Transzonular capsulo-hyaloidal hydroseparation with optional triamcinolone enhancement: A technique to detect or induce anterior hyaloid membrane detachment for primary posterior laser capsulotomy

Incidence and Risk Factors for Berger's Space Development after Uneventful Cataract Surgery: Evidence from Swept-Source Optical Coherence Tomography

Background: This study investigates the incidence and risk factors for the development of Berger’s space (BS) after uneventful phacoemulsification based on swept-source optical coherence tomography (SS-OCT). Methods: Cataractous eyes captured using qualified SS-OCT images before and after uneventful phacoemulsification cataract surgery were included. Six high-resolution cross-sectional anterior segment SS-OCT images at 30° intervals were used for BS data measurements. BS width was measured at three points on each scanned meridian line: the central point line aligned with the cornea vertex and two point lines at the pupil’s margins. Results: A total of 223 eyes that underwent uneventful cataract surgery were evaluated. Preoperatively, only two eyes (2/223, 0.9%) were observed to have consistent BS in all six scanning directions. BS was observed postoperatively in 44 eyes (44/223, 19.7%). A total of 13 eyes (13/223, 5.8%) with insufficient image quality, pupil dilation, or lack of preoperative image data were excluded from the study. A total of 31 postoperative eyes with BS and 31 matched eyes without BS were included in the final data analysis. The smallest postoperative BS width was in the upper quadrant of the vertical meridian line (90°), with a mean value of 280 μm. The largest BS width was observed in the opposite area of the main clear corneal incision, with a mean value >500 μm. Conclusions: Uneven-width BS is observable after uneventful phacoemulsification. Locations with a much wider BS (indirect manifestation of Wieger zonular detachment) are predominantly located in the opposite direction to the main corneal incisions.

Detection of Anterior Hyaloid Membrane Detachment Using Deep-Range Anterior Segment Optical Coherence Tomography

The visibility of anterior hyaloid membrane (AHM) and Berger’s space in phakic eyes was investigated. In 624 eyes of 624 patients, the retrolental space was scanned with the deep-range anterior segment optical coherence tomography (AS-OCT, CASIA2, Tomey). Subgroup analysis was conducted in 223 eyes undergoing cataract surgery. The logistic regression analysis using the backward-elimination method was performed to evaluate the influence of various factors on the visibility of AHM (dependent variable). Explanatory variables included age, gender, axial length, corneal power, corneal cylinder, and the Co III gradings. Intrarater repeatability for AHM visibility was excellent with the prevalence-adjusted bias-adjusted kappa (κ coefficient) of 0.90. AHM was observed in 43 eyes (6.9%). The patients with visible AHM (68.1 ± 8.8 years) were significantly older than those without visible AHM (52.6 ± 25.6 years) (p < 0.001). The logistic regression analysis in the cataract surgery subgroup revealed that axial length (p = 0.030) and corneal power (p = 0.043) were significantly associated with AHM visibility. The mean absolute refractive error from target was significantly larger in eyes with visible AHM (0.670 ± 0.384 D) than with invisible AHM (0.494 ± 0.412 D) (p = 0.037). The postoperative refractive prediction was less accurate in eyes with visible AHM, but no significant tendency existed in terms of myopic or hyperopic shifts.

Automatic segmentation of intraocular lens, the retrolental space and Berger's space using deep learning

PURPOSE

To develop and validate a deep learning model to automatically segment three structures using an anterior segment optical coherence tomography (AS-OCT): The intraocular lens (IOL), the retrolental space (IOL to the posterior lens capsule) and Berger's space (BS; posterior capsule to the anterior hyaloid membrane).

METHODS

An artificial intelligence (AI) approach based on a deep learning model to automatically segment the IOL, the retrolental space, and BS in AS-OCT, was trained using annotations from an experienced clinician. The training, validation and test set consisted of 92 cross-sectional OCT slices, acquired in 47 visits from 41 eyes. Annotations from a second experienced clinician in the test set were additionally evaluated to conduct an inter-reader variability analysis.

RESULTS

The AI model achieved a Precision/Recall/Dice score of 0.97/0.90/0.93 for IOL, 0.54/0.65/0.55 for retrolental space, and 0.72/0.58/0.59 for BS. For inter-reader variability, Precision/Recall/Dice values were 0.98/0.98/0.98 for IOL, 0.74/0.59/0.62 for retrolental space, and 0.58/0.57/0.57 for BS. No statistical differences were observed between the automated algorithm and the inter-reader variability for BS segmentation.

