Immediate sequential bilateral cataract surgery (ISBCS): A single-site experience of 41 patients during the COVID-19 pandemic.

Background: The practice of immediate sequential bilateral cataract surgery (ISBCS) was more widely adopted in the UK during the COVID-19 pandemic, in response to limited surgical capacity and the risk of nosocomial infection. This study reports on a single site experience of ISBCS in Northern Ireland. Methods: Data was collected prospectively between 17th November 2020 and 30th November 2021. The ISBCS surgical protocol, recommended by RCOphth and UKISCRS, was followed. Primary outcomes measures were: postoperative visual acuity (VA), refractive prediction accuracy, intraoperative and postoperative complications. Results: Of 41 patients scheduled, 39 patients completed ISBCS and two patients underwent unilateral surgery (n=80 eyes). Mean age at the time of surgery was 71.6 years (standard deviation (SD) ±11.8 years). Median preoperative VA was 0.8 logMAR (range: PL to 0.2 logMAR). Seventeen (20.9%) eyes were highly myopic and 9 (11.1%) eyes were highly hypermetropic. Median cumulative dissipated phacoemulsification energy was 15.7 sec (range: 1.8 sec to 83.4 sec). Median case time was 10.4 min (range: 4.3 min to 37.1 min).One eye (1.3%) developed iritis secondary to a retained tiny cortical fragment. Four eyes (5.0%, n=3 patients) developed cystoid macular oedema, with full resolution. On wide field imaging, an asymptomatic unilateral peripheral suprachoroidal haemorrhage was noted in two highly myopic patients (axial lengths of 27.01mm and 25.05mm respectively). The posterior pole was spared, and both resolved spontaneously without any visual impairment. Conclusions: In our initial experience, ISBCS was found to be a safe approach to cataract surgery. Our patient cohort included eyes with dense cataracts and high ametropia. Further studies are required to assess patient reported outcome measures and the possible economic benefits of ISBCS in our local population.

Intraoperative Performance and Early Postoperative Outcomes Following Phacoemulsification With Three Fluidic Systems: A Randomized Trial.

PURPOSE: To compare intraoperative performance and early postoperative outcomes following phacoemulsification with two systems using active fluidics and one using gravity-based fluidics. METHODS: In this prospective randomized trial, 200 eyes were randomized to the traditional and Active Sentry groups (n = 80 eyes each) where the Centurion Vision System was used with traditional or Active Sentry (Alcon Laboratories, Inc) hand-pieces, respectively, or the Infinit group (n = 40 eyes) where the Infiniti Vision System (Alcon Laboratories, Inc) was used. Within the traditional and Active Sentry groups, there were two subgroups with low (30 mm Hg) or high (55 mm Hg) intraocular pressure (IOP) used. Outcome measures compared were: cumulative dissipated energy (CDE), percentage change in central corneal thickness (CCT) at 1 day, 1 week, and 1 month, anterior chamber cells at 1 day and 1 week, rate of rise and fall of IOP following occlusion break, corneal endothelial cell density (ECD), and macular thickness 6 months postoperatively. RESULTS: CDE was significantly lower in group II compared to the traditional group (2.96 ± 1.4 vs 4.14 ± 2.2, P = .001). With 30 mm Hg IOP, the Active Sentry group had significantly less percentage change in CCT at 1 week postoperatively compared to the traditional handpiece group (0.01% vs 0.02%, P = .008). Incidence of anterior chamber cells less than grade 2 on day 1 was significantly higher in the Active Sentry group (82.9% vs 52%, P = .03). Percentage change in ECD was significantly lower in the Active Sentry group (-0.957 vs -0.98%, P = .005). Significantly faster rise of IOP to baseline following occlusion break was seen in the Active Sentry group. CONCLUSIONS: The use of Active Sentry handpiece was associated with lower CDE, less postoperative increase in CCT, fewer anterior chamber cells, and faster rise of IOP following occlusion break. [J Refract Surg. 2024;40(5):e304-e312.].

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.

Lens subluxation combined with parry-romberg syndrome: case report.

