Comparison of Nd:YAG Laser Capsulotomy Rates Between Refractive Segmented Multifocal and Multifocal Toric Intraocular Lenses

Application of objective optical quality analysis system in guiding early posterior capsule opacification laser treatment: An observational study

In the present study, we aimed to demonstrate the objective guiding role of objective scatter index (OSI) in patients with early stage posterior capsule opacification (PCO), especially in patients with multifocal intraocular lens (IOL) implantation. A prospective randomized case analysis was conducted on elderly patients experiencing PCO, exhibiting best-corrected visual acuity (BCVA) below 0.2 LogMAR. Exclusion criteria comprised patients with diabetes, glaucoma, high myopia, trauma, endothelial dystrophy, maculopathy or prior eye surgery affecting visual acuity. The main observational indicators were patient gender, age, post-cataract surgery duration, BCVA (LogMAR), and OSI values. For patients undergoing laser posterior capsulotomy, meticulous documentation of pre-laser OSI values and post-laser OSI values was undertaken. Subjective visual quality was then compared using the Chinese version visual function index-14 (VF-14-CN). The study comprised 65 eyes from 56 patients. PCO developed, on average, 2.06 ± 0.94 years (ranging from 0.5 to 4 years) after the initial surgery, with the OSI consistently exceeding 3.0. Among these cases, only 40 eyes underwent laser posterior capsulotomy using Nd:YAG laser, including 26 eyes implanted with monofocal IOLs and 14 eyes implanted with multifocal IOLs. Following laser posterior capsulotomy for early-stage secondary cataracts, there was a significant decrease in OSI values compared to the presurgery state, coupled with a notable increase in VF-14-CN scores. Among the 14 cases with multifocal IOL implantation, pre-laser VF-14-CN scores were lower compared to those with monofocal IOLs. Post-laser posterior capsulotomy, patients reported a marked improvement in self-perceived symptoms. The OQAS functioned as an objective assessment metric for the laser treatment of early stage PCO. In cases involving multifocal IOL implantation, the visual disturbance caused by PCO was more pronounced, underscoring the significance of OSI as a valuable guide for laser treatment in these patients.

Evaluation of nintedanib efficacy: Attenuating the lens fibrosis in vitro and vivo

PURPOSE

Organ fibrosis is a huge challenge in clinic. There are no drugs for fibrotic cataracts treatments in clinic. Nintedanib is approved by the FDA for pulmonary fibrosis treatments. This study aims to investigate the efficacy and mechanism of nintedanib on fibrotic cataracts.

METHODS

Drug efficacy was validated through TGFβ2-induced cell models and injury-induced anterior subcapsular cataract (ASC) mice. A slit lamp and the eosin staining technique were applied to access the degree of capsular fibrosis. The CCK-8 assay was used to evaluate the toxicity and anti-proliferation ability of the drug. The cell migration was determined by wound healing assay and transwell assay. The anti-epithelial mesenchymal transition (EMT) and anti-fibrosis efficacy were evaluated by qRT-PCR, immunoblot, and immunofluorescence. The inhibition of nintedanib to signaling pathways was certified by immunoblot.

RESULTS

Nintedanib inhibited the migration and proliferation of TGFβ2-induced cell models. Nintedanib can also repress the EMT and fibrosis of the lens epithelial cells. The intracameral injection of nintedanib can also allay the anterior subcapsular opacification in ASC mice. The TGFβ2/ Smad and non-Smad signaling pathways can be blocked by nintedanib in vitro and in vivo.

CONCLUSION

Nintedanib alleviates fibrotic cataracts by suppressing the TGFβ2/ Smad and non-Smad signaling pathways. Nintedanib is a potential drug for lens fibrosis.

Clinical efficacy of femtosecond laser-assisted phacoemulsification in diabetic cataract patients

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.

Influence of Nd:YAG laser capsulotomy on toric intraocular lens rotation and change in cylinder power

PURPOSE

To investigate toric monofocal intraocular lens (TIOL) rotation and associated changes in cylinder power caused by Nd:YAG laser capsulotomy performed due to posterior capsule opacification (PCO).

SETTING

Ekol Eye Hospital, Izmir, Turkey.

DESIGN

Prospective case series.

METHODS

41 eyes of 20 women and 21 men were included in the study. Before and 1 month after Nd:YAG laser capsulotomy, TIOL tilt and decentration were determined with Scheimpflug camera, and TIOL axial rotation and the change in cylinder power induced by this rotation were measured by ray tracing aberrometry. The time interval between cataract surgery and Nd:YAG laser capsulotomy was noted.

