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  • Aqueous level abatement profiles of intracameral antibiotics: A comparative mathematical model of moxifloxacin, cefuroxime, and vancomycin with determination of relative efficacies
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-11-06
    Steve A. Arshinoff, Tina Felfeli, Milad Modabber

    Purpose To create a model of the abatement profiles of the three most commonly employed endophthalmitis prophylaxis intracameral (IC) antibiotics—cefuroxime, vancomycin, and moxifloxacin—to enable comparison of their durations of efficacy against common endophthalmitis pathogens. Settings Humber River Hospital and The Eye Foundation of Canada, Toronto, Ontario, the University of Toronto, Ontario, and McGill University, Montreal, Quebec, Canada. Design Literature review, as well as review of our clinical experience with 4797 consecutive cases with IC vancomycin, followed by 9185 consecutive cases with IC moxifloxacin. Methods A detailed review of the prophylactic antibiotic literature was performed. Exponential decay models of the selected IC antibiotics were updated from previous work by the study authors with decay constants adjusted to agree with the available published objective data. Results The graphs generated by the study data demonstrate the relative duration of IC bactericidal activity of moxifloxacin, cefuroxime, and vancomycin. They suggest that at present, IC moxifloxacin, when administered in appropriate doses, is the most effective agent in preventing postoperative endophthalmitis. Unlike vancomycin and cefuroxime, bacterial resistance to moxifloxacin is dose-dependent, and it is overcome in the vast majority of cases with doses that can safely be achieved intracamerally. The graphs can serve as a useful tool to assess the expected efficacy of each antibiotic in reference to local pathogen resistances. Conclusion The model shows IC moxifloxacin, cefuroxime, and vancomycin durations of bactericidal efficacy post-cataract surgery, which correlate well with the published objective data.

    更新日期:2019-11-07
  • Effect of central hole location in phakic intraocular lenses on visual function under progressive headlight glare sources
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-11-06
    Elena Martínez-Plaza, Alberto López-Miguel, Itziar Fernández, Francisco Blázquez-Arauzo, Miguel J. Maldonado

    Purpose To analyze the effect of the central hole location in the V4c implantable collamer lens (ICL) on the quality of vision, including progressive headlight glare simulation and quality of life. Setting IOBA-Eye Institute, Valladolid, Spain. Design Case series. Methods The central hole location was determined by slitlamp and dual Scheimpflug imaging for 6 months or more postoperatively. The visual acuity, mesopic contrast sensitivity, halogen glare contrast sensitivity, xenon glare contrast sensitivity, photostress recovery time after glare, de Boer scale, and Quality of Life Impact of Refractive Correction (QIRC) questionnaire results were evaluated. Multiple regression models were used to analyze the effect of the central hole location on parameters using the pupil center and visual axis as references based on Cartesian and polar coordinates. Results The safety index was 1.13 and the efficacy index, 1.12. Under all testing circumstances, central hole decentration did not affect the visual acuity or contrast sensitivity. With the visual axis as a reference, worse QIRC values were associated with greater upward central hole displacement (P = .03) and a lower polar angle value (P = .008); also, halogen glare discomfort was greater with a higher radius (P = .04). Using the pupil center as a reference, greater nasal central hole decentration was associated with longer xenon glare photostress recovery time (P = .002). Conclusions Implantation of the ICL with a central hole yielded excellent visual outcomes, even under increasing glare sources, regardless of the hole's location. However, hole decentration might affect patient-perceived quality of life, bothersome halogen glare, and longer xenon glare photostress recovery time. Such complaints after the early postoperative period might be managed with discrete ICL centration if the central hole is decentered upward or nasally.

    更新日期:2019-11-07
  • Comparison of toric intraocular lens alignment error with different toric markers
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-11-06
    Lior Lipsky, Graham Barrett

    Purpose To compare the error in intraocular lens (IOL) toric alignment of 2 toric markers. Setting Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. Design Retrospective case series. Methods Two consecutive groups of patients had cataract surgery with implantation of an AcrySof SN6A toric IOL (versions T2–T8) by the same surgeon at 2 public hospitals. The only difference in the toric alignment method between the groups was the toric maker used (Group 1: Barrett dual axis toric marker; Group 2: Mendez gauge). A mobile phone application (toriCAM) was used in both groups to determine the reference meridian. The primary outcome measure was the error in toric IOL alignment in degrees at 1 month. The secondary outcome measure was the percentage of eyes achieving a manifest refraction astigmatism within ±0.50 diopter (D) at 1 month. Results Seventy-two eyes of 56 patients were included (Group 1: 36 eyes of 35 patients; Group 2: 36 eyes of 25 patients). The mean absolute toric alignment error (intended versus achieved axis of alignment) was 4.0 degrees ± 2.9 (SD) in Group 1 and 8.4 ± 6.5 degrees in Group 2 (P = .0015). Twenty-nine eyes (80.6%) in Group 1 and 21 eyes (53.8%) in Group 2 achieved a manifest refractive astigmatism of 0.50 D or less (P < .05). Conclusion Toric IOL alignment using the mobile phone application was more accurate with the Barrett dual axis toric marker than with the commonly used Mendez gauge, with a significantly higher percentage of eyes achieving a manifest refraction astigmatism within ±0.50 D.

    更新日期:2019-11-07
  • Tomographic analysis of anterior and posterior surgically induced astigmatism after 2.2 mm temporal clear corneal incisions in femtosecond laser–assisted cataract surgery
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-11-06
    Thomas Kohnen, Franziska Löffler, Michael Herzog, Kerstin Petermann, Myriam Böhm

    Purpose To evaluate surgically induced astigmatism (SIA) of temporal clear corneal incisions (CCIs) on anterior and posterior corneal curvature after femtosecond laser–assisted cataract surgery (FLACS) using Scheimpflug tomographic measurements. Setting Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany. Design Prospective interventional case series. Methods This study enrolled patients who underwent FLACS from June 2013 to July 2014. All eyes were measured with a Pentacam HR preoperatively and at 1 month and 3 months postoperatively, had preoperative total corneal refractive power (TCRP) astigmatism (CATCRP) of 0.50 diopters (D) or less, and received a temporal 2.2 mm incision at 0 degrees and 180 degrees. Vector analysis, using the Holladay-Cravy-Koch formula and the Alpins method, determined astigmatic changes in anterior corneal astigmatism (CAant), posterior corneal astigmatism (CApost), and CATCRP. Student t and Wilcoxon tests were performed. A P value less than 0.05 was considered statistically significant. Results This study comprised 53 eyes of 38 patients. At 3 months postoperatively, the CAant, CApost, and CATCRP were significantly higher compared with the preoperative values (P = .015, P = .007, P = .008, respectively); however, CApost and CATCRP were significantly lower compared with the limit of 0.50 D (P < .001, P = .01, respectively), whereas CAant was not (P = .11). The mean SIA of CAant, CApost, and CATCRP was 0.25 D ± 0.15 (SD), 0.16 ± 0.11 D, and 0.28 ± 0.17 D, respectively. The angle of error was high (−1.98 ± 52.95 degrees, 1.64 ± 51.27 degrees, and −1.72 ± 48.79 degrees, respectively). Conclusion Femtosecond laser temporal CCIs induce minimal astigmatism in CAant, CApost, and CATCRP, but can be evaluated statistically as astigmatically neutral.

    更新日期:2019-11-07
  • Repeatability and reproducibility of optical biometry implemented in a new optical coherence tomographer and comparison with a optical low-coherence reflectometer
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-11-06
    Piotr Kanclerz, Kenneth J. Hoffer, Jos J. Rozema, Katarzyna Przewłócka, Giacomo Savini

    Purpose To examine the repeatability and reproducibility of biometry provided by a new anterior–posterior segment spectral-domain optical coherence tomography (SD-OCT) device (Revo NX) and compare it with that provided by a validated optical low-coherence reflectometry (OLCR) biometer (Lenstar LS 900). Setting Hygeia Clinic, Gdańsk, Poland. Design Prospective evaluation of diagnostic test. Methods The axial length (AL), lens thickness (LT), central corneal thickness (CCT), and anterior chamber depth (ACD) (corneal epithelium to lens) were measured in eyes of volunteers. Two skilled operators obtained 3 measurements in random order with the SD-OCT device. Repeatability was calculated for each observer, while reproducibility was assessed by a change in observer. To compare agreement between the SD-OCT device and OLCR device, the first observer took 3 measurements with both devices. Results The study evaluated 63 eyes of 63 volunteers. The mean AL measurement (+0.11 mm ± 0.02 [SD]) and mean ACD measurement (0.05 ± 0.04 mm) were significantly higher with the SD-OCT device than with the OLCR device; the CCT measurements did not differ between the devices. A very strong correlation was found for all parameters, while Bland-Altman analysis showed narrow 95% limits of agreement for AL (0.06 to 0.15 mm), ACD (−0.02 to 0.12 mm), LT (−0.23 to 0.17 mm), and CCT (−7.83 to 6.17 μm). Conclusions The new SD-OCT device provided repeatable and reproducible AL, ACD, LT, and CCT measurements. The results with the SD-OCT device showed strong correlations with those obtained with the OLCR device. However, the AL and ACD measurements of the 2 devices cannot be considered interchangeable.

    更新日期:2019-11-07
  • Defocus curves of 4 presbyopia-correcting IOL designs: Diffractive panfocal, diffractive trifocal, segmental refractive, and extended-depth-of-focus
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-11-06
    Myriam Böhm, Kerstin Petermann, Eva Hemkeppler, Thomas Kohnen

    Purpose To evaluate the defocus curves of 4 presbyopia-correcting intraocular lenses (IOLs). Setting Department of Ophthalmology, Goethe University, Frankfurt, Germany. Design Prospective case series. Methods Patients included in the study had bilateral surgery with implantation of diffractive panfocal, diffractive trifocal, segmental refractive (SegRef), or extended-depth-of-focus (EDOF) presbyopia-correcting IOLs. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, uncorrected intermediate and near visual acuities, distance-corrected intermediate (DCIVA) and near (DCNVA) visual acuities, defocus curve, and spectacle independence were measured. Results The UDVA and CDVA were not significantly different between groups (P > .05); however, the EDOF group had worse near CDVA (P < .001). The trifocal and EDOF groups showed better DCIVA than the panfocal and SegRef group at 80 cm (P < .001); the EDOF and panfocal groups had comparable DCIVA at 60 cm (P > .05). Defocus curves showed no significant between-group differences from 4 m to 2 m (P > .05). The EDOF group had better visual acuity from 1 m to 67 cm than the trifocal and SegRef groups and better visual acuity than the panfocal group at 1 m (P > .05). Compared with the other IOLs, the panfocal IOL yielded significantly better visual acuity at 50 cm (P < .001) and the EDOF IOL worse visual acuity at 40 cm (P < .01). There was a significant difference in spectacle independence between the panfocal group and EDOF group (P < .05) but no difference between the other groups. Conclusions The 4 IOLs provided equally good CDVA. The EDOF IOL yielded slightly better DCIVA but worse DCNVA than the other IOLs. Only the panfocal IOL gave better DCIVA at 50 cm.

    更新日期:2019-11-07
  • Intraocular lens tilt and decentration after Nd:YAG laser posterior capsulotomy: Femtosecond laser capsulorhexis versus manual capsulorhexis
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-11-06
    Esat Cinar, Berna Yuce, Fatih Aslan, Gökhan Erbakan, Cem Küçükerdönmez

    Purpose To compare intraocular lens (IOL) tilt and decentration after Nd:YAG laser posterior capsulotomy in eyes that had femtosecond laser–assisted capsulotomy versus manual capsulorhexis. Setting Ekol Eye Hospital, Izmir, Turkey. Design Retrospective case series. Methods Intraocular lens decentration and angle of tilt were measured using a Scheimpflug camera before and 1 month after Nd:YAG capsulotomy. Results Eighteen eyes had a femtosecond laser–assisted capsulotomy and 25 eyes a manual capsulorhexis. The mean age was 58.2 years ± 10.2 (SD) (range 44 to 69 years) and 60.6 ± 8.3 years (range 45 to 70 years), respectively. Before capsulotomy, the angle of tilt and decentration at both meridians did not differ significantly between the 2 groups (P > .05). After capsulotomy, the angle of tilt was significantly decreased in both groups (femtosecond: vertical 1.5 degrees and horizontal 1.2 degrees; manual: vertical 1.1 degrees and horizontal) and decentration was significantly increased (femtosecond: vertical 0.085 mm and horizontal 0.096 mm; manual: vertical 0.2 mm and horizontal 0.2 mm) at both meridians (P < .05). After capsulotomy, all tilt and decentration parameters were significantly different between the 2 groups (P < .05) except decentration on the horizontal meridian (P = .669). Conclusions Nd:YAG posterior capsulotomy performed after femtosecond laser–assisted capsulotomy resulted in better mechanical stability of the IOL. This suggests that a femtosecond laser–created capsulotomy better maintains a proper IOL position. Although the differences were statistically significant, the tilt and decentration values were small and might not be clinically significant.

