A comparative study on calculation of intraocular lens power using different formulas between IOLMaster 700 and IOLMaster 500 in cataract eyes / 中华实验眼科杂志

Objective:To compare the accuracy of IOLMaster 700 and IOLMaster 500 in intraocular lens (IOL) power calculation.Methods:A cross-sectional study was conducted.Two hundred and sixty-two eyes of 262 patients who underwent phacoemulsification combined with IOL implantation at the Eye Hospital of Wenzhou Medical University from November 2018 to November 2019 were enrolled.Preoperative biometry for cataract surgery was performed using IOLMaster 700 and IOLMaster 500.IOL power was calculated through the built-in formulas, Haigis, Holladay Ⅰ, Hoffer Q and SRK/T of the two devices.The difference in IOL power calculation between the two devices was analyzed through the prediction error of IOL power calculation using different formulas across different axial length (AL) ranges.This study complied with the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the Eye Hospital of Wenzhou Medical University (No.2020-038-K-33). Written informed consent was obtained from each patient before the surgery.Results:There was no significant difference in mean absolute error (MAE) between IOLMaster 700 and IOLMaster 500 using Haigis, Hoffer Q and SRK/T over the entire AL range (all at P >0.05). The MAE of IOLMaster 500 was 0.47 (0.24, 0.90) D, which was significantly lower than 0.50 (0.28, 0.99) D of IOLMaster 700 using Holladay Ⅰ formula ( Z=-3.120, P=0.002). When AL was <22.0 mm and ≥24.5 mm-<26.0 mm, there was no significant difference in MAE between the two devices using the four formulas (all at P >0.05). When AL was ≥22.0 mm-24.5 mm, there was no significant difference in the MAE between the two devices using Haigis, Hoffer Q and SRK/T (all at P >0.05), but 0.42 (0.18, 0.75) D from IOLMaster 500 was smaller than 0.45 (0.25, 0.79) D from IOLMaster 700 using Holladay Ⅰ, showing a statistically significant difference ( Z=-3.487, P <0.001). But the difference was negligible and therefore was of no clinical significance.When AL was ≥26.0 mm, there was no statistically significant difference in the MAE between the two devices using Haigis, Holladay Ⅰ and SRK/T, but 0.66 (0.38, 1.00) D from IOLMaster 500 was significantly smaller than 0.98 (0.62, 1.32) D from IOLMaster 700 using Hoffer Q ( Z=-3.046, P=0.002). Conclusions:The refractive prediction accuracy of IOLMaster 700 and IOLMaster 500 using Haigis, Hoffer Q and SRK/T is similar over the entire AL range.For patient with long AL, the IOL calculation from IOLMaster 700 using Hoffer Q is significantly larger than that from IOLMaster 500, which requires extra caution in clinical practice.The accuracy of IOLMaster 700 and IOLMaster 500 for IOL prediction is very similar.

Comparative Evaluation in Intense Pulsed Light Therapy Combined with or without Meibomian Gland Expression for the Treatment of Meibomian Gland Dysfunction.

OBJECTIVE: To determine whether the combination of meibomian gland expression (MGX) with intense-pulsed light (IPL) has a better efficacy to treat meibomian gland dysfunction (MGD) than IPL alone. METHODS: One hundred patients with MGD were randomly divided into three groups: MGX, IPL, and IPL+ MGX. Clinical parameters included the Ocular Surface Disease Index (OSDI), tear meniscus height (TMH), noninvasive keratograph tear breakup time (NIBUT), redness, meibomian gland dropout, tear breakup time (TBUT), corneal fluorescent staining (CFS), eyelid margin score, meibomian gland secretion function, and Schirmer I tests were collected before treatment and at 1 and 3 months after treatment. Compare the indexes of each group before and after treatment and also compare the differences of each group on follow-up. RESULTS: Compared to the baseline, OSDI, TBUT, and meibomian gland secretion function in IPL group improved throughout the follow-up period (all P < .05) and part of the meibomian gland secretion function increased continuously. OSDI, TBUT, lower eyelid margin scores, and meibomian gland secretion function in IPL + MGX group improved at the both follow-up visits (all P < .05), and continued improvement in meibomian gland secretion function can be observed. Lower meibomian gland dropout and CFS reduced at 1 month and 3 months respectively in IPL ± MGX group (P = .001,P = .001).Compared to IPL group, only CFS has reduction in IPL + MGX group at 1-month (P < .001), CFS, upper and lower MGYCS were improved at the 3 months (P = .037,P = .014, P = .049). CONCLUSIONS: MGX may have synergistic effect when combined with IPL therapy, and the effect can last at least 3 months.

Agreement between anterior segment parameters obtained by a new ultrasound biomicroscopy and a swept-source fourier-domain anterior segment optical coherence tomography.

