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Clinical Ophthalmology (Auckland, N.Z.) 2024To evaluate postoperative outcomes after implantation of toric intraocular lenses (IOLs) made of high-water-content hydrophobic acrylic material in Japanese patients...
Implantation of Hydrophobic Acrylic Toric Intraocular Lens with High-Water Contents Using Swept-Source Optical Coherence Tomography Biometer Integrated with a Surgical Guiding System.
PURPOSE
To evaluate postoperative outcomes after implantation of toric intraocular lenses (IOLs) made of high-water-content hydrophobic acrylic material in Japanese patients using a swept-source optical coherence tomography (SS-OCT) biometer integrated with a surgical guiding system.
PATIENTS AND METHODS
In this prospective observational study, toric IOL models CNW0T3 to CNW0T9 (Alcon) were implanted in 33 eyes of 33 patients and followed-up for one month. Powers and toric models were determined using an SS-OCT biometer ARGOS Ver 1.5 (Alcon), and the IOLs were aligned using surgical guidance. Differences between planned and actual axis positions at the end of the surgery (misalignment) and rotations from the end of surgery to one month postoperatively were measured. Additionally, postoperative uncorrected visual acuity, refraction, and residual astigmatism were evaluated.
RESULTS
Mean and median misalignments were 2.3° (standard deviation [SD]: 1.6, 95% confidence interval [CI]: 1.7-2.9) and 2°, and those of postoperative rotation were 2.4° (SD: 2.6, 95% CI: 1.5-3.4) and 2°, respectively. Mean postoperative refraction was 0.06 D (SD: 0.62). Prediction errors within ±0.5 and ±1.0 D were 69.7% and 93.9%, respectively. Mean residual astigmatisms were 0.19 D (SD: 0.41), and mean uncorrected visual acuity was 0.00 logMAR (SD: 0.11), and 64% of the eyes scored 20/20 or better.
CONCLUSION
Implantation of high-water-content hydrophobic acrylic toric IOLs using SS-OCT biometry integrated with a surgical guiding system effectively corrected corneal astigmatism with accurate IOL alignment in Japanese patients.
PubMed: 38686014
DOI: 10.2147/OPTH.S456609 -
Analysis of Corneal Biomechanical Properties in Different Keratotopographic Patterns of Keratoconus.Journal of Current Ophthalmology 2023To analyze the frequency of main keratotopographic patterns at the 1, 2, and 3 stages of keratoconus and investigate corneal biomechanical properties across different...
PURPOSE
To analyze the frequency of main keratotopographic patterns at the 1, 2, and 3 stages of keratoconus and investigate corneal biomechanical properties across different patterns.
METHODS
The study comprised two stages. The first stage was computational-experimental, where we utilized COMSOL Multiphysics® software (COMSOL AB, Stockholm, Sweden) to mathematically model corneal mechanical behavior under intraocular pressure and pulsed air jet action in both normal and keratoconic conditions. The second stage was the clinical phase, during which we retrospectively analyzed the examination results of both healthy subjects and patients with keratoconus. In total, the study included 256 eyes (256 subjects). Among them, 174 eyes (174 healthy individuals) had normal corneas with different refractions, and 82 eyes (82 individuals) had stages 1, 2, and 3 of keratoconus based on Amsler-Krumeich classification. The keratotopographic characteristics of the participants were assessed using Sirius (Schwind, Germany) and Pentacam AXL (OCULUS Optikgeräte GmbH, Germany) keratotomographs, while the corneal biomechanical properties were studied using noncontact tonometry with the Corvis ST device (OCULUS Optikgeräte GmbH, Germany). The study focused on evaluating corneal stiffness index values in the central optical zone under various keratotopographic patterns. In addition, it compared the elastic coefficient values , , and for the model of hyperelastic behavior of corneal material outside the keratoconus zone. Furthermore, the study examined the values of reduced stiffness zone characteristics, including the stiffness reduction factor ψ, effective radius , and the ratio of maximum and minimum strain intensity in keratoconus of different stages.
RESULTS
The mean age of the patients in the study was 30.16 ± 8.31 years, with 166 men and 90 women participating. The study revealed typical keratotopographic patterns in the examined keratoconus stages, as well as their occurrence frequency. In the 1 stage of keratoconus, the pattern of asymmetric astigmatism was noted more frequently (in 75% of cases). In the 2 stage, the pattern with an ectasia zone in the lower cornea was observed in 80% of cases, and in the 3 stage, a centrally located keratotopographic ectasia pattern was found in 42% of cases. Comparative analysis showed that the greatest decrease in stiffness parameter (SpA1) and stress-strain index occurred in the central pattern (by 64% and 46%, respectively), while the least decrease was observed in local corneal radius reduction in the lower cornea (by 42% and 33%, respectively).
