Repeatability and agreement of two ocular biometers with single and dual Scheimpflug cameras in keratoconus eyes.

BACKGROUND: To evaluate the repeatability and agreement of two different ocular biometers and Scheimpflug devices in keratoconus eyes. METHODS: This prospective, comparative trial took place at the University hospital, Goethe University, Frankfurt am Main, Germany. We included eyes with keratoconus, one eye per patient, randomly selected. Measurements were taken with Galilei G6 (Ziemer, Switzerland) and Pentacam AXL (Oculus, Germany), three consecutive measurements each. Repeatability and agreement were evaluated for simulated keratometry (simK), astigmatism (simA), maximum keratometry (KMax) and its axis, total keratometry (TCP), axial length (AL), anterior chamber depth (ACD), and thinnest pachymetry (TCT). RESULTS: Both devices showed an excellent repeatability with intra class correlation (ICC) of > 0.97 for all parameters. The 95% limits of repeatability (LoR95%) and agreement (LoA95%) were narrow for all parameters. The Galilei G6 had a narrower LoAR95% for TCT (2.1 µm vs. 4.6 µm), but a wider LoR95% for KMax (0.52D vs. 1.18D). No relevant difference was found for the other parameters. Agreement between the devices was good to moderate, especially for simK and TCP. CONCLUSIONS: Both devices show excellent repeatability with narrow LoR95% and high ICC for all parameters. The only relevant difference was found for KMax and TCT in favor of Pentacam AXL and Galilei G6, respectively. Agreement was good to moderate, and most parameters should not be considered interchangeable.

IOL calculation using six formulas in children undergoing lens extraction and primary IOL implantation with and without posterior optic capture.

PURPOSE: To evaluate formulas for intraocular lens (IOL) calculation in children undergoing lens extraction and IOL implantation. METHODS: Retrospective, consecutive case series at the Department of Ophthalmology, Goethe University Frankfurt, Germany. We included eyes that received lens extraction and IOL implantation (SN60AT, Alcon, Fort Worth, TX) due to congenital or juvenile cataract. Preoperative assessments included biometry (IOLMaster 500/700, Carl Zeiss Meditec, Germany). To evaluate the measurements, we compared the mean prediction error (MPE), mean and median absolute prediction error (MAE, MedAE) of six different formulas, and number of eyes within ± 0.5, ± 1.0, ± 2.0D of target refraction. Postoperative spherical equivalent was measured by retinoscopy 4-12 weeks after surgery. RESULTS: 66 eyes matched our inclusion criteria with a mean age of 6.3 years ± 3.2. MedAE was lowest in SRK/T (0.55D ± 1.08) followed by Holladay I (0.75D ± 1.00), EVO 2.0 (0.80D ± 0.89), Barrett Universal II (BUII, 0.86D ± 1.00), Hoffer Q (0.97 D ± 0.94), and Haigis (1.10D ± 0.95). Regarding eyes within ± 0.5D SRK/T (45.5.%, 30 eyes) performed best, followed by Holladay I (36.4%, 24 eyes), EVO 2.0 and BUII (each 34.8%, 23 eyes). There was a myopic shift seen in all formulas (MPE: -0.21 to -0.90D). CONCLUSION: Using modern formulas, or even AI formulas, for IOL calculation in children's eyes does barely improve predictability of the postoperative refraction. A myopic shift can be found for all formulas. However, specific formulas like SRK/T seem to better anticipate this.

Axial length adjustment in eyes with silicone oil endotamponade reduces overestimation by a swept-source optical coherence tomography-based biometer.

