Accuracy of 20 Intraocular Lens Power Calculation Formulas in Medium-Long Eyes.

INTRODUCTION: The aim of this work is to compare 20 intraocular lens (IOL) power calculation formulas in medium-long eyes (24.50-25.99 mm) in terms of root mean square absolute error (RMSAE), median absolute error (MedAE), and percentage of eyes with prediction error (PE) within ± 0.50 D. METHODS: The data of patients who underwent uneventful phacoemulsification between January 2017 and September 2023 were reviewed. Pre-surgery IOL power was calculated using Holladay1, SRK/T, Hoffer Q, Holladay 2, and Haigis. Three months after phacoemulsification, refraction was measured. Post-surgery IOL power calculations were performed utilizing the following formulas: Barrett Universal II, Kane, K6, Olsen (OLCR), Olsen (standalone), PEARL-DGS, Ladas Super Formula AI (LSF AI), T2, EVO, VRF, Hoffer QST, Castrop, VRF-G, Karmona, and Naeser 2. RMSAE, MedAE, and percentage of eyes with PE within ± 0.25 D, ± 0.50 D, ± 0.75 D and ± 1.00 were calculated. RESULTS: One hundred twenty-four eyes with axial length ranges between 24.52 and 25.97 mm were studied. The SRK/T formula yielded the lowest RMSAE (0.206) just before Holladay 1 (0.260) and T2 (0.261). In terms of MedAE, the best outcome was obtained by SRK/T (0.12) followed by Barrett Universal II (0.15) and LSF AI (0.15). The highest percentage of eyes with prediction error within ± 0.50 D was achieved by SRK/T, T2, and Holladay 1 (97.58, 93.55, and 93.55%, respectively). CONCLUSIONS: Third-generation formulas (SRK/T, Holladay 1) provided highly accurate outcomes in medium-long eyes and still can be wildly used to calculate IOL power.

[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.

[Optimization of phacoemulsification technique for Morgagnian cataract]. / Optimizatsiya tekhnologii fakoemul'sifikatsii morganievoi katarakty.

PURPOSE: This study was conducted to develop a new optimized phacoemulsification technique for Morgagnian cataract taking into account the anatomical and topographic parameters of the lens nucleus. MATERIAL AND METHODS: A working classification of Morgagnian cataract was developed based on the size of the nucleus: if the edge of the nucleus is visualized at the upper edge of the pupil or between the upper edge and the middle of the pupil, it was classified as an initial stage of Morgagnian cataract with a large nucleus; if the upper edge of the nucleus is visualized in the middle of the pupil and below, it was classified as an advanced stage of Morgagnian cataract with a small nucleus. The first group included six patients who underwent surgery using the scaffold technique with removal of the whole small nucleus into the anterior chamber. The second group included 11 patients who underwent surgery using the scaffold technique with removal of the last fragment of the nucleus into the anterior chamber. RESULTS: The use of the scaffold technique with removal of the nucleus into the anterior chamber helped reduce the number of intraoperative complications to 16.7% in the first group, compared to 27.3% in the second group, and the percentage of endothelial cell loss to 10.1% in the first group, compared to 10.7% in the second group. CONCLUSIONS: The anatomical and topographic features of the lens and the anterior segment of the eye in Morgagnian cataract with a small nucleus allow for preliminary implantation of an intraocular lens into the capsular bag to protect the posterior capsule during phacoemulsification of the nucleus with minimal mechanical, hydrodynamic and acoustic damage to the surrounding structures of the eye.

[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.

Surgical Efficiency Comparison Between Two Phacoemulsification Systems.

