Suprachoroidal hemorrhage during femtosecond laser assisted cataract surgery.

Purpose:To describe a case of suprachoroidal hemorrhage that occurred during femtosecond laser assisted cataract surgery (FLACS). Observations:A 67-year-old woman with high myopia underwent FLACS. Following two unsuccessful attempts at docking due to interface air bubbles, the third attempt was successful. Laser treatment and cataract surgery proceeded uneventfully until intraocular lens (IOL) implantation. While positioning the IOL within the capsular bag, the anterior chamber began to shallow, intraocular pressure became high by palpation, and the optic of the IOL prolapsed partially out of the bag. A segmental suprachoroidal hemorrhage was identified in the superior peripheral retina by intraoperative indirect ophthalmoscopy. Following an hour of waiting in the recovery room, the anterior chamber deepened and the intraocular pressure was low enough to position the IOL centrally within the bag. Her subsequent postoperative course was uneventful. Conclusions and Importance:To our knowledge, this is the first report of suprachoroidal hemorrhage during FLACS. We speculate that repeated sudden drops in intraocular pressure associated with multiple undockings triggered the suprachoroidal hemorrhage in this case

Growth factor restriction impedes progression of wound healing following cataract surgery: identification of VEGF as a putative therapeutic target

Secondary visual loss occurs in millions of patients due to a wound-healing response, known as posterior capsule opacification (PCO), following cataract surgery. An intraocular lens (IOL) is implanted into residual lens tissue, known as the capsular bag, following cataract removal. Standard IOLs allow the anterior and posterior capsules to become physically connected. This places pressure on the IOL and improves contact with the underlying posterior capsule. New open bag IOL designs separate the anterior capsule and posterior capsules and further reduce PCO incidence. It is hypothesised that this results from reduced cytokine availability due to greater irrigation of the bag. We therefore explored the role of growth factor restriction on PCO using human lens cell and tissue culture models. We demonstrate that cytokine dilution, by increasing medium volume, significantly reduced cell coverage in both closed and open capsular bag models. This coincided with reduced cell density and myofibroblast formation. A screen of 27 cytokines identified nine candidates whose expression profile correlated with growth. In particular, VEGF was found to regulate cell survival, growth and myofibroblast formation. VEGF provides a therapeutic target to further manage PCO development and will yield best results when used in conjunction with open bag IOL designs

Review on the study of intraocular lens dislocation

Dislocation of intraocular lens(IOL)is one complication of cataract extraction and posterior chamber IOL implantation. The reasons for IOL dislocation include incompletion of lens capsule cut, unevenness of capsulorhexis, break of zonules and/or posterior capsule, remain of lens cortex, capsule contraction, drag of exudate and organize strap, after cataract, trauma, etc. And the treatments for IOL dislocation include simple IOL reposition, capsular tension ring(CTR)implantation, anterior chamber IOL implantation, suspensory IOL implantation, IOL dislodgment, vitrectomy, etc

In Vivo Intraocular Lens Thickness Measurement and Power Estimation Using Optical Coherence Tomography

Purpose: To estimate the power of an implanted intraocular lens (IOL) by measuring IOL thickness using anterior segment optical coherence tomography (AS-OCT) and to assess the repeatability of measurements. Methods: Ninety-seven eyes were studied one month after uneventful phacoemulsification within the bag Acrysof SA60AT IOL implantation (range +11 to +35). All eyes had postoperative refraction of ±0.5 D of target refraction. AS-OCT was used to measure the central thickness of the IOL. Correlation between labelled IOL power and central IOL thickness as well as the measure of repeatability, for example, intraclass correlation coefficient (ICC), were evaluated. IOL thicknesses were also calculated using a formula and compared with AS-OCT-derived measurements. Results: IOL thickness correlated significantly with labelled IOL power (R2 = 0.985, P < 0.001). The regression equation (IOL Power = [0.04 × IOL thickness in micron] – 7.56) indicates 25 microns of central IOL thickness change per 1D power change. Over the studied range, IOL power could be estimated with a precision of 0.85 ± 0.02 D (95% confidence interval: 0.83–0.94D). ICC for repeated measurements was 0.999. There was a significant correlation between calculated and measured (AS-OCT) IOL thickness (R2 = 0.984, P < 0.001). Conclusion: Central IOL thickness measurements with the AS-OCT are highly repeatable and closely correlated with the labelled IOL power, which can predict the IOL power with ±0.85 D from the actual power. This method can be helpful in cases of postoperative IOL surprise

Intraocular Lens

The first clinical application of intraocular lens (IOL) goes back to 1949 when Dr. Harold Ridley successfully implanted a PMMA IOL into an eye on 29 November 1949. This innovation is a big step forward for cataract surgery. With development of the IOL material and biocompatibility, more and more IOL types have been used in clinical ophthalmology. This book is the fruit of worldwide cooperation between clinical teams. In this book we discuss the IOL materials and design, aberration and astigmatism correction with IOL, entopic phenomenon of IOL, myopia and phakic IOL, and secondary IOL techniques. We believe that this content provides the readers with a comprehensive knowledge of the latest developments of IOL

A comparison of anterior and posterior chamber lenses after cataract extraction in rural Africa: a within patient randomised trial.