BACKGROUND: To assess changes in ocular biometry of the phakic eye after pars-plana-vitrectomy (PPV) and silicone oil (SO) endotamponade in eyes with a retinal detachment. METHODS: This retrospective, consecutive case series included 72 eyes of 72 patients who underwent PPV with 5000-centistokes SO endotamponade between July 2018 and June 2023. Pseudophakic eyes and eyes with a combined phacovitrectomy were excluded. Primary endpoints were keratometry values, anterior chamber depth (ACD), lens thickness (LT), horizontal corneal diameter (HCD), and axial length (AL) measured by swept-source optical coherence tomography-based biometry (IOLMaster 700) preoperatively and six weeks postoperatively. A recently described formula was used to adjust the AL (aAL) in eyes with SO endotamponade and a theoretical intraocular lens (IOL) calculation was performed. RESULTS: The mean age was 62.1 ± 8.3 years (range: 37-85). After PPV with SO fill, there was an increase in Kmean (0.19 ± 0.51D), while ACD (0.05 ± 0.13 mm), LT (0.03 ± 0.14 mm), and HCD (0.02 ± 0.24 mm) decreased. Preoperatively, the mean AL was 25.22 ± 1.78 mm, while postoperatively the AL was overestimated by 0.12 ± 0.42 mm on average (p = 0.04). By adjusting the AL, the mean difference could be reduced to -0.002 ± 0.41 mm. The aAL resulted in a difference in the refractive outcome in eyes with an AL > 25 mm of 0.34 ± 0.10D in the IOL calculation. CONCLUSIONS: While changes in biometry after PPV with SO endotamponade in the anterior segment are clinically less relevant, a considerable overestimation of AL with IOLMaster 700 was found. We recommend the use of a recently introduced formula for adjusting AL in eyes with SO, allowing overestimation to be minimised considerably.

Five-year follow-up of a posterior chamber phakic intraocular lens with a central hole for correction of myopia.

PURPOSE: To evaluate intermediate and long-term visual outcomes and safety of a phakic intraocular posterior chamber lens with a central hole (ICL V4c) for myopic eyes. METHODS: Retrospective, consecutive case study of patients that uneventfully received a ICL V4c for myopia correction, with a 5-year postoperative follow-up. Department of Ophthalmology, Goethe University Frankfurt, Germany. RESULTS: From 241 eyes that underwent ICL implantation, we included 45 eyes with a mean age at surgery of 33 years ± 6 (18-48 years), with a 5 years follow-up. CDVA improved from 0.05logMAR ± 0.15 CDVA preoperatively to - 0.00 ± 0,07 at 5 years and did not change significantly from 3 to 5 years' time (p = 0.266). The mean spherical equivalent (SE) improved from -10.13D ± 3.39 to - 0.45D ± 0.69. The change in endothelial cell count showed a mean decrease of 1.9% per year throughout the follow-up. Safety and efficacy index were 1.16 and 0.78, respectively. Cataract formation was seen in 2 of 241 eyes (0.8%), but in none of the 45 eyes that finished the 5-year follow-up. CONCLUSIONS: Our data show a good intermediate and long-term stability, efficiency, and safety of ICL V4c phakic lenses in myopic eyes comparable to other known literature.

[Peri-/postoperative Antiinflammation Therapy after Cataract and Refractive Surgery]. / Peri-/Postoperative antientzündliche Therapie nach Kataraktoperation und refraktiver Chirurgie.

Cataract surgery is the most frequently performed surgery worldwide, and refractive surgery is gaining more and more popularity. Although they are rare, some possible complications of these procedures remain relevant for surgeons and patients. Macular edema in cataract surgery and sterile infections of the cornea after refractive corneal surgery can lower the visual outcome significantly. Such complications can occur due to activation of inflammation cascades as a result of local tissue manipulation during the surgery. Even though the incidence is very low, there are affected patients as a result of the high number of performed surgeries. Therefore, lowering those numbers with perioperative application of local eye drops is critical. Studies show a lower risk of macular edema, anterior chamber inflammation and postoperative pain in patients treated with perioperative non-steroidal anti-inflammatory drugs (NSAID). That is why a treatment with corticosteroid and NSAID drops should be prescribed. After lamellar corneal surgery, a local steroid application is recommended to lower the incidence of haze and deep lamellar keratitis (DLK).

Intraocular lens calculation using the ESCRS online calculator in pediatric eyes undergoing lens extraction.