Purpose: To assess the surgical efficiency in cataract surgery comparing two phacoemulsification systems. Methods: Prospective, consecutive-comparative study in a two-site private practice. Three hundred and one eyes undergoing standard or femtosecond laser-assisted (FLACS) cataract surgery with either the R-Evo Smart (BVI, Waltham, USA) and/or the Centurion Vision System (Alcon, Fort Worth, USA). Preoperative eye characteristics (degree of cataract using the lens opacities classification system LOCS III grading) and intraoperative outcomes (total ultrasound time and total estimated fluid aspirated/drainage bag weighting) were registered in all cases. Results: One hundred and fifty-five eyes undergone cataract surgery with the R-Evo Smart and 146 eyes with the Centurion Vision System phacoemulsification systems. Mean cataract grade was 3.07 ± 0.78 and 2.96 ± 0.85 for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.12). Mean total ultrasound time was 18.99 ± 12.85 and 40.24 ± 21.91 seconds for the R-Evo Smart and Centurion Vision System groups, respectively (p < 0.01). Mean total estimated fluid aspirated/drainage bag weighting was 53.00 ± 14.56 g and 54.33 ± 14.88 cc for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.21). Considering non-FLACS surgery (98 eyes with the R-Evo Smart and 63 eyes with the Centurion Vision System), mean cataract grade was 2.95 ± 0.74 and 2.97 ± 0.91 for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.44). Mean total ultrasound time was 19.96 ± 11.20 and 42.84 ± 28.35 seconds for the R-Evo Smart and Centurion Vision System groups, respectively (p < 0.01). Mean total estimated fluid aspirated/drainage bag weighting was 55.95 ± 14.76 g and 55.97 ± 13.62 cc for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.49). No adverse events were found in the two groups of eyes. Conclusion: The objective measurement of surgical efficiency through total ultrasound time during lens removal and fluid consumption during both lens removal and irrigation/aspiration proved R-Evo Smart to be an efficient phacoemulsification platform, in comparison with the current standard of care Centurion Vision System.

A Retrospective Comparison of Phaco-Tube vs. Phaco-Trabeculectomy in Glaucoma Patients.

PURPOSE: To compare surgical outcomes of phacoemulsification combined with Baerveldt implantation (phaco-tube) or trabeculectomy with mitomycin-C (MMC) (phaco-trab) in patients without prior incisional ocular surgery. DESIGN: Single-center, retrospective, comparative case series. PARTICIPANTS: A total of 90 patients underwent surgical treatment, including 45 patients in the phaco-tube group and 45 patients in the phaco-trab group. METHODS: Eligible patients were identified using current procedural terminology (CPT) codes, and their medical records were retrospectively reviewed. MAIN OUTCOME MEASURES: The primary outcome measure was the rate of surgical failure (IOP ≤5 mmHg or >21 mmHg or reduced <20% from baseline on two consecutive study visits after 3 months, reoperations for glaucoma, or experienced loss of light perception vision). Patients who had successful surgical outcomes without use of glaucoma medications were classified as complete successes, while those that used glaucoma medications were classified as qualified successes. Secondary outcome measures were visual acuity (VA), visual field mean deviation (VFMD), intraocular pressure (IOP), glaucoma medication use, and complications. RESULTS: The cumulative probability of failure was 6.7% in the phaco-tube group and 32.8% in the phaco-trab group after 3 years (P= 0.005; Restricted Mean Survival Time = 5.9 months, 95% CI = 1.4 to 10.4 months). IOP was 13.1 ± 3.4 mmHg in the phaco-tube group and 13.3 ± 6.2 mmHg in the phaco-trab group at 3 years (P= 0.90), and the number of glaucoma medications was 2.6 ± 1.5 in the phaco-tube group and 1.7 ± 1.3 in the phaco-trab group (P= 0.015). LogMAR VA was 0.39 ± 0.58 in the phaco-tube group and 0.43 ± 0.73 in the phaco-trab group at 3 years (P= 0.82) and VFMD was -18.3 ± 9.0 dB in the phaco-tube group and -14.1 ± 7.0 dB in the phaco-trab group (P= 0.16). Postoperative complications developed in 21 patients (47%) in the phaco-tube group and 15 patients (33%) in the phaco-trab group (P= 0.28). CONCLUSIONS: Phaco-tubes had a significantly lower rate of surgical failure compared to phaco-trabs after 3 years of follow-up. However, phaco-trabs used significantly fewer glaucoma medications at multiple postoperative timepoints and had a higher proportion of complete success.

Utility of real-time 3D visualization system in the early stage of phacoemulsification training.