    更新日期:2019-11-07
  • Semiautomated optical coherence tomography-guided robotic surgery for porcine lens removal
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-11-06
    Cheng-Wei Chen, Anibal Andrés Francone, Matthew J. Gerber, Yu-Hsiu Lee, Andrea Govetto, Tsu-Chin Tsao, Jean-Pierre Hubschman

    Purpose To evaluate semiautomated surgical lens extraction procedures using the optical coherence tomography (OCT)–integrated Intraocular Robotic Interventional Surgical System. Setting Stein Eye Institute and Department of Mechanical and Aerospace Engineering, University of California, Los Angeles, USA. Design Experimental study. Methods Semiautomated lens extraction was performed on postmortem pig eyes using a robotic platform integrated with an OCT imaging system. Lens extraction was performed using a series of automated steps including robot-to-eye alignment, irrigation/aspiration (I/A) handpiece insertion, anatomic modeling, surgical path planning, and I/A handpiece navigation. Intraoperative surgical supervision and human intervention were enabled by real-time OCT image feedback to the surgeon via a graphical user interface. Manual preparation of the pig-eye models, including the corneal incision and capsulorhexis, was performed by a trained cataract surgeon before the semiautomated lens extraction procedures. A scoring system was used to assess surgical complications in a postoperative evaluation. Results Complete lens extraction was achieved in 25 of 30 eyes. In the remaining 5 eyes, small lens pieces (≤1.0 mm3) were detected near the lens equator, where transpupillary OCT could not image. No posterior capsule rupture or corneal leakage occurred. The mean surgical duration was 277 seconds ± 42 (SD). Based on a 3-point scale (0 = no damage), damage to the iris was 0.33 ± 0.20, damage to the cornea was 1.47 ± 0.20 (due to tissue dehydration), and stress at the incision was 0.97 ± 0.11. Conclusions No posterior capsule rupture was reported. Complete lens removal was achieved in 25 trials without significant surgical complications. Refinements to the procedures are required before fully automated lens extraction can be realized.

    更新日期:2019-11-07
  • Corneal crosslinking: Current protocols and clinical approach
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-11-06
    Kenneth A. Beckman, Preeya K. Gupta, Marjan Farid, John P. Berdahl, Elizabeth Yeu, Brandon Ayres, Clara C. Chan, José A.P. Gomes, Edward J. Holland, Terry Kim, Christopher E. Starr, Francis S. Mah

    Members of the ASCRS Cornea Clinical Committee performed a review of the current literature on the corneal crosslinking (CXL) procedure for treating corneal ectasia. The members explored the data on the techniques currently in use and under investigation, including their advantages, safety profiles, risks, and cost analyses, compared with data on corneal transplantation. They concluded that CXL limits the progression of keratoconus, thus reducing the need for transplantation. They also found that compared with permitting the disease to progress naturally, CXL techniques carry significant and long-term cost and safety benefits, primarily by reducing the need for corneal transplantation. Studies of various CXL techniques (eg, epithelium-on treatment, changes in ultraviolet light parameters, riboflavin composition) continue with the ultimate goal of improving the procedure's safety and efficacy.

    更新日期:2019-11-07
  • Precision pulse capsulotomy complicated by radial tear of the anterior capsule: a proposed mechanism
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-11-06
    Shadi Safuri, Nitsan Duvdevan, Sergiu Socea, Eytan Z. Blumenthal

    Zepto precision pulsed capsulotomy is an emerging technology aimed at providing a safer and more reproducible anterior capsulorhexis, with potential advantages in challenging cases. Initial reports suggest high safety, and thus far to our knowledge, no complications have been reported. Herein we report an unexpected complication. After the pulse delivery phase on a routine cataract case, a radial tear of the anterior capsule was observed. Upon careful review of the surgery video, an air bubble was noted, at the precise clock hour of the radial tear, trapped between the device wire and capsule. This air bubble presumably prevented the transfer of rapid phase transition at this site, interfering with capsule cleavage, and resulting in incomplete capsulotomy. Based on this observation, if a trapped air bubble is observed after the vacuum phase, we recommend applying more vacuum or disengaging and reattaching, before proceeding to the pulse delivery stage.

    更新日期:2019-11-07
  • Ten-year clinical outcomes after implantation of a posterior chamber phakic intraocular lens for myopia
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-10-03
    Jae Hwan Choi, Dong Hui Lim, Seung Wan Nam, Chan Min Yang, Eui Sang Chung, Tae-Young Chung

    Purpose To report the long-term clinical outcomes, including efficacy and safety, of implantable collamer lens (ICL) implantation to treat myopia. Setting Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Design Retrospective case series. Methods Medical records of patients who had ICL implantation were reviewed. The preoperative and postoperative visual acuity, spherical equivalent (SE), endothelial cell density (ECD), and intraocular pressure (IOP) were analyzed. The postoperative vault and complication rate, including cataract and glaucoma, were evaluated. Patients were placed in the lens opacity group or clear lens group based on whether lens opacity developed postoperatively. Results One hundred ten eyes (60 patients) were analyzed. The mean preoperative age was 30.3 years ± 8.3 (SD). The mean SE was −12.01 ± 3.70 diopters (D) preoperatively and −0.65 ± 1.09 D 10 years postoperatively. The mean vault height was 562.4 ± 175.9 μm 6 months postoperatively, decreasing to 352.9 ± 171.8 μm at 10 years. There were no significant changes in the ECD and IOP at any timepoint. Lens opacities developed in 21 eyes (12.1%) during the 10-year follow-up. The mean vault in the lens opacity group was significantly lower than in the clear lens group after 4 years. No patient who had ICL implantation when they were 30 years or younger developed lens opacity or required phacoemulsification. Conclusions The results indicate that ICL implantation provided long-term stability and good refractive outcomes. Performing this surgery in young patients, especially those 30 years or younger, may be safe in terms of long-term cataract formation.

    更新日期:2019-10-04
  • Visual quality and patient satisfaction with a trifocal intraocular lens and its new toric version
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-10-03
    Laureano A. Rementería-Capelo, Inés Contreras, Jorge L. García-Pérez, Vanesa Blázquez, Javier Ruiz-Alcocer

    Purpose To assess and compare the visual quality and subjective outcomes of a trifocal spherical intraocular lens (IOL) and its new toric version. Setting Clínica Rementería, Madrid, Spain. Design Prospective case series. Methods Patients had bilateral implantation of the AcrySof IQ PanOptix spherical or toric IOL. Three months postoperatively, monocular and the binocular uncorrected and corrected distance, intermediate, and near visual acuities; binocular defocus curves; and binocular contrast sensitivity function (CSF) were assessed. Patient satisfaction was evaluated with the Catquest 9SF questionnaire. Results The study comprised 250 eyes (166 with spherical IOL; 84 with toric IOL) of 125 patients. Both groups had good monocular visual acuity at all distances with no statistically significant differences between groups. The mean monocular uncorrected acuity in the spherical group was 0.06 logarithm of the minimum angle of resolution (logMAR) ± 0.07 (SD), 0.20 ± 0.10 logMAR, and 0.05 ± 0.07 logMAR for far, intermediate, and near, respectively, and in the toric group, 0.07 ± 0.10 logMAR, 0.23 ± 0.20 logMAR, and 0.07 ± 0.12 logMAR, respectively. Defocus curves showed a visual acuity of 0.1 logMAR or better between −2.5 diopters (D) and +0.5 D with no differences between groups. The CSF values were within normal ranges with both IOLs. The questionnaire showed high rates of patient satisfaction with no differences between groups. Conclusions The visual outcomes with the 2 IOLs were similar. With optimum implantation and alignment, the trifocal toric IOL seems to provide visual quality and patient satisfaction that is equivalent to that with the nontoric version with the same platform.

    更新日期:2019-10-04
  • Face-to-face phacoemulsification using a slitlamp in patients who are unable to lie flat
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-10-03
    Marc Muraine, Guillaume Boutillier, David Toubeau, Julie Gueudry

    Phacoemulsification can be challenging in patients who are unable to lie flat or sit in a reclined position that exceeds 30 degrees to 45 degrees during surgery. We describe a new technique that we have used on 4 eyes of two patients. Both were operated on while sitting in a strictly upright position, resting their chin in front of a mobile slitlamp in the same manner as during a standard ophthalmologic examination. The surgeon sits on the other side of the slitlamp, facing the patient, and operates via a temporal corneal incision. The described operating conditions were deemed perfectly adequate by the experienced surgeon. Both patients recovered a corrected distance visual acuity of 20/20 in both eyes and said they would recommend this surgery to anyone who cannot lie flat. Surgeons should consider this technique when standard surgical positioning is not possible.

    更新日期:2019-10-04
  • Billing of cataract surgery as complex versus routine for Medicare beneficiaries
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-10-03
    Sidra Zafar, Peiqi Wang, Divya Srikumaran, Oliver D. Schein, Jennifer E. Thorne, Martin A. Makary, Fasika A. Woreta

    Purpose To estimate ophthalmologist-level variation in cataract surgery billing and evaluate patient and ophthalmologist characteristics associated with complex cataract surgery coding. Setting Cross-sectional study. Design Retrospective case series. Methods Medicare beneficiaries aged 65 years or older who had cataract surgery between January 1, 2016, and December 31, 2017, were included. Billing of cataract surgery as complex versus routine and patient and physician characteristics associated with billing of cataract surgery as complex were evaluated. Results An estimated 3.5 million cataract procedures were performed on Medicare beneficiaries in 2016 and 2017. Men (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.75-1.82), patients 75 years or older (versus those aged 65 to 74 years: OR, 1.35; 95% CI, 1.33-1.36), and racial minorities (blacks versus whites: OR, 1.80; 95% CI, 1.75-1.85) had increased odds of having cataract surgery coded as complex. The mean rate of coding for complex cataract surgery by individual surgeons (n = 10 075) in the United States was 11.2%, with significant variation. A high-risk clinical diagnosis code was associated with 40.0% of complex cataract surgeries. Adjusted for patient characteristics, ophthalmologists who graduated from medical school within the past 10 years (OR, 1.35; 95% CI, 1.22-1.49) were more likely to code for complex cataract surgery. Higher volume ophthalmologists were less likely to code for complex cataract surgery than low-volume ophthalmologists. Conclusions There was marked variation among ophthalmologists in the use of complex cataract surgery. Some variability might represent inaccurate coding and was not entirely based on differences in referral patterns for more complex patients.

    更新日期:2019-10-04
  • Visual and refractive outcomes, spectacle independence, and visual disturbances after cataract or refractive lens exchange surgery: Comparison of 2 trifocal intraocular lenses
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-10-03
    Bilgehan Sezgin Asena

    Purpose To compare the clinical performance of a hydrophobic (AcrySof PanOptix) and a hydrophilic (AT LISA tri 839MP) diffractive trifocal intraocular lens (IOL). Setting Kaskaloglu Eye Hospital, Izmir, Turkey. Design Prospective case series. Methods Patients had bilateral cataract surgery or refractive lens exchange with implantation of the hydrophobic diffractive IOL or hydrophilic diffractive IOL. The binocular corrected distance visual acuity (CDVA) at 4 m, corrected intermediate visual acuity (CIVA) at 80 cm and 60 cm, and corrected near visual acuity at 40 cm; low-contrast CDVA; spherical equivalent refraction; binocular corrected defocus curve; photic phenomena; and spectacle use were compared. Results The study comprised 238 eyes (119 patients). The mean CIVA at 60 cm was better in the hydrophobic diffractive IOL group than in the hydrophilic diffractive IOL group (0.07 logarithm of the minimum angle of resolution [logMAR] ± 0.07 [SD] versus 0.22 ± 0.10 logMAR; P < .001). The mean CIVA at 80 cm was better in the hydrophilic IOL group (0.07 ± 0.08 logMAR versus 0.17 ± 0.09 logMAR; P < .001). Visual acuity at 1.00 diopter (D) to −2.50 D was significantly better in the hydrophobic diffractive group (P = .011 to <.001). The rate of severe and bothersome halos was higher in the hydrophilic diffractive group (P = .032 and P = .004, respectively). The percentage of patients reporting never using spectacles for intermediate vision was significantly higher in the hydrophobic group (P = .016). Conclusion Both IOLs gave similar and favorable visual and refractive outcomes. The hydrophobic diffractive IOL might be more suitable for patients who require good closer intermediate viewing.