PURPOSE: To evaluate the ESCRS online calculator for intraocular lens (IOL) calculation in children undergoing lens extraction and primary IOL implantation. SETTING: Department of Ophthalmology, Goethe-University Frankfurt, Frankfurt am Main, Germany. DESIGN: Retrospective, consecutive case series. METHODS: Eyes that received phacoemulsification and IOL implantation (Acrysof SN60AT) due to congenital or juvenile cataract were included. We compared the mean prediction error (MPE), mean and median absolute prediction error (MAE, MedAE) of formulas provided by the recently introduced online calculator provided by the ESCRS with the SRK/T formula, as well as the number of eyes within ±0.5 diopters (D), ±1.0 D, ±2.0 D of target refraction. Postoperative spherical equivalent was measured by retinoscopy 4 to 12 weeks postoperatively. RESULTS: 60 eyes from 47 patients with a mean age of 6.5 ± 3.2 years met the inclusion criteria. Mean axial length was 22.27 ± 1.19 mm. Mean preoperative spherical equivalent (SE) was -0.25 ± 3.78 D, and mean postoperative SE was 0.69 ± 1.53 D. The MedAE was lowest in the SRK/T formula (0.56 D, ± 1.03) performed significantly better ( P = .037) than Hoffer QST and Kane, followed by BUII (0.64 D, ± 0.92), Pearl DGS (0.65 D, ± 0.94), EVO (0.69 D, ± 0.94), Hoffer QST (0.75 D, ± 0.99), and Kane (0.78 D, ± 0.99). All of those were significantly above zero ( P < .001). 41 eyes received an intraoperative optic capture (68%). When excluding eyes that did not receive intraoperative optic capture (n = 19; 32%), the MedAE was shown to be lower. CONCLUSIONS: Using modern IOL calculation formulas provided by the ESCRS calculator provides good refractive predictability and compares for most of the formulas with the results with SRK/T. In addition, the formulas seem to anticipate the postoperative refraction better for eyes that receive a posterior optic capture.

Fellow eye data for intraocular lens calculation in eyes undergoing combined phacovitrectomy.

PURPOSE: To evaluate whether the intraocular lens (IOL) calculation of the fellow eye (FE) can be used in eyes undergoing combined phacovitrectomy. METHODS: In this retrospective, consecutive case series, we enrolled patients who underwent combined phacovitrectomy with silicone oil removal and IOL implantation at the Goethe-University. Preoperative examinations included biometry (IOLMaster 700; Carl Zeiss). We used the IOL calculation of the FE (FE group) to calculate the prediction error compared with the IOL calculation using only the axial length (AL) of the FE (AL-FE group), as well as using the AL of the operated eye (OE group) in addition to the measurable biometric parameters. IOL calculation was performed using the Barrett Universal II formula. We compared the mean (MAE) and median absolute prediction error (MedAE) with each other. Furthermore, the number of eyes with ±0.50, ±1.00 and ±2.00 dioptres (D) deviation from the target refraction was compared. RESULTS: In total, 79 eyes of 79 patients were included. MedAE was lowest in the OE group (0.41 D), followed by FE group (1.00 D) and AL-FE group (1.02 D). Comparison between the AL-FE and FE groups showed no statistically significant difference (p = 0.712). Comparing eyes within ±0.50 D of the target refraction, the OE group (63.3%) performed best, followed by the AL-FE group (27.8%) and the FE group (26.6%). CONCLUSION: Our results indicate no clinically relevant difference between using the IOL calculation of the FE versus using only the AL of the FE in addition to the measurable parameters for the IOL calculation. A two-step procedure should always be strived for.

Visual Outcomes and Safety of a Refractive Corneal Inlay for Presbyopia: One-Year Results.

PURPOSE: To determine the visual outcomes and safety 12 months after implantation of the Presbia Flexivue Microlens refractive corneal inlay. METHODS: In this prospective, non-randomized trial, 22 patients with a mean age of 52.54 ± 2.86 years were implanted with the Flexivue Microlens refractive corneal inlay in the non-dominant eye at the Department of Ophthalmology, Goethe University, Frankfurt, Germany. Corrected near, intermediate, and distance (CNVA, CIVA, and CDVA) visual acuity and uncorrected near, intermediate, and distance (UNVA, UIVA, and UDVA) visual acuity, manifest refraction, subjective quality of vision, endothelial cell count, and contrast sensitivity were measured 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. RESULTS: For binocular CDVA, no patient lost two or more lines and 30% lost only one line at the 12-month visit. In the eye that had surgery, 85% of the patients lost two or more lines of UDVA, which was statistically significant. Sixty-five percent of the patients gained one or more lines in binocular UIVA, and 80% achieved 20/40 or better in DCIVA. UNVA showed a statistically significant improvement, with 90% of the patients achieving 20/40 or better 12 months after implantation. A total of 85% gained two or more lines in binocular UNVA. CONCLUSIONS: This refractive corneal inlay showed an improvement in binocular UNVA, UIVA, CNVA, and CIVA, whereas binocular CDVA and UDVA were not statistically affected. [J Refract Surg. 2024;40(1):e1-e9.].