AIM: To determine the teaching effects of a real-time three dimensional (3D) visualization system in the operating room for early-stage phacoemulsification training. METHODS: A total of 10 ophthalmology residents of the first-year postgraduate were included. All the residents were novices to cataract surgery. Real-time cataract surgical observations were performed using a custom-built 3D visualization system. The training lasted 4wk (32h) in all. A modified International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR) containing 4 specific steps of cataract surgery was applied. The self-assessment (self) and expert-assessment (expert) were performed through the microsurgical attempts in the wet lab for each participant. RESULTS: Compared with pre-training assessments (self 3.2±0.8, expert 2.5±0.6), the overall mean scores of post-training (self 5.2±0.4, expert 4.7±0.6) were significantly improved after real-time observation training of 3D visualization system (P<0.05). Scores of 4 surgical items were significantly improved both self and expert assessment after training (P<0.05). CONCLUSION: The 3D observation training provides novice ophthalmic residents with a better understanding of intraocular microsurgical techniques. It is a useful tool to improve teaching efficiency of surgical education.

The effect of sodium hyaluronate on dry eye and corneal epithelial thickness following cataract surgery.

PURPOSE: To evaluate the effects of sodium hyaluronate drops on dry eye parameters and corneal epithelial thickness following cataract surgery. METHODS: The study included 84 patients who underwent uncomplicated phacoemulsification. In Group A, 0.15% sodium hyaluronate drops were added to the postoperative antibiotic/anti-inflammatory treatment. In Group B, only antibiotic/anti-inflammatory treatment was applied. Preoperatively and at 1 week and 1 month postoperatively, all the patients were evaluated in respect of tear break-up time (TBUT), the Schirmer test under anesthesia, the corneal fluorescein staining (CFS) score, mean central corneal thickness (CCT) and mean central corneal epithelial thickness (CCET), and the two groups were compared. RESULTS: A statistically significant difference was determined between the two groups at postoperative 1 month in respect of TBUT, Schirmer test, CFS score, and CCET (p < 0.01). In Group A, a statistically significant increase was determined in the TBUT and Schirmer values at 1 month postoperatively (p < 0.01, p = 0.01, respectively) and in Group B, these values were decreased compared to preoperatively (p < 0.01). The CCET was determined to be significantly thinner in Group B 1 month postoperatively (p < 0.01). A significant increase in CCT was observed in both groups at postoperative 1 week (p < 0.01) and preoperative values were reached at 1 month postoperatively. CONCLUSION: In the patient group using sodium hyaluronate, significant differences were determined in all dry eye parameters and CCET. The use of hyaluronate sodium drops after cataract surgery was seen to improve dry eye parameters and contribute to a healthy ocular surface by ensuring continuity of the corneal epithelium.

[Rotational technique for emulsification of soft lens nucleus]. / Rotatsionnaya metodika emul'sifikatsii myagkogo yadra khrustalika.

Effective and atraumatic removal of a soft lens nucleus requires different surgical techniques compared to phacoemulsification of a dense nucleus. PURPOSE: This study was conducted to develop a non-ultrasound technique for emulsification of a soft lens nucleus. MATERIAL AND METHODS: Fifty-seven patients (57 eyes) underwent surgery. In 23 cases, early or immature cataracts were detected, and in 34 cases, lens removal was performed for refractive purposes in high myopia and complex myopic astigmatism. Phacoemulsifier Centurion Vision System (Alcon Laboratories, Inc., USA) was used for the surgery. Aspiration of soft lens nucleus was done using a rotational technique. The following aspects were evaluated in the course of the surgery: the volume of the required irrigation solution, and the frequency needing to involve ultrasound for complete emulsification of the lens nucleus. Intraoperative and postoperative complications were also assessed. RESULTS: The surgery was uneventful in all cases. There were no violations of the integrity of capsulorhexis edge. The need for short pulses of minimal power ultrasound during the removal of the soft lens using this technique arose only in 11 (19.3%) cases. The effective ultrasound time was less than 1 second. The required volume of irrigation solution was 33.0 (24.0; 43.0) ml, which does not differ significantly from that in ultrasonic phacoemulsification. CONCLUSIONS: The use of modern phacoemulsifiers providing a high vacuum level allows successful removal of a soft lens without using ultrasound, which prevents its negative impact on the ocular tissues. The use of adequate surgical techniques, including the optimal direction of rotation of the lens nucleus in the rotational technique, improves the efficiency of soft lens nucleus removal.