RESULTS

Rotational misalignment of the TIOL was measured as 4.65 ± 2.75 degrees (range 0 to 11 degrees) before vs 6.97 ± 2.92 degrees (range 0 to 13 degrees) after capsulotomy, and absolute rotation was 2.75 ± 1.94 degrees (range 0 to 7 degrees, P = .028). Before and after Nd:YAG laser capsulotomy, cylinder power was 0.24 ± 0.70 diopter (D) (range 0.00 to 0.63 D) vs 0.56 ± 0.77 D (range 0.02 to 0.91 D), respectively, with an absolute change in cylinder power of 0.34 ± 0.22 D (range 0.01 to 0.90 D, P = .001). After capsulotomy, there was a significant decrease in IOL tilt in the horizontal and vertical planes and an increase in decentration ( P < .05). Time interval (33.02 ± 12.9 months) and IOL horizontal decentration were independent factors affecting IOL rotation after capsulotomy ( P < .05).

CONCLUSIONS

Nd:YAG laser capsulotomy may cause TIOL rotation as well as tilt and decentration, resulting in a change in the TIOL's corrective effect on corneal astigmatism. Although this change was clinically insignificant, it may be beneficial to consider that TIOL rotational misalignment may occur in patients undergoing early capsulotomy.

The Role of Early Nd:YAG Laser Capsulotomy in Improving Visual Performance in Mild to Moderately Symptomatic Trifocal Patients

Purpose

To determine the effect of early Nd:YAG (neodymium:yttrium-aluminum-garnet) laser capsulotomy on objective and subjective visual quality in symptomatic trifocal intraocular lens (IOL) patients.

Methods

A single-center, prospective study examined symptomatic patients after bilateral cataract extraction with trifocal IOL implantation. A ten-question survey was conducted one month after surgery. Study endpoints included the assessment of monocular and binocular uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), contrast sensitivity (CS), and subjective visual quality before and after Nd:YAG capsulotomy prior to 4 months after cataract surgery.

Results

A total of 38 eyes from 21 patients were included with a TFAT00 (n = 23) or TFAT30-60 (n = 15). Overall satisfaction with the IOL was 8.55 ± 1.77 (range 5-10). A Nd:YAG capsulotomy was performed at 55 ± 26 days. Monocular UDVA and UNVA > 20/25 before Nd:YAG were 53.0% and 42.0%, which improved post-Nd:YAG to 63.0% and 66.0%, respectively (P = 0.41, P = 0.051). Binocular UDVA and UNVA >20/25 before Nd:YAG were 82.0% and 63.0%, which increased to 97% and 97%, respectively (P < 0.05, P < 0.001). CS increased in all post-Nd:YAG capsulotomies (P < 0.01). The presence of glare was documented at 74% pre-Nd:YAG, which decreased to 41% post-Nd:YAG (P < 0.01). Glare which limited activities was documented at 24%, which decreased to 5% post-Nd:YAG (P = 0.21).

Conclusion

Early treatment of posterior capsule opacities in mild to moderately dissatisfied trifocal IOL patients may be beneficial in improving CS, visual quality, and reducing the presence and severity of dysphotopsias.

Development and Validation of a Prediction Model for Nd:YAG Laser Capsulotomy: A Retrospective Cohort Study of 9768 eyes

INTRODUCTION

Posterior capsular opacification (PCO) is the most common complication of cataract surgery. In this study, we develop a model to quantitatively predict the probability of Nd:YAG laser capsulotomy for vision-threatening PCO to improve the life quality of postoperative patients.

METHODS

A registry analysis of cataract procedures performed between the years 2010 and 2021. Following the screening of 16,802 patients (25,883 eyes), 9768 patients (eyes) were enrolled. The cohort was randomly divided into two groups: training (n = 6838) and validation (n = 2930). To identify relevant risk factors, univariate, multivariate, and Least Absolute Shrinkage and Selection Operator (LASSO) algorithm Cox regression analysis were employed, and a nomogram was created to demonstrate the prediction result.

RESULTS

At 5 years, the overall cumulative incidence of Nd:YAG laser capsulotomy was 12.0% (1169/9768). The following variables were included in the prediction model: sex [hazard ratio (HR) = 1.53, 95% CI 1.32-1.76], age (HR = 0.71, 95% CI 0.56-0.88), intraocular lens (IOL) material (HR = 2.65, 95% CI 2.17-3.24), high myopia (HR = 2.28, 95% CI 1.90-2.75), and fibrinogen (HR = 0.79, 95% CI 0.72-0.88). In the validation cohort, the area under the curve (AUC) of 1-, 3-, and 5-year predictions for Nd:YAG laser capsulotomy were 0.702, 0.691, and 0.688, respectively. For a subgroup of patients with high myopia, the protective effect of hydrophobic IOL disappeared (HR = 0.68, 95% CI 0.51-1.12, P = 0.127).

CONCLUSION

This model could predict the probability of Nd:YAG laser capsulotomy for vision-threatening PCO after cataract surgery by taking into account factors such as age, gender, IOL material, high myopia, and fibrinogen. Meanwhile, implantation of a hydrophobic IOL in individuals with high myopia did not demonstrate a protective impact against vision-threatening PCO.

Comparison of visual outcomes after two types of mix-and-match implanted trifocal extended-depth-of-focus and trifocal intraocular lenses

PURPOSE

To compare visual outcomes between two types of mix-and-match implanted trifocal extended-depth-of-focus (EDoF) and trifocal intraocular lenses (IOLs).