CONCLUSIONS
The decrease in strength properties in keratoconus occurs in a local area, the size and degree of which are determined by the disease stage. The indicated biomechanical parameters are consistent regardless of the shape and localization of keratotopographic patterns but are relevant to diagnostic specifications using the Corvis ST pneumotonometer, which assesses corneal properties in the apical zone.
PubMed: 38681694
DOI: 10.4103/joco.joco_83_23 -
Journal of Clinical Medicine Apr 2024: Scheimpflug tomography has for many years been an integral part of our pre-operative assessment in cataract extraction. We retrospectively reviewed the incidence of...
: Scheimpflug tomography has for many years been an integral part of our pre-operative assessment in cataract extraction. We retrospectively reviewed the incidence of topographic keratoconus and keratoconus suspicion in our routine cataract surgery population over 5 years. The Laservision Clinical and Research Institute, Athens, Greece. In 1250 consecutive cataract surgery cases in otherwise naïve eyes, accounting for years 2017 to 2021, we retrospectively evaluated preoperative Pentacam HR imaging. The cases already classified as keratoconus were included in group A. The residual cases were assessed by five different experienced evaluators (two ophthalmic surgeons and three optometrists) for topographic and tomographic keratoconus suspicion based on irregular pachymetry distribution, astigmatism truncation, and/or astigmatic imaging irregularity and included in group B. Regular corneas, by this assessment, were included in group C; irregular corneas, as determined by the evaluators but unrelated to keratoconus, were included in group D. Based on the above, 138 cases (11.08%) were classified by Pentacam tomography as keratoconus and by default were included in group A. Of the residual cases, 314 or 25.12% were classified as suspect keratoconus and included in group B; 725 cases (58%) were classified as normal and non-keratoconus and included in group C; and 73 cases or 5.84% were placed in group D as non-keratoconus but abnormal. There was no disagreement between the five evaluators over any of the cases in groups C and D, and little variance among them for cases included in group B (less than 5% by ANOVA). The incidence of keratoconus and corneas suspicious for keratoconus in Greece appears to be much higher than respective reports from other regions: one in ten Greeks appear to have topographic keratoconus, most not diagnosed even by the age of cataract surgery, and almost an additional one in four may have suspicious corneal imaging for keratoconus. These data strongly imply that routine screening for disease should be promoted among Greeks, especially during puberty, to halt possible progression; moreover, careful screening should be performed when laser vision correction is being considered.
PubMed: 38673651
DOI: 10.3390/jcm13082378 -
Metabolites Apr 2024Citric acid cycle deficiencies are extremely rare due to their central role in energy metabolism. The gene encodes the mitochondrial isoform of aconitase (aconitase 2),...
Citric acid cycle deficiencies are extremely rare due to their central role in energy metabolism. The gene encodes the mitochondrial isoform of aconitase (aconitase 2), the second enzyme of the citric acid cycle. Approximately 100 patients with aconitase 2 deficiency have been reported with a variety of symptoms, including intellectual disability, hypotonia, optic nerve atrophy, cortical atrophy, cerebellar atrophy, and seizures. In this study, a homozygous deletion in the gene in two brothers with reduced aconitase 2 activity in fibroblasts has been described with symptoms including truncal hypotonia, optic atrophy, hyperopia, astigmatism, and cerebellar atrophy. In an in vivo trial, triheptanoin was used to bypass the defective aconitase 2 and fill up the citric acid cycle. Motor abilities in both patients improved.
PubMed: 38668366
DOI: 10.3390/metabo14040238 -
Frontiers in Medicine 2024To compare different corneal keratometry readings (swept-source-OCT-assisted biometry and Scheimpflug imaging) with a novel software platform for calculation of toric...
PURPOSE
To compare different corneal keratometry readings (swept-source-OCT-assisted biometry and Scheimpflug imaging) with a novel software platform for calculation of toric intraocular lenses.
SETTING
Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.
DESIGN
Retrospective, non-randomized, clinical trial.
