Medicine › Ophthalmology

Intraocular Surgery and Lenses

Works Count: 74314

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Description

This cluster of papers covers advancements in cataract surgery techniques, including the use of femtosecond laser, sutureless intraocular lens fixation, and prevention of posterior capsule opacification. It also explores complications such as glaucoma, impact on lens epithelial cells, and outcomes in pediatric cataract surgery.

Keywords

Intraocular Lens Implantation; Femtosecond Laser; Posterior Capsule Opacification; Sutureless Intraocular Lens Fixation; Phacoemulsification; Lens Epithelial Cells; Glaucoma; Corneal Endothelium; Capsular Tension Ring; Pediatric Cataract

Prevalence of Cataract and Pseudophakia/Aphakia Among Adults in theUnited States

2004-04-01

Nathan Congdon , Johannes R. Vingerling , Ronald Klein +6 more

Objectives: To determine the prevalence of cataract and pseudophakia/aphakia in the United States and to project the expected change in these prevalence figures by 2020.Methods: Summary prevalence estimates of cataract … Objectives: To determine the prevalence of cataract and pseudophakia/aphakia in the United States and to project the expected change in these prevalence figures by 2020.Methods: Summary prevalence estimates of cataract and of pseudophakia/aphakia were prepared separately for black, white, and Hispanic persons (for whom only cataract surgery data were available) in 5-year age intervals starting at 40 years for women and men.The estimates were based on a standardized definition of various types of cataract: cortical, greater than 25% of the lens involved; posterior subcapsular, present according to the grading system used in each study; and nuclear, greater than or equal to the penultimate grade in the system used.Data were collected from major population-based studies in the United States, and, where appropriate, Australia, Barbados, and Western Europe.The age-, gender-, and race/ethnicity-specific rates were applied to 2000 US Census data, and projected population figures for 2020, to obtain overall estimates.Results: An estimated 20.5 million (17.2%)Americans older than 40 years have cataract in either eye, and 6.1 million (5.1%) have pseudophakia/aphakia.Women have a significantly (odds ratio=1.37;95% confidence interval, 1.26-1.50)higher age-adjusted prevalence of cataract than men in the United States.The total number of persons who have cataract is estimated to rise to 30.1 million by 2020; and for those who are expected to have pseudophakia/aphakia, to 9.5 million. Conclusion:The number of Americans affected by cataract and undergoing cataract surgery will dramatically increase over the next 20 years as the US population ages.

Diffusion of high molecular weight compounds through sclera.

2000-04-01

Jayakrishna Ambati , Christina Canakis , Joan W. Miller +6 more

To determine the in vitro permeability of the sclera to high molecular weight compounds and the relationship between scleral permeability and molecular size.Fresh rabbit sclera was mounted in a two-chamber … To determine the in vitro permeability of the sclera to high molecular weight compounds and the relationship between scleral permeability and molecular size.Fresh rabbit sclera was mounted in a two-chamber diffusion apparatus, and its permeability to sodium fluorescein, fluorescein isothiocyanate (FITC)-conjugated bovine serum albumin, FITC-IgG, and FITC dextrans ranging in molecular weight from 4 to 150 kDa was determined by fluorescence spectrophotometry. Electron microscopy was used to assess the impact of the experimental design on scleral ultrastructural integrity. The effect of the diffusion apparatus on scleral hydration was examined. Rabbit scleral permeability was compared with previously reported data for human and bovine sclera.Scleral permeability decreased with increasing molecular weight and molecular radius, consistent with previous human and bovine data. Molecular radius was a better predictor of scleral permeability than molecular weight. The sclera was more permeable to globular proteins than to linear dextrans of similar molecular weight. The experimental apparatus did not alter scleral ultrastructure. Permeability of rabbit sclera was similar to human sclera but greater than bovine sclera.Large molecules, such as IgG, diffuse across sclera in a manner consistent with porous diffusion through a fiber matrix. Transscleral delivery of immunoglobulins and other large compounds to the choroid and retina may be feasible.

Principles and Practice of Ophthalmology

1981-05-01

Daniel M. Albert , Frederick A. Jakobiec

Cataract blindness--challenges for the 21st century.

2001-01-01

Garry Brian , Hugh R. Taylor

Cataract prevalence increases with age. As the world's population ages, cataract-induced visual dysfunction and blindness is on the increase. This is a significant global problem. The challenges are to prevent … Cataract prevalence increases with age. As the world's population ages, cataract-induced visual dysfunction and blindness is on the increase. This is a significant global problem. The challenges are to prevent or delay cataract formation, and treat that which does occur. Genetic and environmental factors contribute to cataract formation. However, reducing ocular exposure to UV-B radiation and stopping smoking are the only interventions that can reduce factors that affect the risk of cataract. The cure for cataract is surgery, but this is not equally available to all, and the surgery which is available does not produce equal outcomes. Readily available surgical services capable of delivering good vision rehabilitation must be acceptable and accessible to all in need, no matter what their circumstances. To establish and sustain these services requires comprehensive strategies that go beyond a narrow focus on surgical technique. There must be changes in government priorities, population education, and an integrated approach to surgical and management training. This approach must include supply of start-up capital equipment, establishment of surgical audit, resupply of consumables, and cost-recovery mechanisms. Considerable innovation is required. Nowhere is this more evident than in the pursuit of secure funding for ongoing services.

Calculation of intraocular lens power: a review

2007-04-02

Thomas Olsen

This review describes the principles and practices involved in the calculation of intraocular lens (IOL) power. The theories behind formulas for calculating IOL power are described, using regression and optical … This review describes the principles and practices involved in the calculation of intraocular lens (IOL) power. The theories behind formulas for calculating IOL power are described, using regression and optical methods employing 'thin lens' and 'thick lens' models, as well as exact ray-tracing methods. Numerical examples are included to illustrate the points made. The paper emphasizes the importance of establishing an accurate estimation of corneal power as well as an accurate technique for the measurement of axial length and accurate methods of predicting postoperative anterior chamber depth (ACD). It is concluded that current improvements in diagnostic and surgical technology, combined with the latest generation IOL power formulas, make the calculation and selection of appropriate IOL power among the most effective tools in refractive surgery today.

Shock wave emission and cavitation bubble generation by picosecond and nanosecond optical breakdown in water

1996-07-01

Alfred Vogel , S. Büsch , Ulrich Parlitz

Shock wave emission and cavitation bubble expansion after optical breakdown in water with Nd:YAG laser pulses of 30-ps and 6-ns duration is investigated for energies between 50 μJ and 10 … Shock wave emission and cavitation bubble expansion after optical breakdown in water with Nd:YAG laser pulses of 30-ps and 6-ns duration is investigated for energies between 50 μJ and 10 mJ which are often used for intraocular laser surgery. Time-resolved photography is applied to measure the position of the shock front and the bubble wall as a function of time. The photographs are used to determine the shock front and bubble wall velocity as well as the shock wave pressure as a function of time or position. Calculations of the bubble formation and shock wave emission are performed using the Gilmore model of cavitation bubble dynamics and the Kirkwood–Bethe hypothesis. The calculations are based on the laser pulse duration, the size of the plasma, and the maximally expanded cavitation bubble, i.e., on easily measurable parameters. They yield the dynamics of the bubble wall, the pressure evolution inside the bubble, and pressure profiles in the surrounding liquid at fixed times after the start of the laser pulse. The results of the calculations agree well with the experimental data. A large percentage of the laser pulse energy (up to 72%) is transformed into the mechanical energy ES and EB of the shock wave and cavitation bubble, whereby the partitioning between ES and EB is approximately equal. 65%–85% of ES is dissipated during the first 10 mm of shock wave propagation. The pressure at the plasma rim ranges from 1300 MPa (50 μJ, 30 ps) to 7150 MPa (10 mJ, 6 ns). The calculated initial shock wave duration has values between 20 and 58 ns, the duration measured 10 mm away from the plasma is between 43 and 148 ns. A formation phase of the shock front occurs after the ns pulses, but not after the ps pulses where the shock front exists already 100 ps after the start of the laser pulse. After shock front formation, the pressure decays approximately proportional to r−2, and at pressure values below 100 MPa proportional to r−1.06. The maximum bubble wall velocity ranges from 390 to 2450 m/s. The calculations of bubble and shock wave dynamics can cover a large parameter range and may thus serve as a tool for the optimization of laser parameters in medical laser applications.

Anatomy and physiology of the cornea

2011-02-18

Derek W. DelMonte , Terry Kim

The importance of the cornea to the ocular structure and visual system is often overlooked because of the cornea's unassuming transparent nature. The cornea lacks the neurobiological sophistication of the … The importance of the cornea to the ocular structure and visual system is often overlooked because of the cornea's unassuming transparent nature. The cornea lacks the neurobiological sophistication of the retina and the dynamic movement of the lens; yet, without its clarity, the eye would not be able to perform its necessary functions. The complexity of structure and function necessary to maintain such elegant simplicity is the wonder that draws us to one of the most important components of our visual system. Financial Disclosure: Neither author has a financial or proprietary interest in any material or method mentioned.

Dissatisfaction after multifocal intraocular lens implantation

2009-05-23

Maria A. Woodward , J. Bradley Randleman , R. Doyle Stulting

To analyze the reasons for patient dissatisfaction after phacoemulsification with multifocal intraocular lens (IOL) implantation and the outcomes after intervention. To analyze the reasons for patient dissatisfaction after phacoemulsification with multifocal intraocular lens (IOL) implantation and the outcomes after intervention.

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Effect of cataract surgery on the corneal endothelium*1Modern phacoemulsification compared with extracapsular cataract surgery

2004-04-01

Rupert Bourne , Darwin Minassian , John Dart +3 more

Risk factors for corneal endothelial injury during phacoemulsification

1996-10-01

Ken Hayashi , Hideyuki Hayashi , Fuminori Nakao +1 more

To determine the principal risk factors for corneal endothelial injury during phacoemulsification.Hayashi Eye Hospital, Fukuoka, Japan.We prospectively investigated 859 consecutive eyes of 800 patients who had had phacoemulsification surgery. The … To determine the principal risk factors for corneal endothelial injury during phacoemulsification.Hayashi Eye Hospital, Fukuoka, Japan.We prospectively investigated 859 consecutive eyes of 800 patients who had had phacoemulsification surgery. The percentage of corneal endothelial cell loss at 3 months after surgery was quantitated using specular microscopy. The firmness of the nucleus was graded by Emery's classification prior to surgery. We selected nine variables that could be associated with endothelial injury. The univariate associations between the endothelial cell loss and these variables were evaluated using simple correlation coefficients. A multiple linear regression analysis was performed to identify independent predictors of endothelial cell loss.In the simple regression analysis, older age, small pupil diameter, high nucleus grade, large nucleus, greater infusion volume, type of IOL implanted, and a greater amount of total emitted ultrasound energy were univariately associated with endothelial cell loss. In the multiple linear regression analysis, the best final model (R2 = 0.42) identified high nucleus grade, greater infusion volume, type of IOL implanted, and large nucleus as independent predictors of endothelial cell loss.Both univariate and multivariate analyses identified the firmness of the nucleus as the most significant risk factor for endothelial cell loss. Therefore, mechanical contact with nuclear fragments is considered the principal cause of endothelial injury.

Techniques of Intraocular Lens Suspension in the Absence of Capsular/Zonular Support

2005-09-01

Y. M. Por , Michael Lavin

A three-part system for refining intraocular lens power calculations

1988-01-01

Jack T. Holladay , Kathryn H. Musgrove , Thomas C. Prager +3 more

A three-part system that determines the correct power for an intraocular lens (IOL) to achieve a desired postoperative refraction is presented. The three components are (1) data screening criteria to … A three-part system that determines the correct power for an intraocular lens (IOL) to achieve a desired postoperative refraction is presented. The three components are (1) data screening criteria to identify improbable axial length and keratometry measurements, (2) a new IOL calculation formula that exceeds the current accuracy of other formulas for short, medium, and long eyes, and (3) a personalized “surgeon factor” that adjusts for any consistent bias in the surgeon's results, from any source, based on a reverse solution of the new formula; the reverse solution uses the postoperative stabilized refraction, the dioptric power of the implanted IOL, and the preoperative corneal and axial length measurements to calculate the personalized surgeon factor. The improved accuracy of the new formula was proven by performing IOL power calculations on 2,000 eyes from 12 surgeons and comparing the results to seven other currently used formulas.