[Influence of the pattern of femtosecond laser-assisted lens nucleus fragmentation on the energy and hydrodynamic parameters of phacoemulsification]. / Vliyanie patterna fragmentatsii yadra khrustalika femtosekundnym lazerom na energeticheskie i gidrodinamicheskie parametry fakoemul'sifikatsii.

The influence of various patterns of preliminary femtosecond laser-assisted fragmentation of the lens nucleus on the energy and hydrodynamic parameters of phacoemulsification remains insufficiently studied. PURPOSE: This study evaluates the influence of various patterns of preliminary femtosecond laser-assisted fragmentation of the lens nucleus on the energy, hydrodynamic parameters of phacoemulsification, and the degree of corneal endothelial cell loss. MATERIAL AND METHODS: Hybrid phacoemulsification was performed in 336 patients (336 eyes) with grade IV immature cataract according to the Buratto classification in three age-matched groups. Group 1 included 103 patients (103 eyes) who underwent hybrid phacoemulsification with preliminary femtosecond laser-assisted fragmentation of the nucleus with a «pizza¼ pattern (division of the nucleus with 10 radial cuts). Group 2 included 112 patients (112 eyes) who underwent femtosecond laser-assisted fragmentation of the nucleus with a «cylinders¼ pattern (division of the nucleus with 8 radial cuts in combination with 5 circular cuts). Group 3 included 121 patients (121 eyes) who underwent femtosecond laser-assisted fragmentation of the nucleus with a «grid¼ pattern (division of the nucleus with 8 radial cuts in combination with multiple mutually perpendicular cuts in the central zone in the form of a grid with a 0.5 mm cell). Effective ultrasound time and the volume of irrigation solution for emulsification of the lens nucleus fragments were determined during the operation. The loss of corneal endothelial cells was assessed 3 months after surgery. RESULTS: The minimum effective ultrasound time was noted after using the "grid" pattern - 4.05 (2.88; 4.74) s, which was significantly less than with the "cylinders" pattern - 4.97 (3.78; 5.88) s and the "pizza" pattern - 6.15 (4.52; 7.75) s (p<0.05). The effective ultrasound time when using the "cylinders" pattern was significantly less than with the "pizza" pattern (p<0.05). The volume of irrigation solution used for emulsification of the lens nucleus fragments was significantly less in the "grid" pattern - 41.5 (33.5; 49.5) ml compared to the "cylinders" patterns 58.5 (51.0; 66.0), p<0.05 and "pizza" pattern 75.0 (66.0; 83.5), p<0.01. The volume of irrigation solution when using the "cylinders" pattern was significantly less than when using the "pizza" pattern (p<0.05). The loss of corneal endothelial cells after using the "grid" pattern was 8.82 (7.59; 9.87)%, which was significantly less than after the "cylinders" patterns - 9.97 (8.81; 10.83)%, p<0.05 and "pizza" - 11.70 (10.62; 12.97)%, p<0.05. At the same time, the loss of endothelial cells after using the "cylinders" pattern was significantly less than after the "pizza" pattern (p<0.05). CONCLUSIONS: The choice of the optimal pattern of preliminary femtosecond laser-assisted fragmentation of the lens nucleus provides a significant decrease in the energy and hydrodynamic parameters of phacoemulsification and, accordingly, the loss of corneal endothelial cells.

[Surgical technique for aspiration of soft lens nucleus with preoperative femtosecond laser-assisted fragmentation]. / Khirurgicheskaya tekhnika aspiratsii myagkogo yadra khrustalika s predvaritel'noi femtolazernoi fragmentatsiei.