BACKGROUND: Extracapsular cataract extraction (ECCE) with a posterior chamber intraocular lens (PC IOL) is the preferred method of cataract surgery in developed countries. However, intracapsular cataract extraction (ICCE) with an anterior chamber lens (AC IOL) may be appropriate in rural Africa. A randomised controlled trial was carried out to compare these surgical strategies. METHODS: Participants over 50 years requiring bilateral cataract surgery were recruited from outreach clinics in rural north and east Uganda. One eye was randomly allocated to AC IOL or PC IOL, the other eye being allocated to the second strategy. The main outcome measure was WHO distance visual acuity (VA) category after a minimum of 1 year. Secondary outcomes were numbers and causes of complications and refractive corrections. RESULTS: Of the 110 participants recruited, 98 (89%) were assessed at least 1 year after the operation (median follow up 17.5 months). Nine eyes randomised to PC IOL were converted to AC IOL; one eye randomised to AC IOL inadvertently received PC IOL. There was no difference in VA between 95 pairs of eyes for which data for both eyes were available (uncorrected VA, p = 0.26; corrected VA, p = 0.59). 80 (82%, 95% CI 73 to 89) and 82 (84%, 95% CI 75 to 90) eyes randomised to AC IOL and PC IOL respectively had corrected VA of 6/18 or better. 16 (16%, 95% CI 10 to 25) and eight (8%, 95% CI 4 to 15) eyes respectively had secondary procedures or other complications. CONCLUSIONS: Where both strategies are available, ECCE with PC IOL should be first choice because of fewer complications. Where ECCE with PC IOL is not immediately feasible, ICCE with AC IOL is an acceptable interim technique

Evaluation of a Novel Non-Diffractive Extended Depth of Focus Intraocular Lens : First Results from a Prospective Study

Purpose: To evaluate a novel hydrophobic, non-diffractive, extended depth of focus (EDOF) intraocular lens (IOL) design in comparison to two monofocal aspheric lenses. Methods: Inclusion criteria for this prospective, monocentric cohort study were opacification of the crystalline lens and patients’ wishes for surgery. In the case of the EDOF IOL, patients asked for a presbyopia correction. All patients received surgery on both eyes. Corrected and uncorrected distance visual acuity (CDVA, UCDVA), uncorrected and distance corrected intermediate visual acuity (UIVA, DCIVA) and defocus curves (all monocular and binocular) were compared three months postoperatively. Results: Fifty-six eyes were implanted with an EDOF IOL (LuxSmartTM, Bausch & Lomb GmbH, Berlin, Germany), 50 eyes with a monofocal aspheric IOL: 32 eyes with a clear IOL (PolylensVR AS 61, Polytech Domilens, Roßdorf, Germany), 16 eyes with a yellow IOL (iSertVR 251, Hoya Surgical Optics GmbH, Frankfurt, Germany). Three months postoperatively, UCDVA was comparable with the EDOF IOL, versus the monofocal IOL (P> 0.9). Binocular DCIVA in the EDOF IOL was significantly higher than in the monofocal IOL (P¼ 0.001). Monocular DCIVA better than 20/23 Snellen was achieved in 10% with the monofocal IOL and in 68% (P< 0.0001) with the EDOF IOL. Defocus curves showed a depth of focus at 20/23 Snellen of 1.6 vs. 0.83 diopters (D) in the EDOF IOL, vs. the monofocal IOL. No patient reported halos or starbursts in non-standardized questioning. Conclusion: This non-diffractive EDOF IOL provided comparably high UCDVA and significantly higher DCIVA than the mono-focal lenses, causing only mild optical phenomena

In vitro optical quality measurements of three intraocular lens models having identical platform