Biometry of 7,500 Cataractous Eyes

1980-09-01

Kenneth J. Hoffer

Cystoid Macular Edema and Papilledema Following Cataract Extraction

1966-11-01

J. Donald M. Gass

Cystoid macular edema with or without papilledema should be suspected in any post-operative cataract patient whose visual acuity either fails to improve to normal or suddenly decreases following cataract extraction. … Cystoid macular edema with or without papilledema should be suspected in any post-operative cataract patient whose visual acuity either fails to improve to normal or suddenly decreases following cataract extraction. The slit lamp appearance of the macular lesion is characteristic, but may be difficult to see in the postoperative eye. The pattern of fluorescence following intravenous injection of fluorescein is diagnostic and provides the clinician with a valuable means of detecting the lesion, which may be difficult to see by other means. Fluorescein studies suggest that the pathogenesis of the macular and optic nerve lesions involves leakage of serous exudate from the retinal and optic nerve head capillaries. The cause of this leakage is unknown.

Dissatisfaction after implantation of multifocal intraocular lenses

2011-03-16

Niels E. de Vries , Carroll A.B. Webers , Wouter Touwslager +4 more

To analyze the symptoms, etiology, and treatment of patient dissatisfaction after multifocal intraocular lens (IOL) implantation.Department of Ophthalmology, Maastricht University Medical Center, The Netherlands.Case series.In this retrospective chart review, the … To analyze the symptoms, etiology, and treatment of patient dissatisfaction after multifocal intraocular lens (IOL) implantation.Department of Ophthalmology, Maastricht University Medical Center, The Netherlands.Case series.In this retrospective chart review, the main outcome measures were type of complaints, uncorrected and corrected distance visual acuities, uncorrected and distance-corrected near visual acuities, refractive state, pupil diameter and wavefront aberrometry measurements, and type of treatment.Seventy-six eyes of 49 patients were included. Blurred vision (with or without photic phenomenon) was reported in 72 eyes (94.7%) and photic phenomena (with or without blurred vision) in 29 eyes (38.2%). Both symptoms were present in 25 eyes (32.9%). Residual ametropia and astigmatism, posterior capsule opacification, and a large pupil were the 3 most significant etiologies. Sixty-four eyes (84.2%) were amenable to therapy, with refractive surgery, spectacles, and laser capsulotomy the most frequent treatment modalities. Intraocular lens exchange was performed in 3 cases (4.0%).The cause of dissatisfaction after implantation of a multifocal IOL can be identified and effective treatment measures taken in most cases.

National Outcomes of Cataract Extraction

1994-01-01

Jonathan C. Javitt , Debra Street , James M. Tielsch +7 more

A near-total shift to cataract extraction on an outpatient basis occurred as a result of an administrative ruling by the Health Care Financing Administration. No national study has been conducted … A near-total shift to cataract extraction on an outpatient basis occurred as a result of an administrative ruling by the Health Care Financing Administration. No national study has been conducted to assess the possible effects of that decision on clinical outcomes of surgery. The authors compared the rates of retinal detachment (RD) repair and hospitalization for endophthalmitis after extracapsular cataract extraction (ECCE) (including phacoemulsification) in 1986 and 1987 with those following inpatient cataract extraction in 1984.Using the 5% random sample of Medicare beneficiaries, we analyzed the claims of all individuals 66 years of age or older who underwent ECCE by nuclear expression or phacoemulsification in 1986 and 1987. A total of 57,103 patients were identified and followed to the end of 1988. Cumulative probability of RD repair and hospitalization for endophthalmitis was calculated by standard lifetable methods. These findings were compared with the cumulative probability of the same complications in a cohort of 330,000 patients who underwent cataract extraction on an inpatient basis in 1984.In the 1986-to-1987 cohort, the cumulative probability of RD within 3 years after cataract surgery was 0.81% and the cumulative probability of endophthalmitis within 1 year was 0.08%. The rate of RD is similar to that which we previously reported for 330,000 patients who underwent inpatient surgery in 1984, but the rate of endophthalmitis is significantly lower in the 1986-to-1987 outpatient cohort (0.08% versus 0.12%; z = 2.42; P = 0.01).The shift to outpatient cataract surgery was accompanied by no significant increase in the probability of RD repair and possibly a significant decrease in the rate of hospitalization for endophthalmitis.

Fibrin glue–assisted sutureless posterior chamber intraocular lens implantation in eyes with deficient posterior capsules

2008-08-21

Amar Agarwal , Dhivya Ashok Kumar , Soosan Jacob +3 more

We report a new surgical technique that uses biological glue to implant a posterior chamber intraocular lens (PC IOL) in eyes with a deficient or absent posterior capsule. Two partial-thickness … We report a new surgical technique that uses biological glue to implant a posterior chamber intraocular lens (PC IOL) in eyes with a deficient or absent posterior capsule. Two partial-thickness limbal-based scleral flaps are made 180 degrees apart diagonally, and the haptics of the PC IOL are externalized to place them beneath the flaps. Fibrin glue is used to attach the haptics to the scleral bed, beneath the flap. This simple method of PC IOL implantation requires no specially designed haptics. It provides good flap closure and IOL centration and stability without suture-related complications.

Posterior peribulbar anesthesia: An alternative to retrobulbar anesthesia

1986-03-01

David B. Davis , Mark R. Mandel

Posterior peribulbar anesthesia is a safe alternative to retrobulbar anesthesia for ophthalmic surgery. Because the anesthetic is deposited outside the muscle cone, the potential for intraocular or intradural injection is … Posterior peribulbar anesthesia is a safe alternative to retrobulbar anesthesia for ophthalmic surgery. Because the anesthetic is deposited outside the muscle cone, the potential for intraocular or intradural injection is greatly minimized. Furthermore, intraconal hemorrhage and direct optic nerve injury is avoided. We illustrate the details of our technique for posterior peribulbar anesthesia and describe our experience in over 1,600 cases.

Synthesis of the Literature on Visual Acuity and Complications Following Cataract Extraction With Intraocular Lens Implantation

1994-02-01

Neil R. Powe

<h3>Objective:</h3> To better define the effectiveness and risks of modern cataract surgery. <h3>Design:</h3> Meta-analysis (formal systematic identification, selection, review, and synthesis) of published literature. <h3>Patients:</h3> Patients described in 90 studies … <h3>Objective:</h3> To better define the effectiveness and risks of modern cataract surgery. <h3>Design:</h3> Meta-analysis (formal systematic identification, selection, review, and synthesis) of published literature. <h3>Patients:</h3> Patients described in 90 studies published between 1979 and 1991 that addressed visual acuity (n=17 390 eyes) or complications (n=68 316 eyes) following standard extracapsular cataract extraction with posterior chamber intraocular lens implantation, phacoemulsification with posterior chamber intraocular lens implantation, or intracapsular cataract extraction with flexible anterior chamber intraocular lens implantation. Main Outcome Measures: The proportion of eyes with postoperative Snellen visual acuity of 20/40 or better and the proportion of eyes with each of 18 complications. <h3>Results:</h3> The pooled percentage of eyes (weighted by sample size) with postoperative visual acuity of 20/40 or better was 95.5% (95% confidence interval [CI], 95.1% to 95.9%) among eyes without preexisting ocular comorbidity and 89.7% (95% CI, 89.3% to 90.2%) for all eyes. The pooled percentage of eyes experiencing complications (weighted by sample size and, when pertinent, by quality score of the individual studies but not adjusted for variation in duration of follow-up) ranged from 0.13% for endophthalmitis to 19.7% for posterior capsule opacification. Pooled proportions of eyes with other complications were as follows: bullous keratopathy, 0.3%; intraocular lens malposition/dislocation, 1.1%; clinically apparent cystoid macular edema, 1.5%; and retinal detachment, 0.7%. Pooled results for postoperative Snellen visual acuity and most complications were similar for surgery performed via phacoemulsification vs standard extracapsular cataract extraction, although comparisons of the outcomes between these procedures should be interpreted with caution. <h3>Conclusions:</h3> The published literature indicates that modern cataract surgery yields excellent visual acuity and, although not free of complications, is a very safe procedure regardless of the extraction technique used.

Posterior Subcapsular Cataracts Induced by Corticosteroids in Patients with Rheumatoid Arthritis

1960-09-10

Roger L. Black

POSTERIOR subcapsular cataracts (PSC) are generally associated with exposure to toxic agents, posterior intraocular disease, ionizing radiation, or blunt trauma. As a rule these lenticular lesions are differentiated from senile … POSTERIOR subcapsular cataracts (PSC) are generally associated with exposure to toxic agents, posterior intraocular disease, ionizing radiation, or blunt trauma. As a rule these lenticular lesions are differentiated from senile cataracts by their location and appearance on slit lamp examination. The discovery of PSC, in the absence of any of the above etiologic factors, in four rheumatoid arthritis patients who were receiving prolonged administration of synthetic corticosteroids prompted a careful review and examination of rheumatoid arthritis patients available for study between June, 1959, and April, 1960. This survey revealed that 39% of patients with rheumatoid arthritis who had received long-term corticosteroid therapy developed PSC, whereas those who had not were free of this type of lenticular opacity. This ocular lesion, to date, has been relatively benign and has not caused severe impairment of vision. Since formation of PSC has not been described previously as one of the adverse effects of

The Facet Syndrome

1976-03-01

Vert Mooney , James T. Robertson

Injection of irritant fluid precisely into the facet joint causes referred pain patterns indistinguishable from the pain complaints frequently associated with the "disk syndrome." Even straight leg raising and diminished … Injection of irritant fluid precisely into the facet joint causes referred pain patterns indistinguishable from the pain complaints frequently associated with the "disk syndrome." Even straight leg raising and diminished reflex signs can be obliterated by precise local anesthetic injection into the facet joint. The use of radiographically localized injection of steroids and local anesthetic into the facet joint has been presented as a diagnostic-therapeutic procedure. Clinical experience with a group of 100 consecutive patients suggests that this treatment alone can achieve long-term relief in one-fifth of the patients with lumbago and sciatica and partial relief in another one-third of these patients. This information suggests that the structures related to the facet joint can be a persistent contributor to the chronic pain complaints of individuals with low back and leg pain.

Posterior Capsular Opacification

2009-04-13

Niranjan Awasthi

Posterior capsular opacification (PCO) is the most frequent complication of cataract surgery. Advances in surgical techniques, intraocular lens materials, and designs have reduced the PCO rate, but it is still … Posterior capsular opacification (PCO) is the most frequent complication of cataract surgery. Advances in surgical techniques, intraocular lens materials, and designs have reduced the PCO rate, but it is still a significant problem. The only effective treatment for PCO, Nd:YAG laser capsulotomy carries vision-related complications and risks and puts a significant financial burden on the health care system. This review contains current knowledge about the mechanisms of PCO development. Posterior capsular opacification is caused mainly by remnant lens epithelial cell proliferation and migration, epithelial-mesenchymal transition, collagen deposition, and lens fiber generation. All of these processes are influenced by cytokines, growth factors, and extracellular matrix proteins. We also describe advances and improvements in surgical techniques, intraocular lens materials, and the designs and use of therapeutic agents leading to safe, effective, and less expensive strategies to eradicate PCO.