Fragmentation and aspiration of soft cataracts require different surgical techniques and approaches compared to the removal of dense nuclei, including when using a femtosecond laser. PURPOSE: This study was conducted to develop a non-ultrasound technique for aspiration of a soft lens nucleus after its preliminary femtosecond laser-assisted fragmentation. MATERIAL AND METHODS: The study included 63 patients (63 eyes) aged 23 to 40 years who underwent surgery. In 27 cases, early or immature cataract was observed, and in 36 cases, cataract removal was performed for refractive purposes in high myopia and complex myopic astigmatism. The VICTUS femtosecond laser surgical system (Technolas Perfect Vision GmbH, Germany) was used for preliminary fragmentation of the lens nucleus. Surgeries were performed using the Centurion Vision System phacoemulsifier (Alcon Laboratories, Inc., USA). The volume of the required irrigation solution was evaluated during the surgery. Intraoperative and postoperative complications were assessed. RESULTS: The surgery was performed without complications in all cases. Capsulorhexis edge was completely preserved along its entire circumference. The study showed the fundamental possibility of aspirating a cataract with a nucleus of grade I-II density without low-frequency ultrasound after preliminary femtosecond laser-assisted fragmentation of the nucleus with a "grid" pattern, which ensures minimal fragment size in the central zone of the nucleus. The volume of irrigation solution required for aspiration of the nucleus was 36.0 (27.0; 44.0) ml, which does not significantly differ from the volume of solution during ultrasound phacoemulsification of a nucleus of such density. CONCLUSIONS: Femtosecond laser-assisted fragmentation of the lens nucleus with a "grid" pattern and phacoemulsifier systems with a high vacuum level allow effective aspiration of a soft lens without using low-frequency ultrasound.

An analysis of the factors involved in IOL decentration after phacoemulsification using CASIA 2 anterior segment optical coherence tomography.

PURPOSE: To evaluate the magnitude of IOL transversal shift (ITS) after phacoemulsification and to analyse the factors contributing to IOL decentration and ITS. METHODS: 94 consecutive patients who underwent cataract surgery and IOL implantation was enrolled. Each patient underwent anterior segment optical coherence tomography with CASIA 2 (Tomey, Nagoya, Japan) to assess crystalline lens decentration, thickness and diameter seven days preoperatively and at one and sixty days postoperatively. Univariate and multivariate linear regression analysis were performed to evaluate the determinants of ITS and final decentration. RESULTS: The preoperative crystalline lens diameter was associated with the ITS and with the IOL final decentration. A positive association between the final IOL decentration and the first post-surgical day decentration was found (p < 0.0001). CONCLUSION: Greater crystalline lens diameter was associated with greater decentration and with greater ITS. Day-one IOL decentration seems to be the main determinant of final IOL decentration.

Risk factors for corneal endothelial cell loss after phacoemulsification.

PURPOSE: The purpose of this study was to evaluate the changes in corneal endothelial cell density (CECD) occurring after cataract phacoemulsification surgery and identify factors associated with cell loss. MATERIALS AND METHODS: This was a retrospective study involving patients who underwent cataract phacoemulsification surgery between January 1, 2018, and December 31, 2018, at two private hospitals. Demographic data and biometric parameters were obtained preoperatively. Ultrasound metrics were recorded for each operation, including total on time (TOT), total equivalent power in position 3, and cumulative dissipated energy (CDE). Using corneal specular microscopy, CECD was measured preoperatively and postoperatively at 12, 24, and 36 months. Factors associated with decreased CECD were identified. RESULTS: This study included 223 eyes of 133 patients. The mean CECD was 2530.03 ± 285.42 cells/mm2 preoperatively and significantly decreased to 2364.22 ± 386.98 cells/mm2 at 12 months (P < 0.001), 2292.32 ± 319.72 cells/mm2 at 24 months (P < 0.001), and 2242.85 ± 363.65 cells/mm2 at 36 months (P < 0.001). The amount of cell loss was associated with age, gender, preoperative CECD, preoperative anterior chamber depth, lens thickness, TOT, and CDE. Using multivariate analysis, age, preoperative CECD, and TOT were identified as independent predictors for CECD loss 12 months after surgery. CONCLUSION: The greatest decrease in CECD occurred during the first year after cataract surgery, and the amount of cell loss was influenced by both baseline patient characteristics and ultrasound metrics. Longer-term prospective studies in a larger cohort may yield more information.