    更新日期:2019-10-04
  • Artisan-style iris-claw intraocular lens implantation in patients with uveitis
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-10-01
    Guy S. Negretti, Weng Onn Chan, Carlos Pavesio, Mahiul M.K. Muqit

    Purpose To study the use of iris-claw Artisan intraocular lenses (IOLs) in patients with uveitis. Setting Moorfields Eye Hospital, London, England. Design Retrospective case series. Methods Data on all patients with anterior uveitis, intermediate uveitis, and panuveitis who had anterior-fixated Artisan IOL insertion between January 2014 and July 2019 at Moorfields Eye Hospital were assessed. Patients who had less than 2 months of follow-up were excluded from the analysis. Results The study comprised 11 patients. The mean age of the 7 women and 4 men was 61 years ± 14 (SD). The mean follow-up was 1.7 years. After Artisan IOL insertion, the corrected distance visual acuity (CDVA) improved significantly from 20/200 to 20/50 (P = .02). No patients had a significant flare-up of their uveitis after the surgery, and there were no intraocular pressure-related events. One patient developed cystoid macular edema, which responded to treatment. Conclusion This case series showed the efficacy and safety of Artisan-style IOLs in patients with a history of uveitis. After the Artisan IOL insertions, these patients experienced a significant improvement in CDVA with minimal side effects.

    更新日期:2019-10-02
  • Repairing iridodialysis by riveting with a double-flanged polypropylene suture
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-10-01
    Mami Kusaka, Naomi Miyamoto, Masayuki Akimoto

    Three patients with iridodialysis were recruited. A 6-0 polypropylene suture was cut to the proper length and flanged by cautery. A long (19.0 mm), ultrathin 30-gauge needle was inserted in the anterior chamber from the sclera around the iris and penetrated in the dialyzed iris, then exited through the cornea on the contralateral side. The flanged polypropylene suture was inserted in the needle from the unflanged side. After the 30-gauge needle was withdrawn, the flanged suture remained, passing the dialyzed iris and sclera. The unflanged ends of the polypropylene sutures were cut and flanged until each flange reached the sclera. It was easy to place multiple sutures. There were no cases of extrusion of the suture nor of the recurrence of iridodialysis up to 1 year. This technique is a good alternative to repair iridodialysis.

    更新日期:2019-10-02
  • Topography and longitudinal chromatic aberration characterizations of refractive–diffractive multifocal intraocular lenses
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-10-01
    Jérôme Loicq, Nicolas Willet, Damien Gatinel

    Purpose Most optical systems present chromatic aberration quantified along the optical axis by the longitudinal chromatic aberration (LCA). LCA is controlled by the biomaterial Abbe number combined with diffractive effects, driven by the intraocular lens (IOL) topography. This study experimentally aimed at describing the effect in vitro of LCA in diffractive multifocal IOLs, with the help of dedicated optical benches and topographic characterization. Setting Centre Spatial de Liège, Belgium. Design Optical and topology analysis of various multifocal diffractive IOLs. Methods Seven diffractive multifocal IOLs, available on the market and exhibiting different diffractive profiles, made from various biomaterials, were characterized under different wavelengths. Results Through-focus modulation transfer function (MTF) curves and IOL diffraction efficiency depends on the incident light wavelength. In this study, the topology properties of various multifocal IOLs were investigated and their characteristics were correlated to their optical behavior for various wavelengths. Chromatic properties and their origins were then compared. As expected, diffractive and refractive effects were found to act in opposite ways, and could be partially or completely compensated. Conclusions The LCA of each of the IOLs was evaluated in vitro. In most of the multifocal IOLs studied, some of the foci were found to be refractive, whereas others were diffractive. Although the results were not extrapolated to clinical relevance, it was shown, in some of the cases, that LCA could be fully compensated.

    更新日期:2019-10-02
  • Validation of the SToP formula for calculating intraocular lens power in eyes with previous myopic excimer laser surgery
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-10-01
    Giacomo Savini, Kenneth Hoffer, Piero Barboni, Nicole Balducci, Domenico Schiano-Lomoriello

    Purpose To validate the accuracy of the SToP formula for calculating the intraocular lens (IOL) power from measurements obtained with a rotating Scheimpflug camera (Pentacam) in eyes with previous myopic excimer laser surgery. Setting IRCCS - Fondazione Bietti, Rome, Italy. Design Retrospective case series. Methods Corneal curvature measurements were taken in eyes that had cataract surgery after myopic excimer laser surgery. Values from both versions of the SToP calculator (based, respectively, on the Holladay 1 and the SRK/T formulas) were compared with historical (Masket and Savini) and no-history methods (Barrett True-K, BESSt formula, equivalent K-readings, Triple-S, and Shammas). Results Fifty eyes of 50 patients with historical data were analyzed. The SToP formula based on the SRK/T achieved the lowest median absolute error (MedAE) (0.31 diopters [D]) and a higher percentage of eyes (62%) with a prediction error in refraction within ±0.5 D. Excellent outcomes were also achieved with the Masket method, the BESSt formula, the Savini method, and the Triple-S method, which led to similar MedAEs (from 0.31 to 0.37 D) and an even higher percentage of eyes with a prediction error within ±0.5 D (from 64% to 76%). The SToP formula based on the Holladay 1 was slightly less accurate. Conclusions Several methods based on Scheimpflug camera measurements were used to successfully calculate the IOL power in eyes with previous myopic excimer laser surgery. The SToP formula based on the SRK/T was one of the best choices.

    更新日期:2019-10-02
  • Evaluation of the capsular safety of a new hybrid phacoemulsification tip in a cadaver eye model
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-10-01
    Caleb Shumway, Nathan Ellis, Joshua Heczko, Bill Jiang, Liliana Werner, Nick Mamalis

    Purpose To evaluate the use of a new hybrid phacoemulsification tip made with a high strength polymer overmold designed to prevent posterior capsule rupture (PCR) compared with a metal tip. Setting John A. Moran Eye Center, University of Utah, USA. Design Experimental study. Methods This ex vivo crossover study compared a new phacoemulsification tip to a metal tip. After a preliminary experiment applying the tips to the posterior capsule with the bevel down, 10 phakic cadaver eyes were prepared using the Miyake-Apple technique, after which each tip was tested in a series. After lensectomy, the posterior capsule was subjected to direct contact from the tip with the bevel up. The vacuum limit was set to 150 mm Hg, and the aspiration flow rate to 30 cc/min, after which the torsional power was increased by increments of 5% up to a maximum amplitude of 60%. The primary endpoint was the torsional power required to produce PCR. Results Vacuum alone did not cause PCR with either tip. All tests showed that a higher torsional power was required for PCR with the hybrid tip. With the bevel directed upward, the hybrid tip required higher torsional power before PCR than the metal tip (55% ± 10.0% [SD] versus 15% ± 4.1%, respectively) (P value < .001). This indicates that there is a lower likelihood for PCR with the hybrid tip. Conclusion The hybrid tip used in this study can be an effective means of preventing surgical complications such as PCR. This tip would be useful for experienced surgeons as well as for those who are in training.

    更新日期:2019-10-02
  • Determinants of subjective patient-reported quality of vision after small-incision lenticule extraction
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-10-01
    Valerie Schmelter, Martin Dirisamer, Jakob Siedlecki, Mehdi Shajari, Thomas C. Kreutzer, Wolfgang J. Mayer, Siegfried G. Priglinger, Nikolaus Luft

    Purpose To characterize patient-reported long-term quality of vision (QoV) after small-incision lenticule extraction (SMILE), and to identify potential clinical parameters that might predispose to experiencing deteriorated visual quality. Setting University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany. Design Prospective cross-sectional study. Methods For the assessment and scoring of visual symptoms, the Quality of Vision questionnaire was employed, which constitutes a clinically validated, linear-scaled 30-item instrument providing a QoV score on three scales (symptom frequency, severity, and bothersome). Subgroup analyses were performed for patient subgroups stratified by baseline characteristics (eg, age) and treatment parameters (eg, surgical refractive correction) as well as refractive outcomes (eg, residual refraction) and visual outcomes (eg, uncorrected distance visual acuity [UDVA]). Results The study comprised 394 eyes of 197 patients (117 women [59.4%], 80 men [40.6%]) were included with a mean postoperative follow-up of 24.4 months ± 14.1 (SD). The QoV scores for symptom frequency, severity, and bothersome were 34.63 ± 13.69, 29.60 ± 12.38, and 24.56 ± 16.00, respectively. Patients with a preoperative binocular corrected distance visual acuity (CDVA) of 20/12.5 or better, patients who lost 1 or more lines of UDVA as compared with preoperative CDVA, patients older than the age of 40, and patients with inadvertent anisometropia more than 0.375 diopters reported worse QoV scores. Conclusion The relationship between objective clinical parameters and patient-reported subjective QoV after SMILE seems complex. Defined prognostic factors that convey a higher risk for experiencing visual disturbances were identifiable and should be discussed with patients seeking SMILE treatment during preoperative counseling.

    更新日期:2019-10-02
  • Refractive surgery in the HIV-Positive U.S. Military Natural History Study Cohort: Complications and risk factors
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-10-01
    Carter S. Tisdale, Grant A. Justin, Xun Wang, Xiuping Chu, Darrel K. Carlton, Jason F. Okulicz, Christina Schofield, Ryan C. Maves, Brian K. Agan, Gary L. Legault

    Purpose This study sought to assess the frequency of refractive surgery complications in human immunodeficiency virus-positive (HIV+) individuals and related risk factors. Settings Multiple centers in the United States. Design Prospective observational cohort study. Methods The U.S. Military HIV Natural History Study is a prospective observational cohort study of HIV+ servicemembers and beneficiaries. Participants were selected who had Current Procedural Terminology codes for laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and other refractive surgeries. The frequency of complications was determined using International Classification of Diseases-9 codes. Covariates included age, sex, antiretroviral therapy, time since HIV diagnosis, history of acquired immune deficiency syndrome (AIDS), and CD4 (T lymphocytes) count and viral load. Statistical analysis was completed using univariate (χ2 and Wilcoxon-Mann-Whitney tests) and multivariate analyses. Results Seventy-nine of 2073 participants had refractive surgery. Fifty-three patients underwent PRK, 23 LASIK, two radial keratotomy (RK), and one astigmatic correction. Complications occurred in 6 (7.6%) of 79 participants, including 5 patients who underwent PRK and one after RK, occurring between 8 and 217 days after surgery. Five ulcers and one unspecified keratitis were noted. In the univariate analysis, type of surgery (P = .02) and history of AIDS (P = .02) were risk factors for complications. In logistic regression analysis, no variables were found to be risk factors for complications. Conclusion Complications were infrequent among HIV+ participants after refractive surgery. Point estimates suggest that PRK might have more complications than LASIK and that advanced HIV, reflected by previous AIDS, might be associated with an increased risk for complications. Further study will be required to confirm these findings.

    更新日期:2019-10-02
  • Sutureless intrascleral fixation of intraocular lens through self-sealing sclerotomy wounds using haptic externalization and reinternalization technique
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-09-26
    Ernst Janse van Rensburg, Christina L. Ryu, Natalia Vila, John C. Chen

    In eyes with absent or insufficient capsule support, three-piece posterior chamber intraocular lens (PC IOL) may be fixed to the sclera. Previous techniques involve the use of sutures, flaps, glue, needles, trocars, or intrascleral tunnels to fixate the distal tips of the haptics intrasclerally. Herein we describe a modified technique for the sutureless scleral fixation of a standard 3-piece PC IOL using self-sealing sclerotomies created with a crescent blade and a 20-gauge microvitreoretinal blade, and then reinserting the haptics to leave the tips inside the vitreous cavity. We believe the relative simplicity of this technique makes it widely applicable for the placement of an IOL with insufficient capsule support.