CONCLUSION

The deep learning model allows for fully automatic segmentation of all investigated structures, achieving human-level performance in BS segmentation. We, therefore, expect promising applications of the algorithm with particular interest in BS in automated big data analysis and real-time intra-operative support in ophthalmology, particularly in conjunction with primary posterior capsulotomy in femtosecond laser-assisted cataract surgery.

Evaluation of the Vitreolenticular Interface with Intra-Operative OCT

Abstract.

PURPOSE

To determine the prevalence of anterior vitreous detachment (AVD) in routine bag-in-the-lens cataract cases and whether we could identify risk factors for its presence.

SETTING

University Hospital of Antwerp, Belgium.

DESIGN

Prospective cross sectional study.

METHODS

Patients having routine bag-in-the-lens cataract surgery were included. Patients with traumatic cataract, prior intra-ocular surgeries, YAG-laser, intravitreal injection or medical conditions that might affect normal ophthalmologic anatomy were excluded. Several parameters were collected from the patients records and their surgical videos/photos/OCT were evaluated.

RESULTS

99 Eyes of 99 patients were included. Detectable AVD was observed in 62 eyes (63%). AVD was not present in 37 eyes (37%). The difference in prevalence of AVD between males and females was not statistically significant (P = 0. 55, Pearson Chi Square test). The Mann Whitney U test for axial length was not statistically significant (P = 0. 38). The Mann Whitney U test for age was statistically significant (P < 0.005). A logistic regression model to ascertain the effect of age on the likelihood that patients had AVD did reach statistical significance (χ2(1) = 8.246, P < 0.005).

CONCLUSION

The prevalence of AVD in a routine cataract population is 63%. We identified age as a risk factor, our model determined that the odds for AVD increase with 5.3% for each year patients age. This data allows for better pre- and postoperative assessment of complications. The bag-in-the-lens, by its mandatory PPCCC, does not increase the risk of postoperative ocular complications in the posterior segment of the eye.

Volumetric Optical Imaging and Quantitative Analysis of Age-Related Changes in Anterior Human Vitreous

Purpose

The purpose of this study was to characterize age-related changes in anterior human vitreous with 3-D swept source optical coherence tomography (SS-OCT) and evaluate associations with axial length (AL) and contrast sensitivity function (CSF).

Methods

There were 49 phakic eyes in 49 patients (40.0 ± 19.3 years) had 3-D volumetric scanning of the lens and retrolental vitreous with SS-OCT at 1050 nm. OCT-derived indices of vitreous optical density (VOD), vitreous opacification ratio (VOR), and lens optical density (LOD) were correlated with AL and double-pass assessment of retinal point spread function (Objective Scatter Index [OSI]). CSF was measured using an adaptive-optics visual simulator (area under log-log contrast sensitivity function [AULCSF]).

Results

Vitreous SS-OCT detected gel vitreous, liquefied lacunae, Berger's space, retrolental laminae, and fibrous opacifications. VOD, VOR, and LOD showed high reproducibility (intraclass correlation coefficients 0.968, 0.975, and 0.998, respectively). VOD was highly correlated with VOR (Pearson's R = 0.96, P < 0.000001). VOD, VOR, and LOD correlated with age (R = 0.48, 0.58, and 0.85, P < 0.001 for each). VOR and LOD correlated with OSI (R = 0.36, P = 0.0094, and R = 0.36, P = 0.0096, respectively). VOR correlated negatively with AULCSF (R = −0.53, P < 0.00009), which was related to OSI. Myopic eyes had higher OSI than nonmyopic eyes (P = 0.0121), consistent with correlation between OSI and AL (R = 0.37, P = 0.0091). Multivariable regression confirmed these findings.

Conclusions

SS-OCT visualized microstructural features of anterior human vitreous, where opacification is associated with increased light scattering and CSF degradation. SS-OCT enables high-resolution optical evaluation of vitreous opacities.

[Current value of femtosecond laser-assisted cataract surgery]

After more than 10 years of experience with the femtosecond laser in cataract surgery, it can be concluded that the safety profile of femtosecond laser-assisted cataract surgery (FLACS) is comparable to that of conventional cataract surgery. This technique offers the possibility to perform incisions with a precision superior to that of any surgeon in the world, based on the connection of preoperative and intraoperative diagnostics. This results in new possibilities to revolutionize the surgical procedure of cataract surgery and to generate new therapeutic approaches for the treatment of cataracts. The combination of keratotomy for correcting astigmatism, intraocular lenses supported by capsulotomy and individually adapted fragmentation patterns is already a component of a personalized cataract surgery.