Clinical efficacy of femtosecond laser-assisted phacoemulsification in diabetic cataract patients.

BACKGROUND: Diabetic patients with cataracts encounter specific difficulties during cataract surgery due to alterations in microcirculation, blood supply, metabolism, and the microenvironment. Traditional phacoemulsification may not fully tackle these issues, especially in instances with substantial preoperative astigmatism. The utilization of femtosecond laser-assisted phacoemulsification, in conjunction with Toric intraocular lens (IOL) implantation, offers a potentially more efficient strategy. This research seeks to evaluate the efficacy and possible complications of this approach in diabetic cataract patients. AIM: To investigate the clinical efficacy and complications of femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation in diabetic cataract patients, comparing it with traditional phacoemulsification methods. METHODS: This retrospective study enrolled 120 patients with diabetes cataract from May 2019 to May 2021. The patients were divided into two groups: the control group underwent traditional phacoemulsification and Toric IOL implantation, while the treatment group received Len Sx femtosecond laser-assisted treatment. Outcome measures included naked eye vision, astigmatism, high-level ocular phase difference detection, clinical efficacy, and complication. RESULTS: There were no significant preoperative differences in astigmatism or naked eyesight between the two groups. However, postoperative improvements were observed in both groups, with the treatment group showing greater enhancements in naked eye vision and astigmatism six months after the procedure. High-level corneal phase difference tests also indicated significant differences in favor of the treatment group. CONCLUSION: This study suggests that femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation appears to be more effective in enhancing postoperative vision in diabetic cataract patients compared to traditional methods offering valuable insights for clinical practice.

Trocar blade-assisted skewer technique for phacoemulsification of a dislocated lens.

A posteriorly dislocated lens is often managed with a fragmatome through a pars plana approach because it is difficult to manage anteriorly. The lens often sinks to the surface of the retina or floats around in the vitreous cavity during pars plana lensectomy. Mechanical trauma can occur while removing the dislocated lens fragments. However, sometimes the lens can be confined to the anterior vitreous cavity even though the zonules are completely disrupted. It would be ideal if there was a simple way to stabilize and support the lens so that the lens could remain in the posterior chamber while phacoemulsification is performed through a corneal incision as usual. We describe a technique using a trocar blade to stabilize the lens while performing phacoemulsification through a corneal incision. We found it to be a useful and safe instrument to support the subluxated lens during phacoemulsification.

Trypan Blue and Endoillumination-Assisted Phacoemulsification in a Patient With Advanced Keratoglobus.

Keratoglobus is a rare subset of noninflammatory corneal ectasia, which is a group of disorders characterized by corneal thinning, projection, and scarring. Patients with keratoglobus commonly present with poor vision. A case of advanced keratoglobus was managed by a modified phacoemulsification surgical technique using endoillumination and capsular staining with trypan blue. In this case, we present a 54-year-old man with keratoglobus. In January 2023, a modified phacoemulsification surgical technique using endoillumination was described with a video in a patient with bilateral corneal opacification, neovascularization, significant peripheral thinning, and moderate to severe corneal opacity in which cataract surgery had to be performed alone without considering penetrating keratoplasty. Postoperatively, the patient was doing well with no leaks. We may conclude that this method allows for better visualization during surgery and decreases the risk of intraoperative complications due to poor visualization in patients with severe corneal opacity.

Evaluation of changes of anterior segment parameters in patients with pseudoexfoliation syndrome after cataract surgery using anterior segment optical coherence tomography.