    更新日期:2019-09-26
  • Precision of bag-in-the-lens intraocular lens power calculation in different age groups of pediatric cataract patients: Report of the Giessen Pediatric Cataract Study Group
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-09-26
    Lyubomyr M. Lytvynchuk, Maximilian V. Thiele, Werner Schmidt, Birgit Lorenz

    Purpose To evaluate the precision of bag-in-the-lens intraocular lens (BIL IOL) power calculation in different age groups of pediatric cataract patients. Settings Department of Ophthalmology, Justus-Liebig-University Giessen, University Hospital Giessen and Marburg GmbH, Campus Giessen, Giessen, Germany. Design Retrospective nonrandomized consecutive case series. Methods Pediatric patients diagnosed with cataract and operated with BIL IOL implantation were divided into 4 age groups: Group 1 (0 to 3 months), Group 2 (>3 months, <12 months), Group 3 (12 to 36 months), and Group 4 (>36 months to 17 years). BIL IOL power was calculated with the SRK/T formula. The prediction error (PE) was defined as the absolute difference between the preoperative selected target and postoperative achieved refraction. The impact of age at the time of surgery, axial length (AL), keratometry, and corneal astigmatism on PE was analyzed. Results The study comprised 87 eyes of 56 pediatric patients. The mean and median PEs for the entire group were 1.79 diopters (D) and 1.23 D, respectively. The mean PE in each age group was: 3.43 D in Group 1, 2.14 D in Group 2, 1.60 D in Group 3, and 1.33 D in Group 4. The mean PE in eyes with ALs shorter than 20 mm was 2.67 D, and 1.44 D in eyes with an AL of 20 mm or longer. The mean PE in eyes with corneal radii less than 7.3 mm was 2.45 D, and 1.66 D in eyes with corneal radii of 7.3 mm or more. In the age and AL subgroups, the PE differences were statistically significant (P < .05). Conclusions The PE was larger in the youngest study group, and it decreased gradually with age and in eyes with ALs shorter than 20 mm. The PE has to be considered during BIL IOL power calculation in children.

    更新日期:2019-09-26
  • Posterior capsule opacification rate after phacoemulsification in pediatric cataract: Hydrophilic versus hydrophobic intraocular lenses
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-09-26
    Pradhnya Sen, Mansi Kshetrapal, Chintan Shah, Amit Mohan, Elesh Jain, Alok Sen

    Purpose To compare the rate of posterior capsule opacification (PCO) of hydrophilic acrylic intraocular lenses (IOLs) and hydrophobic acrylic IOLs in pediatric cataract surgery. Setting Sadguru Netra Chikitsalaya, Chitrakoot, India. Design Retrospective case series. Methods The medical records of children who had uneventful cataract surgery with acrylic IOL implantation from 2010 to 2016 and a follow-up of at least 1-year were reviewed. The patients had implantation of a hydrophilic IOL (Ocuflex ANU6 IOL) or a hydrophobic IOL (AcrySof SA60AT). The main outcome measure was the PCO rate at the last follow-up. Results The study comprised 103 eyes (80 children). The mean age was 8.2 years ± 4 (SD) in the hydrophilic group (51 eyes) and 6.9 ± 4 years in the (52 eyes) hydrophobic group (P = .1). The mean follow-up was 38.8 months and 39.4 months, respectively. When the posterior capsule was left intact, 39.3% of eyes in the hydrophilic group and 13.4% of eyes in the hydrophobic group developed PCO (P = .03). When primary posterior capsulotomy (PPC) and anterior vitrectomy were performed, 4.3% and 6.8%, respectively, developed PCO (P = .69). Kaplan-Meier survival plots with stratification for type of procedure (ie, PPC and anterior vitrectomy) showed a survival (ie, no PCO formation at 5-year follow-up) rate of 95.4% in the hydrophobic group and 88.8% in the hydrophilic group. Conclusion Hydrophilic acrylic IOLs and hydrophobic acrylic IOLs implanted in the bag had comparable visual and surgical outcome and an equal rate of PCO formation when PPC and anterior vitrectomy were performed.

    更新日期:2019-09-26
  • Bag-in-the-lens implantation helps avoid posterior synechiae of the iris after phacovitrectomy
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-09-26
    Clément Auchère Lavayssiere, Anne-Laure Lux, Guillaume Beraud, Alice Degoumois, Christian Billotte, Éric Denion

    Purpose To compare the rate of posterior synechiae of the iris (PSI) occurrence after phacovitrectomy between a group with lens-in-the-bag (LIB) implantation, that is, implantation in the capsular bag, and a group with bag-in-the-lens (BIL) implantation. Setting CHU de Caen, Department of Ophthalmology, Caen, France. Design Comparative retrospective study. Methods One hundred consecutive cases of phacovitrectomies conducted between May 2013 and July 2016 were included. A retrospective analysis of the occurrence rate of PSI in the LIB group and in the BIL group was performed, using multivariate analysis including multiple risk factors such as preoperative synechiae, proliferative diabetic retinopathy, use of 20-gauge vitrectomy, use of gas or silicone tamponade, and use of endophotocoagulation. Results One hundred eyes of 92 patients were included in this study (55 eyes in the LIB group and 45 in the BIL group). The occurrence of PSI was significantly lower in the BIL group with 1 case (2%) versus 22 cases (40%) in the LIB group (P < .001). Among the risk factors studied, preoperative synechiae and the use of retinal endophotocoagulation were almost significantly associated with the occurrence of PSI (P = .068 and P = .087, respectively). In the LIB group, these PSI led to 1 case of acute elevation of intraocular pressure by pupillary seclusion and the use of laser iridotomy in 8 cases. Conclusion The use of BIL rather than LIB implantation in phacovitrectomy practically eliminates PSI.

    更新日期:2019-09-26
  • Blue light–filtering and violet light–filtering hydrophobic acrylic foldable intraocular lenses: Intraindividual comparison
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-09-26
    Shinichiro Nakano, Akira Miyata, Junya Kizawa, Daijiro Kurosaka, Kazunori Miyata, Tetsuro Oshika

    Purpose To compare the clinical outcomes after cataract surgery and implantation of a blue light–filtering IOL (AcrySof IQ SN60WF) or a violet light–filtering intraocular lens (IOL) (OptiBlue ZCB00V). Setting Four surgical sites in Japan. Design Prospective case series. Methods One eye of patients with bilateral cataract was randomly allocated to the blue light–filtering IOL and the fellow eye to the violet light–filtering IOL. Visual acuity and contrast sensitivity were assessed over 3 months. The incidence of cyanopsia was evaluated using the neutralization method. Results The study enrolled 110 eyes of 55 patients. There was no significant difference in visual acuity between the two IOLs. Based on the neutralization results 1 week postoperatively, 15 cases (27.8%) with the light–filtering IOL and 8 cases (14.8%) with the violent light–filtering IOL had cyanopsia; the difference reached statistical significance (P = .049). After 2 weeks, the difference in the incidence of cyanopsia was not significant. Postoperative contrast sensitivity under photopic condition at 1 week and 3 months and contrast sensitivity under mesopic conditions at 3 months were significantly better with the violet light–filtering IOL than with the blue light–filtering IOL (P < .05). Conclusions The violet light–filtering IOL yielded highly satisfactory clinical outcomes, including reduction of cyanopsia and a potential improvement in contrast sensitivity. The different chromophores of the IOL and its different material and design might have contributed.

    更新日期:2019-09-26
  • Presbyopic refractive lens exchange with trifocal intraocular lens implantation after corneal laser vision correction: Refractive results and biometry analysis
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-09-26
    Luis F. Brenner, Bjørn Gjerdrum, Bente Monica Aakre, Per Olof Lundmark, Kristin Nistad

    Purpose To evaluate the refractive and biometry results of presbyopic refractive lens exchange (RLE) with trifocal intraocular lens (IOL) implantation in eyes with previous myopic or hyperopic corneal laser vision correction (LVC). Settings Memira AS, Norway, Sweden, and Denmark. Design Retrospective case series. Methods The refractive results included the manifest refraction spherical equivalent, uncorrected near (UNVA) and distance (UDVA) visual acuities, corrected distance visual acuity, safety, efficacy, and precision. The biometry analysis included the refractive prediction error (RPE), median absolute error (MedAE), and percentage of eyes within a certain RPE range for the formulas from the American Society of Cataract and Refractive Surgery (ASCRS) online calculator. Results The study comprised 241 eyes. Six months postoperatively, 60.0% of eyes were within ±0.25 diopter (D), 80.9% within ±0.50 D, and 97.9% within ±1.00 D of emmetropia. There were no statistical differences in the mean monocular UDVA (0.87 ± 0.20 [SD]), safety index (0.98 ± 0.09), or efficacy index (0.81 ± 0.18) between the myopic ablation group and hyperopic ablation group. Binocularly, 85% of patients had simultaneous UDVA and UNVA of 0.9 or better and Jaeger 3, respectively. The ASCRS online calculator formulas gave different performances for previous myopic and hyperopic ablation profiles. Using optimized constants and nomogram for correcting the mean RPE improved the MedAE. Conclusions Presbyopic RLE was safe and effective in selected cases with a history of LVC. The use of optimized IOL constants and nomograms can improve the refractive precision of lens-based refractive surgery.

    更新日期:2019-09-26
  • Evaluating the relative value of intraoperative aberrometry versus current formulas for toric IOL sphere, cylinder, and orientation planning
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-09-26
    Kerry D. Solomon, Helga P. Sandoval, Richard Potvin

    Purpose To retrospectively review toric intraocular lens (IOL) outcomes and compare actual results to those expected from preoperative calculations and intraoperative aberrometry (IA) in normal eyes. Setting Carolina Eyecare Physicians, Mt. Pleasant, South Carolina, USA. Design Retrospective data review of earlier clinical trial data. Methods Toric IOL planning data and results were obtained from two previous clinical studies of normal eyes receiving toric IOL implants. Back-calculation techniques were used to estimate expected residual refractive sphere and cylinder for preoperative and IA calculations. Results Toric IOL planning data and clinical outcomes for 132 eyes receiving two different toric IOLs were analyzed. The mean spherical equivalent refractions expected with preoperative planning and IA were not statistically significantly different (P = .44), but a higher percentage of eyes within ±0.50 D of the intended spherical refraction was expected with preoperative calculations (P = .05). The mean expected residual refractive astigmatism based on preoperative calculations was significantly lower than for IA (P < .001), with more eyes expected to have 0.50 D or less of residual refractive astigmatism. Conclusion The use of current-generation formulas for sphere power and toric IOL planning in normal eyes seems sufficient to produce clinical outcomes with toric IOLs that are as good or better than those achieved using IA.

    更新日期:2019-09-26
  • Cystoid macular edema with prostaglandin analogue use after uneventful cataract surgery in glaucoma patients
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-09-26
    Ghasem Fakhraie, Masoud Mirghorbani, L. Jay Katz, Amirhossein Mollazadeh, Zakieh Vahedian, Reza Zarei, Yadollah Eslami, Masoud Mohammadi, Nikoo Hamzeh, Ahmad Masoomi

    Purpose To evaluate the effect of postoperative latanoprost administration on central macular thickness (CMT) after uneventful cataract surgery in glaucoma patients. Setting Farabi Eye Hospital, Tehran, Iran. Design Prospective randomized clinical trial. Methods In this single-masked trial, glaucoma patients treated with latanoprost who had no other risk factor for the development of pseudophakic macular edema were randomly allocated to continuation of latanoprost or discontinuation of the drop after uneventful cataract surgery. At baseline and postoperatively at 1 month and 3 months, patients had complete ocular examinations and CMT measurements using optical coherence tomography. The main outcome measure was the change in the CMT between baseline measurements and postoperative measurements at 1 month and 3 months. Results One hundred fifty-six eyes (latanoprost 76; discontinuation 80) finished the trial. There were no differences in baseline patient demographics or characteristics, including the CMT, between the two groups. There was transient increase in the mean CMT by 12 μm ± 49 (SD) in the latanoprost group at 1 month (P = .03); however, the value returned to baseline by 3 months (6 ± 55 μm; P = .27). The between-group difference in the mean change in the CMT from baseline was −3.1 μm (95% confidence interval [CI], −18.4 to 12.0; P = .68) after 1 month and −10.5 μm (95% CI, −26.6 to 5.5; P = .19) after 3 months; the differences were not significant. Conclusion Latanoprost administration after cataract surgery had no measurable effect on macular thickness.