BACKGROUND: Parry-Romberg syndrome (PRS) is a rare progressive degenerative disorder of unknown etiology. Here we report a rare case of PRS combined with lens subluxation in Eye and ENT hospital of Fudan University, Shanghai. To our knowledge, it is the first reported case of PRS combined with lens subluxation that has been managed surgically with phacoemulsification and CTR placement and IOL implantation in Shanghai. CASE PRESENTATION: A 60-year-old woman was referred for "right visual blur for 2 years" and had persistent right facial paralysis of unknown etiology since the age 12. She had right facial muscle atrophy and paralysis. Eye examination also showed the right eyelid pseudoptosis, enophthalmos, age-related cataract combined with lens subluxation existed in the right eye. The patient was diagnosed as age-related cataract and lens subluxation in the right eye and progressive hemifacial atrophy (Parry-Romberg syndrome). We conducted a combined phacoemulsification, IOL and CTR implantation and pupilloplasty surgery for the patient under general anesthesia and the postoperative UCVA was 20/30 and remained for 1 year's follow up. CONCLUSIONS: Here we reported a rare case of PHA combined with lens subluxation in China. After appropriate eye surgery, the patient achieved satisfying vision result in the right eye.

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

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

[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.

Endocyclotamponade with pars plana vitrectomy for management of post-traumatic tractional cyclodialysis cleft.

A female in her 20s presented with a diminution of vision in the right eye (RE) following an open globe injury (scleral penetration) and repair a year back. At the presentation, she had low intraocular pressure (IOP) of 7 mm Hg, posterior subcapsular cataract (PSC), retrolental vitreous bands incarcerated at the penetration site, disc oedema, tortuous vessels and choroidal folds. Inferotemporal and superonasal cyclodialysis clefts were detected on CASIA 2 optical coherence tomography (OCT). The diagnosis of RE repaired scleral penetration, PSC and cyclodialysis cleft with hypotony maculopathy was made. The case was managed by phacoemulsification with an intraocular lens in the bag and a capsular tension ring in the sulcus, as a tamponading agent to close the cleft. Intraoperatively on endoscopic visualisation, vitreous membrane was noticed encasing the ciliary processes causing a tractional cyclodialysis and hence single port 23G pars plana vitrectomy was performed to relieve the traction. Postsurgery, IOP was 14 mm Hg, and the repaired cleft was visualised on anterior segment OCT.

Intraoperative quantitative crystalline lens nuclear opacities analysis based on crystalline lenSx platform.

PURPOSE: The main objective is to quantify the lens nuclear opacity using spectral-domain optical coherence tomography (SD-OCT) and to evaluate its association with Lens Opacities Classification System III (LOCS-III) system, lens thickness (LT), and surgical parameters. The secondary objective is to assess the diagnostic model performance for hard nuclear cataract. METHODS: This study included 70 eyes of 57 adults with cataract, with 49 (70%) and 21 (30%) in training and validation cohort, respectively. Correlations of the average nuclear density (AND) /maximum nuclear density (MND) with LOCS-III scores, LT, and surgical parameters were analyzed. Univariate and multivariate logistic regression analysis, receiver operating characteristic curves and calibration curves were performed for the diagnostic of hard nuclear cataract. RESULTS: The pre-operative uncorrected distance visual acuity (UDVA), intraocular pressure (IOP), mean axial length (AL), and LT were 1.20 ± 0.47 log MAR, 15.50 ± 2.87 mmHg, 27.34 ± 3.77 mm and 4.32 ± 0.45 mm, respectively. The average nuclear opalescence (NO) and nuclear colour (NC) scores were 3.61 ± 0.94 and 3.50 ± 0.91 (ranging from 1.00 to 6.90), respectively. The average AND and MND were 137.94 ± 17.01 and 230.01 ± 8.91, respectively. NC and NO scores both significantly correlated with the AND (rNC = 0.733, p = 0.000; rNO = 0.755, p = 0.000) and MND (rNC = 0.643, p = 0.000; rNO = 0.634, p = 0.000). In the training cohort, the area under the curve (AUC) of the model was 0.769 (P < 0.001, 95%CI 0.620-0.919), which had a good degree of differentiation (Fig. 2a). The calibration curve showed good agreement between predicted and actual probability. CONCLUSION: The nuclear density measurement on SD-OCT images can serve as an objective and reliable indicator for quantifying nuclear density.

Air bubble guide for adequacy of ophthalmic viscosurgical device during phacoemulsification.

Phacoemulsification in hard cataracts is a challenge. The use of dispersive ophthalmic viscosurgical devices (OVDs) to protect the endothelium is a routine step in such scenarios. However, as OVD is transparent, it is difficult to spot within the anterior chamber. Therefore, surgeons may not be aware when the OVD coating of the endothelium disappears during surgery. Consequently, there may be too frequent OVD injections, resulting in a waste of resources. On the contrary, the surgeon may fail to inject OVD at an appropriate time, leading to greater endothelial damage. We propose a novel technique of using an air bubble as a guide that helps in identifying the time when OVD disappears from the anterior chamber, thereby suggesting the surgeon to reinject before proceeding further.