METHODS

A total of 212 eyes of 106 subjects with mix-and-match implanted FineVision Triumf and FineVision HP IOLs (Triumf-HP group) and 212 eyes of 106 subjects with mix-and-match implanted Zeiss AT LARA and AT LISA IOLs (AT LARA-LISA group) were enrolled in this retrospective case-control study. Uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), and binocular distance-corrected defocus curves were measured between 6 and 10 weeks after cataract surgery.

RESULTS

There was no significant difference in UDVA among the four IOLs. UNVA was the best in eyes with the FineVision HP IOL (0.04 ± 0.06 logMAR), followed by eyes with the AT LISA IOL (0.07 ± 0.07 logMAR), the FineVision Triumf IOL (0.09 ± 0.09 logMAR), and the AT LARA IOL (0.11 ± 0.08 logMAR), respectively. The AT LARA-LISA group had better visual acuity than the Triumf-HP group between - 1.00 D and - 1.50 D of defocus, and the Triumf-HP group had better visual acuity than the AT LARA-LISA group between - 3.00 D and - 4.00 D of defocus.

CONCLUSION

Mix-and-match implantation of trifocal EDoF and trifocal IOLs provided good visual outcomes in far, intermediate, and near distances. The mix-and-match implantation of Triumf-HP IOLs led to better visual outcomes in near vision, while that of the AT LARA-LISA IOLs led to better visual outcomes in intermediate vision.

Comparison of Anterior Capsule Polishing on the Rate of Neodymium: YAG Laser Capsulotomy After Two Multifocal Intraocular Lens Implantation

Purpose

To compare the impact of anterior capsule polishing (ACP) during cataract surgery on the rate of neodymium: YAG (Nd: YAG) laser capsulotomy in pseudophakic eyes with two multifocal intraocular lenses (MIOLs).

Methods

Data were collected on patients who underwent cataract surgery and implanted segmental refractive MIOLs (SBL-3, Lenstec) or diffracted MIOLs (AT LISA tri 839MP, Carl Zeiss Meditec). The participants were divided into ACP and non-ACP groups based on whether the anterior capsule was polished. The primary outcome measure was whether Nd: YAG capsulotomy was performed during the 3 years follow-up. We used Kaplan–Meier survival curves to determine the time from IOL implantation to Nd: YAG laser capsulotomy.

Results

ACP and non-ACP groups comprised 70 and 60 eyes, respectively. One year postoperatively, 7.14% of ACP group eyes and 8.33% of non-ACP group required Nd: YAG laser capsulotomy (P &gt; 0.99). After 2 years, it was 24.29 and 18.33%, respectively (P = 0.52), while after 3 years, it reached 30.0 and 28.33% (P = 0.85). No distinct difference existed in the probability of using Nd: YAG laser in both groups evaluated using Kaplan-Meier survival curves (P = 0.81). Patients with diffractive MIOLs (AT LISA tri 839MP) implantation were more likely to require Nd: YAG laser capsulotomy (P &lt; 0.01).

Conclusion

Polishing the anterior capsule had no remarkable effect on reducing the rate of Nd: YAG laser capsulotomy following phacoemulsification in MIOLs. Patients with diffractive MIOLs implantation had a high probability of requiring Nd: YAG laser capsulotomy.

Nd:YAG Capsulotomy Rates with Two Multifocal Intraocular Lenses

Purpose

To investigate the incidence of Nd:YAG capsulotomy after implantation of two types of multifocal intraocular lenses (MIOLs).

Methods

This retrospective analysis included patients who had undergone cataract extraction and implanted diffractive MIOL (Acri. LISA tri 839M) or asymmetric refractive MIOL (SBL-3) from May 2016 to September 2018. They were followed up for at least 3 years. During the follow-up period, the relevant data of patients were kept by special person in the hospital. The rates of Nd:YAG capsulotomy and the Kaplan-Meier survival curve were used to analyze the two groups.

Results

The Asymmetric Refractive MIOL group was comprised of 98 patients (121 eyes), while the Diffractive MIOL group was comprised of 99 patients (120 eyes). There were no significant differences in age, sex, or IOL power between the two groups. The Nd:YAG rate of the asymmetric refractive MIOL group and the diffractive MIOL group was 3.3% and 7.5% respectively (P = 0.15) in the first year, 14.88% and 22.5% respectively (P = 0.129) in the second year, and 21.49% and 34.17% respectively (P = 0.028) in the third year. In the first 7 months of follow-up, the two groups showed the same performance in the Nd:YAG rate. After that, there was a difference between the two groups, and the difference gradually increased. Until the 27th month of follow-up, the difference was significant (P < 0.05). What is more, there were significant differences in survival (without Nd:YAG capsulotomy)/failure (with Nd:YAG capsulotomy) functions (P = 0.0035).

Conclusion

The incidence of Nd:YAG laser capsulotomy in patients with diffractive MIOLs was higher than that in patients with asymmetric refractive MIOLs.