    更新日期:2019-09-26
  • Influence of sclerotomy size on intraocular lens tilt after intrascleral intraocular lens fixation
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-09-26
    Takehiro Matsumura, Yoshihiro Takamura, Jun Makita, Akira Kobori, Masaru Inatani

    Purpose To determine whether differences in sclerotomy size during intrascleral intraocular lens (IOL) fixation influence IOL tilt and visual acuity after surgery. Setting University of Fukui Hospital and Japanese Red Cross Fukui Hospital, Japan. Design Retrospective case series. Methods The study reviewed the records of patients who had intrascleral IOL fixation with transconjunctival 25-gauge pars plana vitrectomy and a follow-up longer than 6 months. The preoperative and postoperative visual outcomes, degree of IOL tilt, and intraoperative and postoperative complications were statistically compared between the sclerotomy groups. Results The study included 65 eyes (60 patients). Postoperatively, the maximum degree of IOL tilt was significantly smaller in the 24-gauge sclerotomy group than in the 30-gauge sclerotomy group (P = .003). The degree of IOL tilt was significantly correlated with the amount of postoperative IOL astigmatism (total astigmatism − corneal astigmatism) (P = .0001, R2 = 0.23). There were no statistically significant differences in the preoperative or postoperative corrected distance visual acuity (CDVA) or the complication rate between the sclerotomy groups. Conclusion A smaller sclerotomy for intrascleral IOL fixation was associated with greater IOL tilt and IOL astigmatism after surgery; however, this did not clinically or significantly affect the postoperative CDVA.

    更新日期:2019-09-26
  • Crystalline lens changes after selective laser trabeculoplasty in Afro-Caribbean patients with open-angle glaucoma; report 4 of the West Indies Glaucoma Laser Study (WIGLS)
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-09-26
    Tony Realini, Hazel Shillingford-Ricketts, Darra Burt, Goundappa K. Balasubramani

    Purpose To characterize changes in nuclear, cortical, and posterior subcapsular lens opacities after selective laser trabeculoplasty (SLT) in Afro-Caribbean eyes with primary open-angle glaucoma (POAG). Setting Three clinical practices, Saint Lucia and Dominica. Design Prospective case series. Methods Patients with POAG in the West Indies Glaucoma Laser Study (WIGLS) had 360-degree SLT after medication washout. No antiinflammatory therapy was used after SLT. Nuclear, cortical, and posterior subcapsular lens opacities were graded through dilated pupils using the Lens Opacification Classification System III (LOCS III) at baseline and 12, 24, and 36 months after SLT, with the grader masked to all previous values after baseline assessment. Changes in opacity scores from baseline were evaluated using paired t tests. Results Seventy-two patients (142 phakic eyes) were evaluated. The mean (±SD) baseline LOCS III opacity scores in right eyes and left eyes, respectively, were 2.44 ± 1.23 and 2.40 ± 1.16 (nuclear), 0.39 ± 1.08 and 0.30 ± 0.85 (cortical), and 0.22 ± 0.59 and 0.15 ± 0.36 (posterior subcapsular). Other than a small improvement in bilateral nuclear opacity scores at 12 months, no statistically or clinically significant changes in any opacity score occurred in either eye up to 36 months postoperatively. Three eyes (2.1%) with preexisting lens opacities had cataract surgery for progressive lens changes at 3 months, 21 months, and 26 months, respectively, after SLT. Conclusions Selective laser trabeculoplasty was not associated with clinically significant changes in nuclear, cortical, or posterior subcapsular lens opacities in glaucomatous Afro-Caribbean eyes. The rate of cataract surgery is consistent with reported rates from longitudinal natural history studies in Caribbean and non-Caribbean populations.

    更新日期:2019-09-26
  • Laser flap enhancement 5 to 9 years and 10 or more years after laser in situ keratomileusis: Safety and efficacy
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-09-26
    Jorge L. Alió del Barrio, Rana Hanna, Mario Canto-Cerdan, Alfredo Vega-Estrada, Jorge L. Alió

    Purpose To study the safety and efficacy of refractive enhancement by flap lifting 5 and 10 years after laser in situ keratomileusis (LASIK). Setting Vissum Alicante, Spain. Design Retrospective case series. Methods Eyes with a flap lift at least 5 years after primary LASIK with a 3-month follow-up were evaluated. The primary outcome measures were safety and the complication rate. Moderate epithelial ingrowth was managed with Nd:YAG laser treatment. Results The primary LASIK procedure was myopic in 45 eyes, hyperopic in 22 eyes, and presbyopic in 3 eyes. The mean time from primary LASIK to the flap lift was 12.3 years ± 3.45 (SD). In 57 eyes, the primary LASIK flap was created at least 10 years before the enhancement. The mean pre-lift spherical equivalent was −1.29 ± 1.23 diopters (D) in the myopia group and +0.65 ± 1.72 D in the hyperopia group. Three months later, 88% of eyes and 74% of eyes, respectively, had an uncorrected distance visual acuity of 20/20 or better; 100% achieved at least 20/25. No eye lost 2 lines or more of corrected distance visual acuity. In the myopia group, the efficacy index was 0.94 and the safety index was 0.98 at 6 months. Mild epithelial ingrowth developed in 31.43% of eyes and clinically significant epithelial ingrowth in 11.42% of eyes; 4.28% required a relift for severe epithelial ingrowth. Conclusions Late flap lift for refractive enhancement 10 years or more after LASIK provided good efficacy and safety with fast visual recovery. The rate of surgical intervention for significant postoperative epithelial ingrowth was low.

    更新日期:2019-09-26
  • Long-term changes in visual outcomes and ocular morphometrics after myopic and toric phakic intraocular lens implantation: Five- and 10-year results
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-09-26
    Soraya M.R. Jonker, Tos T.J.M. Berendschot, Annick E. Ronden, Isabelle E.Y. Saelens, Noël J.C. Bauer, Rudy M.M.A. Nuijts

    Purpose To evaluate the long-term refractive and visual, anterior chamber depth, and axial length (AL) changes and complications after rigid iris-fixated phakic intraocular lens (pIOL) implantation to treat myopia or astigmatism. Setting University Eye Clinic Maastricht, Maastricht UMC+, the Netherlands. Design Prospective case series. Methods The study evaluated patients who had implantation of an Artisan myopic or toric iris-fixated pIOL as of January 1998. Changes were measured annually and reported after 1, 5, and 10 years postoperatively. Results The study comprised 460 eyes (250 patients; mean age 41.1 years ± 10.7 [SD]). Over 10 years, the mean myopization was −0.79 diopters (D) (P < .001), with 52% of eyes within ±1.0 D of target. The mean increase in the logarithm of the minimum angle of resolution (logMAR) corrected distance visual acuity (CDVA) over 10 years was 0.05 (P < .001); 95% of eyes had a CDVA of 20/40 or more and 7% lost 2 or more lines of CDVA. The mean logMAR uncorrected visual acuity (UDVA) increased by 0.14 over 10 years (P < .001); 96% had a UDVA 20/40 or better. The AL increased by 1.14 mm over 10 years (P = .009). Ten percent of pIOLs were explanted because of cataract formation after a mean of 97.9 ± 34.9 months. A higher preoperative age (hazard ratio [HR], 1.08; P < .001) and longer AL (HR, 1.34; P < .001) were risk factors for shorter survival because of cataract formation. Conclusion Ten years after rigid iris-fixated pIOL implantation, the CDVA and UDVA decreased significantly as a result of significant myopization caused by an increased AL unrelated to the pIOL.

    更新日期:2019-09-26
  • Osmotically induced removal of lens epithelial cells to prevent PCO after pediatric cataract surgery: Pilot study to assess feasibility
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-09-26
    JinJun Zhang, Ali Hussain, Sun Yue, Tao Zhang, John Marshall

    Purpose Development of an osmotic-shock technique to remove human lens epithelial cells (LECs) as a preventive measure to address posterior capsule opacification (PCO) after pediatric cataract surgery. Setting Department of Genetics, UCL Institute of Ophthalmology, London, England, and Department of Ophthalmology, Ruijin Hospital, Jiao Tong University, Shanghai, China. Design Laboratory study. Methods Various tissue preparations of human LECs (cultured on coverslips/collagen-coated membrane inserts, human lens capsule biopsies, and lens organ cultured PCO models) were subjected to a single or incremental hyperosmotic shock (NaCl, 350–4000 mOsm/L) in the presence of inhibitors of the Na+-K+-2Cl− cotransporter (NKCC) (to disable the regulatory volume increase [RVI] process). The integrity of the cell monolayer was determined by phase–contrast microscopy, viability assays, and measurement of transepithelial resistance. Results Hyperosmotic shock (400 mOsm/L) caused rapid cell shrinkage (<5 minutes) in all the LEC models studied. In the absence of the NKCC inhibitor, the shrunk cells gradually returned to their original cell volume and architecture over time, while still exposed to the hyperosmotic shock. However, inhibition of the RVI process disabled the ability for restoration of cell volume leading to persistent cell shrinkage, subsequently resulting in cell detachment from the underlying support medium. Conclusion Hyperosmotic shock in the presence of inhibitors of the RVI process was effective in rapidly detaching LECs from their basement membranes. This technique could potentially facilitate removal of residual LECs left on the lens capsule after cataract surgery, thus decreasing or eliminating the risk for aggressive cell proliferation and the development of PCO.

    更新日期:2019-09-26
  • Phakic intraocular lens implantation for the correction of hyperopia
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-09-26
    Abdulaziz A. Alshamrani, Saad S. Alharbi

    The prevalence of myopia is much higher than hyperopia. Hence, there are relatively few studies investigating phakic intraocular lens (pIOL) implantation for the correction of hyperopia. This review aimed to summarize the available relevant literature on the efficacy and safety of pIOL implantation for the correction of hyperopia and hyperopic astigmatism. At present, two types of pIOLs are used to correct hyperopia and hyperopic astigmatism: anterior chamber iris-fixated pIOLs and posterior chamber implantable collamer lenses. Both have been found to be safe and effective. No serious events (eg, retinal or choroidal detachment, endophthalmitis) were reported in the reviewed articles. Implantation of pIOLs might be the optimal refractive surgery for the correction of high hyperopia.

    更新日期:2019-09-26
  • Misdiagnosed opacification of a hydrophobic acrylic intraocular lens
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-09-26
    Syed Naqib Ahmed, Syed Mohammed Shahid, Mayank A. Nanavaty

    A 75-year-old woman was referred for decreased visual acuity resulting from “opacification of the IOL” in the immediate period after uneventful bilateral cataract surgery with single-piece AcrySof IQ intraocular lens (IOL) implantation. A neodymium:YAG laser capsulotomy had been performed in both eyes to treat the complication. Anterior segment optical coherence tomography performed at presentation showed an opaque membrane enveloping the IOL. The membrane was peeled from the anterior IOL surface, and all adherences between the IOL and capsular bag were freed. One year later, the eyes remained stable; the uncorrected distance visual acuity was 20/20, the IOL was clear, and there was no evidence of recurrence of the membrane. Appropriate imaging for the diagnosis and surgical peeling with freeing of the adhesions between the IOL and the capsular bag were essential to the success in this case.

    更新日期:2019-09-26
  • Enhancing rotational stability of toric intraocular lenses using a type 2L Cionni capsular tension ring in patients with high myopia
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-08-27
    Calin Petru Tataru, Anca Cristina Dogaroiu, Catalina Ioana Tataru, Catalin Dogaroiu

    We present the technique used in a patient with high myopia to obtain rotational stability of a plate-haptic multifocal toric intraocular lens (IOL) (AT LISA tri toric 939MP). Both of the patient's eyes had long axial lengths and large capsular bags. The first operated eye experienced consecutive toric IOL malpositions. In the fellow eye, toric IOL alignment was preserved by implanting a type 2L Cionni capsular tension ring. This was reversely inserted so the two eyelets, which are positioned slightly anterior to the ring, pressed the IOL on the posterior capsule. This unsophisticated technical artifice provided rotational stability of the IOL, even at 12 months postoperatively.

    更新日期:2019-08-27
  • Ophthalmic Simulated Surgical Competency Assessment Rubric for manual small-incision cataract surgery
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-08-27
    William H. Dean, Neil L. Murray, John C. Buchan, Karl Golnik, Min J. Kim, Matthew J. Burton

    Purpose To develop and test the validity of a surgical competency assessment tool for simulated small-incision cataract surgery (SICS). Setting Participating ophthalmologists contributed from 8 countries. Design Qualitative and quantitative development and evaluation of face and content validity of an assessment rubric, and evaluation of construct validity and reliability. Methods The SICS Ophthalmic Simulated Surgical Competency Assessment Rubric (Sim-OSSCAR) was developed and assessed for face and content validity by an international group of experienced ophthalmologists. Groups of novice and competent surgeons from 4 countries were recorded performing surgery, and masked assessments were performed by 4 expert surgeons, to determine construct validity and reliability. Results The Sim-OSSCAR for SICS was assessed by a panel of 12 international experts from 8 countries. In response to the question, “Do you think the OSSCAR represents the surgical techniques and skills upon which trainees should be assessed?,” all respondents either agreed or strongly agreed. Face validity was rated as 4.60 (out of 5.0). The content was iteratively agreed to by the panel of experts; final content validity was rated as 4.5. Interobserver reliability was assessed, and 17 of 20 items in the assessment matrix had a Krippendorff α correlation of more than 0.6. A Wilcoxon rank-sum test showed that competent surgeons perform better than novices (P = .02). Conclusions This newly developed and validated assessment tool for simulation SICS, based on the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric, has good face and content validity. It can play a role in ophthalmic surgical education.