Subsurface Ultrasound Microscopic Imaging of the Intact Eye

1990-02-01

Charles J. Pavlin , Michael D. Sherar , F. Stuart Foster

Persistent Fetal Vasculature (PFV): An Integrated Interpretation of Signs and Symptoms Associated With Persistent Hyperplastic Primary Vitreous (PHPV) LIV Edward Jackson Memorial Lecture

1997-11-01

Morton F. Goldberg

Initial Clinical Evaluation of an Intraocular Femtosecond Laser in Cataract Surgery

2009-12-01

Zoltán Z. Nagy , Ágnes I. Takács , Tamás Filkorn +1 more

To evaluate femtosecond laser lens fragmentation and anterior capsulotomy in cataract surgery.Anterior capsulotomy and phacofragmentation procedures performed with an intraocular femtosecond laser (LenSx Lasers Inc) were initially evaluated in ex … To evaluate femtosecond laser lens fragmentation and anterior capsulotomy in cataract surgery.Anterior capsulotomy and phacofragmentation procedures performed with an intraocular femtosecond laser (LenSx Lasers Inc) were initially evaluated in ex vivo porcine eyes. These procedures were then performed in an initial series of nine patients undergoing cataract surgery. In addition to standard intraoperative assessments (including capsulotomy diameter accuracy and reproducibility), optical coherence tomography was used to evaluate human procedures.For an intended 5-mm capsulorrhexis in porcine eyes, average achieved diameters were 5.88+/-0.73 mm using a standard manual technique and 5.02+/-0.04 mm using the femtosecond laser. Scanning electron microscopy revealed equally smooth cut edges of the capsulotomy with the femtosecond laser and manual technique. Compared to control porcine eyes, femtosecond laser phacofragmentation resulted in a 43% reduction in phacoemulsification power and a 51% decrease in phacoemulsification time. In a small series of human clinical procedures, femtosecond laser capsulotomies and phacofragmentation demonstrated similarly high levels of accuracy and effectiveness, with no operative complications.Initial results with an intraocular femtosecond laser demonstrate higher precision of capsulorrhexis and reduced phacoemulsification power in porcine and human eyes.

Endothelial cell loss after phacoemulsification: Relation to preoperative and intraoperative parameters

2000-05-01

Tony Walkow , N. Anders , Sonja Klebe

To evaluate the effect of the location of the corneoscleral tunnel incision as well as preoperative and intraoperative parameters on total and localized endothelial cell loss.Department of Ophthalmology, Humboldt-University of … To evaluate the effect of the location of the corneoscleral tunnel incision as well as preoperative and intraoperative parameters on total and localized endothelial cell loss.Department of Ophthalmology, Humboldt-University of Berlin, Berlin, Germany.Fifty consecutive patients scheduled for routine cataract surgery were selected prospectively for this clinical trial. Preoperatively, the axial length, anterior chamber depth, lens thickness, and astigmatism were measured. Phacoemulsification time and relative energy as well as total surgical time were recorded. With a specular microscope, endothelial cell counts were determined centrally, superiorly, and temporally preoperatively and 6 weeks and 6 and 12 months postoperatively.After 12 months, the mean overall central endothelial cell loss in all eyes was 8.5%. The mean endothelial cell loss was 11.9% in the lateral quadrant and 11.4% in the superior quadrant. There were no significant differences between superior and temporal surgical approaches in intraoperative parameters of phacoemulsification time, relative intensity of phacoemulsification, and surgical time. There were no significant differences in central endothelial cell loss or in the area localized in the quadrant of the positions of the corneal surgical site. The only risk factors found significant for higher endothelial cell loss were shorter axial length and longer phacoemulsification time.The location of corneoscleral incisions for phacoemulsification can be chosen according to the preoperative astigmatism without inducing additional adverse effects on the corneal endothelium. Shorter eyes have a significantly higher risk for greater endothelial cell loss.

Comparison of immersion ultrasound biometry and partial coherence interferometry for intraocular lens calculation according to Haigis

2000-09-19

Wolfgang Haigis , Barbara A.M. Lege , Naomi R. Miller +1 more

The number of ophthalmologists in practice and training worldwide: a growing gap despite more than 200 000 practitioners

2012-03-26

Serge Resnikoff , William Campbell Felch , Tina-Marie Gauthier +1 more

<h3>Background/aims</h3> To assess the current number of ophthalmologists practicing worldwide in 2010 and to create a system for maintaining, collecting and improving the accuracy of data on ophthalmologists per population, … <h3>Background/aims</h3> To assess the current number of ophthalmologists practicing worldwide in 2010 and to create a system for maintaining, collecting and improving the accuracy of data on ophthalmologists per population, ophthalmologists performing surgery, growth rate of the profession, and the number of residents in training. <h3>Methods</h3> Between March 2010 and April 2010, the International Council of Ophthalmology emailed a standardised survey of 12 questions to 213 global ophthalmic societies. Missing data and additional information were gathered from direct correspondences with ophthalmologist contacts. <h3>Results</h3> The total number of ophthalmologists reported was 204 909. Data are presented for 193 countries. Information was obtained from 67 countries on the number of ophthalmologists doing surgery, entering practice, leaving practice, rate of growth and resident training. <h3>Conclusion</h3> The survey results show that despite over 200 000 ophthalmologists worldwide, there is currently a significant shortfall of ophthalmologists in developing countries. Furthermore, although the number of practitioners is increasing in developed countries, the population aged 60+ is growing at twice the rate of the profession. To meet this widening gap between need and supply, it is necessary to aggressively train eye care teams now to alleviate the current and anticipated deficit of ophthalmologists worldwide.

Complications of intraocular lenses. A historical and histopathological review

1984-07-01

David J. Apple , Nick Mamalis , Katherine Loftfield +5 more

Age-related cataract

2005-02-01

Penny A. Asbell , Ivo Dualan , Joel S. Mindel +3 more

Acute Endophthalmitis Following Cataract Surgery

2005-05-01

Mehran Taban

To determine the reported incidence of acute endophthalmitis following cataract extraction over time and to explore possible contributing factors, such as type of cataract incision.A systematic review of English-language articles … To determine the reported incidence of acute endophthalmitis following cataract extraction over time and to explore possible contributing factors, such as type of cataract incision.A systematic review of English-language articles was conducted by performing a broad search of PubMed from 1963 through March 2003 using such terms as cataract extraction, endophthalmitis, and postoperative complication. Additional studies were identified from bibliographies of relevant articles and published proceedings. Surgical approach was recorded, when available. Pooled incidence rates and relative risks of developing endophthalmitis using different incision techniques were assessed.From 4916 unique, potentially relevant citations, 215 studies that addressed endophthalmitis and met the selection criteria were analyzed. A total of 3 140 650 cataract extractions were pooled resulting in an overall rate of 0.128% of postcataract endophthalmitis. However, the incidence of acute endophthalmitis changed over time, with a significant increase since 2000 compared with previous decades (relative risk, 2.44 [95% confidence interval, 2.27-2.61]). The rate of endophthalmitis was 0.265% in the 2000-2003 period, 0.087% in the 1990s, 0.158% in the 1980s, and 0.327% during the 1970s. Furthermore, an upward trend in rates after 1992 was noted, compared with 1991 and prior. Incision type appeared to significantly influence risk, as endophthalmitis following clear corneal cataract extraction during the 1992-2003 period was 0.189% compared with 0.074% (relative risk, 2.55 [95% confidence interval, 1.75-3.71]) for scleral incision and 0.062% (relative risk, 3.06 [95% confidence interval, 2.48-3.76]) for limbal incision.This systematic review indicates that the incidence of endophthalmitis associated with cataract extraction has increased over the last decade. This upward trend in endophthalmitis frequency coincides temporally with the development of sutureless clear corneal incisions.

Corneal refractive surgery with femtosecond lasers

1999-01-01

T. Juhász , Frieder H. Loesel , Ron M. Kurtz +3 more

We investigated the use of ultrashort pulsed (femtosecond) laser technology in corneal refractive surgery. When compared to longer pulsewidth nanosecond or picosecond laser pulses, femtosecond laser-tissue interactions are characterized by … We investigated the use of ultrashort pulsed (femtosecond) laser technology in corneal refractive surgery. When compared to longer pulsewidth nanosecond or picosecond laser pulses, femtosecond laser-tissue interactions are characterized by significantly smaller and more deterministic photodisruptive energy thresholds, as well as reduced shock waves and smaller cavitation bubbles. We utilized a highly reliable all-solid-state femtosecond laser system for all studies to demonstrate practicality in real-world operating conditions. Contiguous tissue effects were achieved by scanning a 5-/spl mu/m focused laser spot below the corneal surface at pulse energies of approximately 2-4 /spl mu/J. A variety of scanning patterns was used to perform three prototype procedures in animal eyes; corneal flap cutting, keratomileusis, and intrastromal vision correction. Superior dissection and surface quality results were obtained for lamellar procedures (corneal flap cutting and keratornileusis). Preliminary in vivo studies of intrastromal vision correction suggest that consistent refractive changes can also be achieved with this method. We conclude that femtosecond laser technology may be able to perform a variety of corneal refractive procedures with high precision, offering advantages over current mechanical and laser devices and techniques.

Sutureless intrascleral posterior chamber intraocular lens fixation

2007-11-01

Scharioth G.B. Gabor , Mitrofanis Pavlidis

We report a technique for sutureless fixation of standard 3-piece posterior chamber intraocular lenses (PC IOLs) in the ciliary sulcus in eyes without capsule support, which we have used in … We report a technique for sutureless fixation of standard 3-piece posterior chamber intraocular lenses (PC IOLs) in the ciliary sulcus in eyes without capsule support, which we have used in cases of subluxated and luxated cataract and for secondary IOL implantation. Fixation of the haptics in a limbus-parallel scleral tunnel allows exact centration and provides axial stability of the PC IOL to prevent distortion. The technique uses uncomplicated maneuvers for standard 3-piece PC IOL fixation without the need for special haptic architecture or preparation.

Multifocal versus monofocal intraocular lenses after cataract extraction

2016-12-12

Samantha R. De Silva , Jennifer Evans , Varo Kirthi +2 more

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Femtosecond laser capsulotomy

2011-06-25

Neil J. Friedman , Daniel Palanker , Georg Schuele +7 more

To evaluate a femtosecond laser system to create the capsulotomy.Porcine and cadaver eye studies were performed at OptiMedica Corp., Santa Clara, California, USA; the human trial was performed at the … To evaluate a femtosecond laser system to create the capsulotomy.Porcine and cadaver eye studies were performed at OptiMedica Corp., Santa Clara, California, USA; the human trial was performed at the Centro Laser, Santo Domingo, Dominican Republic.Experimental and clinical study.Capsulotomies performed by an optical coherence tomography-guided femtosecond laser were evaluated in porcine and human cadaver eyes. Subsequently, the procedure was performed in 39 patients as part of a prospective randomized study of femtosecond laser-assisted cataract surgery. The accuracy of the capsulotomy size, shape, and centration were quantified and capsulotomy strength was assessed in the porcine eyes.Laser-created capsulotomies were significantly more precise in size and shape than manually created capsulorhexes. In the patient eyes, the deviation from the intended diameter of the resected capsule disk was 29 μm ± 26 (SD) for the laser technique and 337 ± 258 μm for the manual technique. The mean deviation from circularity was 6% and 20%, respectively. The center of the laser capsulotomies was within 77 ± 47 μm of the intended position. All capsulotomies were complete, with no radial nicks or tears. The strength of laser capsulotomies (porcine subgroup) decreased with increasing pulse energy: 152 ± 21 mN for 3 μJ, 121 ± 16 mN for 6 μJ, and 113 ± 23 mN for 10 μJ. The strength of the manual capsulorhexes was 65 ± 21 mN.The femtosecond laser produced capsulotomies that were more precise, accurate, reproducible, and stronger than those created with the conventional manual technique.