[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.

Comparative efficacy and safety of all kinds of intraocular lenses in presbyopia-correcting cataract surgery: a systematic review and meta-analysis.

PURPOSE: To assess the efficacy and safety of various intraocular lenses (IOLs), including standard monofocal, bifocal, trifocal, extended depth of focus (EDOF), and enhanced monofocal IOLs, post-cataract surgery through a network meta-analysis. METHODS: A systematic search of PubMed, Cochrane Library, and Web of Science was conducted to identify relevant studies from the past 5 years. Parameters such as binocular visual acuities, spectacle independence, contrast sensitivity (CS), and optical quality were used to evaluate efficacy and safety. Data from the selected studies were analyzed using Review Manager 5.4 and STATA 17.0 software. RESULTS: Twenty-eight Randomized Controlled Trials (RCTs) comprising 2465 subjects were included. Trifocal IOLs exhibited superior uncorrected near visual acuity (UNVA) compared to monofocal IOLs (MD: -0.35; 95% CI: -0.48, -0.22). Both trifocal (AcrySof IQ PanOptix IOLs group MD: -0.13; 95% CI: -0.21, -0.06) and EDOF IOLs (MD: -0.13; 95% CI: -0.17, -0.09) showed better uncorrected intermediate visual acuity (UIVA) than monofocal IOLs. Trifocal IOLs ranked highest in spectacle independence at various distances (AT LISAtri 839MP group: SUCRA 97.5% for distance, 80.7% for intermediate; AcrySof IQ PanOptix group: SUCRA 83.0% for near). CONCLUSIONS: For cataract patients who want to treat presbyopia, trifocal IOLs demonstrated better visual acuity and spectacle independence at near distances. Different types of trifocal IOL characteristics differ. EDOF and enhanced monofocal IOLs have improved visual quality at intermediate distances.Therefore, It is very important to select the appropriate IOLs based on the lens characteristics and patient needs.

Comparatively analysing the postoperative optical performance of different intraocular lenses: a prospective observational study.

BACKGROUND: Postoperative performance, including best corrected distance visual acuity (BCDVA) and optical metrics (from the OQAS and iTrace devices), was compared among 4 different intraocular lenses (IOLs). METHODS: This prospective observational study included 104 eyes from 104 subjects who underwent cataract surgery combined with implantation of 4 different IOLs: monofocal (Mon) IOLs, segmental refractive (SegRef) IOLs, diffractive (Dif) IOLs and extended depth of focus (EDoF) IOLs. Postoperative BCDVA and optical metrics were collected at the 6th month. The OQAS optical metrics included the objective scattering index (OSI), Strehl ratio (SR), modulation transfer function (MTF) cut-off frequency, and predicted visual acuity (PVA); the iTrace optical metrics included blur/double vision, glare/halo, starburst, mixed focus, night myopia, and night hyperopia. RESULTS: There was no significant difference in BCDVA among the 4 groups (P = 0.059; power = 70.3%). Differences were observed in all OQAS optical metrics among the groups (all P < 0.001). Overall, Mon IOLs and EDoF IOLs exhibited better performance than Dif IOLs and SegRef IOLs. Starburst was the only iTrace optical metric that differed among the groups (P < 0.001): SegRef IOLs caused more starbursts than Mon IOLs (P = 0.001), Dif IOLs (P = 0.006) and EDoF IOLs (P < 0.001). Spearman rank correlation analysis was used to determine the relationships among the iTrace optical metrics, OQAS optical metrics and BCDVA: starburst was negatively correlated with BCDVA, PVA at contrasts of 100% and 20%, OSI, and MTF cut-off frequency (all P ≤ 0.001); mixed focus was positively correlated with BCDVA, PVA at contrasts of 100% and 20%, OSI, and MTF cut-off frequency (all P ≤ 0.001). CONCLUSIONS: Postoperative BCDVA and optical metrics varied among the different IOLs, which should be taken into account in the selection and management of IOLs for cataract patients. TRIAL REGISTRATION: This study was approved by the First Affiliated Hospital of Guangzhou Medical University Ethical Review Board (No. 50 2022).

Quality of vision clinical outcomes for a new fully-refractive extended depth of focus Intraocular Lens.