    更新日期:2019-08-27
  • Rotational stability and refractive outcomes of a single-piece aspheric toric intraocular lens with 4 fenestrated haptics
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-08-27
    Giacomo Savini, Giovanni Alessio, Giuseppe Perone, Scipione Rossi, Domenico Schiano-Lomoriello

    Purpose To assess the outcomes of implantation of a single-piece toric intraocular lens (IOL) with 4 fenestrated haptics. Setting IRCCS Fondazione Bietti, Rome, Italy. Design Prospective case series. Methods All patients who had implantation of the Mini Toric Ready IOL were consecutively enrolled. Intraoperatively, the IOL was aligned using an automated system. Follow-up visits were performed at 1 day, 1 week, and 1, 3, and 6 months. At each visit, retroillumination pictures were taken to assess IOL orientation; visual acuity and refraction were also measured. Results The final analysis comprised 63 eyes (63 patients). From the first to the last follow-up, the mean arithmetic rotation was −0.2 degrees ± 3.5 (SD) (range −13 to +10 degrees) and the mean absolute rotation was 1.6 ± 3.1 degrees. Intraocular lens rotation from the first to the last examination was within 5 degrees in 92.1% of eyes and on consecutive visits, within 5 degrees in 98.4% or more of eyes. By 6 months, 10 IOLs (15.9%) had rotated clockwise and 10 counterclockwise. Linear regression did not show a statistically significant relationship between rotational stability and the axis of placement with any preoperative parameter (eg, axial length). The mean magnitude of preexisting corneal astigmatism was 1.9 ± 0.7 diopters (D) (range 0.76 to 3.72 D). At the last follow-up, the mean magnitude of refractive astigmatism was 0.5 ± 0.4 D (range 0.0 to 1.5 D); the difference was statistically significant (P < .05). Conclusion The toric IOL showed good rotational stability and is an option for correcting corneal astigmatism at the time of cataract surgery.

    更新日期:2019-08-27
  • Clinical and experimental evaluation of new back-flow hydrodissection technique
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-08-27
    Atsushi Hirota, Kazuomi Yasuda, Shinichi Morita, Fumiki Okamoto, Sujin Hoshi, Tomoya Murakami, Tetsuro Oshika

    Purpose To assess the efficacy and safety of a new technique, back-flow hydrodissection. Setting Hirota Eye Clinic, Yamaguchi, and Department of Ophthalmology, University of Tsukuba, Ibaraki, Japan. Design Prospective case series and experimental study. Methods For back-flow hydrodissection, the irrigation line was connected to the aspiration port of an irrigation/aspiration handpiece using a female–female connector with the irrigation port open. The balanced salt solution was irrigated from the aspiration tip opening with constant pressure, hydrodissection was performed, and the excess fluid was evacuated via the sleeve lumen. In a clinical study, 200 eyes were randomly assigned to conventional hydrodissection with an irrigation cannula or back-flow hydrodissection. In experimental studies, intraocular pressure (IOP) fluctuation and fluid dynamics in the anterior and posterior chamber were evaluated in porcine eyes. Results The lens became freely mobile in the capsular bag in 99 (99%) of 100 eyes and in 96 (96%) of 100 eyes in the back-flow hydrodissection group and conventional hydrodissection group, respectively (P = .369). There were no between-group differences in any other surgery-related parameters, including surgical time and the complication rate. In porcine eyes, conventional hydrodissection induced a significantly larger increase in IOP than back-flow hydrodissection (P < .0001). Conventional hydrodissection immediately washed out fluorescein-stained ophthalmic viscosurgical device (OVD) from the anterior chamber, while there was little leakage of OVD from the eye with back-flow hydrodissection. The endoscopic view showed that conventional hydrodissection induced rapid and severe bulging of the posterior capsule; however, bulging was gentle and mild with back-flow hydrodissection. Conclusion Back-flow hydrodissection was safe and effective in disengaging the lens from the capsule, ensuring a freely mobile lens.

    更新日期:2019-08-27
  • Quantification of residual ophthalmic viscosurgical device after irrigation/aspiration in experimental cataract surgery in vitro
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-08-27
    Hisato Gunji, Tetsutaro Ohki

    Purpose To determine the distribution and quantity of ophthalmic viscosurgical device (OVD) retained in the lens capsular bag after irrigation/aspiration (I/A) in experimental cataract surgery. Setting Department of Ophthalmology, Kashiwa Hospital, Jikei University School of Medicine, Japan. Design Experimental study. Methods Fifteen freshly enucleated porcine eyes were used. Sodium hyaluronate 1.0% (Healon) was mixed with a fixed concentration of silica nanoparticles encapsulating fluorescein isothiocyanate (labeled OVD), and it was injected separately into the capsular bag and injector cartridge for intraocular lens (IOL) insertion. After a 3-piece IOL (YA-60BBR) or a 1-piece IOL (iSert 255) was implanted within the capsular bag, OVD was removed by thorough I/A. Eyes that were injected with the labeled OVD into the capsular bag without IOL insertion were used as controls. The distribution of residual OVD in the capsular bag was observed under ultraviolet irradiation using Miyake-Apple view. Then, the excised capsular bag was dissolved in hydrogen fluoride, and silica concentration was measured quantitatively by elemental analysis. Results The quantity of residual OVD in the capsular bag was 243.1 μg ± 1.3 (SD) in the 3-piece IOL–implanted group, 383.8 ± 11.1 μg in the 1-piece IOL–implanted group, and 99.0 ± 1.3 μg in the control group. In the 1-piece IOL–implanted eyes, OVD in the form of clumps tended to remain near the center of the optic on the posterior side, and the quantity of residual OVD was significantly greater than in 3-piece IOL–implanted eyes (P < .05). Conclusion The quantity of residual OVD after I/A could be determined indirectly using labeled OVD, and the quantity was significantly greater in 1-piece IOL–implanted eyes than in 3-piece IOL–implanted eyes.

    更新日期:2019-08-27
  • Comparative meta-analysis of toric intraocular lens alignment accuracy in cataract patients: Image-guided system versus manual marking
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-08-27
    Fengqi Zhou, Wu Jiang, Zhuoling Lin, Xiaoyan Li, Jing Li, Haotian Lin, Weirong Chen, Qiwei Wang

    This meta-analysis studied toric intraocular lens (IOL) alignment accuracy using image-guided and manual marking methods by comparing the axis misalignment of toric IOLs, percentage of eyes with toric IOL axis misalignment within ±5 degrees, postoperative astigmatism, difference vector, and postoperative uncorrected distance visual acuity. The methodological quality was assessed using the modified Quality Assessment of Diagnostic Accuracy Studies-2 tool. Continuous variables were analyzed using weighted mean differences, and dichotomous variables were compared using the odds ratio. Five studies comprising a total of 257 eyes were analyzed. For heterogeneity, neither sensitivity analysis nor the Egger test detected statistical findings. The image-guided marking group had smaller toric IOL axis misalignment (P < .00001), less postoperative astigmatism (P = .003), and a smaller difference vector (P < .00001) than the manual marking group. The overall evidence from the studies indicates that image-guided marking is better than manual marking, resulting in less axis misalignment, a smaller difference vector, and less postoperative astigmatism.

    更新日期:2019-08-27
  • Combined DSAEK and intraocular lens flipping with retropupillary fixation in a patient with anterior chamber iris-claw intraocular lens and corneal edema
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-08-27
    George D. Kymionis, Nafsika Voulgari, Kattayoon Hashemi, Michael A. Grentzelos, Dimitrios Mikropoulos

    An 84-year-old monocular woman was referred to our institution for the management of corneal decompensation in her only eye, the right eye. The patient had secondary implantation of an anterior chamber iris-claw intraocular lens (IOL) for IOL dislocation in the setting of pseudoexfoliation syndrome 2 years before presentation. Descemet-stripping automated endothelial keratoplasty (DSAEK) combined with retropupillary repositioning of the iris-claw IOL using a flipping technique was performed for the treatment of corneal edema. No intraoperative or postoperative complications occurred. Six months postoperatively, the corneal graft was attached and clear and the retropupillary iris-claw IOL was well positioned. The uncorrected distance visual acuity and corrected distance visual acuity improved from counting fingers preoperatively to 20/200 and 20/63, respectively, after surgery. Combined DSAEK and retropupillary refixation of a prepupillary iris-claw IOL using the flipping technique was a safe technique in this patient with corneal decompensation.

    更新日期:2019-08-27
  • An objective scatter index cutoff point as a powerful objective criterion for preoperative nuclear cataract decision-making based on ROC analysis
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-08-20
    Clara Monferrer-Adsuara, Lucía Mata-Moret, Verónica Castro-Navarro, Marisa Hernández-Garfella, Alicia Gracia-García, Miguel Ortiz-Salvador, Lidia Remolí-Sargues, Enrique Cervera-Taulet

    Purpose To assess the correlation between clinical cataract surgery indication and the objective scatter index (OSI) by defining the optimal OSI cutoff point in the surgery scheduling. Setting Ophthalmology service, Consorcio Hospital General Universitario, Valencia, Spain. Design Prospective triple-masked randomized single-center study. Methods Patients with cataractous eyes were recruited, and those with anterior segment disease, abnormal posterior pole, and/or previous ocular surgery were excluded. The principle of double-pass aberrometry was used by the main investigator to determine an OSI, after measuring subjective refraction and corrected distance visual acuity (CDVA), and then slitlamp evaluation was carried out by an independent researcher. The surgical decision was based on the current protocol according to the European guidelines. Correlation between the surgical decision, CDVA, and OSI were analyzed and an OSI discriminative value was calculated, implementing a receiver operating characteristic (ROC) curve. Results The study comprised 106 eyes (73 patients). The analysis established an inverse linear correlation between OSI and CDVA (r = −0.455, P < .0001). The comparison of the mean OSI between the surgical group (7.05 ± 4.65 [SD]) and the nonsurgical group (2.92 ± 1.88), revealed statistically significant differences (P = 5.04 × 10−9). The OSI score 3.2 was determined as the optimal cutoff value to discriminate surgical treatment (sensitivity 80%, specificity 84%). Conclusions An optimal OSI value, according to an ROC curve calculation, was capable of providing clinicians with a powerful criterion for preoperative decision-making, thus suggesting an end to the subjectivity implicit in the cataract surgery decision-making process.

    更新日期:2019-08-20
  • Extended depth-of-focus toric intraocular lens targeted for binocular emmetropia or slight myopia in the nondominant eye: Visual and refractive clinical outcomes
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-08-20
    Helga P. Sandoval, Stephen Lane, Stephen Slade, Richard Potvin, Eric D. Donnenfeld, Kerry D. Solomon

    Purpose To compare the visual and refractive outcomes with a diffractive toric extended depth-of-focus (EDOF) intraocular lens (IOL) when both eyes are targeted for emmetropia and the nondominant eye is targeted for slight myopia. Setting Three clinical practices, United States. Design Prospective case series. Methods Patients having routine cataract surgery with bilateral Tecnis Symfony toric EDOF IOL implantation were assigned to 1 of 2 groups. In 1 group, the nondominant eye was targeted for −0.50 diopter (D) (mini-monovision). Assessments included uncorrected monocular and binocular visual acuities (logarithm of the minimum angle of resolution) at distance (4 m), intermediate (66 cm), and near (40 cm) and the postoperative residual refractive error. Results Forty patients were enrolled in each group, with 1 dropout. The mean postoperative residual refractive astigmatism was 0.25 D in both groups, with no statistically significant difference. The mean residual refractive astigmatism was 0.50 D or lower in 92% of eyes (72/78) in the mini-monovision group and 95% of eyes (74/78) in the emmetropia group 3 months postoperatively. The mini-monovision group had slightly worse uncorrected visual acuity at 4 m than the emmetropia group (0.16 versus 0.09; P = .002) but better uncorrected acuity at 40 cm (0.25 versus 0.34; P < .001). Binocular uncorrected acuity was not statistically significantly different between groups at 4 m (−0.03 versus −0.01; P = .33) or 66 cm (0.06 versus 0.04; P = .34) but was statistically significant at 40 cm (0.25 versus 0.19; P = .03). Conclusions The EDOF toric IOL provided functional distance, intermediate, and near vision. A slight monovision approach appears to improve near visual acuity.

