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Bin Helayel H, Balbaid NT, Fairaq R, Bin Dakhil TA, Al-Blowi M, Al-Swailem SA, Khandekar R, AlMutlak M. Assessment of refractive outcomes in eyes that underwent intraocular lens implantation in the posterior chamber but not "in-the-capsular bag:" A comparative retrospective study. Saudi J Ophthalmol 2024; 38:71-77. [PMID: 38628420 PMCID: PMC11017000 DOI: 10.4103/sjopt.sjopt_186_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/30/2023] [Accepted: 02/20/2023] [Indexed: 04/19/2024] Open
Abstract
PURPOSE The purpose of this study was to report visual and refractive outcomes in eyes that underwent intraocular lens (IOL) fixation in the absence of capsular support. METHODS This was a retrospective chart review of cases undergoing posterior chamber iris-fixated IOL (IFIOL) and scleral-fixated IOL (SFIOL) implants from June 2014 to March 2020 with more than 3 months of follow-up and having a preoperative best-corrected visual acuity of 20/80 and more. RESULTS Records of 120 eyes of 112 patients were reviewed. The mean age of the patients was 46.9 ± 22.3 (14.4-98.0) years, and 62% (n = 70) of participants were male. Most of the eyes (102: 85%) were aphakic at the time of surgery. The mean follow-up was 22.95 ± 17.1 months. The efficacy index of sutured IFIOL and glued SFIOL outperformed sutured SFIOL at 3 months and final visits postoperatively (P < 0.001). All techniques studied here resulted in a similar safety index at 3 months (P = 0.4). The mean predictive error (postoperative spherical equivalent refraction minus intended target refraction) was +0.07 ± 1.5 D and -0.12 ± 1.4 D at 3 months and the final postoperative visit, respectively. CONCLUSION The studied techniques have relatively good visual and refractive outcomes in this series. In addition, techniques involving a small corneal incision with foldable IOL fixation to the iris or scleral tissue have superior efficacy and safety indices compared to creating large corneoscleral wounds for rigid IOL fixation techniques.
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Affiliation(s)
- Halah Bin Helayel
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Rafah Fairaq
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Turki A. Bin Dakhil
- Department of Ophthalmology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed Al-Blowi
- Department of Optometry, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Samar A. Al-Swailem
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Rajiv Khandekar
- Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Department of Ophthalmology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mohammed AlMutlak
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Langenbucher A, Szentmáry N, Cayless A, Wendelstein J, Hoffmann P. Prediction of corneal power vectors after cataract surgery with toric lens implantation-A vector analysis. PLoS One 2023; 18:e0288316. [PMID: 37682881 PMCID: PMC10490976 DOI: 10.1371/journal.pone.0288316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/25/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Intraocular lenses are typically calculated based on a pseudophakic eye model, and for toric lenses (tIOL) a good estimate of corneal astigmatism after cataract surgery is required in addition to the equivalent corneal power. The purpose of this study was to investigate the differences between the preoperative IOLMaster (IOLM) and the preoperative and postoperative Casia2 (CASIA) tomographic measurements of corneal power in a cataractous population with tIOL implantation, and to predict total power (TP) from the IOLM and CASIA keratometric measurements. METHODS The analysis was based on a dataset of 88 eyes of 88 patients from 1 clinical centre before and after tIOL implantation. All IOLM and CASIA keratometric and total corneal power measurements were converted to power vector components, and the differences between preoperative IOLM or CASIA and postoperative CASIA measurements were assessed. Feedforward neural network and multivariate linear regression prediction algorithms were implemented to predict the postoperative total corneal power (as a reference for tIOL calculation) from the preoperative IOLM and CASIA keratometric measurements. RESULTS On average, the preoperative IOLM keratometric / total corneal power under- / overestimates the postoperative CASIA keratometric / real corneal power by 0.12 dpt / 0.21 dpt. The prediction of postoperative CASIA real power from preoperative IOLM or CASIA keratometry shows that postoperative total corneal power is systematically (0.18 dpt / 0.27 dpt) shifted towards astigmatism against the rule, which is not reflected by keratometry. The correlation of postoperative CASIA real power to the corresponding preoperative CASIA values is better than those as compared to the preoperative IOLM keratometry. However, there is a large variation from preoperative IOLM or CASIA keratometry to the postoperative CASIA real power of up to 1.1 dpt (95% confidence interval). CONCLUSION One of the challenges of tIOL calculation is the prediction of postoperative total corneal power from preoperative keratometry. Keratometric power restricted to a front surface measurement does not fully reflect the situation of corneal back surface astigmatism, which typically adds some extra against the rule astigmatism.