A Newly Defined Vitreous Syndrome Following Cataract Surgery*

1953-05-01

S. Rodman Irvine

Evidence-based guidelines for cataract surgery: Guidelines based on data in the European Registry of Quality Outcomes for Cataract and Refractive Surgery database

2012-06-01

Mats Lundström , Peter J. Barry , Ype Henry +2 more

In March 2008, the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) commenced. This 3-year project was cofunded by the European Union (EU) and the European Society … In March 2008, the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) commenced. This 3-year project was cofunded by the European Union (EU) and the European Society of Cataract & Refractive Surgeons (ESCRS). The ESCRS became the lead partner in the project with 11 national societies as associated partners. The aims of the project were to improve treatment and standards of care for cataract and refractive surgery and to develop evidence-based guidelines for cataract and refractive surgery across Europe. Surgeons from all participating societies contributed to the database, which contained data on 820 000 cataract surgeries in November 2011. The present guidelines are based on data entered from January 1, 2009, to August 28, 2011 (523 921 cataract extractions). The guidelines include only those steps in the cataract surgery process that can be analyzed by the database. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

A systematic overview of the incidence of posterior capsule opacification

1998-07-01

Debra A. Schaumberg , M. Reza Dana , William G. Christen +1 more

POSTERIOR CAPSULE OPACIFICATION

1999-10-01

David J. McIntyre

[Capsule contraction syndrome].

1999-01-01

Ewa Rakowska , Tomasz Żarnowski , Z Zagórski

To analyse the occurrence of the anterior capsule contraction following cataract surgery. Capsule contraction syndrome (CCS) is defined as an extreme reduction in diameter of anterior capsulectomy, capsular bag diameter … To analyse the occurrence of the anterior capsule contraction following cataract surgery. Capsule contraction syndrome (CCS) is defined as an extreme reduction in diameter of anterior capsulectomy, capsular bag diameter and, occasionally, displacement of the IOL after extracapsular cataract extraction. It is relatively frequent in pseudoexfoliation, advanced age, in association with uveitis, pars planitis and myotonic muscular dystrophy.5965 eyes of patients were operated on cataract between 1.01.1994 and 31.12.1997 in Tadeusz Krwawicz Chair of Ophthalmology and 1st Eye Hospital, Medical School in Lublin. Two types of surgical procedures were performed: "divide and conquer" phacoemulsification with 4.5-8 mm continuous curvilinear capsulorhexis (3385 eyes) and extracapsular cataract extraction with "can opener" capsulotomy (2580 eyes).20 cases of clinically apparent CCS were referred to the Department: in the course of intensive postoperative inflammation--5, in patients over 80--4, in pseudoexfoliation syndrome--2, myotonic dystrophy--1, ectopia lentis--2, other causes--6. In order to improve visual acuity in 4 cases surgical removal of the distorted and opaque anterior capsule was performed, in 3 cases relaxing radial tears were done, in 3 cases secondary anterior capsulotomy was performed using Q-switched Nd:YAG laser.In cases where the occurrence of CCS is especially high large diameter capsulorhexis should be performed and IOL designed to provide maximal peripheral capsular bag expansion should be implanted.

Intraocular lens implantation in the absence of capsular support

2003-04-01

Michael D. Wagoner , Terry A. Cox , Reginald G. Ariyasu +2 more

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Multifocal intraocular lenses: An overview

2017-03-31

Jorge L. Alió , Ana B. Plaza-Puche , Roberto Férnandez-Buenaga +2 more

Flanged Intrascleral Intraocular Lens Fixation with Double-Needle Technique

2017-04-27

Shin Yamane , Shimpei Sato , Maiko Maruyama-Inoue +1 more

Phaco-Emulsification and Aspiration

2018-06-19

Charles D. Kelman

The mechanical properties of wood

1950-06-01

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Comparative Neurology of the Optic Tectum

1984-01-01

Horacio Vanegas , Centro Latino Americano de Ciencias Biológicas

Cataracts

2017-02-26

Yu‐Chi Liu , Mark Wilkins , Terry Kim +2 more

Calculation of intraocular lens power: a review

2007-08-01

Thomas Olsen

Day care versus in-patient surgery for age-related cataract

2005-01-17

Zbys Fedorowicz , David S. Lawrence , Peter Gutierrez

Age-related cataract accounts for more than 40% of cases of blindness in the world with the majority of people who are blind from cataract found in the developing world. With … Age-related cataract accounts for more than 40% of cases of blindness in the world with the majority of people who are blind from cataract found in the developing world. With the increased number of people with cataract there is an urgent need for cataract surgery to be made available as a day care procedure.To provide reliable evidence regarding the safety, feasibility, effectiveness and cost-effectiveness of cataract extraction performed as day care versus in-patient procedure.We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) on The Cochrane Library (Issue 3 2004), MEDLINE (1966 to July 2004), EMBASE (1980 to August 2004) and LILACS (July 2004).This review includes randomised controlled trials comparing day care and in-patient surgery for age-related cataract. The primary outcome was the achievement of a satisfactory visual acuity six weeks after the operation.Although two trials are included in the review, adequate data were available for only one trial and therefore pooling of data from studies was not attempted. A descriptive summary is presented.Two trials, involving a total of 1284 people, are included in this review. One trial reported statistically significant differences in early postoperative complication rates in the day care group, with an increased risk of increased intraocular pressure, which had no clinical relevance to visual outcomes four months postoperatively. The mean change in visual acuity (Snellen lines) of the operated eye four months postoperatively was 4.1 (standard deviation (SD) 2.3) for the day care group and 4.1 (SD 2.2) for the in-patient group and not statistically significant. The four-month postoperative mean change in quality of life score measured using the VF14 showed minimal differences between the two groups. Costs were 20% more for the in-patient group and this was attributed to higher costs for overnight stay. One study only reported hotel costs for the non-hospitalised participants making aggregation of data on costs impossible.This review provides some evidence that there is a cost saving but no significant difference in outcome or risk of postoperative complications between day care and in-patient cataract surgery. This is based on one detailed and methodologically sound trial conducted in the developed world. The success, safety and cost-effectiveness of cataract surgery as a day care procedure appear to be acceptable but additional well-designed trials are required to confirm these perceptions.

A Practical Guide for Trainees and Applicants on Conducting an Ophthalmology Audit on Posterior Capsule Rupture

2025-06-25

| Journal of the Foundations of Ophthalmology

Patient reported outcome measurements (PROM) of cataract surgery: comparison of outcomes between hospital-based versus outreach cataract centre: a prospective cohort study

2025-06-24

Boon Juan Yeoh , Mohamad Aziz Salowi , Amir Samsudin +1 more | International Ophthalmology

Scleral reactions to different suture materials: A comparative quantitative histological study in a rabbit model

2025-06-24

Л. В. Ванькова , Věra Křížková , Martina Grajciarová +7 more | Animal Models and Experimental Medicine

Abstract Background Scleral fixation of intraocular lenses is a surgical technique that involves anchoring an artificial lens to the sclera. Traditional approaches, such as capsular bag placement, may not be … Abstract Background Scleral fixation of intraocular lenses is a surgical technique that involves anchoring an artificial lens to the sclera. Traditional approaches, such as capsular bag placement, may not be feasible in certain situations, making scleral fixation a valuable alternative. The scleral reactions to different types of suture materials are not fully understood. Therefore, the present study describes the microscopic structure of normal scleral tissue and its changes with suture materials. Methods We compared six groups of rabbit eyes focusing on the sclera: group with polytetrafluoroethylene ( PTFE ) chain, PTFE fiber, polypropylene ( PPE ) fiber and control groups. multilevel sampling and stereological methods were used for histological quantification of the leukocyte infiltration fractions and type I and type III collagen. Results Quantitative histological evaluation revealed the following: (1) For all materials used, inflammation was present in the surrounding scleral tissue compared with healthy controls. However, leukocyte infiltration in the sclera was not statistically different between the materials. (2) As part of the evaluation of collagen, the greatest changes occurred in the PTFE fiber group at 2 weeks postoperatively. In the PTFE chain group, more significant changes were visible at 4 weeks. (3) The changes in the PPE fiber group compared to healthy scleral tissue were the least significant. Conclusions From a histological point of view, it is evident that there are differences in the quantitative parameters between the untouched sclera and the sclera with suture material. Furthermore, distinctions were observed among various materials and across different time intervals.

The morphological type of senile cataract and its effect on uptake of cataract surgery

2025-06-24

Amanjot Singh Nokwal , Ashiya Loomba , Parveen Rewri | Global Journal of Cataract Surgery and Research in Ophthalmology

Objectives: The purpose of this study was to know how the type of cataract and demographics affect the timing of cataract surgery in rural Northern Indian patients. Materials and Methods: … Objectives: The purpose of this study was to know how the type of cataract and demographics affect the timing of cataract surgery in rural Northern Indian patients. Materials and Methods: This cross-sectional pilot study enrolled cataract patients aged ≥40 years with best-corrected visual acuity of ≤6/18 in the affected eye. A pre-validated, structured questionnaire was used to collect demographic information. A comprehensive ocular examination was done to collect clinical information. Descriptive statistics were carried out and unpaired t -test, Mann–Whitney test or Welch t -test were used to compare groups. An association between the type of cataract and independent variables was done using the Chi-square test of independence and logistic regression. Results: A total of 441 eligible patients, 255 (58%) men and 186 (42%) women were enrolled. Women were more likely than men to have cataracts in pre-senile age than in senile age, χ 2 (1, n = 395) = 4.5, P = 0.03. The mean (±standard deviation) age of cataract surgery in patients with cataracts other than significant nuclear sclerosis (NS) was 60.4 years compared to the 64.5 years for the NS group, and the difference was statistically significant ( P < 0.000l). Conclusion: The morphological type of cataract affects the timing of uptake of surgery.

Effects of uncomplicated phacoemulsification surgery on retinal vascular diameters, subfoveal choroidal and central macular thickness

2025-06-24

Selen Akbulut , Gökhan Pekel | International Ophthalmology

Comparative analysis of anterior chamber stability with a cohesive ophthalmic viscosurgical device versus the soft-shell technique

2025-06-21

Daniel M. Handzel , Chiraz Ben Abdallah , Markus S. Ladewig +1 more | Graefe s Archive for Clinical and Experimental Ophthalmology

Diagnosis of congenital ectopia lentis: a case report and review of the literature

2025-06-20

Xue‐Bi Cai , Wei Chen , Jie Xue +5 more | Journal of Medical Case Reports

Congenital ectopia lentis (CEL) is a rare ophthalmic disorder characterized by partial or complete dislocation of the lens, leading to significant visual impairment. The etiology is complex, often involving genetic … Congenital ectopia lentis (CEL) is a rare ophthalmic disorder characterized by partial or complete dislocation of the lens, leading to significant visual impairment. The etiology is complex, often involving genetic factors and systemic diseases. Early diagnosis and treatment are crucial to prevent complications and preserve the patient's vision. This report presents a case of a 7-year-and-6-month-old Chinese male patient with congenital ectopia lentis. The patient had a history of high myopia from an early age and poor corrected vision. Diagnostic evaluations included slit-lamp biomicroscopy, biometry, retinal OCT, corneal thickness measurement, corneal topography, and ultrasound examinations. Additionally, whole exome sequencing (WES) was performed to identify gene mutations potentially linked to the clinical manifestations. Imaging studies revealed bilateral lens dislocation accompanied by corneal astigmatism and vitreous opacities. Genetic testing detected a known pathogenic missense mutation (c.3209G > A) in the FBN1 gene, associated with Marfan syndrome. A variant of uncertain significance (VUS) in the COL2A1 gene, potentially related to Stickler syndrome, was also identified. The diagnosis of congenital ectopia lentis can be confirmed through a combination of imaging studies and genetic testing, particularly when associated with systemic diseases. Imaging techniques help determine the extent of lens dislocation and related complications, while genetic testing provides critical insights into the underlying genetic causes. Early diagnosis and intervention are essential to reduce the risk of complications and improve patients' quality of life.