    更新日期:2019-08-20
  • Injection volume and intracameral moxifloxacin dose
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-08-20
    Neal H. Shorstein, Susanne Gardner

    Purpose To test the effect of injection volume and concentration on dosing and residence time of moxifloxacin in the anterior chamber (AC). Setting Kaiser Permanente, Walnut Creek, California, USA. Design Experimental study. Methods Moxifloxacin 0.5%/0.05 mL, moxifloxacin 0.5%/0.10 mL, and moxifloxacin 0.15%/0.50 mL were drawn into 5 1.0 mL syringes each, injected into tared vials, and weighed. The doses delivered were calculated. The AC concentrations and elimination rates of the drug for two AC volumes were modeled for each dosing method. Results The 0.05 mL injection volume resulted in the greatest range (35 μg) of delivered dose compared with larger injection volumes (≤25 μg). The mathematical model predicted that variation in dosing in each group would result in differences of 12 minutes or less for the presence of the drug in the AC. Injection of 0.5%/0.1 mL produced AC concentrations above 500 μg/mL for 1.9 to 3.0 hours and above 64 μg/mL for 5.5 to 6.5 hours, depending on the AC volume; however, flushing with a 0.15% concentration sustained AC levels for 1.9 hours and 5.5 hours, respectively, for the two AC volumes. Conclusions Smaller injection volumes of a higher concentration moxifloxacin resulted in less accuracy and less precision in the delivered dose (0.05 mL, P = .005; 0.10 mL, P = .03); however, the clinical significance of this might vary. Injection of 0.5%/0.1 mL and flushing with 0.15%/0.5 mL of moxifloxacin would provide similar drug AC residence times according to the model. Flushing provided more consistent AC concentrations with differing AC volumes.

    更新日期:2019-08-20
  • Accuracy of thick-lens intraocular lens power calculation based on cutting-card or calculated data for lens architecture
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-08-20
    Kristian Næser, Giacomo Savini

    Purpose To compare the accuracy of a thick-lens intraocular lens (IOL) power formula using the manufacturer's cutting-card information (the Næser 1 formula) and calculated data from open sources (the Næser 2 formula) for IOL architecture; and to compare these results with the achievements of the Barrett Universal II, Haigis, Hoffer Q, Holladay 1, and SRK/T formulas. Setting IRCCS GB Bietti Foundation, Rome, Italy. Design Retrospective case series. Methods For each IOL power formula, the prediction error in refraction was retrospectively calculated in eyes after phacoemulsification with implantation of the SN60WF posterior chamber IOL. The predictions made using the different formulas were optimized in retrospect by adjusting the respective constants. The mean arithmetic error (ME), the variance, and the median absolute error (MedAE) were calculated, as well as the dependency of the arithmetic error on the axial length. Results The study comprised 151 eyes. The Næser 1 and Næser 2 formulas were identical clinically and statistically. The ME (P = .278 with a one-way analysis of variance) and the variances for arithmetic errors (P = .248 with Levene's homogeneity test) were similar for all 7 formulas. A combined metric of ME, variance, MedAE, and arithmetic error on the axial length suggested the Næser 2 formula as the most accurate, followed by the Næser 1, Barrett Universal II, Haigis, SRK/T, Hoffer Q, and Holladay 1 formulas. Conclusions The Næser thick-lens IOL power equations based on calculated and manufacturer's IOL data provided similar accuracies and performed approximately as the best thin-lens formulas. Cutting-card information is not necessary in current IOL power calculation.

    更新日期:2019-08-20
  • Evaluation of clarity characteristics in a new hydrophobic acrylic IOL in comparison to commercially available IOLs
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-08-06
    Liliana Werner, Israwal Thatthamla, Marcia Ong, Hillary Schatz, Montserrat Garcia-Gonzalez, Juan Gros-Otero, Rafael Cañones-Zafra, Miguel A. Teus

    Purpose To perform in vitro assessments of surface haze and roughness, subsurface nanoglistenings (SSNGs), and glistenings of a new hydrophobic acrylic intraocular lens (IOL) in comparison to commercially available IOLs. Setting Universities of Utah and Alcalá, and Alcon Vision, LLC. Design Experimental study. Methods The IOLs used were Clareon CNA0T0, Tecnis ZCB00 and Tecnis OptiBlue ZCB00V, Eternity W-60, enVista MX60, and Vivinex XY1. Surface haze was assessed by the pixel intensity units (PIU) from cross-sectional slitlamp images, and it was correlated to atomic force microscopy roughness. For SSNGs, the IOLs were artificially aged up to 10 years, followed by Scheimpflug densitometry (computer-compatible tape unit [CCTU]) measurements. For glistenings, the IOLs were immersed in a water bath and subjected to temperature changes before analysis. Results The surface haze (n = 10, PIU) was 4.25 ± 0.87 (SD) (CNA0T0), 9.50 ± 1.66 (ZCB00), 39.48 ± 1.97 (ZCB00V), 46.68 ± 3.16 (W-60), 44.70 ± 4.00 (MX60), and 4.42 ± 0.71 (XY1) (P < .001), which showed a strong correlation with surface roughness measurements (R = 0.94, P = .006). The densitometry (n = 10, CCTU at 10 years) was 7.30 ± 1.36 (CNA0T0), 11.88 ± 3.10 (ZCB00), 38.12 ± 2.24 (ZCB00V), 48.13 ± 9.44 (W-60), 20.20 ± 3.84 (MX60), and 6.75 ± 6.66 (XY1) (P < .001), with no significant differences between CNA0T0 vs. ZCB00 and XY1. The glistenings density (n = 30) was the lowest for the CNA0T0, W-60, and MX60 IOLs. Conclusions The new Clareon CNA0T0, which is manufactured from a hydrophobic acrylic material, exhibited among the lowest levels of surface haze and roughness, SSNGs, and glistenings compared with other commercially available hydrophobic acrylic IOLs.

    更新日期:2019-08-06
  • Evaluation of total keratometry and its accuracy for intraocular lens power calculation in eyes after corneal refractive surgery
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-08-06
    Li Wang, Tatyana Spektor, Rodrigo G. de Souza, Douglas D. Koch

    Purpose To compare the accuracy of total keratometry (TK) and standard keratometry (K) from a swept-source optical coherence tomography biometer for intraocular lens (IOL) power calculation in eyes with previous corneal refractive surgery. Setting Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. Design Retrospective case series. Methods The differences between the TK and K and their association with K were assessed. For IOL power calculation, combinations of 1) K with Haigis, Haigis-L, and Barrett True-K, and 2) TK with Haigis (Haigis-TK) were used. The mean absolute error (MAE) and the percentages of eyes within prediction errors of ± 0.50 diopters (D), ± 1.00 D, and ± 2.00 D were calculated. Results The study comprised 129 eyes. For Haigis, Haigis-L, Barrett True-K, and Haigis-TK, respectively, the MAEs were 0.72 D, 0.61 D, 0.54 D, and 0.50 D in the myopic laser in situ keratomileusis (LASIK)/photorefractive keratectomy (PRK) group, and 0.74 D, 0.68 D, 0.71 D, and 0.70 D in hyperopic LASIK/PRK group. For the radial keratotomy (RK) eyes, the MAEs were 0.66 D, 0.71 D, and 0.72 D for the Haigis, Barrett True-K, and Haigis-TK formulas, respectively. In the myopic LASIK/PRK group, the Barrett True-K and Haigis-TK produced significantly lower MAEs than did Haigis (P < .05). In the hyperopic LASIK/PRK and RK groups, there were no significant differences between the formulas in MAEs and percentages of eyes within the above prediction errors. Conclusions The performance of the combination of Haigis and TK in refractive prediction was comparable with Haigis-L and Barrett True-K in eyes with previous corneal refractive surgery.

    更新日期:2019-08-06
  • Predictive value of intracrystalline interphase point measured by optical low-coherence reflectometry for the estimation of the anatomical position of an intraocular lens after cataract surgery
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-07-30
    Francisco Javier Castro-Alonso, Daniel Bordonaba-Bosque, David P. Piñero, Beatriz Latre-Rebled

    Purpose To investigate the predictive value of the intracrystalline interphase point (ICIP) measured with optical low-coherence reflectometry (OCLR) to estimate the final lens position (FLP) of an intraocular lens (IOL) after cataract surgery. Setting Alcañiz Hospital, Teruel, Spain. Design Single-center retrospective descriptive study. Methods Patients undergoing cataract surgery were enrolled. They were grouped according to the IOL implanted as follows: Group 1, Acrysof IQ aspheric SN60WF IOL (77 eyes); Group 2, enVista MX60 IOL (71 eyes); Group 3, CT Asphina 409 IOL (44 eyes). An OCLR-based biometer (Lenstar LS 900 system) was used for biometric measurements preoperatively and at 4 to 5 weeks postoperatively. Results The study comprised 192 eyes of 174 patients (mean age: 76.4 years). One hundred seventy eyes (88.5%) eyes showed an absolute refractive prediction error (ARPE) less than 0.50 diopters (D). The mean ARPE was 0.25 D ± 0.21 (SD). Significantly higher FLP values were found in Group 2 compared with the other two groups (P < .001). Significantly lower ICIP values were found in the eyes with an ARPE of 0.50 D or more compared with eyes that had an ARPE less than 0.50 D in Group 1 (P = .042) and Group 2 (P = .023). The correlation of the FLP with the ICIP was good in all three groups (r ≥ 0.74, P <.001). Three linear expressions were obtained to predict the FLP from the ICIP and other preoperative data (R2: 0.85, 0.69, and 0.49 in Groups 1, 2, and 3, respectively). Conclusions The position of the ICIP measured with OCLR correlated with the FLP after cataract surgery, and it can be used to optimize IOL power calculations.

    更新日期:2019-07-30
  • Biologic stromal ring to manage stromal melting after intrastromal corneal ring segment implantation
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-07-29
    Elias Jarade, Mohamad Issa, Wassef Chanbour, Pramod Warhekar

    We report a new technique to replace a manufactured poly(methyl methacrylate) (PMMA) ring with a biologic stromal ring fashioned from human corneal donor tissue in eyes with stromal melting above the PMMA ring. The biologic stromal ring is prepared using manual or femtosecond laser trephination of a donor cornea to obtain a 360-degree ring that is denuded and adjusted to match the PMMA ring being replaced. The biologic ring is attached to the PMMA ring. The PMMA ring is pushed and retrieved from the other side, which installs the biologic ring in place. Six biologic stromal rings were implanted successfully in 5 eyes of 5 patients with previous stromal melting; no complications were reported up to 6 months postoperatively. The biologic stromal ring stopped and healed the melting, prevented further ring complications, and preserved the therapeutic refractive effect of the previously implanted PMMA ring.

    更新日期:2019-07-30
  • Optimization of surgical parameters based on patient-specific models: Application to arcuate keratotomy
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-07-29
    Oskar Truffer, Daniel Abler, Bojan Pajic, Günther Grabner, Hannes Kraker, Philippe Büchler

    Purpose To determine surgical parameters for arcuate keratotomy by simulating the intervention with a patient-specific model. Setting University Eye Clinic Salzburg, Paracelsus Medical University, Austria, and Institute for Surgical Technology and Biomechanics, University of Bern, Switzerland. Design Computational modeling study. Methods A new approach to plan arcuate keratotomy based on personalized finite element simulations was developed. Using this numeric tool, an optimization algorithm was implemented to determine the incision parameters that best met the surgeon's requirements while preserving the orientation of the astigmatism. Virtual surgeries were performed on patients to compare the performance of the simulation-based approach with results based on the Lindstrom and Donnenfeld nomograms and with intrastromal interventions. Results Retrospective data on 28 patients showed that personalized simulation reproduced the surgically induced change in astigmatism (Pearson correlation = 0.8). Patient-specific simulation was used to examine strategies for arcuate interventions on 621 corneal topographies. The Lindstrom nomogram resulted in low postoperative astigmatism (mean 0.03 diopter [D] ± 0.3 [SD]) but frequent overcorrections (20%). The Donnenfeld nomogram and intrastromal incisions resulted in a small amount of overcorrection (1.5%) but a wider spread in astigmatism (mean 0.63 ± 0.35 D and 0.48 ± 0.50 D, respectively). In contrast, the new numeric parameter optimization approach led to postoperative astigmatism values (mean 0.40 ± 0.08 D, 0.20 ± 0.08 D, and 0.04 ± 0.13 D) that closely matched the target astigmatism (0.40 D, 0.20 D, and 0.00 D), respectively, while keeping the number of overcorrections low (<1.5%). Conclusion Using numeric modeling to optimize surgical parameters for arcuate keratotomy led to more reliable postoperative astigmatism, limiting the risk for overcorrection.