Background: With recent advances in technology and introduction of new intraocular lens (IOL) models, surgeons today have the opportunity to choose from various optical designs, which can influence the postoperative quality of vision. In our laboratory study, we compared the optical quality of three different IOLs that use the identical platform and are produced by the same manufacturer. The study included two diffractive multifocal IOLs, a bifocal and a trifocal one, as well as a monofocal IOL. Methods: Three IOL models: monofocal CT ASPHINA 409 M, diffractive bifocal AT LISA 809 M, and diffractive trifocal AT LISA Tri 839MP (Carl Zeiss Meditec AG, Germany) were assessed for optical quality by measuring modulation transfer function (MTF) and Strehl Ratio (SR) values at pupil sizes of 3.0 and 4.5 mm on the OptiSpheric® IOL PRO (Trioptics GmbH, Germany). The United States Air Force (USAF) Target images were also recorded to comfirm the optical performance qualitatively. Results: For far focus at 50 lp/mm and 3.0 mm pupil size, MTF value of the monofocal lens (MTF = 0.798) was 1.8-fold and 2.1-fold better than the bifocal (MTF = 0.446) and the trifocal (MTF = 0.382) IOLs, respectively. For near focus, bifocal IOL (MTF = 0.265) was 1.4-fold better than trifocal IOL (MTF = 0.187), while for intermediate focus, the trifocal IOL (MTF = 0.148) was 1.7-fold better than the bifocal IOL (MTF = 0.086). For the same pupil size, total sum of light loss amounted to 5.2% for the monofocal, 16.0% for the bifocal and 6.0% for the trifocal IOL. For a larger pupil, the amount of light loss increased significantly for the multifocal IOLs. Conclusions: The monofocal IOL performed the best for far, the bifocal IOL for near and the trifocal IOL for intermediate focus. While the monofocal IOL created the least amount of light loss for both pupil sizes, the trifocal IOL created less than half the amount of light loss than the bifocal IOL for small pupil. For large pupil, however, less light scatter was observed for the bifocal than the trifocal IOL

Comprehensive Laboratory Diagnostic Workup for Patients with Suspected Intraocular Lymphoma including Flow Cytometry, Molecular Genetics and Cytopathology.

BACKGROUND Intraocular lymphoma (IOL) presents a real challenge in daily diagnostics. Cyto- and/or histopathology of vitreous body represent the diagnostic cornerstones. Yet, false negative results remain common. Therefore, we analyzed the diagnostic significance of flow cytometry (FC) within the workup algorithm of IOL and compared its sensitivity with the results obtained from routine cytopathology and molecular genetics; Methods: Seven patients undergoing vitrectomy due to suspected IOL were investigated by FC and parallel cytopathology and, if available, digital droplet PCR (ddPCR) for MYD88 L265P; Results: Four out of seven patients were finally diagnosed with IOL. Among the IOL patients, cytopathology confirmed the presence of lymphoma cells in only two cases. In contrast, FC was positive for IOL in all four cases, and FC additionally confirmed the lack of IOL in the remaining patients. In IOL patients diagnosed by FC and with available ddPCR, the diagnosis of IOL was confirmed by the presence of the MYD88 L265P mutation in all three patients; Conclusions: The combination with FC was superior to cytopathology alone in the diagnostic work-up of IOL, and it showed an excellent correlation with ddPCR results. A comprehensive diagnostic panel consisting of cytopathology, FC and molecular genetics should be considered for the work-up of suspected IOL

Biometry and Intraocular Lens Power Calculation by Combined Scheimpflug-Placido Disc versus Optical Interferometry Devices

Purpose: To compare the results of the current gold standard, laser interferometry, and keratometry by the IOL-Master, with a newly developed Galilei G6 using raytracing software Okulix for intraocular lens (IOL) power calculations. Methods: For comparison of the IOL-power calculation of both devices, we analyzed the difference between the actual one-month postoperative subjective refraction and the theoretically calculated target refraction before cataract surgery. The IOL was selected according to the IOL Master recommendation aiming for emmetropia after surgery. We analyzed the differences of the measurements of the basic biometric data in 205 healthy eyes by each device. Results: Our study included 205 healthy, unoperated eyes from 117 patients (61 women, 56 men) aged 20 to 75 years. Twenty-two eyes of cataract patients were also included in this retrospective study design. The mean difference between the prediction of the postoperative refraction and the refraction actually achieved was 0.03 D for the IOL Master and –0.23 D for the Galilei G6. The difference was not statistically significant (P = 0.059). The difference between the IOL power calculation of the IOL Master and the calculation of the G6 was not statistically significant (P = 0.064). The difference between the predicted refraction of the G6 and the refraction achieved after one month was also not statistically significant (P = 0.12) and neither was the difference between the predicted refraction of the IOL Master and the achieved refraction (P = 0.39). The mean axial length was calculated as 24.21 ± 0.80 mm using the IOL Master and 24.27 ± 0.82 mm using the Galilei G6 device. The mean value regarding anterior chamber depth (ACD) of the IOL master was 3.46 ± 0.23 mm and for the Galilei was G6 3.51 ± 0.25 mm. When comparing the white to white (WTW) values of the IOL master, it showed mean values of 12.32 ± 0.31 and Galilei showed mean values of G6 12.21 ± 0.28. All of these differences (between Galileo and IOL Master measurements) were statistically significant (P &lt; 0.001). Conclusion: Both the laser interferometry/keratometry performed by the IOL Master and the interferometry/raytracing biometry strategy performed by the Galilei G6 demonstrated equal results when executing the IOL power calculation before cataract surgery in eyes with no prior ocular surgery