Biacuplasty

2025-06-20

Steven D. Waldman | Elsevier eBooks

Secondary intrascleral intraocular lens (IOL) fixation with capsule preservation for IOL dislocation following mature cataract surgery with incomplete capsulorhexis: A case report

2025-06-20

Suguru Nakagawa , Kiyoshi Ishii | Medicine

The objective of this study was to apply secondary intraocular lens (IOL) intrascleral fixation with lens capsule preservation in a patient with IOL dislocation following mature cataract surgery with incomplete … The objective of this study was to apply secondary intraocular lens (IOL) intrascleral fixation with lens capsule preservation in a patient with IOL dislocation following mature cataract surgery with incomplete continuous curvilinear capsulorhexis (CCC). A 56-year-old Japanese woman experienced distorted vision 4 days after phacoemulsification and intracapsular IOL implantation for a mature cataract. Slit-lamp examination revealed inferior-nasal dislocation of the intracapsular IOL through an anterior capsule defect (3-6 o'clock) caused by peripheral extension of the CCC during the primary surgery. IOL extraction followed by intrascleral fixation with lens capsule preservation was performed 1 week after the initial surgery. The secondary surgery involved inserting a 30 G needle between the lens capsule and iris, with IOL fixation to the sclera using a double-needle technique. The IOL optics were successfully captured through the incomplete anterior CCC of the preserved lens capsule. No intraoperative vitreous prolapse occurred, eliminating the need for a vitrectomy. The IOL remained well-fixed without IOL pupillary capture. Additionally, no significant complications such as retinal detachment or vitreous hemorrhage were observed. Preserving the capsule during secondary intrascleral fixation for IOL dislocation in patients with incomplete CCC offers several advantages, including reduced intraoperative vitreous prolapse, minimized surgical invasiveness, suppression of postoperative iris flutter, and prevention of IOL capture within the pupil. However, the long-term outcomes, including the potential risk of lens capsule drop, warrant further investigation with more cases.

Assessment of tilt and decentration of a 4-point scleral fixated intraocular lens using an innovative digital measurement methodology

2025-06-20

Denise Pardini , Misako Matsumoto , Marina Roizenblatt +6 more | International Journal of Retina and Vitreous

Haptics and Axis Stability of Customized Vertical Implantable Collamer Lens Implantation

2025-06-20

Boliang Li , Mingrui Cheng , Yadi Lei +3 more | Journal of Cataract & Refractive Surgery

To evaluate the postoperative vault, haptic position, and axis stability of vertical implantable collamer lens (ICL) implantation. Fudan University Eye and ENT Hospital, Shanghai, China. Prospective. This study included patients … To evaluate the postoperative vault, haptic position, and axis stability of vertical implantable collamer lens (ICL) implantation. Fudan University Eye and ENT Hospital, Shanghai, China. Prospective. This study included patients who underwent ICL implantation. Three months postoperatively, the vault, haptic position, and axis were measured. Ninety-eight eyes from 98 patients were included. At 3 months postoperatively, the vault was 517.10 ± 200.08 µm in the vertical group and 506.88 ± 204.19 µm in the horizontal group (P = .803). There was a significant difference in the distribution of haptics in the ciliary sulcus (ICS) between the two groups (P = .045). In the vertical group, an average of 0.90 ± 0.83 haptics near the incision and 1.33 ± 0.81 haptics away from the incision were located in the sulcus, showing a significant difference (P = .002). In those undergoing toric ICL implantation, 54% of eyes in the vertical group and 79% in the horizontal group experienced rotation, with a significant difference (P = .042). In the horizontal group, there were significant differences in both the vault and difference value between vertical and horizontal sulcus-to-sulcus (vSTS - hSTS) between the non-rotated and rotated subgroups (P = .019 and P = .035, respectively). Customized vertical ICL implantation does not affect refractive outcomes and achieves an ideal vault. Situating the haptic near the incision in the ciliary sulcus is relatively more difficult for vertical implantation. Vertical implantation improves ICL stability in patients with a large vSTS - hSTS.

Accuracy of IOL power calculation in pediatric aphakia secondary implantation

2025-06-20

Yingshi Zou , Yunqian Li , Ling Jin +6 more | International Journal of Ophthalmology

AIM: To evaluate the accuracy of intraocular lens (IOL) power calculation formulas with/without preoperative aphakic anterior chamber depth (aph-ACD) in pediatric aphakia. METHODS: A total of 102 pediatric patients (150 … AIM: To evaluate the accuracy of intraocular lens (IOL) power calculation formulas with/without preoperative aphakic anterior chamber depth (aph-ACD) in pediatric aphakia. METHODS: A total of 102 pediatric patients (150 eyes) undergoing secondary IOL implantation were divided into two groups (in-the-bag or ciliary sulcus). Prediction error was calculated for 9 IOL power calculation formulas, including: 1) not requiring ACD: Hoffer Q, Holladay 1, SRK/T; 2) usable without or with entering ACD: Barrett Universal II (BUII), Emmetropia Verifying Optical (EVO) 2.0, and Ladas Artificial Intelligence Super (Ladas AI); 3) requiring ACD: Haigis, Kane, and Pearl-DGS. Mean prediction error (ME), mean absolute error (MAE), median absolute error (MedAE) and the percentage of eyes within ±0.25, ±0.50, ±0.75, and ±1.00 D were calculated. RESULTS: For the BUII, EVO 2.0, and Ladas AI, with aph-ACD demonstrated a higher MedAE compared to without aph-ACD (BUII: 1.27 vs 1.13 D, EVO 2.0: 1.26 vs 1.06 D, Ladas AI: 1.30 vs 1.10 D; all P&#x003C;0.05). Formulas requiring ACD (Haigis, Kane, and Pearl-DGS) exhibited larger MedAE than those not requiring aph-ACD (Hoffer Q, Holladay 1, and SRK/T; P&#x003C;0.05). In the capsular group, the percentage of eyes within ±1.00 D ranged from 44.83% to 74.14%, and it was 19.57% to 32.61% in the sulcus group. CONCLUSION: The introduction of aph-ACD does not improve the accuracy of IOL calculation for pediatric aphakia, regardless of in-the-bag or sulcus IOL secondary implantation. The relationship between aph-ACD and effective lens position in pediatric aphakia warrants further study.

Implantation of Sutureless Scleral-Fixated Carlevale Intraocular Lens (IOL) in Patients with Insufficient Capsular Bag Support: A Retrospective Analysis of 100 Cases at a Single Center

2025-06-19

Jan Strathmann , Sami Dalbah , Tobias Kiefer +3 more | Journal of Clinical Medicine

Background/Objectives: Different surgical techniques are available in cases of missing or insufficient capsular bag support. Next to the anterior chamber or iris-fixated intraocular lenses (IOL), the implantation of the Carlevale … Background/Objectives: Different surgical techniques are available in cases of missing or insufficient capsular bag support. Next to the anterior chamber or iris-fixated intraocular lenses (IOL), the implantation of the Carlevale IOL provides a sutureless and scleral fixated treatment method. Methods: In a retrospective single-center study, the perioperative data of 100 patients who consecutively received a scleral fixated Carlevale IOL combined with a 25 gauge (G) pars plana vitrectomy between September 2021 and June 2024 were investigated. The intraoperative and postoperative results were analyzed in terms of complication rates and refractive outcomes. Results: IOL dislocation was the most common surgical indication (50%) for sutureless Carlevale IOL implantation, followed by postoperative aphakia in 35 patients (35%). Nearly every fourth patient (24%) had a preoperative traumatic event, and 21% had pseudoexfoliation (PEX) syndrome. The average surgery time was 60.2 (±20.1) min. Intraoperative intraocular hemorrhage occurred in seven cases, and IOL haptic breakage in two patients. Temporary intraocular pressure fluctuations represented the most common postoperative complications (28%). Severe complications such as endophthalmitis or retinal detachment were not observed in our cohort. The mean refractive prediction error was determined in 67 patients and amounted to an average of -0.7 ± 2.0 diopters. The best corrected visual acuity (BCVA) at the last postoperative follow-up showed an improvement of 0.2 ± 0.5 logMAR (n = 76) compared to the preoperative BCVA (p = 0.0002). The postoperative examination was performed in 72% of the patients, and the mean follow-up period amounted to 7.2 ± 6.4 months. Conclusions: Overall, sutureless and scleral fixated implantation of the Carlevale IOL represents a valuable therapeutic option in the treatment of aphakia and lens as well as IOL dislocation in the absence of capsular bag support with minor postoperative complications and positive refractive outcomes.

Phacoemulsification in the Boston Terrier Breed: A Pilot Study Comparing Success Rates of Intentional Aphakia to Pseudophakia

2025-06-19

Maria E. Moriyon , John S. Sapienza , Nicola Di Girolamo +1 more | Veterinary Ophthalmology

ABSTRACT Objective To compare visual outcomes of Boston Terriers following phacoemulsification and intraocular lens placement over a 5‐year period. Animals Studied Twenty‐five Boston Terriers. Procedures Retrospective medical record review was … ABSTRACT Objective To compare visual outcomes of Boston Terriers following phacoemulsification and intraocular lens placement over a 5‐year period. Animals Studied Twenty‐five Boston Terriers. Procedures Retrospective medical record review was conducted on Boston Terriers that underwent phacoemulsification with intraocular lens placement or intentional aphakia between January 2013 and December 2018. All surgeries were performed by the same board‐certified ophthalmologist. Information collected included signalment, surgical parameters, postoperative complications, concurrent use of an endolaser and/or anterior vitrectomy, and duration of follow‐up. A minimum of 6 months of ophthalmic evaluation after surgery was required for inclusion. Multivariate Firth logistic models were used to determine the association between predictor surgical variables and the primary outcome (visual/blind at last follow up). Results Fourteen of 14 of aphakic Boston Terrier eyes were still visual while only 12/26 (42.3%) of the pseudophakic eyes remained visual. Average follow‐up time was 20.2 months. Commonly reported postoperative complications in the pseudophakic eyes included fibrin accumulation 15/26 (58%), glaucoma 12/26 (46%), and retinal detachment 2/26 (7%). At final evaluation, 7/12 (58%) of the eyes in which endolaser cycloablation was used were blind versus 8/28 (29%) of the eyes in which laser was not used. Conclusions Intraocular lens placement in Boston Terriers undergoing phacoemulsification resulted in an approximately 40x increase in odds of blindness as an outcome even after control for vitrectomy and use of endolaser.

Clinical Outcomes and Optical Bench Analysis of a Novel Enhanced Monofocal Intraocular Lens

2025-06-19

Giovanni Romualdi , Matilde Buzzi , Pier Giuseppe Ruggeri +4 more | Life

Purpose: A novel enhanced monofocal intraocular lens (IOL) has been developed to improve functional intermediate vision, maintaining a distance vision comparable to a standard monofocal lens and avoiding the drawbacks … Purpose: A novel enhanced monofocal intraocular lens (IOL) has been developed to improve functional intermediate vision, maintaining a distance vision comparable to a standard monofocal lens and avoiding the drawbacks of multifocal IOLs. The aim of this study is to perform optical bench analysis and to evaluate refractive and visual outcomes and patient satisfaction. Methods: This prospective comparative single-center study was conducted in Careggi Hospital, University of Florence (Italy). We included 100 eyes from 50 patients who underwent bilateral cataract surgery. One group received the standard monofocal Tecnis GCB00 IOL, while the other group received the novel enhanced monofocal Evolux IOL. We evaluated binocular visual and refractive outcomes at 6 months after surgery. Binocular defocus curves and contrast sensitivity (CS) were also assessed. Optical quality was also analyzed in terms of higher-order aberrations (HOAs), modulation transfer function (MTF), objective scatter index (OSI), Strehl ratio, effective lens position (ELP), and halo analysis. A Patient-Reported Spectacle Independence Questionnaire (PRSIQ) was performed to assess spectacle independence outcomes. Finally, we analyzed the optical bench of both lenses. Results: All eyes implanted with Evolux achieved excellent distance vision, comparable to that achieved with GCB00. Evolux showed better intermediate and near vision, without any loss of visual quality, contrast sensitivity, or the presence of halos and photic phenomena. The optical bench analysis confirmed the different optical properties of the two lenses and supported the behavior obtained with the clinical defocus curve. Conclusions: These preliminary results show good refractive accuracy and visual outcomes for the enhanced monofocal IOL Evolux after cataract surgery. Further studies are needed to confirm our findings in terms of the number of patients and the period of follow-up.