Prospective evaluation of the ESCRS online calculator for calculation of a multifocal intraocular lens.

PURPOSE: To evaluate a recently introduced ESCRS online calculator for intraocular lens (IOL) calculation of a multifocal IOL in refractive lens exchange and cataract surgery in a prospective setting. SETTING: Department of Ophthalmology, Goethe University Frankfurt, Germany. DESIGN: Prospective, consecutive case series. METHODS: Eyes that received lens extraction and multifocal IOL implantation were included. The mean prediction error, mean absolute error, and median absolute prediction error (MedAE) provided by the ESCRS online calculator were compared, as were the number of eyes within ±0.5 diopters (D), ±1.0 D, ±2.0 D of target refraction. The SRK/T formula was also included for comparison. Postoperative spherical equivalent was measured at 3 months. 1 eye per patient was included. RESULTS: 88 eyes from 88 patients with a mean age of 62 ± 9.5 years were included. The MedAE was low for all formulas and ranged from 0.26 D (Kane), Hill-RBF (0.27 D), Hoffer Q Savini/Taroni (Hoffer QST) (0.27 D), Barrett Universal II (BUII) (0.28 D), Emmetropia Verifying Optical (EVO) (0.29 D), Cooke K6 (0.27 D), 0.30 D (Postoperative spherical Equivalent prediction using Artificial intelligence and Linear algorithms, by Debellemaniére, Gatinel, and Saad [Pearl DGS]) to 0.31 D (SRK/T). No statistically significant difference was found ( P = .627). Considering the number of eyes within ±0.5 D of the calculated refraction the best performing was again the Hill-RBF (84%, 74 eyes), again followed by Kane (71, 81%), EVO, Pearl DGS, Hoffer QST, BUII (each 80%, 70 eyes), Cooke K6 (78%, 69 eyes), and SRK/T (74%). Again, no statistically significant difference was found ( P = .39). CONCLUSIONS: Using a recently introduced ESCRS online IOL calculator in multifocal IOLs leds to a high number of eyes reaching target refraction and low prediction errors. All formulas performed similarly well. Hill-RBF showed the highest number of eyes within ±0.5 D, but no significance was found.

Assessment of Visual Habituation Measured With the Halo & Glare Simulator and Its Impact on Patient Satisfaction Following Quadrifocal IOL Implantation.

PURPOSE: To evaluate the levels of habituation and its influence on outcome satisfaction in patients who underwent bilateral multifocal intraocular lens (IOL) implantation. METHODS: A total of 24 patients underwent bilateral multifocal IOL implantation surgery with the AcrySof IQ PanOptix trifocal diffractive IOL (Alcon Laboratories, Inc) following cataract extraction or for refractive purposes. Data were collected 3 and 6 months after surgery, which included subjective refraction, corrected and uncorrected visual acuity (distance, intermediate, near), a contrast sensitivity test, simulation with the Halo & Glare Simulator (Carl Zeiss Meditec AG), two visual quality surveys, and a slit-lamp examination by an ophthalmologist. RESULTS: All patients were spectacle independent for distance vision and 92% (n = 22) needed no visual aid for near vision. Minor visual acuity improvement was detected between both examinations at monocular uncorrected distance visual acuity (P = .025). Improvements of presence, size, and intensity of visual disturbances were not statistically significant, but overall patient satisfaction (P = .009) and Weber-Contrast sensitivity under mesopic conditions (P = .029) increased significantly. CONCLUSIONS: Diffractive multifocal IOLs are a stable treatment for presbyopia and/or cataract with a high spectacle independence rate. Visual disturbances caused by their optics do not decrease significantly between 3 and 6 months after surgery. Habituation and neuroadaptation play a significant role in patient satisfaction and contrast sensitivity during and possibly beyond that period. [J Refract Surg. 2023;39(8):510-517.].

Accuracy of using the axial length of the fellow eye for IOL calculation in retinal detachment eyes undergoing silicone oil removal.