METHODS
Twenty-three eyes undergoing toric intraocular lens implantation were included. Inclusion criteria were preoperative regular corneal astigmatism of at least 1.00 D, no previous refractive surgery, no ocular surface diseases and no maculopathies. Lens exchange was performed with CALLISTO eye (Zeiss). For each patient, the expected postoperative residual refraction was calculated depending on three different corneal parameters of two different devices: standard K-front (K) and total keratometry (TK) obtained by a swept-source-OCT-assisted biometry system (IOL Master 700, Zeiss) as well as total corneal refractive power (TCRP) obtained by a Scheimpflug device (Pentacam AXL, Oculus). Barrett's formula for toric intraocular lenses was used for all calculations within a novel software platform (EQ workplace, Zeiss FORUM). Results were statistically compared with postoperative refraction calculated according to the Harris dioptric power matrix.
RESULTS
The standard K values (mean PE 0.02 D ± 0.45 D) and TK values (mean PE 0.09 D ± 0.43 D) of the IOL Master 700 reached similar results ( = 0.96). 78% of eyes in both K and TK groups achieved SE within ±0.5 D of attempted correction and all eyes (100%) were within ±1.0 D of attempted correction in both groups. By contrast, the prediction error in the IOL calculation using the TCRP of the Scheimpflug device was significantly greater (mean PE -0.56 D ± 0.49 D; = 0.00 vs. standard K and = 0.00 vs. TK) with adjusted refractive indices. Thirty-nine and Ninety-one percentage of eyes in the TCRP group achieved SE within ±0.5 D ( = 0.008 K vs. TCRP and = 0.005 TK vs. TCRP) and ± 1.0 D ( = 0.14 vs. TCRP) of attempted correction, respectively.
CONCLUSION
All three corneal parameters (standard K, TK, TCRP) performed well in calculating toric IOLs. The most accurate refractive outcomes in toric IOL implantation were achieved by IOL calculations based on swept-source-OCT-assisted biometry. The SS-OCT-based K-front and TK values achieve comparable results in the calculation of toric IOLs.
PubMed: 38665295
DOI: 10.3389/fmed.2024.1363286 -
Ophthalmology and Therapy Jun 2024Dry eye can compromise corneal astigmatism measurement repeatability during preoperative cataract surgery examination. No previous studies have analyzed the...
INTRODUCTION
Dry eye can compromise corneal astigmatism measurement repeatability during preoperative cataract surgery examination. No previous studies have analyzed the effectiveness of long-acting 3% diquafosol sodium (LA-DQS) on astigmatism measurement repeatability. This research assessed the effect of LA-DQS on astigmatism measurement repeatability in preoperative patients with cataract and short tear break-up time (TBUT) type dry eyes in both eyes of the same patient. Correlations between repeatability and TBUT, corneal high-order aberrations (HOAs), and corneal astigmatism magnitude were also analyzed.
METHODS
In total, 122 eyes (61 patients) with short TBUT-type dry eye were enrolled. Preoperatively, only one eye of all patients was treated with LA-DQS for 4 weeks. TBUT and corneal HOAs were checked using CASIA 2 before and 4 weeks post-treatment. The cylindrical power and meridian of astigmatism were measured at 3- and 4-week post-treatment using IOLMaster 700. Power vectors J0 and J45 were used for astigmatism calculations. Repeatability of astigmatism measurements was assessed as the within-subject standard deviation (Sw). The relative effects of TBUT and HOAs on J0 Sw and J45 Sw were also analyzed. Comparative changes in these variables were evaluated between treated and non-treated eyes, with additional analysis of their correlations.
RESULTS
Treated eyes exhibited significant improvements in TBUT, HOAs, and post-treatment measurements of J0 Sw and J45 Sw at 3 and 4 weeks. In non-treated eyes, J0 Sw and J45 Sw showed significant correlation with TBUT and corneal HOAs. HOAs showed stronger relative associations with J0 Sw and J45 Sw than TBUT. In non-treated eyes, no significant correlation was found between cylindrical power and astigmatism measurement repeatability.
CONCLUSIONS
In short TBUT-type dry eye, preoperative treatment with LA-DQS significantly improved astigmatism measurement repeatability. This may improve the precision of intraocular lens (IOL) power calculations regardless of the magnitude of corneal astigmatism, especially when toric IOLs are used.
PubMed: 38662192
DOI: 10.1007/s40123-024-00940-z -
World Journal of Clinical Cases Apr 2024Diabetic patients with cataracts encounter specific difficulties during cataract surgery due to alterations in microcirculation, blood supply, metabolism, and the...