Visual outcomes following pediatric cataract surgery at Komfo Anokye Teaching Hospital in Ghana

2025-06-18

Lynette Delali Amematekpor , Doreen Amankwaa-Frempong , Emmanuel Owusu | World Journal of Ophthalmology

BACKGROUND Pediatric cataract is a public health concern, and it causes long-term functional impairment and impacts the quality of life of the child with cataract. Visual impairment in children due … BACKGROUND Pediatric cataract is a public health concern, and it causes long-term functional impairment and impacts the quality of life of the child with cataract. Visual impairment in children due to cataract has devastating consequences on their health, social life, and academic performance and places a socio-economic burden on the child’s family and society as a whole. Globally, pediatric cataract is a significant contributor to ocular morbidity and blindness. Findings from this study will help quantify the visual benefits of pediatric cataract surgical interventions and identify opportunities for improving pediatric cataract services. AIM To evaluate the visual acuity outcomes of children after cataract surgery. METHODS The study employed a retrospective electronic review of pediatric cataract surgeries from January 2019 to July 2021 at the pediatric unit of the eye department at Komfo Anokye Teaching Hospital (KATH), Ghana. Patient clinical data including demographics, cataract presentation, pre-operative and post-operative visual acuity, surgical procedure, postoperative complications, interventions and refraction were collected and analyzed using the Statistical Package and Service Solution. Pearson's χ 2 test and regression statistics were used to summarize data at a significance of P < 0.05. RESULTS 163 children (257 eyes) underwent cataract surgery at KATH. The overall mean age was 3.81 ± 3.56 years. Congenital cataract was commonly observed (56.4%). All children underwent keratometry and phacoemulsification procedures. A few children (9.8%) experienced postoperative complications while 90.8% did not require further intervention after the surgery. After the surgery 27.0% of the children had refraction and the majority were corrected for myopia and near addition (12.9%). An analysis of the association of postoperative visual acuity and the type of cataract was statistically significant (P value < 0.05). There was a significant improvement in the visual outcomes following cataract surgery. CONCLUSION Timely pediatric cataract surgery improves postoperative visual outcomes. Creating awareness and implementing screening programs is important to ensure that the prevalence of childhood blindness is reduced to the barest minimum.

Surgical Management of Dislocated Lenses with Temporary Use of Capsular Tension Ring

2025-06-18

Fikret Uçar , Adnan Çınal | Retina

Purpose: To compare the surgical outcomes of two techniques for managing dislocated lenses with zonular insufficiency. Methods: This study included 64 eyes of 64 patients with complete or near-complete zonular … Purpose: To compare the surgical outcomes of two techniques for managing dislocated lenses with zonular insufficiency. Methods: This study included 64 eyes of 64 patients with complete or near-complete zonular loss undergoing lens removal surgery. Patients were divided into two groups: Group 1 (n=34) underwent phacoemulsification with temporary capsular tension ring (CTR) assistance, followed by anterior vitrectomy (AV) or pars plana vitrectomy (PPV); Group 2 (n=30) underwent ultrasonic fragmatome-assisted lens removal with perfluorocarbon liquid (PFCL) support and subsequent PPV. Intrascleral intraocular lens (IOL) fixation and peripheral iridectomy were performed in all cases. Results: The mean age of patients was 64.1 ± 9.7 years in Group 1 and 65.7 ± 8.6 years in Group 2 (p=0.51). Postoperative best-corrected visual acuity significantly improved in both groups (p<0.001). No clinically significant IOL decentration or tilt was observed in either group. Cystoid macular oedema and transient intraocular pressure elevation were noted in 5.9% of Group 1, compared to 23.3% and 20% in Group 2, respectively (p=0.04 and p=0.08, respectively). Retinal detachment occurred in 3 cases (10%) in Group 2, whereas no such complications were observed in Group 1 (p=0.05). Cortical remnants were detected in the posterior segment in 3 eyes (10%) in Group 2, whereas no such complications were observed in Group (p=0.05). Conclusion: Phacoemulsification with temporary CTR assistance, followed by scleral IOL fixation and PPV/AV, provided a safer surgical approach with fewer complications in patients with dislocated lenses compared to fragmatome-assisted techniques.

Presbyopia intraocular lens in aberrated corneas

2025-06-18

Julian Cheong Kiat Tay , Jodhbir S. Mehta | Taiwan Journal of Ophthalmology

Abstract Increasingly, patients desire spectacle independence postcataract surgery, for which multifocal intraocular lens (IOL) implantation is widely performed. However, multifocal IOLs have certain drawbacks: fixed focal change, increased photic phenomena, … Abstract Increasingly, patients desire spectacle independence postcataract surgery, for which multifocal intraocular lens (IOL) implantation is widely performed. However, multifocal IOLs have certain drawbacks: fixed focal change, increased photic phenomena, and unsuitability for use in aberrated eyes. Monovision is an option, but can only achieve fixed focal points as well. An alternative IOL that bridges the gap between providing an extended depth of focus (DOF) and decreasing induced aberrations is the IC-8 Apthera IOL, which utilizes small aperture technology to provide a continuous DOF with good near, intermediate and distance vision in eyes with up to 1.50D of preoperative astigmatism. Importantly, the IC-8 IOL has shown potential for use in aberrated eyes, demonstrating increased visual acuity at all distances, good contrast sensitivity, minimal photic phenomena, and high levels of spectacle independence in patients with corneal irregularities and higher order aberrations, especially postrefractive surgery. The IC-8 IOL has also been able to achieve good centration and positional stability, which is key for good visual outcomes and spectacle independence after surgery. This paper aims to bring together relevant literature to review the outcomes of IC-8 IOL.

Prevalence of Cannula Dislocation During Cataract Surgery: a survey

2025-06-17

Amar Alwitry | Journal of Cataract & Refractive Surgery

Aim: To investigate the prevalence of cannula dislocation during cataract. Method: A survey was carried out online via a link sent to members of the UKISCRS, ESCRS and readership of … Aim: To investigate the prevalence of cannula dislocation during cataract. Method: A survey was carried out online via a link sent to members of the UKISCRS, ESCRS and readership of Eye News®. Results: Five hundred and fifty one responses were obtained. 84% of respondents had experienced dislocation of the cannula with 78.04% seeing harm due to this. 50.37% indicated that the last time this occurred there was ocular damage. 22.95% indicated that a cannula dislocation occurred on average once per year, 38.43% experienced it twice per year, 15.66% responded that it occurred 3 times per year, while 6.92% stated that it occurred 4 or more times per year. Conclusion: Cannula dislocation happens not infrequently and ocular harm occurs frequently when this occurs. It is likely that that harm is minimal and therefore the issue is underreported. Further work is required it attempting to prevent avoidable harm from this complication.

Intracameral anesthetics in cataract surgery and its toxicity to the cornea – a review

2025-06-17

S Safár , Diana Vargas , C.V. Araújo +1 more | Brazilian Journal of Health Review

A facectomia com facoemulsificação é uma das cirurgias mais realizadas no mundo. As injeções retrobulbares e peribulbares vêm sendo substituídas pelos anestésicos tópicos, mas os pacientes podem sentir desconforto durante … A facectomia com facoemulsificação é uma das cirurgias mais realizadas no mundo. As injeções retrobulbares e peribulbares vêm sendo substituídas pelos anestésicos tópicos, mas os pacientes podem sentir desconforto durante a cirurgia. A anestesia intracameral fornece efeito anestésico adicional. Alguns anestésicos e seus conservantes podem acarretar danos ao endotélio da córnea, dependendo da concentração e do tempo de exposição. Objetiva-se avaliar a segurança e a eficácia de anestésicos na câmara anterior durante a cirurgia de facectomia. Para tanto, procede-se uma revisão na literatura científica, utilizando o banco de dados PubMed/Medline. Encontrou-se que a lidocaína 1% intracameral não causou danos ao endotélio da córnea, mas em concentrações mais altas ou exposição prolongada, pode causar citotoxicidade. A bupivacaína e a proparacaína apresentaram maior toxicidade à córnea, apenas a ropivacaína apresentou superioridade em relação à segurança comparada à lidocaína. O cloreto de benzalcônio é altamente tóxico para córnea e não dever ser injetado na câmara anterior, já o metilparabeno não levou a alterações significativas para córnea. Conclui-se que a lidocaína é segura para uso intracameral, a bupivacaína e proparacaína mostraram toxicidade para a córnea e apenas a ropivacaína mostra superioridade comparada à lidocaína. Conservantes devem ser evitados devido à sua potencial toxicidade para o endotélio da córnea.

Strategic Design of Biocompatible, Glistening-Free, and Foldable Artificial Intraocular Lenses Based on Hydro-Amphiphilic Ternary Copolymers

2025-06-17

Cheng‐Ti Hu , Z. Liang , Jingdong Luo +7 more | Biomacromolecules

The increasing prevalence of cataracts underscores the urgent need for intraocular lens (IOL) materials that provide optical clarity, foldability, glistening resistance, and long-term biocompatibility. In this study, we developed hydro-amphiphilic … The increasing prevalence of cataracts underscores the urgent need for intraocular lens (IOL) materials that provide optical clarity, foldability, glistening resistance, and long-term biocompatibility. In this study, we developed hydro-amphiphilic ternary copolymers composed of styrene, hydroxyethyl methacrylate (HEMA), and poly(ethylene glycol) phenyl ether acrylate (PEGPEA) to address these requirements. This rational design integrates the strength and refractive index of hydrophobic styrene with the flexibility and hydrophilicity of HEMA and PEGPEA. The optimized formulation (H3), comprising 50 wt % HEMA, 30 wt % PEGPEA, and 20 wt % styrene, showed excellent transparency after accelerated aging, sufficient modulus and elongation for safe surgical handling, and low cytotoxicity in CCK-8 assays. Cytokine analyses revealed no significant inflammatory response compared to a commercial hydrophobic acrylic IOL. These findings highlight hydro-amphiphilic copolymers as a promising next-generation material platform for IOLs, offering a biocompatible, glistening-free, and foldable solution for enhanced surgical outcomes and long-term patient satisfaction.

Using Patient-Specific 3D-Printed C1–C2 Interfacet Spacers for the Treatment of Type 1 Basilar Invagination: A Clinical Case Report

2025-06-17

Tim Bui , Alexander T. Yahanda , Karan Joseph +6 more | Biomimetics

Background: Type 1 basilar invagination (BI) is caused by a structural instability at the craniovertebral junction (CVJ) and has been historically treated with distraction and stabilization through fusion of the … Background: Type 1 basilar invagination (BI) is caused by a structural instability at the craniovertebral junction (CVJ) and has been historically treated with distraction and stabilization through fusion of the C1-C2 vertebrae. Recent advances in 3D printed custom implants (3DPIs) have improved the array of available options for reaching distraction and alignment goals. Case Presentation: We report the case of a 15-year-old male who presented with early signs of cervical myelopathy. Radiographic evaluation revealed type 1 BI with a widened atlantodental interval (ADI) of 3.7 mm and a 9 mm McRae's line violation (MLV) of the dens, resulting in severe narrowing at the CVJ and brainstem/spinal cord impingement. Of note, the patient had bilateral dysplastic C1 and C2 anatomy, thus requiring a patient-specific 3DPI to conform to this anatomy and enable sufficient distraction and fusion. Custom 3D printed C1-C2 interfacet spacers were created and implemented within 14 days to achieve sufficient distraction, osteoconduction, and stabilization of the C1-C2 joint. Outcome: Postoperatively, the patient remained neurologically intact with myelopathic symptom improvement before discharge on postoperative day 4. Postoperative imaging demonstrated the resolution of BI from successful C1-C2 joint distraction and confirmed intended implant placement with resolution of canal stenosis. During his 6-week follow-up, the patient remained neurologically stable with intact hardware and preserved alignment. Conclusions: This case is the first in the United States demonstrating the use of custom 3D printed interfacet spacers to achieve successful distraction, decompression, and stabilization of type 1 BI. These patient-specific 3DPIs were designed and created in a streamlined manner and serve as proof-of-concept of pragmatic implant design and manufacturing. Future optimization of the workflow and characterization of long-term patient outcomes should be explored for these types of 3DPI.