PURPOSE: Evaluate whether the axial length of the fellow eye can be used to calculate the intraocular lens (IOL) in eyes with retinal detachment. DESIGN: Retrospective, consecutive case series. METHODS: Our study was conducted at the Goethe University and included patients who underwent silicone oil (SO) removal combined with phacoemulsification and IOL implantation. Preoperative examinations included biometry (IOLMaster 700, Carl Zeiss). We measured axial length (AL) of operated eye (OE) or fellow eye (FE) and compared mean prediction error and mean and median absolute prediction error (MedAE) using four formulas and AL of the OE (Barrett Universal II (BUII)-OE). Additionally, we compared the number of eyes within ±0.50, ±1.00 and ±2.00 dioptre (D) from target refraction. RESULTS: In total, 77 eyes of 77 patients met our inclusion criteria. MedAE was lowest for the BUII-OE (0.42 D) compared with Kane-FE (1.08 D), BUII-FE (1.02 D) and Radial Basis Function 3.0 (RBF3.0)-FE (1.03 D). This was highly significant (p<0.001). The same accounts for the number of eyes within ±0.50 D of the target refraction with the BUII-OE (44 eyes, 57%) outperforming the RBF3.0-FE (20 eyes, 25.9%), Kane-FE and BUII-FE formula (21 eyes, 27.2%) each. CONCLUSION: Our results show a statistically and clinically highly relevant reduction of IOL power predictability when using the AL of the FE for IOL calculation. Using the AL of the SO filled eye after initial vitrectomy results in significantly better postoperative refractive results. A two-step procedure using the AL of the OE after reattachment of the retina is highly recommended.

Postoperative vault prediction for phakic implantable collamer lens surgery: LASSO formulas.

PURPOSE: To develop and evaluate reliable formulas for predicting postoperative vault more accurately after implantable collamer lens (ICL) surgery in a White patient population with varying degrees of ametropia. SETTING: Private clinical practice. DESIGN: Retrospective analysis on dataset split into a separate training and test set. METHODS: 115 eyes of 59 patients were used to train regression models predicting postoperative vault based on anterior segment optical coherence tomography (OCT) parameters (Least Absolute Shrinkage and Selection Operator [LASSO]-OCT formula), ocular biometry data (LASSO-Biometry formula), or data from both devices (LASSO-Full formula). The performance of these models was evaluated against the manufacturer's nomogram (Online Calculation and Ordering System [OCOS]) and Nakamura 1 (NK1) and 2 (NK2) formulas on a matched separate test set of 37 eyes of 19 patients. RESULTS: The mean preoperative spherical equivalent was -5.32 ± 3.37 (range: +3.75 to -17.375 diopters). The mean absolute errors of the estimated vs achieved postoperative vault for the LASSO-Biometry, LASSO-OCT, and LASSO-Full formulas were 144.1 ± 107.9 µm, 145.6 ± 100.6 µm, and 132.0 ± 86.6 µm, respectively. These results were significantly lower compared with the OCOS, NK1, and NK2 formulas ( P < .006). Postoperative vault could be estimated within 500 µm in 97.3% (LASSO-Biometry) to 100% of cases (LASSO-OCT and LASSO-Full). CONCLUSIONS: The LASSO suite provided a set of powerful, reproducible yet convenient ICL sizing formulas with state-of-the-art performance in White patients, including those with low to moderate degrees of myopia. The calculator can be accessed at http://icl.emmetropia.be .

Corneal Lenticule Creation Using a New Solid-State Femtosecond Laser Measured by Spectral Domain OCT in a Porcine Eye Model.

Purpose: To determine the accuracy and precision of corneal lenticule creation with a new solid-state femtosecond laser in a porcine eye model. Methods: Corneal lenticule creation was performed using a new solid-state femtosecond laser on 60 porcine eyes with 10 subgroups. Optical coherence tomography images were acquired immediately after laser treatment. Cap thickness (CT), cap diameter (CD), and lenticule thickness (LT) were measured manually by three independent readers. Additionally, CT and LT were measured by an automated algorithm (aLT, aCT). Results: Measured LT was significantly greater than the intended LT (average difference 14.3 ± 5.6 µm, P < 0.001). aLT was closer but still significantly different from the intended LT (-2.9 ± 5.8 µm, P < 0.001). Measured CT showed no significant difference from the intended CT (2.6 ± 13.3, P = 0.145). aCT was significantly smaller compared to the intended CT (-9.6 ± 13.6, P < 0.001). Measured CD was significantly smaller compared to the intended CD (-0.21 ± 0.20 mm, P < 0.001). All lenticules were cut as planned with no laser-related complications. Conclusions: This new solid-state femtosecond laser used in our trial provides corneal lenticule creation in a porcine eye model comparable to other established systems. However, measuring those lenticules in the provided setting seems too challenging even when using semiautomated algorithms, which seems to be due to the experimental setting of the trial. Translational Relevance: This trial shows the precision and repeatability of corneal cuts performed by a new femtosecond laser that could translate to refractive corneal lenticule surgery.