Purpose: To evaluate the agreement between anew UBM and an SS-OCT. Methods: The scans of the right eye of each volunteer were obtained using the two devices. Data were fitted and recorded including: central corneal thickness (CCT), aqueous depth (AQD) (the distance from endothelium to lens), angle-to-angle distance (ATA), lens thickness (LT), diameter of the lens in the horizontal direction (LDiaangle: distance between the sharp angles on both sides of the lens, LDiaarc: distance between the vertex of the circular arcs on both sides of the lens), anterior and posterior corneal radius (Rf and Rb). Results: 25 eyes were included in this study. It could be seen that the differences in CCT, LDiaangle, Rf measured by the two instruments were not statistically significant. Bland-Altman analysis plots of CCT, LDiaangle and Rf showed mean differences of 0.2 µm, 0.01mm and 0.0mm for the 2 devices, respectively. Conclusion: The values of CCT, LDiaangle and Rf obtained via two instruments were not clinically interchangeable and the AQD, ATA, LT, and Rb have poor agreement affected by accommodation. We can estimate the real lens diameter by subtracting 0.61 ± 0.43mm when the lens diameter can only be simulated with SS-OCT.

Relationship of Posterior Capsular Opacification and Capsular Bend Type Investigation Based on Swept-source Optical Coherence Tomography.

Purpose: To investigate the relationship between capsular bend type and posterior capsule opacification (PCO) at a three-dimensional (3D) level using high-speed swept-source optical coherence tomography (SS-OCT).Methods: This was a retrospective study. A total of 99 eyes that underwent standard cataract surgery with phacoemulsification 2 years ago were analyzed. Standard SS-OCT radial scanning was performed in all eyes and the obtained photos were used for morphological observations of the capsular bend-IOL complex, the adhesion of posterior capsule to the IOL optic, and the position of the anterior capsulorhexis. Digital retroillumination photographs were taken of the posterior capsule of each eye to evaluate PCO (scoring and area).Results: In terms of the PCO score and area, there was no statistical difference between eyes with complete and incomplete adhesion of posterior capsule to IOL (both P > .05), whereas the partial overlap group showed a statistical difference greater than the total overlap group (P < .05). There were two types of capsular bends, completed adhesion (CA) and incomplete adhesion (IA). IA was divided into funnel adhesion (IA-F), parallel adhesion (IA-P), and detached adhesion (IA-D). The incomplete adhesion index (IAI) varied between eyes and ranged from 0 to 1. The PCO score and area in the high IAI group (higher than 0.50) were significantly greater than the low IAI group (< 0.50) (P < .05). In addition, the PCO score and area were significantly higher in the cohort with at least one IA-D capsular bend in six districts to the group that did not have IA-D capsular bend (P < .05).Conclusions: Complete or incomplete adhesion of the posterior capsule to the IOL optic may not be necessary for the development of PCO. Our study suggests that capsular bend type may be used as an index to predict PCO.

Three-Dimensional Morphology Study of Capsule in Pseudophakic Eyes with High-Speed Swept-Source Optical Coherence Tomography.

PURPOSE: To study the capsule morphology in pseudophakic eyes on the three-dimensional level using high-speed swept-source optical coherence tomography (SSOCT). METHODS: This study collected patients with age-related cataract and divided them into two groups according to the anterior capsule and intraocular lens (IOL) optic relationship: total anterior capsule overlap (360°, Group-T) and partial anterior capsule overlap (<360°, Group-P). One standard SSOCT radial scanning was performed in all eyes at 1 day, 1 week, 1 month, and 3 months postoperatively. RESULTS: Thirty-two eyes from 25 patients were enrolled in the Group-T and 17 eyes from 13 patients in the Group-P. No eyes achieved complete adhesion between IOL optic and posterior capsule at 1 day after the surgery. However, the rate of complete adhesion was low (15/49, 30.6%) even at 3 months postoperatively and there was no statistically difference between Group-T and Group-P (21.9% vs. 47.1%, P > 0.05). At 1 day, 1 week, 1 month, and 3 months after the surgery, the capsule bend index (CBI) in the Group-T was 0.02 ± 0.09, 1.35 ± 1.48, 3.60 ± 0.54, and 3.88 ± 0.19, respectively. CBI rises linearly during the first month and the rise goes stable relatively with the great reduction of standard deviation in the following 2 months (All P < 0.05). The anterior capsule opening area and diameter were both reduced in the first month, and then they both became stable. CONCLUSIONS: With square-edge IOL, posterior capsule opacification risk is still high in most eyes at 3 months postoperatively for the complete adhesion of posterior capsule and IOL was only achieved in 30.6% eyes. IOL-in-bag may be driven by the significant capsule bag changes especially in the first month postoperatively.