Refractive, Visual, and Safety Outcomes of Three Surgical Techniques for Aphakia Correction

2025-06-17

Liam Redden , David Hoang , Nitin Rangu +4 more | Journal of Cataract & Refractive Surgery

Purpose: To compare refractive, visual, and safety outcomes of three methods for surgical correction of aphakia: anterior chamber IOL (ACIOL), intrascleral haptic fixation IOL (ISHF-IOL), and Gore-Tex suture fixation of … Purpose: To compare refractive, visual, and safety outcomes of three methods for surgical correction of aphakia: anterior chamber IOL (ACIOL), intrascleral haptic fixation IOL (ISHF-IOL), and Gore-Tex suture fixation of modified eyelet toric IOL (GSF-MET IOL). Setting: Tertiary care academic center. Design: Multi-surgeon retrospective case series Methods: Review of 357 eyes undergoing one of the above three techniques between 2017 and 2024. Comparative refractive (defocus (spherical equivalent (SE)), astigmatism (refractive cylinder (RefCyl)), and blur (defocus equivalent (DEQ))), visual acuity (corrected distance visual acuity (CDVA)), and safety outcomes (cystoid macular edema (CME) and return to the operating room (ROR) events) were recorded. Due to concerns about IOL tilting with one of the models, a subgroup analysis was performed on two IOL models within the ISHF group. Statistical analyses included descriptive statistics, Chi-Square tests, one-way ANOVA, and two-sample t-testing. Results: All three groups had similar SE (p = 0.87), RefCyl (p = 0.91), and CDVA in eyes without significant comorbidities (p = 0.23). ROR was similar among all groups (p = 0.08). Within the ISHF-IOL group, CT Lucia 602 and Sensar AR40 had similar SE and RefCyl (p = 0.18 and p = 0.15, respectively). CDVA was similar in eyes without significant comorbidities for both IOL models (p = 0.70). ROR was significantly higher with CT Lucia 602 than with Sensar AR40 (p = 0.03). Conclusions: All three surgical techniques can provide good refractive, visual acuity, and safety outcomes. Within the ISHF-IOL group, the Sensar AR40 had lower ROR rates than the CT Lucia 602, with similar CDVA outcomes.

Long-term Clinical Course of Intraocular Pressure Elevation Following Intraocular Lens Dislocation Surgery

2025-06-15

Dong Gyu Na , Sae Mi Park | Journal of the Korean Ophthalmological Society

Purpose: Intraocular lens (IOL) dislocation is a relatively common complication after cataract surgery, leading to an increase in intraocular pressure (IOP) following IOL dislocation surgery. This study investigated the long-term … Purpose: Intraocular lens (IOL) dislocation is a relatively common complication after cataract surgery, leading to an increase in intraocular pressure (IOP) following IOL dislocation surgery. This study investigated the long-term clinical course of patients who experienced IOP elevation after IOL dislocation surgery.Methods: This retrospective study analyzed 65 patients who underwent IOL dislocation surgery by a single retinal specialist from January 2020 to December 2022. The patients were divided into high (≥ 22 mmHg) and normal (< 22 mmHg) IOP groups based on the IOP within 1 week of surgery. IOP was tracked for over a year to assess the incidence of glaucoma.Results: There were no significant (<i>p</i> = 0.254) differences in dislocation types between the high (48 patients) and normal (17 patients) IOP groups. One month after surgery, the mean IOP was 18.6 ± 5.9 mmHg in the high IOP group and 14.3 ± 4.0 mmHg in the normal IOP group (<i>p</i> < 0.001). At 1 year, the values were 15.3 ± 3.7 and 16.2 ± 5.0 mmHg, respectively (<i>p</i> = 0.696). One week after surgery, the high IOP group used 1.2 ± 0.8 IOP-lowering medications compared to 0.2 ± 0.7 in the normal IOP group (<i>p</i> < 0.001). At the final follow-up, medication use was 0.5 ± 0.9 and 0.2 ± 0.6, respectively (<i>p</i> = 0.227).Conclusions: Although IOP elevation may occur following IOL dislocation surgery, it tends to improve over time.

Role of densitometry and combination therapy in ultrasound-free femtosecond laser lens surgery in patients with refractive disorders

2025-06-14

D. E. Arakelyan , S. Yu. Kopaev , M. M. Kacharava | Russian Ophthalmological Journal

Purpose the study — to evaluate the effectiveness of a personalized approach to femtosecond laser fragmentation of the lens nucleus based on densitometry, as well as to analyze the effect … Purpose the study — to evaluate the effectiveness of a personalized approach to femtosecond laser fragmentation of the lens nucleus based on densitometry, as well as to analyze the effect of a combination drug (ketorolac + levofloxacin) on perioperative patient management. Material and methods . The study included 64 patients (64 eyes) aged 52 ± 10 with ametropia of various degrees and types, as well as with cataracts of I–III degrees of lens nucleus density according to the PNS and Buratto classification. Preoperative densitometry was performed on Pentacam and Galilei G6. The data were used for personalized selection of femtosecond laser energy and nuclear fragmentation pattern. Patients of group 1 (n = 33) received a combination drug (non-steroidal anti-inflammatory drug (NSAID) and antibiotic), in group 2 (n = 31) — NSAID and antibiotic separately. Results . Personalized femtolaser parameters provided effective fragmentation of the nucleus in all cases. Combined therapy showed advantages over separate therapy in terms of mydriasis stability, inflammation prevention, and treatment adherence. Conclusion . The study confirms the importance of densitometric assessment of lens density and combined drug therapy to improve the efficacy and safety of femtolaser-assisted refractive lens surgery.

Clinical Outcomes of 100% Glistening Free Intraocular Lens Implantation

2025-06-14

Hasan Alı Bayhan , Koçer Furkan Durukan , Seray Aslan Bayhan +1 more | Bozok Tıp Dergisi

Objective: The purpose of this study is to investigate the outcomes of ENOVA GF3 intraocular lens (IOL) implantation. Materials and Methods: In this retrospective study, we evaluated the clinical results … Objective: The purpose of this study is to investigate the outcomes of ENOVA GF3 intraocular lens (IOL) implantation. Materials and Methods: In this retrospective study, we evaluated the clinical results of patients undergoing phacoemulsification and implanted ENOVA GF3, a hydrophobic acrylic IOL, in XXXX ophthalmology clinic. 320 eyes of 292 patients were included in the study. All operations were performed by the same surgeon. The postoperative follow-up examinations were conducted on the 1 st and 7 th postoperative days and at the 1 st , 3 rd , 6 th and 12 th months. In these examinations, we examined uncorrected distance visual acuity, corrected distance visual acuity, uncorrected and corrected near visual acuity. Photographs of the anterior segment were taken after pupil dilation, Glistening and posterior capsule opacification (PCO) formations were noted. Deviations from the target refraction were determined by postoperative autorefractometer values. The patients underwent contrast sensitivity tests. All patients’ quality of life was determined with the National Eye Institute-Visual Function Questionnaire (NEI VFQ 25). Results: In 282 eyes (88%) the mean incision size was 2.20 and in 38 eyes (12%) it was 2.80 mm. In terms of intraoperative complications, intraoperative floppy iris (IFIS) occurred in 3 patients (0.01%) and posterior capsule rupture (PCR) occurred in 1 patient (0.003%). Evaluations at 6 and 12 months showed no glistening, PCO or any other complications. The target refraction deviation values were 0.06 ± 0.71 and the mean corrected visual acuity was 0.98 ± 20 at the 12-month evaluation after IOL implantation. Conclusion: It was found that the ENOVA GF3 IOL was a safe lens in terms of intraoperative complications, postoperative fibrin reaction, deviation from target refraction, PCO and glistening. Considering the short- and long-term results of ENOVA GF3, we suggest that it can be preferred in clinical practice.

Evidenzbasierter Einsatz von Sonderlinsen: Management von postoperativer Unzufriedenheit

2025-06-13

Isabella D. Baur , Arthur Mueller , Grzegorz Łabuz +2 more | Deleted Journal

The majority of patients report a high degree of satisfaction after implantation of premium intraocular lenses (IOL); however, cases of postoperative dissatisfaction occasionally occur. The most frequent symptoms are blurred … The majority of patients report a high degree of satisfaction after implantation of premium intraocular lenses (IOL); however, cases of postoperative dissatisfaction occasionally occur. The most frequent symptoms are blurred vision and dysphotopsia. The possible causes include a deviation of the target refraction, cystoid macular edema, dry eye, secondary cataract, decentration of the IOL and a large pupil size. A standardized evaluation can help to identify the possible cause and to initiate an adequate treatment when a pathology has been identified. If the complaints are inherent to the IOL optics, an exchange of the IOL is available as a last resort.

Pyramidal Cataract with Detached Apex

2025-06-13

Riccardo Genovese , Marco Coassin | Journal of Cataract & Refractive Surgery

Prevalence and risk factors of pre-senile lens opacities in the 1969-73 Vellore Birth Cohort

2025-06-13

Padma Paul , Belavendra Antonisamy , Neena John +7 more | Eye

Abstract Purpose To estimate the prevalence and determine predictors of lens opacities (LO) among South Asian Indians aged 41–44 years. Methods This cross-sectional study included 1080 participants from the Vellore … Abstract Purpose To estimate the prevalence and determine predictors of lens opacities (LO) among South Asian Indians aged 41–44 years. Methods This cross-sectional study included 1080 participants from the Vellore Birth Cohort, Vellore, South India. All underwent anthropometric measurements, detailed ophthalmic examination including assessment of LO by LOCS III classification and biochemical metabolic measurements. ‘Any cataract’ was defined as any opacity type with a score of >2 or evidence of cataract surgery in either eye. Data collected included information on ocular history, life-style factors, socio-economic and educational status, cooking fuel and sunlight exposure. Multivariable logistic regression analysis was used to examine the association between risk predictors and LO. Results The mean age (SD) of participants was 41.8 (1.0) years; 53.8% were male and 50% were rural residents. The overall prevalence of ‘any cataract’ was 13.8% (148/1075, 95% confidence interval (CI) 11.8,16.0). The types of cataract were nuclear 59.1%, cortical 16.9%, posterior subcapsular 4.1%, mixed cataracts 18.9% and pseudophakia 0.7%. Increased risk for LO was observed with a history of asthma (OR 4.51; 95% CI 2.1, 9.7), HbA1C of ≥6.5% (OR 2.29; 95% CI 1.4, 3.7), hypertension (OR 1.73; 95% CI 1.1, 2.7) and, in a subgroup ( n = 372), lower 25(OH) vitamin D levels (≤20 ng/dL)(OR 5.56; 95% CI 2.3, 13.2). Conclusion The high prevalence of LO at a relatively young age in South Asian Indians suggests earlier onset of ageing. History of asthma, higher HbA1C, hypertension and lower 25(OH) vitamin D levels were associated with LO.

Evaluating Force and Motion in Posterior Vitreous Detachment Manoeuvres Using a Robotic Data Acquisition System in Cadaveric Human Eyes

2025-06-12

Reza Heidari , Esmaeil Asadi Khameneh , Ali Rastaghi +7 more | Research Square (Research Square)

<title>Abstract</title> Deep vitrectomy, a complex ophthalmic procedure, requires significant surgical skill. This study evaluated the ARASH:ASiST robotic system for real-time, quantifiable assessment of deep vitrectomy in a pre-clinical setting using … <title>Abstract</title> Deep vitrectomy, a complex ophthalmic procedure, requires significant surgical skill. This study evaluated the ARASH:ASiST robotic system for real-time, quantifiable assessment of deep vitrectomy in a pre-clinical setting using cadaveric human eyes. Four surgeons, with varying experience levels, performed procedures while intraoperative force, positional, and temporal data were recorded. Analysis of seven surgical datasets revealed experience-specific differences in force application, particularly during posterior vitreous detachment induction, which emerged as a key performance metric. Time data provided insights into surgeon control. The system's real-time graphical user interface offered immediate feedback and facilitated postoperative analysis. Usability assessments confirmed the system's practicality and non-intrusiveness. The ARASH:ASiST system demonstrates potential as an objective platform for evaluating and understanding surgical skill in deep vitrectomy, offering a novel approach to surgical training and assessment.