BACKGROUND
Diabetic patients with cataracts encounter specific difficulties during cataract surgery due to alterations in microcirculation, blood supply, metabolism, and the microenvironment. Traditional phacoemulsification may not fully tackle these issues, especially in instances with substantial preoperative astigmatism. The utilization of femtosecond laser-assisted phacoemulsification, in conjunction with Toric intraocular lens (IOL) implantation, offers a potentially more efficient strategy. This research seeks to evaluate the efficacy and possible complications of this approach in diabetic cataract patients.
AIM
To investigate the clinical efficacy and complications of femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation in diabetic cataract patients, comparing it with traditional phacoemulsification methods.
METHODS
This retrospective study enrolled 120 patients with diabetes cataract from May 2019 to May 2021. The patients were divided into two groups: the control group underwent traditional phacoemulsification and Toric IOL implantation, while the treatment group received Len Sx femtosecond laser-assisted treatment. Outcome measures included naked eye vision, astigmatism, high-level ocular phase difference detection, clinical efficacy, and complication.
RESULTS
There were no significant preoperative differences in astigmatism or naked eyesight between the two groups. However, postoperative improvements were observed in both groups, with the treatment group showing greater enhancements in naked eye vision and astigmatism six months after the procedure. High-level corneal phase difference tests also indicated significant differences in favor of the treatment group.
CONCLUSION
This study suggests that femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation appears to be more effective in enhancing postoperative vision in diabetic cataract patients compared to traditional methods offering valuable insights for clinical practice.
PubMed: 38660074
DOI: 10.12998/wjcc.v12.i10.1733 -
Clinical Ophthalmology (Auckland, N.Z.) 2024To assess long term changes of the surgically induced astigmatism (SIA) and corneal higher-order aberrations (HOAs) after 2.2 mm clear corneal incisions (CCIs) in...
Long Term Evaluation of Surgically Induced Astigmatism and Corneal Higher-Order Aberrations After 2.2 Mm Clear Corneal Incisions in Femtosecond Laser-Assisted Cataract Surgery: Temporal versus Superior Approach.
PURPOSE
To assess long term changes of the surgically induced astigmatism (SIA) and corneal higher-order aberrations (HOAs) after 2.2 mm clear corneal incisions (CCIs) in femtosecond laser-assisted cataract surgery and compare them between 2 types of CCIs: temporal and superior approach.
PATIENTS AND METHODS
Patients received the temporal CCIs (Group A) or the superior CCIs (Group B). Outcome measures included visual acuity, manifest refraction, corneal astigmatism, SIA, flattening effect, and corneal HOAs. Correlation between postoperative corneal HOA and SIA at each follow-up were analysed.
RESULTS
This study assessed data from 106 eyes, of which 64 in Group A and 42 in Group B. The two groups had similar postoperative visual acuity of distance, intermediate and near (all P > 0.05). SIA and corneal HOAs were significantly lower in Group A than Group B in the early postoperative period, while there was no significant difference in the late postoperative period. At 6 months after surgery, the arithmetic mean of SIA over corneal 4mm zone was 0.33 ± 0.19D for temporal incision, and 0.37 ± 0.25D for superior incision. For Group A, the correlations of HOAs and SIA persisted from 1 week to 6 months after surgery. For Group B, the changes in corneal HOAs were significantly related to the SIA at 1 week and 1 month postoperatively.
CONCLUSION
This study suggested the consistency of increasing and recovering process of corneal HOAs and SIA after surgery. Compared to the superior incisions, temporal incisions might induce quicker corneal recovery and less change in SIA and corneal HOAs.
PubMed: 38659425
DOI: 10.2147/OPTH.S456110 -
BMC Ophthalmology Apr 2024To evaluate short-term visual and refractive outcomes after implantation of a diffractive trifocal intraocular lens (IOL) in cataract patients with phacoemulsification... (Observational Study)
Observational Study Comparative Study
PURPOSE
To evaluate short-term visual and refractive outcomes after implantation of a diffractive trifocal intraocular lens (IOL) in cataract patients with phacoemulsification (PHACO) and femtosecond laser assisted cataract surgery (FLACS).
SETTING
Department of Ophthalmology, Shanghai Aier Eye Hospital, China.
DESIGN
A retrospective, observational study.