Influence of age-related cataract and cataract-surgery on dominance eye / 中华实验眼科杂志

Background The alteration of dominance eye is associated with visual quality in patients with age-related cataract or after cataract-surgery.However,the study on the relationship of dominance eye shift with vision following cataract-surgery is lack.Objective This study was to observe the influence of age-related cataract and cataract surgery on ocular dominance in the elderly.Methods A serial cases-observational study was designed.Eighty-seven patients with age-related cataract were collected from December 2011 to April 2012 in Affiliated Eye Hospital of Wenzhou Medical University,and phacoemulsification combined with intraocular lens (IOL) implantation was performed in all the patients.The patients were grouped into binocular vision difference (best corrected distance vision) ≥2 lines group (42 patients) and ≤ 1 line group (45 patients) on the standard logarithmic visual acuity chart.The frequency and shift of dominant eye were determined by card-hole method or thumb method before operation and 1 day,1 week,1 month and 3 months after operation.The difference in the frequencies of dominant eye between before and after operation was analyzed with MecNmar test.Results The median of best corrected distance vision (LogMAR) was 0.40 (0.00-1.40) in preoperation and 0.00 (-0.08-0.30) in postoperation,with significant difference between them (Z=-9.481,P =0.000).In the binocular vision difference ≥ 2 lines group,the dominant eyes were 24 in the right eyes and 18 in the left eyes.The milder cataractous eyes were identified as dominant eyes in 33 (78.57％) patients and heavier cataractous eyes were determined as dominant eyes in 9 (21.43％) patients before operation.However,the right eye was evidenced as dominant eye in 31 patients and the left eye was in 11 patients after operation.In the 42 patients,dominant eye shifted from the left eyes to the right eyes in 10 patients and from the right eyes to the left eyes in 3 patients,and 4 patients presented an unstable change binocularly.In 45 patients of the binocular vision difference ≤ 1 line group,the dominant eyes were the right eyes in 27 patients and the left eyes in 18 eyes in preoperation ; while after operation,dominant eye altered form the left eyes to the right eyes in 3 patients and form the right eyes to the left eyes in 1 patient,and unstable change occurred in 5 patients.There were no significant differences in the frequency of dominant eyes between before and after operation both the two groups (group A:P =0.092 ; group B:P =0.727).Conclusions Age-related cataract impact on eye dominance.Dominance eye may occur alteration binocularly following cataract surgery,which is one of causes of visual discomfort.

Influence of different length corneal limbal incisions on the anterior and posterior corneal astigmatism after phacoemulsification / 中华实验眼科杂志

Background The different incisions in phacoemulsification,including the length,location and shape etc.,can cause surgery-induced astigmatism ( SIA ).But the SIA caused by 2.2 mm,3.0 mm corneal limbal incision after phacoemulsification,especially the change of posterior corneal surface astigmatism is still rarely reported. Objective This study was to investigate the anterior,posterior and total corneal SIA and compare their differences between phacoemulsification and foldable intraocular lens (IOL) implantation with 2.2 mm and 3.0 mm corneal limbal incisions. Methods Seventy-one eyes of 47 cases were randomly divided into two groups with matched age,visual acuity and astigmatism degree.Phacoemulsification and IOL implantation with 2.2 mm incision at the steepest corneal meridian was performed on the patients of 2.2 mm incision group,and the same surgery was adopted with 3.0 mm incision as 3.0 mm incision group.Corneal curvature radius and central corneal thickness were measured by Pentacam at 1 day before surgery and 1 week,1 month and 3 months after surgery respectively.The anterior and posterior corneal surface SIAs were calculated according to the flat axis and steep axis of corneal curvature and the air and the cornea refractive index.Based on the anterior and posterior surface SIAs,the total corneal SIA was then calculated using the vector analysis method.Jaffe/Clayman vector method was used to calculate the anterior and posterior and total corneal SIAs in the different time points,and the differences were compared between the two groups.Oral informed consent was obtained from each subject prior to the trial. Results The mean anterior and posterior surface corneal SIAs appeared to be lower in 2.2 mm incision group compared with 3.0 mm incision group at postoperative 1 day,1 week,1 month and 3 months but were not significantly different among groups at various time points ( anterior SIA:P =0.290 ; posterior SIA:P =0.740 ; total SIA:0.434 ).The mean anterior corneal surface SIAs were significantly lower at the postoperative 3 months than those at postoperative 1 day,1 week in both groups(2.2 mm incision group:P=0.020,0.036;3.0 mm incision group:P=0.006,0.023 ).The posterior corneal surface SIAs were (0.70±0.43 ) D and (0.75 ±0.54 ) D at 1 day in 2.2 mm incision group and 3.0 mm inscision group,respectively,and significantly decreased posterior corneal surface SIAs were found in postoperative 1 week,1 month and 3 months compared with 1 day in both groups ( 2.2 mm incision group:all P =0.001 ; 3.0 mm incision group:P=0.028,0.044,0.032).The total corneal surface SIA showed significant differences between 1 day and 1 week,1 month,3 months after surgery ( 2.2 mm incision group:P =0.015,0.002,0.002 ; 3.0 mm incision group:P =0.049,0.007,0.016 ). Conclusions There are no significant differences in the anterior,posterior and total corneal surface SIAs between 2.2 mm and 3.0 mm incisions after phacoemulsification with IOL implantation.The SIA is gradually reduced with the prolongation of postoperative time.