    更新日期:2019-07-29
  • Risk factors for explantation of iris-fixated phakic intraocular lenses
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-07-29
    Soraya M.R. Jonker, Annelies A.C. Van Averbeke, Tos T.J.M. Berendschot, Isabelle E.Y. Saelens, Rudy M.M.A. Nuijts

    Purpose To determine risk factors for explantation of iris-fixated phakic intraocular lenses (pIOLs) with a maximum 17-year follow-up. Setting University Eye Clinic Maastricht, Maastricht UMC+, the Netherlands. Design Prospective case series. Methods Eyes that had implantation of 1 of various iris-fixated pIOL models from 1998 to 2016 were evaluated. Primary outcome measures were the rate and proportion of pIOL explantations and the survival time (ie, time to pIOL explantation) in general and specifically as a result of cataract formation or endothelial cell loss (ECL). Results The study comprised 1037 eyes. The mean follow-up was 69.3 months ± 52.8 (SD) and the mean preoperative age, 40.2 ± 10.9 years. The overall explantation rate was 12% after a mean of 166.1 months ± 3.0 (standard error). Phakic IOL explantations were performed in 59% of eyes because of cataract formation and in 32% because of ECL. Shorter survival was seen with a higher preoperative age (hazard ratio [HR], 1.07/y; P < .001), longer axial length (AL) (HR, 1.10/mm; P = .009), and smaller anterior chamber depth (ACD) (HR, 4.47/mm; P < .001). Factors for shorter survival resulting from cataract were older preoperative age, longer AL, and larger ACD. Risk factors contributing to shorter survival resulting from ECL were a smaller ACD, lower endothelial cell density, and implantation with an Artisan hyperopia (toric) or Artiflex myopia (toric) IOL. Conclusions The explantation rate of iris-fixated pIOLs was 12% after almost 14 years of follow-up, with 59% of pIOL explantations caused by cataract formation and 32% caused by ECL. An older preoperative age, longer AL, and smaller ACD were risk factors for a shorter survival.

    更新日期:2019-07-29
  • Triphasic polymeric corneal coating gel versus a balanced salt solution irrigation during cataract surgery: A postoperative anterior segment optical coherence tomography analysis and confocal microscopy evaluation
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-07-29
    Rita Mencucci, Michela Cennamo, Eleonora Favuzza, Miguel Rechichi, Stanislao Rizzo

    Purpose To investigate the safety and efficacy of the intraoperative use of a triphasic polymeric gel as corneal coating during cataract surgery and its effect on postoperative ocular comfort. Setting Eye Clinic, University of Florence, Italy. Design Longitudinal observational retrospective study. Methods Data on patients who received an application of a polysaccharide blend of hydroxypropyl methylcellulose, xanthan gum, and carrageenan (EyeDRO) on the corneal surface and data on patients who received a balanced salt solution during phacoemulsification surgery were analyzed. The central corneal thickness (CCT) and epithelial thickness were examined using anterior segment optical coherence tomography, and the corneal basal epithelial cell (BEC) and Langerhans cell densities by in vivo confocal microscopy. The ocular surface disease index (OSDI) score, tear breakup time (TBUT), and Schirmer test I values were evaluated. Results The study comprised data on 28 patients in the coating gel group and 26 patients in the balanced salt solution group. In the coating gel group, the CCT and epithelial thickness values returned to the baseline value within 5 and 15 postoperative days, respectively; the BEC and Langerhans cell densities returned to baseline levels within 15 and 30 postoperative days. In the balanced salt solution group, the mean BEC and Langerhans cell densities were significantly different from the preoperative values at all follow-up assessments. The TBUT returned to the preoperative level at day 5 in the coating gel group. The OSDI scores returned to the preoperative values after 15 days in the coating gel group and 30 days in the balanced salt solution group. Conclusions The use of a tripolymeric gel as a corneal coating during cataract surgery played a protective role on the corneal surface and reduced postoperative discomfort symptoms.

    更新日期:2019-07-29
  • Correlation of virtual reality performance with real-life cataract surgery performance
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-07-29
    Mads Forslund Jacobsen, Lars Konge, Daniella Bach-Holm, Morten la Cour, Lars Holm, Klavs Højgaard-Olsen, Hadi Kjærbo, George Saleh, Ann Sofia Thomsen

    Purpose To investigate the correlation between performance on a virtual reality simulator and real-life cataract surgical performance. Setting Nine ophthalmology departments in Denmark and Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark. Design Prospective multicenter study. Methods Cataract surgeons with different experience levels were included. The participants performed 3 consecutive video-recorded phacoemulsification surgeries that were rated by masked raters using the Objective Structured Assessment of Cataract Surgical Skills (OSACSS) scoring system. Thereafter, the participants performed a previously validated test on an Eyesi virtual reality simulator. Primary outcomes were the mean OSACSS score from all 3 surgeries and the simulator score from the participants' first repetition of the performance test. Result Nineteen surgeons participated. There was a statistically significant correlation between the simulator performance score and the mean OSACSS score across all experience levels, with a Pearson correlation of 0.65 (P = .003, R2 = 0.42). Conclusion Simulator performance was significantly correlated with real-life cataract surgical performance.

    更新日期:2019-07-29
  • Comparison of effective phacoemulsification time and corneal endothelial cell loss using 2 ultrasound frequencies
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-07-29
    Taru Dewan, Praveen Kumar Malik, Ritu Kumari

    Purpose To compare 2 ultrasound (US) frequencies for phacoemulsification for moderate to hard cataract to determine a frequency that makes phacoemulsification safer and more efficacious. Setting Post Graduate Institute of Medical Education and Research, New Delhi, India. Design Randomized controlled trial. Methods Patients with grade 4.0 to 6.9 senile cataract were randomized to 2 groups. Group A had lower frequency (28 kHz) phacoemulsification, and Group B had higher frequency (42 kHz) phacoemulsification. The effective phacoemulsification time (EPT) and estimated fluid usage (EFU) were compared intraoperatively. The endothelial parameters were assessed over 1 year. Results Both groups comprised 80 patients. The groups were matched for age (P = .533), sex (P = .263), and nuclear grade (nuclear color, P = .496; nuclear opalescence, P = .622). Group B had significant reductions in EPT (P = .008) and EFU (P = .004) compared with Group A. Postoperatively, the endothelial cell density (ECD) was significantly higher in Group B at 1 month (P = .004), 3 months (P = .003), 6 months (P = .004), 9 months (P = .002), and 1 year (P = .003). The percentages of ECD loss were also significantly lower in Group B; the difference was statistically significant up to 1 year postoperatively even after adjustments for age, grade of cataract, EPT, and EFU. Conclusion Higher frequency phacoemulsification was associated with a lower EPT and EFU as well as better endothelial preservation than a lower frequency.

    更新日期:2019-07-29
  • Surface properties of commercially available hydrophobic acrylic intraocular lenses: Comparative study
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-07-29
    Chiara De Giacinto, Davide Porrelli, Gianluca Turco, Marco Rocco Pastore, Rossella D'Aloisio, Daniele Tognetto

    Purpose To analyze and compare the surface properties of commercially available hydrophobic acrylic intraocular lenses (IOLs). Setting Eye Clinic, University of Trieste, Italy. Design Experimental study. Methods The following 6 single-piece hydrophobic acrylic IOL models with the same dioptric power were studied and compared: Clareon SY60WF, Tecnis PCB00, enVista MX60, CT Lucia 601P, Vivinex iSert XY1, and iSert 251. Topography of the IOL surface was analyzed using atomic force microscopy (AFM). Surface contact angle measurements using the sessile drop method were performed to assess IOL wettability. Results The AFM analysis showed that the Vivinex iSert XY1 IOL and Clareon SY60WF IOL had the lowest surface roughness (P < .05); there was no statistically significant difference in surface roughness between the those 2 IOL models (P > .05). Surface contact angle measurements showed that the iSert 251 IOL had the highest hydrophobicity. The CT Lucia 601P IOL had the lowest contact angle of all IOL models. Conclusions The AFM analysis and surface contact angle measurements of all IOLs tested showed that the Vivinex iSert XY1 IOL and Clareon SY60WF IOL had the best topographic features. The smoother, more regular surface of these new IOL models might reduce cell adhesion and therefore lower the incidence of posterior capsule opacification.

    更新日期:2019-07-29
  • Endophthalmitis reduction with intracameral moxifloxacin in eyes with and without surgical complications: Results from two-million consecutive cataract surgeries
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-07-29
    Aravind Haripriya, David F. Chang, Ravilla D. Ravindran

    Purpose To analyze the posterior capsule rupture (PCR) rates among staff and trainee cataract surgeons, and the postoperative endophthalmitis (POE) rates in uncomplicated and complicated eyes both with and without intracameral moxifloxacin prophylaxis (ICMP). Setting Ten regional Aravind Eye Hospitals in India. Design Retrospective multicenter clinical registry within a single hospital network. Methods POE rates with and without ICMP were statistically compared for all eyes and separately for trainees versus staff, for phacoemulsification versus manual small-incision cataract surgery (M-SICS), and for a subgroup of eyes complicated by PCR or requiring secondary surgery. Results All cataract surgeries (2 062 643) performed during the 8-year period from 2011 to 2018 at the 10 regional Aravind Eye hospitals were included in the analysis. With ICMP, the overall POE rate declined from 692 (0.07%) of 993 009 eyes to 185 (0.02%) of 1 069 634 eyes (P < .001). This was independently significant for phacoemulsification and for M-SICS (P < .001). The overall PCR rate was 28 352 (1.37%) of 2 062 643 eyes, and it was statistically higher for trainees irrespective of surgical method (P < .001). Both staff and trainee surgeons had higher PCR rates with phacoemulsification than with M-SICS (P < .001). Absent ICMP, PCR increased the overall POE rate by more than 7-fold to 63 (0.43%) of 14 505 eyes. ICMP reduced the POE rate after PCR to 25 (0.18%) of 13 847 eyes (P = .002). This ICMP benefit was separately significant for both M-SICS (0.54% vs 0.26%, P = .01) and phacoemulsification (0.29% vs 0.06%, P = .005). The POE rate was especially high after secondary IOL implantation (0.90% without ICMP vs 0.34% with ICMP; P = .10). Conclusions ICMP reduced the POE rate overall, with phacoemulsification, with M-SICS, and in eyes with PCR.

    更新日期:2019-07-29
  • Development and validation of a new intraocular pressure estimate for patients with soft corneas
    J. Cat. Refract. Surg. (IF 2.238 ) Pub Date : 2019-07-18
    Kai-Jung Chen, Ashkan Eliasy, Riccardo Vinciguerra, Ahmed Abass, Bernardo T. Lopes, Paolo Vinciguerra, Renato Ambrósio, Cynthia J. Roberts, Ahmed Elsheikh

    Purpose To introduce and clinically validate a new method of estimating intraocular pressure (IOP) in patients with keratoconus and soft corneas with the aim of significantly reducing dependence on corneal biomechanics. Setting Vincieye Clinic, Milan, Italy, and Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Brazil. Design Retrospective case series. Method This study comprised participants enrolled at two hospitals on two continents. Numerical analysis based on the finite element method was performed to simulate the effect of tonometric air pressure of the Corvis ST dynamic Scheimpflug analyzer on eye globes with wide variations in thickness, geometry, and tissue. The numerical predictions of ocular behavior were used to develop a new algorithm to produce predictions of the biomechanically corrected IOP (bIOP) in eyes with a soft cornea (bIOPs). Predictions of the bIOPs were assessed in the keratoconic clinical datasets (because on average these corneas are softer) and compared with the previously developed bIOP algorithm predictions obtained for normal healthy eyes. Results The study comprised 722 eyes (722 participants). The main outcome was the absence of a significant difference in IOP between healthy eyes and keratoconic eyes when the bIOP and bIOPs algorithms were used (P > .05). There was, however, a significant difference with the uncorrected Scheimpflug analyzer IOP in both groups (P < .001). Furthermore, the bIOPs predictions were significantly less affected by corneal thickness and patient age than the Scheimpflug analyzer IOP. Conclusion The bIOPs algorithm was more reliable at estimating the IOP in eyes with a soft cornea and was validated for use in eyes with keratoconus.

    更新日期:2019-07-18
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