: a Scheimpflug tomographer with partial coherence interferometry and two swept source optical coherence tomographers.

PURPOSE: To compare the biometric measurements obtained from the Pentacam AXL Wave, IOLMaster 700, and ANTERION and calculate the recommended intraocular lens power using the Barrett Formulae. METHODS: This was a retrospective cross-sectional study of patients who underwent biometry using the Pentacam AXL Wave, IOLMaster 700, and ANTERION. Flat keratometry (K1), steep keratometry (K2), anterior chamber depth (ACD), and axial length (AL) from each device were measured and compared. These parameters were used to calculate the recommended IOL powers using the Barrett formula. RESULTS: The study included 252 eyes of 153 patients. The IOLMaster had the highest acquisition rate among the two biometers. The Pentacam obtained the shortest mean AL, the IOLMaster measured the highest mean keratometry values, and the ANTERION measured the highest mean ACD. In terms of pairwise comparisons, keratometry and axial length were not significantly different between the Pentacam-IOLMaster and ANTERION-IOLMaster groups, while the rest of the pairwise comparisons were statistically significant. In nontoric and toric eyes, 35-45% of patients recommended the same sphere of IOL power. In another 30-40%, the Pentacam and ANTERION recommended an IOL power one step greater than that of the IOLMaster-derived data. 50% of the study population recommended the same toric-cylinder IOL power. CONCLUSIONS: The Pentacam AXL Wave, IOLMaster 700, and ANTERION can reliably provide data for IOL power calculations; however, these data are not interchangeable. In nontoric and toric eyes, 35-45% of cases recommended the same sphere IOL power, and in another 30-40%, the Pentacam and ANTERION recommended one-step higher IOL power than the IOLMaster-derived data. In targeting emmetropia, selecting the first plus IOL power is advisable when using the Pentacam and ANTERION to approximate the IOL power calculations recommended by the IOLMaster 700.

Influence of Visual Field on Visual Acuity and Contrast Sensitivity in Open-Angle Glaucoma Eyes with Monofocal and Extended Depth-of-Focus Intraocular Lenses.

INTRODUCTION: The aim of this prospective and comparative study was to investigate the association of perimetry parameters on visual acuity and contrast sensitivity in primary open-angle glaucoma (POAG) eyes with diffractive extended depth-of-focus (EDoF) and monofocal intraocular lenses (IOLs). METHODS: In cataract eyes with medicinally controlled POAG with no defects in the central visual field and mean deviation (MD) values of - 10 dB or better, EDoF and monofocal IOLs with the same platform except for echelette optics for EDoF were implanted in 22 and 24 eyes, respectively. Corrected distance visual acuity (CDVA), contrast sensitivity at 3 to 18 cycles per degree (cpd), and automated perimetry using 30-2 and 10-2 Swedish Interactive Threshold Algorithm programs were examined 3 months postoperatively. The influences of perimetry parameters including MD, foveal sensitivity (FS), and the means of the central four points (central MD and central FS) on CDVA and contrast sensitivity were evaluated using linear and multiple regression analyses. RESULTS: In POAG eyes with EDoF IOLs, contrast sensitivities at 12 and 18 cpd were associated with 30-2 and 10-2 perimetry parameters. In POAG eyes with monofocal IOLs, associations of 30-2 parameters were found in CDVA and 3-cpd contrast sensitivity. CONCLUSIONS: The visual function of POAG eyes with EDoF IOLs was associated with perimetry parameters in high spatial frequency contrast sensitivity, which was different from that of POAG eyes with monofocal IOL. TRIAL REGISTRATION: Japan Registry for Clinical Research: jRCTs032200218.