Surgical outcomes of phacoemulsification with different fluidics systems (centurion with active sentry vs. centurion gravity) in cataract patients with eye axial length above 26 mm

2025-06-12

Yinan Liu , Xiaoyong Chen | Frontiers in Medicine

Introduction During cataract phacoemulsification surgery, the Alcon Centurion with Active Sentry can achieve a more stable anterior chamber, which allows a lower intraocular pressure (IOP) setting than Centurion under gravity … Introduction During cataract phacoemulsification surgery, the Alcon Centurion with Active Sentry can achieve a more stable anterior chamber, which allows a lower intraocular pressure (IOP) setting than Centurion under gravity mode. In this randomized controlled trial, we compared these two systems’ impact on high myopia patients’ macular blood perfusion under different IOP settings. To evaluate intra-op and post-op clinical performance of the Alcon Centurion with Active Sentry and under gravity mode in cataract patients with eye axial lengths &gt; 26 mm. Methods Fifty-two eyes of 43 cataract patients with axial lengths &gt; 26 mm were enrolled and randomly divided into the active fluidics system (AFS) group using a Centurion Active Sentry handpiece under 30 mmHg IOP setting (26 eyes) and the gravity fluidics system (GFS) group in gravity mode under 80 cmH 2 O IOP setting (26 eyes). Intraoperative parameters, visual acuity, parafoveal macular vessel density and macular thickness were analyzed. Results We observed no significant differences in best corrected visual acuity (BCVA), macular thickness, cumulative dissipated energy (CDE), total case time, as well as ophthalmic viscoelastic devices (OVDs) usage between the two groups. However, we found less pain complaints during surgeries and a more stable macular vessel density post-surgery in the AFS group than in the GFS group, implying higher intraoperative comfort levels and less retinal ischemia during cataract surgery using Centurion with Active Sentry under low IOP settings. Conclusion Owing to a lower IOP setting, Centurion Vision System with Active Sentry handpiece causes less retinal ischemia and pain perception during phacoemulsification for high myopia patients. Clinical trial registration https://www.chictr.org.cn , identifier ChiCTR2400080875.

Quantitative evaluation of inflammation after phacoemulsification surgery: anterior chamber flare and choroidal vascular index

2025-06-12

Metehan Şimşek , Gülay Yalçınkaya Çakır , Efe Koser +2 more | Japanese Journal of Ophthalmology

Abstract Purpose To evaluate the relationship between phacoparameters and inflammation parameters (anterior chamber flare (ACF), macular and peripapillary choroidal vascular index (mCVI and pCVI)) changes after cataract surgery. Study design … Abstract Purpose To evaluate the relationship between phacoparameters and inflammation parameters (anterior chamber flare (ACF), macular and peripapillary choroidal vascular index (mCVI and pCVI)) changes after cataract surgery. Study design Prospective study Methods This prospective observational study included patients without systemic and ocular diseases who underwent uncomplicated cataract surgery that may have affected intraocular inflammation. Preoperative, postoperative 1st week, 1st, 3rd and 6th months ACF were measured. At the same visits, mCVI and pCVI were calculated. The relationship between phacoparameters and postoperative ACF, mCVI and pCVI values were evaluated by correlation analysis. Results Fifty eyes of 50 patients were included in the study. Postoperative 1st week ACF was significantly higher than preoperative ACF (p<0.001). ACF decreased significantly from postoperative 1st week to 6th months. Postoperative 1st month and 3rd month mCVI were significantly higher than preoperative mCVI (p<0.001, p=0.04, respectively). It was observed that pCVI reached its peak value in the 1st postoperative week and decreased to base value in the postoperative 6th month. A strong positive linear correlation was found between total cumulative dissipated energy (CDE) and the difference between postoperative 1st week and preoperative ACF (p<0.001, r=0.68). Conclusion Particularly in the early period after phacoemulsification, ACF, mCVI and pCVI increased. The increase in ACF lost its significance at the third month and the increase in mCVI and pCVI remained significant, which may indicate that the inflammatory effect of cataract surgery lasts longer in the posterior segment. Total CDE can be used to predict postoperative inflammation levels.

Impact of residual ophthalmic viscosurgical device behind intraocular lens on postoperative intraocular pressure and refractive outcomes in cataract surgery

2025-06-12

Ömer Bilgiç , Özlem Evren Kemer | International Ophthalmology

Capsular Tension Ring Implantation for Intraocular Lens Position

2025-06-12

Haowen Lin , Yu Zhang , Xiaohang Xie +5 more | JAMA Ophthalmology

Importance There is currently no consensus regarding the association of capsular tension ring (CTR) on intraocular lens (IOL) position or the indications for its implantation. Objective To evaluate the association … Importance There is currently no consensus regarding the association of capsular tension ring (CTR) on intraocular lens (IOL) position or the indications for its implantation. Objective To evaluate the association of CTR implantation on IOL position. Data Sources PubMed, Embase, and Cochrane Library were searched from their inception to October 18, 2024. Study Selection Randomized clinical trials (RCTs) or prospective cohorts reporting the effect or association of CTR on postoperative anterior chamber depth (ACD), IOL decentration, tilt, or rotation. Data Extraction and Synthesis Data extraction was conducted by 2 reviewers and verified by another for accuracy. Mean difference (MD) was used to synthesize the effect measures, and subgroup analyses were conducted according to IOL haptic design (C-loop and plate haptic) and whether the patient had high myopia. Main Outcome and Measures Postoperative ACD and IOL decentration, tilt, and rotation. Results A total of 11 RCTs and 7 cohort studies, involving 809 eyes with CTR and 822 eyes without CTR, were included in this meta-analysis. The analysis revealed that IOL tilt (MD, −1.04°; 95% CI, −2.05° to −0.03°; P = .04) and rotation (MD, −0.82°; 95% CI, −1.27° to −0.37°; P &amp;lt; .001) were smaller in the CTR group compared with the control group. The subgroup analysis of ACD ( I 2 = 70.7%; P = .03), decentration ( I 2 = 66.5%, P = .08), and tilt ( I 2 = 76.7%, P = .01) revealed a heterogeneity between the subgroups stratified according to IOL haptic design. Additionally, subgroup analysis demonstrated that CTR group showed a deeper ACD in eyes implanted with plate haptic IOLs (MD, 0.11 mm; 95% CI, 0.02 to 0.20 mm; P = .01), and a smaller IOL tilt in highly myopic eyes (MD, −1.43°; 95% CI, −2.59° to −0.26°; P = .02) compared with the control group. Conclusions and Relevance CTR implantation was associated with enhanced stability of IOL rotation in this meta-analysis, while only reducing IOL tilt in high myopia. While the direct clinical relevance of these results could not be determined from this investigation, these findings provide evidence supporting use of CTR implantation when toric IOLs have been implanted or with high myopia, although a hyperopic refractive shift after implantation of plate haptic IOLs may require target refraction adjustment.

Neovascular proliferation over a cosmetic artificial iris implant. Management of multiple complication after cosmetic iris implant

2025-06-12

Natalie di Geronimo , Matilde Roda , Antonio Moramarco +2 more | Case Reports in Ophthalmology

Introduction The NewColorIris and BrightOcular implants were initially developed to address congenital iris defects. However, they found application for cosmetic purposes. Unfortunately, these implants are frequently linked to severe complications, … Introduction The NewColorIris and BrightOcular implants were initially developed to address congenital iris defects. However, they found application for cosmetic purposes. Unfortunately, these implants are frequently linked to severe complications, including glaucoma, endothelial dysfunction, cataract development, and iris abnormalities. In this context, we present an unusual complication that manifested long after the implantation of the BrightOcular artificial iris. Case Presentation A 28-year-old woman presented to our emergency room with blurred vision in both eyes. She had undergone bilateral cosmetic iris implantation (BrightOcular, Stellar Devices, New York, NY, USA) six years earlier in Tunisia. At the first examination, her BCVA was hand motion in the right eye and 20/100 in the left eye, and intraocular pressure (IOP) was 45 mmHg and 30 mmHg, respectively. Despite the maximum-tolerated glaucoma medical treatment, the elevated IOP persisted, leading to the decision to perform bilateral sequential Baerveldt glaucoma drainage device implantation. However, she subsequently developed CCRAVO (combined central retinal artery and vein occlusion) in the right eye and hypotensive maculopathy in the left eye; the latter resolving within one month. Two months post-surgery, extensive neovascularization above the implant of the right eye was observed, and this was successfully treated with three sequential injections of bevacizumab. Conclusion Cosmetic iris implantation is associated with severe, sight-threatening complications. Herein, we describe a previously unreported case of angle neovascularization with new vessels growing over the artificial iris implant. The condition regressed after intravitreal anti-vascular endothelial growth factor injections.

EFFICACY AND SAFETY OF POSTERIOR CAPSULOREXIS USING POBH IN COMPARISON WITH TRADITIONAL IOL IMPLANTATION TECHNIQUE FOR AGE-RELATED CATARACTS

2025-06-07

H.B. Tsurova , L.A. Bazieva | Medicus.

Goal. To evaluate the effectiveness and safety of posterior capsulorexis using primary optical biomechanical fixation (POBH) compared with the traditional technique of implanting an intraocular lens (IOL) into a capsule … Goal. To evaluate the effectiveness and safety of posterior capsulorexis using primary optical biomechanical fixation (POBH) compared with the traditional technique of implanting an intraocular lens (IOL) into a capsule bag during age-related cataract surgery. Materials and methods. The study was conducted on the basis of the Dagestan Eye Microsurgery Center in the period from September 2023 to October 2024. The study included 20 patients (40 eyes) with age-related cataracts who underwent bilateral cataract removal surgery on one day. The patients were randomly divided into two groups: one underwent surgery using the POBH method, the other underwent traditional IOL implantation. The data was analyzed using a variance analysis of repeated measurements. Results. The maximum intensity of the intraocular flare was higher in the eyes with implanted IOL compared with POBH one hour after surgery, but the differences were leveled by the sixth day and a month later (p>0.04). The duration of surgery and the time of phacoemulsification were statistically equivalent between the groups (p=0.32 for the duration of surgery, p=0.54 for phacoemulsification). Conclusions. POBH is a safe and effective technique for IOL implantation during age-related cataract surgery. It does not increase the duration of surgery and minimizes the postoperative inflammatory response. The use of the POBH method may be recommended to reduce the risk of secondary cataracts and inflammation.

Intrascleral Tunnel Clamping of Fluocinolone Acetonide Implant: A Novel Scleral Fixation Technique

2025-06-06

Lucas Séjournet , Laurent Kodjikian , Thibaud Mathis +3 more | Pharmaceuticals

Purpose: This retrospective observational study evaluates the efficacy and safety of a novel scleral fixation technique of the fluocinolone acetonide (FAc) implant in four consecutive patients with post-surgical macular edema … Purpose: This retrospective observational study evaluates the efficacy and safety of a novel scleral fixation technique of the fluocinolone acetonide (FAc) implant in four consecutive patients with post-surgical macular edema (PSME). Case Presentation: Four patients with PSME underwent intrascleral tunnel clamping (ITC) of the FAc implant due to lens defects. A 25-gauge sclerotomy was made 3.5 mm from the limbus and the implant was inserted into it until its end reached the edge of the sclera. Then, an 8-0 absorbable suture was passed through the sclera without penetrating the implant, thereby clamping the sclera around the FAc. All the patients showed improvements in best-corrected visual acuity (from a mean of 20/100 at baseline to 20/40) and central retinal thickness (from a mean of 534 µm at baseline to 318 µm) and with no recurrence of macular edema in most cases, without the need for further treatment. In addition, no anterior migration of the FAc implant or ocular hypertension was observed. This procedure effectively reduced the therapeutic burden for these patients. Although scleral fixation of the FAc implant has been described in small series of patients with successful results, this approach remains off-label. Conclusions: Although off-label, ITC of the FAc implant may offer a promising treatment option for patients who would otherwise remain untreated.