Comparison of visual quality between zero spherical aberration intraocular lens and spherical intraocular lens implanted eyes / 中华实验眼科杂志

Background Zero spherical aberration intraocular lenses(IOL)is designed to prevent the addition of positive spherical aberration after surgery.Research indicated that some positive spherical aberration can provide better depth distance of focus and pseudoaccommodation.Objective The present study was to compare the visual function and wavefront aberrations in pseudophakic eyes with zero spherical aberration IOL and spherical IOL.Methods A prespective case-controlled study was designed.Eighty eyes of 52 patients with age-related cataract were enrolled and divided into two matched groups based on random number table method.The regular phacoemulsification was performed on the eyes,and a zero spherical aberration IOL(Akreos AO)was implanted in the test group and a spherical IOL was used in the control group(Akreos Adapt IOL).The corrected distance visual acuity(CDVA),contrast sensitivity,depth of focus and wavefront aberrations were recorded and compared at 3 months after cataract surgery between these two groups.The trail was approved by the Ethic Committee of Eye Hospital of Wenzhou Medical College,and written informed consent was obtained from each patient prior to the program.Results The clinical demography from the two groups was matched(P ＞ 0.05).There were no significant difference in the CDVA (LogM AR)(-0.03 ±0.08 versus-0.02+0.10)(t =-0.50,P =0.61)and in depth of focus(3.48± 1.07 DS versus 3.20±0.77 DS)(t =1.15,P=0.25)between the zero spherical aberration IOL group and the spherical IOL group.The contrast sensitivities under the mesopic condition at 12.0 c/d and mesopic with glare at 3.0,6.0,18.0 c/d were 12.42 ± 13.16,42.58 ±24.96,30.19± 25.64 and 3.03 ± 5.49 in the zero spherical aberration IOL group,and those in the spherical IOL group were 5.59 ± 8.11,28.74 ± 18.69,17.07 ± 19.35 and 0.22 ± 1.15 without significant differences between these two groups(P＜0.05).Under the 5.0 mm pupil analyzing zone,the spherical aberration in zero spherical aberration IOL group was(0.13 ±0.07)μm,showing a significant reduction in comparison with spherical IOL group(0.21 + 0.07 μm)(P ＜ 0.05).No evidently differences were found in total high-order aberration,coma aberration and trefoil aberration(P＞0.05),but the sphere aberration was considerably lower in the zero spherical aberration IOL group compared with spherical IOL group(t=-4.19,P＝0.00).Conclusions The visual quality of the eyes implanted zero spherical aberration IOL is significantly better than ones implanted with spherical IOL.

Evaluation of long-term visual performance following AcrySof ReSTOR lens implantation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Multifocal lens has become popular in cataract surgery. Short-term outcome after AcrySof ReSTOR Lens implantation had been reported by many studies, but long-term visual performance and the effect of posterior capsular opacification (PCO) on visual performance need further investigation.</p><p><b>METHODS</b>This retrospective study involved 54 eyes from 41 cataract patients implanted with ReSTOR lens, with a follow-up period of 12 to 31 months. Manifest refraction spherical equivalence (MRSE), monocular uncorrected and best-corrected distance visual acuity, uncorrected and distance-corrected near and intermediate visual acuity, contrast sensitivity were assessed. The effect of PCO on visual performance was evaluated by comparing visual parameters between pre and post-capsulotomy.</p><p><b>RESULTS</b>Uncorrected distance visual acuity of eyes with MRSE within +/-0.5 diopter (D) was better than those with MRSE greater than +/-0.5 D (P < 0.05). Uncorrected distance and near visual acuity (LogMAR) was 0.10 and 0.17 respectively. Best corrected distance visual acuity and best distance-corrected near visual acuity (LogMAR) was 0.00 and 0.16, a significant improvement was noted after correction (P = 0.000, P = 0.001, respectively). Contrast sensitivity logarithm was comparable with the normal value at difference spatial frequencies except at 12 cpd. In 5 eyes with mild PCO, post-capsulotomy visual parameters were better than pre-capsulotomy (P < 0.05).</p><p><b>CONCLUSION</b>ReSTOR lens provides a good long-term distance and near vision, functional intermediate vision and contrast sensitivity. Mild PCO significantly affects visual performance and needs early intervention.</p>