Intraocular Lens Calculation Using 8 Formulas in Silicone Oil-Filled Eyes Undergoing Silicone Oil Removal and Phacoemulsification After Retinal Detachment.

PURPOSE: To evaluate formulas for intraocular lens (IOL) calculation in silicone oil (SO)-filled eyes. DESIGN: Retrospective, consecutive case series. METHODS: We conducted our study at the Department of Ophthalmology, Goethe University, Frankfurt, Germany, and included SO-filled eyes that received SO removal combined with phacoemulsification and IOL implantation. Preoperative assessments included biometry (IOLMaster 700; Carl Zeiss Meditec). To evaluate the measurements, we compared the mean prediction error, and mean and median absolute prediction error of 8 different formulas. RESULTS: A total of 90 eyes matched our inclusion criteria. The median absolute error was lowest in the Barrett Universal II formula (0.43 diopters [D] ± 0.75) followed by Kane (0.44 D ± 0.75), Hill-radial basis function (0.47 D ± 0.74), Holladay II (0.47 D ± 0.77), Sanders Retzlaff Kraff/theoretical (0.51 D ± 0.74), Holladay I (0.51 D ± 0.76), and Haigis and Hoffer Q (0.52 D ± 0.74 each). Regarding eyes within ±0.5 D Barrett Universal II (57.8%, 52 eyes) performed best, again followed by Kane (56.7%, 51 eyes) and Hill-radial basis function (54.4%, 49 eyes). CONCLUSION: Using modern formulas for IOL calculation in oil-filled eyes improves predictability but still not as good as in unoperated eyes. This issue is created by the change in refractive index due to the SO fill and therefore a lower precision of axial length measurement and effective lens position prediction.

Visual and patient-reported factors leading to satisfaction after implantation of diffractive extended depth-of-focus and trifocal intraocular lenses.

PURPOSE: To evaluate factors that influence postoperative satisfaction in patients with diffractive extended depth-of-focus (EDoF) and multifocal intraocular lenses (mIOLs). SETTING: Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany. DESIGN: Observational case study. METHODS: Patients were evaluated after implantation of a diffractive EDoF (Symfony, AT LARA) or trifocal/quadrifocal (AT LISAtri, Panoptix) 3 months postoperatively. A subjective refraction was performed, uncorrected and corrected visual acuities were tested for distance (UDVA, CDVA), intermediate (at 60 cm and 80 cm, UIVA, DCIVA), and near (at 40 cm, UNVA, DCNVA). A test for contrast sensitivity was performed, and the patients filled 2 different questionnaires on daily activities and optical phenomena. Parameters with a potential correlation to the postoperative overall satisfaction were investigated. RESULTS: 94 patients with a mean age of 66 ± 19 years were included. Patients with a better UDVA and UIVA at 60 cm were more likely to choose the same IOL again. The intensity of subjective optical phenomena and the visual quality at different tasks of daily living influenced overall satisfaction. UIVA at 80 cm, UNVA, and corrected visual acuity demonstrated no significant influence on patient satisfaction. The uncorrected visual acuity at specific distances had a direct impact on the subjective visual quality regarding the task performed at those distances. CONCLUSIONS: For patients with diffractive EDoF and tri-/quadrifocal IOLs, the UDVA and UIVA at 60 cm seem to be more important than the UNVA and UIVA at 80 cm. Subjective visual quality and optical phenomena influence patient satisfaction, as well.

Nondiffractive wavefront-shaping extended depth-of-focus intraocular lens: visual performance and patient-reported outcomes.