The aim of the study was to compare the anterior segment parameters after cataract surgery in pseudoexfoliation syndrome (PEX) and control eyes. We conducted a prospective comparative study of 36 eyes (PEX group), 16 eyes (PEXG group) and 46 eyes (control group) of 98 patients after phacoemulsification with intraocular lens implantation. Before surgery, 1 week, 1 month and 3 months postoperatively, anterior chamber parameters were evaluated by swept source anterior segment optical coherence tomography (AS-OCT). Anterior chamber depth (ACD), angle opening distance (AOD500/750), trabecular-iris space area (TISA500/750), trabecular-iris angle (TIA500/750) and lens vault (LV) were assessed at each study visit. Preoperatively, ACD, AOD500/750 and TISA500/750 were significantly smaller, while LV was significantly greater in PEX and PEXG eyes than in controls. 3 months postoperatively all irido-corneal parameters and ACD were significantly greater in all study groups without intergroup differences. ACD and LV significantly increased in PEX group between 1 and 3 months after surgery while being stable in control group. Relative increases in ACD, AOD500, TISA750, TIA500/750 were significantly higher in PEX and PEXG groups than in controls. Our study finds that ACD and iridocorneal parameters in AS-OCT demonstrated significantly greater relative increases 3 months after phacoemulsification in PEX and PEXG groups than in control eyes. Significantly greater deepening of anterior chamber and opening of the irido-corneal angle may be a reason for different refractive outcomes and IOP control in patients with PEX and PEXG after routine cataract surgery.

Comparing outcomes of tube versus trabeculectomy among patients with angle-closure glaucoma.

PURPOSE: Compare outcomes of tube shunt surgery (Tube) and trabeculectomy with Mitomycin C (Trab-MMC) in patients with angle-closure glaucoma (ACG). DESIGN: Retrospective, nonrandomized comparative study. SUBJECTS: A total of 80 eyes from 80 patients with ACG who underwent either Tube (N = 50) or Trab-MMC (N = 30) between January 2015 and January 2022 at Massachusetts Eye and Ear. METHODS: Reviewed and analyzed 390 visits from patient charts. MAIN OUTCOME MEASURES: Kaplan-Meier (KM) success rates, Intraocular pressure (IOP), medication burden, best-corrected visual acuity (BCVA), adjusted hazard ratios (HRs), and complications. RESULTS: Baseline demographics were similar between both groups, except for a higher proportion of patients with pseudophakia and prior incisional ocular surgery in the Tube group. The Trab-MMC procedure had significantly higher Kaplan-Meier complete success (CS) rates than the Tube procedure, but similar qualified success (QS) rates. Under QS, the cumulative probability of survival was 87% in the Tube group and 83% in the Trab-MMC group at year 1 (P=0.77), and 75% in the Tube group and 58% in the Trab-MMC group at year 2 (P=0.14). Under CS, the cumulative probability of survival was 13% in the Tube group and 59% in the Trab-MMC group at year 1 (P<0.001), and 11% in the Tube group and 41% in the Trab-MMC group at year 2 (P<0.001). Both Tube and Trab-MMC procedures resulted in significant patterns of IOP and medication reduction from baseline up to 2 years with mean IOP reduced to 12.6 ± 5.9 mmHg on 2.8 ± 1.4 medications after Tube, and 12.1 ± 6.6 mmHg on 2.4 ± 1.7 medications after Trab-MMC. Patients who underwent Trab-MMC required less IOP-lowering medications at every follow-up visit up to year 1, but a similar number at year 2. No significant differences were found in IOP reduction, BCVA, or complication rates between groups." CONCLUSION: We demonstrate that Trab-MMC confers similar IOP reduction and QS rates to Tube placement in ACG patients. Trab-MMC, however, demonstrated greater medication burden reduction up to 1 year, and more favorable CS rates up to 2 years, while still maintaining similar complication rates to Tube.

Ethnic Differences in the Rates of Posterior Capsule Rupture and Long-Term Sequelae in Phacoemulsification Cataract Surgery.