BACKGROUND/OBJECTIVE: To evaluate the visual performance of a purely refractive extended depth of focus (EDF) intraocular lens (IOL). SUBJECTS/METHODS: A prospective, multi-center, randomized, subject/evaluator-masked study. Subjects were bilaterally implanted with the EDF test (Model ZEN00V, N = 60) or an enhanced monofocal control (Model ICB00, N = 57) IOL. Monocular corrected distance (CDVA), intermediate (DCIVA), near acuities (DCNVA) and patient reported visual symptoms were evaluated at the 6-month visit. Monocular mesopic contrast sensitivity (CS) and depth of focus (DOF) testing were assessed at 3 months. RESULTS: CDVA (Mean ± SD) was -0.06 ± 0.08 for test and -0.05 ± 0.08 logMAR for control groups. DCIVA was 0.13 ± 0.08 for test and 0.18 ± 0.14 logMAR for control groups (p = 0.0127). DCNVA was 0.37 ± 0.10 for test and 0.43 ± 0.16 logMAR for control groups (p = 0.0137). Test lens was statistically superior for intermediate and near. Overall, 91.7% (halos), 95.0% (starbursts) and 95.0% (glare) of test lens patients reported that they did not experience, were not bothered, or were slightly bothered by specific visual symptoms, compared to 98.2%, 100% and 96.5% in the control group. The DOF range over which monocular visual acuity was 0.20 logMAR or better was -1.6 D for the test lens. Mesopic CS was comparable between both groups, falling within 0.11 log units for all measured cycles per degree with and without glare. CONCLUSION: The EDF IOL demonstrated extended range of vision and statistically superior intermediate and near performance compared to the monofocal IOL. Distance visual acuity, contrast sensitivity and dysphotopsia profile were similar to the monofocal IOL.

Tolerance to refractive error with a new extended depth of focus intraocular lens.

PURPOSE: To evaluate the tolerance to refractive errors of a new purely refractive extended depth of focus (EDF) intraocular lens (IOL) using preclinical and clinical metrics. METHODS: Preclinical evaluation included computer simulations of visual acuity (sVA) and dysphotopsia profile of different IOL designs (refractive EDF, diffractive EDF, multifocal, standard, and enhanced monofocals) using an appropriate eye model with and without ±0.50 D defocus and/or +0.75 D of astigmatism. Patients bilaterally implanted with a refractive EDF (Model ZEN00V) or an enhanced monofocal (Model ICB00) IOL from a prospective, randomized study were included. At the 6-month postoperative visit, uncorrected and corrected distance vision (UDVA and CDVA), visual symptoms, satisfaction and dependency on glasses were evaluated in a subgroup of patients with absolute residual refractive error of >0.25 D in one or both eyes. RESULTS: In the presence of defocus and astigmatism, sVA was comparable for all except the multifocal IOL design. The refractive EDF was more tolerant to myopic outcomes and maintained a monofocal-like dysphotopsia profile with defocus. Binocular logMAR UDVA was -0.03 ± 0.08 for ZEN00V and -0.02 ± 0.11 for ICB00. 100% ZEN00V and 97% ICB00 patients did not need glasses and were satisfied with their distance vision. Monocular CDVA, contrast sensitivity and visual symptoms were also similar between both groups. CONCLUSIONS: The clinical outcomes of the refractive EDF IOL demonstrated high quality distance vision and dysphotopsia comparable to a monofocal IOL, even in the presence of refractive error, thus matching the design expectations of the EDF IOL.

Evaluation of visual outcomes with toric intraocular lens implantation using digital marker during cataract surgery.

Objectives: To assess the visual improvement and mean residual astigmatism in patients who underwent cataract surgery with toric intraocular lens. METHODS: The retrospective, observational study was conducted at the Department of Ophthalmology, Aga Khan University Hospital, Karachi, and comprised data from January 1, 2018, to December 31, 2020, related to adult patients who had regular astigmatism of at least 0.75D and underwent cataract surgery with toric intraocular lens implantation using a digital marker. The patients were followed up on post-operative days 1, 7, 30, 90 and 180. Along with age, the degree of astigmatism was noted. The visual acuity was calculated pre- and post-operatively. The mean residual astigmatism was then noted for all patients post-operatively. Data was analysed using SPSS 22. RESULTS: The sample comprised 240 eyes of 177 patients; 99(55.9%) males and 78(44.1%) females. The mean age of the sample was 62.5±10.6 years. The mean unaided visual acuity improved post-operatively from 0.57±0.38 to 0.07±0.22 at 90 days. At the 30-day follow-up, mean residual astigmatism had reduced from 1.52±0.84 to 0.01±0.09 (p<0.001). The mean intraocular lens rotation from the intended axis was 0.73°±0.92° on day 30. CONCLUSIONS: Toric intraocular lens implantation using a digital marker could effectively reduce the post-operative cylinder, and improve the unaided visual acuity following cataract surgery.