PURPOSE: To evaluate visual performance and patient-reported outcomes after bilateral implantation of a new nondiffractive wavefront-shaping extended depth-of-focus (EDoF) intraocular lens (IOL). SETTING: Department of Ophthalmology, Goethe University, Frankfurt, Germany. DESIGN: Prospective, single-arm, single-center study. METHODS: Patient population: 16 patients (32 eyes) who received bilateral implantation of a nondiffractive wavefront-shaping EDoF IOL (AcrySof IQ Vivity) were included. Target refraction in both eyes was emmetropia. Observation procedure: Monocular and binocular uncorrected (UCVA) and distance-corrected (DCVA) visual acuity (VA), refractive outcome, defocus curve, and contrast sensitivity (CS) were evaluated 3 months after surgery with a questionnaire on optical phenomena and spectacle independence. Main outcome measure: 3-month postoperative monocular and binocular UCVA and CDVA (logMAR), defocus curve, CS, and quality of vision (QoV) questionnaire results. RESULTS: 16 patients with 32 eyes were included. Mean spherical equivalent was -0.16 ± 0.37 diopters (D) 3 months postoperatively. Binocular uncorrected distance VA at distance, intermediate, and near was 0.01 ± 0.05 logMAR at 4 m, 0.05 ± 0.05 logMAR at 80 cm, 0.07 ± 0.06 logMAR at 66 cm, and 0.25 ± 0.11 logMAR at 40 cm, respectively. Despite some minor optical phenomena, 88% of patients would choose the same lens. 63% of patients reported no optical phenomena at all. CS was 1.25 ± 0.41 logCS (photopic), 0.96 ± 0.24 logCS (mesopic), and 0.93 ± 0.24 (mesopic + glare). CONCLUSIONS: This nondiffractive wavefront-shaping EDoF IOL provides good VA at far and intermediate distance and functional near VA. It showed good QoV and CS and high spectacle independence for distance and intermediate vision with significantly less optical phenomena than with other EDoF or multifocal IOLs.

Ray-tracing Calculation Using Scheimpflug Tomography of Diffractive Extended Depth of Focus IOLs Following Myopic LASIK.

PURPOSE: To evaluate a ray-tracing formula for intraocular lens (IOL) calculation of diffractive extended depth of focus IOLs after myopic laser in situ keratomileusis (LASIK) compared to formulas from an established online calculator. METHODS: This retrospective, consecutive case series included patients after cataract surgery with implantation of an extended depth of focus (EDOF) IOL (AT LARA, Carl Zeiss Meditec; Symfony, Johnson & Johnson) and a history of myopic LASIK. Preoperative assessments included biometry (IOLMaster; Carl Zeiss Meditec) and corneal tomography, including true net power (TNP) (Pentacam; Oculus Optikgeräte GmbH). To evaluate the measurements, the simulated keratometry values (SimK) were compared to the TNP. Regarding IOL calculation, the mean prediction error, mean and median absolute prediction error (MAE and MedAE), and number of eyes within ±0.50, ±1.00, and ±2.00 diopters (D) from the Haigis-L, Shammas, and Barrett True K No History formulas to the Potvin-Hill and Haigis with TNP (Pentacam) formulas were compared. RESULTS: Thirty-six eyes matched the inclusion criteria with a mean spherical equivalent of -6.26 ± 3.25 diopters (D) preoperatively and -0.79 ± 0.75 D postoperatively. The mean difference from SimK and TNP was significantly different from zero (P < .001; -1.24 ± 0.81 D). The best performing formulas by MedAE were the Potvin-Hill and Barrett True K No History (0.39 ± 0.78 and 0.64 ± 1.00 D). The formula with the most eyes within ±0.50 D was the Potvin-Hill (64%), followed by the Barrett True K No History (44%). For MAE and percentage of eyes within ±0.50 D, the Potvin-Hill formula was significantly better than the Haigis-L, Shammas, and Haigis-TNP formulas (P < .05). CONCLUSIONS: Calculation of IOLs in patients who had LASIK remains less predicable than calculations for virgin eyes. Using ray-tracing to calculate diffractive EDOF IOLs after myopic LASIK, the Potvin-Hill formula outperformed established formulas in terms of the percentage within target refraction and the MAE. [J Refract Surg. 2021;37(4):231-239.].

Impact of Pseudoexfoliative Syndrome on Effective Lens Position, Anterior Chamber Depth Changes, and Visual Outcome After Cataract Surgery.