Purpose The purpose of this study is to investigate the rates of posterior capsular rupture (PCR) and its sequelae during phacoemulsification across different ethnicities. Methods This is a retrospective cohort study of all consecutive phacoemulsification cases complicated by PCR that met the inclusion criteria over a four-year period at a single tertiary eye centre in the United Kingdom (UK). Results PCR occurred in 0.85% of cases overall (157/18,481). PCR rates were 1.8% (26/1485), 1.2% (51/4350), and 0.7% (75/10,927) in African-Caribbean, Indian subcontinent, and Caucasian patients, respectively (p < 0.001). Mean final corrected distance visual acuity improved (p < 0.05) in all ethnic groups (0.40 ± 0.57 logMAR) compared to pre-op (0.78 ± 0.61 logMAR). Post-operative cystoid macular oedema and unstable intraocular pressure rates following PCR did not statistically differ amongst ethnicities (p = 0.37 and p = 0.75, respectively). However, post-operative uveitis rates significantly differed at 11.5%, 15.7%, and 1.3% amongst the three ethnic groups, respectively (p = 0.01). Conclusion This is the first study to highlight a possible link between patient ethnicity and the risk of PCR during phacoemulsification cataract surgery. We observed significantly greater numbers of PCR cases amongst certain ethnic groups (highest in African-Caribbean eyes, then Indian subcontinental eyes, and lowest in Caucasian eyes) within the same multi-cultural urban population. Ethnicity may therefore be a contributing factor for PCR and should potentially be taken into consideration during preoperative risk stratification.

Phacoemulsification Combined with Pars Plana Vitrectomy: Outcome in Horses with Acquired Cataracts Associated with Uveitis.

BACKGROUND: Cataracts resulting from equine recurrent uveitis (ERU) or other forms of uveitis are usually associated with rapid progression. ERU is the most common ocular disease cause of blindness and cause of cataracts in horses. The necessity for the posterior capsulorhexis (PC) during phacoemulsification (PE) is controversial. This study aimed to evaluate vision and complications after PE combined with pars plana vitrectomy (PPV) in horses with uveitis-associated cataracts and compare the PE technique with and without posterior capsulorhexis. METHODS: Thirty-two eyes of 28 horses with uveitis-associated cataracts aged 14 months to 19.6 years were treated with PE-PPV under identical conditions. Twenty-three eyes of 21 horses were affected by an ERU-associated (ERU group), and nine eyes of 7 horses were affected by cataracts related to uveitis with pathogenesis different to ERU (non-ERU group). PE-PPV was performed in 12 eyes of 10 horses (PC group) and 20 eyes of 18 horses without posterior capsulorhexis (NPC group). Follow-up examination was performed at a mean of 1.7 ± 1.8 years postoperatively (range: 1 month-6.4 years). RESULTS: In the period up to 1 month postoperatively, 17/20 (85%) NPC-eyes and 8/12 (67%) PC-eyes (total: 25/32 [78%]) were visual. From 1-6 months postoperatively, 16/20 (80%) NPC-eyes and 7/12 (58.3%) PC-eyes (total: 23/32 [72%]), and from 6-12 months, 7/11 (63.6%) NPC-eyes and 3/8 (37.5%) PC-eyes (total: 10/19 [52.6%]) were visual. From 12-18 months postoperatively, 3/7 (42.9%) NPC-eyes and 2/9 (22.2%) PC-eyes (total: 5/16 [31.3%]), and from 18-24 months, 3/8 (37.5%) NPC-eyes and 1/8 (12.5%) PC-eyes (total: 4/16 [25%]) were visual. After 24 months postoperatively, 2/7 (28.6%) NPC-eyes and 1/8 (12.5%) PC-eyes (total: 3/15 [20%]) were visual. Despite the higher number of visual eyes in the NPC group at each time point, differences were not significant. No obvious differences regarding postsurgical vision were observed between the ERU- and non-ERU groups at each time point. In the overall population, a significant decrease in the number of eyes with postoperative active uveitis was observed during the follow-up examinations (p < 0.001). A significant increase in the number of eyes that were blind due to retinal detachment was observed in the overall patient population as the examination period progressed (p < 0.001). Retinal detachment was the sole long-term cause of blindness. CONCLUSIONS: In horses diagnosed with uveitis-associated cataracts and treated with PE-PPV, no persistent active uveitis was observed in the present study during follow-up examinations. However, the proportion of eyes that were blind due to retinal detachment increased. Whilst PE-PPV may prevent postsurgical persistent active uveitis and remove lens opacity, the prognosis for a visual outcome is guarded. A superior outcome in postsurgical vision was observed in the NPC group. However, caution is required when interpreting these results due to several factors that affect the independent comparison of the surgical groups.