METHODS
Patients who underwent cataract surgery combined with Acrysoft IQ PanOptix trifocal IOL implantation were enrolled and divided into three groups: PHACO group, LAstig-FLACS group (astigmatism less then 1D) and HAstig-FLACS group (astigmatism more than 1D). Logarithm of the minimum angle of resolution (logMAR) visual acuity of uncorrected distance (UDVA), intermediate (UIVA), near visual (UNVA), defocus curve, surgically induced astigmatism (SIA) were evaluated in 1 months postoperatively and wavefront aberrations were evaluated in 6 months.
RESULTS
101 eyes of 60 patients were included with 31 eyes in PHACO group, 45 eyes in LAstig-FLACS group and 25 eyes in HAstig-FLACS group. Significant difference was found of internal Strehl Ratio (SR) between PHACO and LAstig-FLACS group (P = 0.026). In PHACO group, 79.31%, 86.21%, 72.41% of eyes gain visual acuity LogMAR 0.1 or more in UDVA, UIVA and UNVA, while 83.72%, 93.02%, 93.02% of those in LAstig-FLACS group and 92.00%, 84.00%, 76.00% in HAstig-FLACS group.
CONCLUSIONS
Panoptix diffractive trifocal IOL provides satisfied visual outcome in no matter FLACS or PHACO. Besides, trifocal IOL implantation via FLACS can provide a better accumulative visual acuity outcome at all distance than PHACO in 1 month. Femtosecond laser assisted limbal relaxing incisions (FLLRIs) is an excellent way to reduce a patient's corneal astigmatism.
Topics: Humans; Retrospective Studies; Male; Female; Phacoemulsification; Visual Acuity; Middle Aged; Laser Therapy; Aged; Multifocal Intraocular Lenses; Refraction, Ocular; Lens Implantation, Intraocular; Pseudophakia; Treatment Outcome; Prosthesis Design; Cataract Extraction; Follow-Up Studies
PubMed: 38658894
DOI: 10.1186/s12886-024-03440-7 -
Arquivos Brasileiros de Oftalmologia 2024To assess the outcomes of deep anterior lamellar keratoplasty or penetrating keratoplasty at the scar and the edema stages. (Comparative Study)
Comparative Study
PURPOSE
To assess the outcomes of deep anterior lamellar keratoplasty or penetrating keratoplasty at the scar and the edema stages.
METHODS
Forty-five patients (45 eyes) with keratoconus scar stage (scar group, n=26; penetrating keratoplasty a subgroup, n=7; deep anterior lamellar keratoplasty b subgroup, n=19) and keratoconus edema stage (edema group, n=19; penetrating keratoplasty c subgroup, n=12; deep anterior lamellar keratoplasty d group, n=7) who received penetrating keratoplasty or deep anterior lamellar keratoplasty from 2000 to 2022 were retrospectively studied. At 1, 6, and 12 months after surgery, the best-corrected visual acuity, astigmatism, spherical equivalent, corneal endothelial cell density, and complications were analyzed.
RESULTS
The best-corrected visual acuity and average corneal endothelial cell loss rate were not significantly different between the scar and edema groups (p>0.05). At 6 and 12 months after surgery, the astigmatism and spherical equivalent in the scar group were significantly lower than those in the edema group (p<0.05). The spherical equivalent of the deep anterior lamellar keratoplasty b subgroup was lower than that of the penetrating keratoplasty a subgroup in the scar group 6 months after surgery (p<0.05). In the edema group, there was no significant difference in spherical equivalent between subgroups (p>0.05). There were no significant differences in best-corrected visual acuity and astigmatism between subgroups within the two groups (p>0.05). In comparison to the scar group, the edema group experienced more complications. According to a survival analysis, there was no statistically significant difference between the scar group and the edema group regarding the progression of vision.
CONCLUSIONS
In terms of the outcomes and prognosis for vision after keratoplasty with edema stage and scar stage, deep anterior lamellar keratoplasty may be as effective as penetrating keratoplasty.
Topics: Humans; Keratoconus; Visual Acuity; Male; Female; Retrospective Studies; Keratoplasty, Penetrating; Adult; Cicatrix; Treatment Outcome; Corneal Edema; Young Adult; Corneal Transplantation; Time Factors; Adolescent; Astigmatism; Middle Aged; Postoperative Complications; Cell Count; Endothelium, Corneal
PubMed: 38656029
DOI: 10.5935/0004-2749.2023-0144