PURPOSE: To compare the effective lens position (ELP), anterior chamber depth (ACD) changes, and visual outcomes in patients with and without pseudoexfoliation syndrome (PEX) after cataract surgery. DESIGN: Prospective, randomized, fellow-eye controlled clinical case series. METHODS: This prospective comparative case series enrolled 56 eyes of 56 consecutive patients with (n = 28) or without PEX (n = 28) and clinically significant cataract who underwent standard phacoemulsification and were implanted with single-piece acrylic posterior chamber intraocular lenses (IOLs). The primary outcome parameters were the ACD referring to the distance between the corneal anterior surface and the lens anterior surface, which is an indicator of the postoperative axial position of the IOL (the so-called ELP) and distance corrected visual acuity (DCVA). RESULTS: Before surgery, the ACD was 2.54 ± 0.42 mm in the PEX group and 2.53 ± 0.38 mm in the control group (p = 0.941). Postoperatively, the ACD was 4.29 ± 0.71 mm in the PEX group and 4.33 ± 0.72 mm in the normal group, respectively (p = 0.533). There was no significant difference in ACD changes between groups (PEX group: 1.75 ± 0.74 mm, control group: 1.81 ± 0.61 mm, p = 0.806) and DCVA pre- (p = 0.469) and postoperatively (PEX group: 0.11 ± 0.13 logMAR, control group: 0.09 ± 0.17 logMAR, p = 0.245) between groups. CONCLUSION: Preoperative and postoperative ACD, as an indicator of ELP, between PEX eyes and healthy eyes after cataract surgery showed no significant difference. Phacoemulsification induced similar changes in eyes with PEX compared to healthy eyes.

[Corneal complications after PRK for hyperopia]. / Korneale Komplikationen nach hyperoper PRK.

We report the case of a patient with epithelial hyperplasia, peripheral haze and regression after transepithelial photorefractive keratectomy (PRK) for hyperopia outside the limits set by the committee for refractive surgery (KRC). Retreatment was performed on both eyes 1 year postoperatively and later an ablation on the left eye due to scarring. Regardless of these procedures haze, scarring and regression appeared again in both eyes. The patient will currently retain a permanent reduction of visual acuity as another treatment of hyperopia outside the KRC recommendations should not be performed due to the high risk of haze, scarring and regression.

Prediction accuracy of IOL calculation formulas using the ASCRS online calculator for a diffractive extended depth-of-focus IOL after myopic laser in situ keratomileusis.

BACKGROUND: To evaluate IOL calculation formulas provided by an online calculation tool from the ASCRS for an extended depth-of-focus (EDOF) IOL after previous myopic laser in situ keratomileusis (LASIK). SETTING: Department of Ophthalmology, Goethe University, Frankfurt, Germany. DESIGN: Retrospective consecutive case series. METHODS: Patients who underwent cataract surgery or refractive lens exchange with implantation of a diffractive EDOF IOL and who had a history of myopic LASIK were included. Biometry, refractive data regarding the LASIK procedure, target refraction, and postoperative refraction were collected. Mean prediction error, mean absolute error (MAE), and the number of eyes within ±0.5 diopters (D), ±1.0 D, ±1.5 D, and ±2.0 D were calculated with the following formulas from the ASCRS calculator: Shammas, Haigis-L, Barrett True-K, Barrett No History, Masket, modified Masket, and the average of all formulas (average). RESULTS: Twenty-five eyes matched the inclusion criteria. Mean spherical equivalent (SE) was -0.81 ± 0.69 D; the mean pre-LASIK SE was -6.4 ± 3.63 D. The formulas ranked by MAE were Shammas (0.7 ± 0.75 D), Haigis-L (0.72 ± 0.57 D), average (0.79 ± 0.8 D), Barrett True-K (1.14 ± 0.89 D), modified Masket (1.4 ± 1.15 D), Barrett No History (1.45 ± 0.7D ), and Masket (1.64 ± 1.27 D). The formulas with the most eyes within ±0.5 D were average (52%), Shammas (48%), and Haigis-L (44%) formulas. CONCLUSIONS: Calculation of IOLs in eyes with a history of refractive surgery remains a challenge. In this study, the Shammas and Haigis-L formulas performed best regarding MAE and percentage of eyes within ±0.5 D; however, the average of all formulas delivered reasonable results.