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Affiliation(s)
- Achim Langenbucher
- Department of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
| | - Nóra Szentmáry
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg/Saar, Germany
- Department of Ophthalmology, Semmelweis-University, Budapest, Hungary
| | - Alan Cayless
- School of Physical Sciences, The Open University, Milton Keynes, United Kingdom
| | - Jascha Wendelstein
- Department of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
- Department of Ophthalmology, Johannes Kepler University Linz, Linz, Austria
| | - Peter Hoffmann
- Augen- und Laserklinik Castrop-Rauxel, Castrop-Rauxel, Germany
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Danjo Y, Ohji R, Maeno S. Lower refractive prediction accuracy of total keratometry using intraocular lens formulas loaded onto a swept-source optical biometer. Graefes Arch Clin Exp Ophthalmol 2023; 261:137-146. [PMID: 35881200 DOI: 10.1007/s00417-022-05777-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To compare refractive outcomes calculated using intraocular lens (IOL) power calculation formulas loaded onto the IOLMaster 700 with the employment of anterior keratometry (K) and total keratometry (TK). METHODS A total of 225 eyes of 225 patients underwent uneventful cataract surgery and implantation of a single model of nontoric monofocal IOL by a single surgeon. All eyes underwent preoperative ocular biometric measurements with the IOLMaster 700. Refractive outcomes, including the mean numerical prediction error (MNE); standard deviation (SD); adjusted mean absolute prediction error (MAE); adjusted median absolute prediction error (MedAE); percentages of eyes with adjusted prediction error (PE) within ± 0.25, ± 0.50, ± 0.75, and ± 1.00 diopter; and IOL Formula Performance Index (FPI), were compared between the K-based formula and the TK-based formula of Barrett Universal II (BUII), Haigis, SRK/T, Holladay 2, and Hoffer Q. Axial length (short, medium, and long) subgroup analyses and anterior and posterior keratometry (flat, medium, and steep) subgroup analyses were conducted. RESULTS The K-based formula performed better than the TK-based formula in the accuracy of refractive prediction of each IOL calculation formula: BUII-K (FPI 0.690), BUII-TK (0.677), Haigis-K (0.617), Haigis-TK (0.584), SRK/T-K (0.608), SRK/T-TK (0.595), Holladay 2-K (0.419), Holladay 2-TK (0.406), Hoffer Q-K (0.364), and Hoffer Q-TK (0.356). The subgroup analyses of refractive prediction outcomes showed that TK influenced the refractive outcomes in eyes with relatively normal ranges of axial length and anterior keratometry. CONCLUSIONS Using TK instead of K leads to lower refractive prediction accuracy of the IOL power calculation formulas loaded on the IOLMaster 700.
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Affiliation(s)
- Yukitaka Danjo
- Department of Ophthalmology, Osaka Minato Central Hospital, Japan Community Health Care Organization (JCHO), 1-7-1 Isoji, Minato-ku, Osaka, 552-0003, Japan.
| | - Reina Ohji
- Department of Ophthalmology, Osaka Minato Central Hospital, Japan Community Health Care Organization (JCHO), 1-7-1 Isoji, Minato-ku, Osaka, 552-0003, Japan
| | - Sayo Maeno
- Department of Ophthalmology, Osaka Minato Central Hospital, Japan Community Health Care Organization (JCHO), 1-7-1 Isoji, Minato-ku, Osaka, 552-0003, Japan
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Bellucci C, Panico A, Tedesco SA, Carta A, Gandolfi S, Bellucci R, Mora P. One-dioptre toric IOL versus spherical IOL in eyes with low preoperative corneal astigmatism. Int Ophthalmol 2022; 43:1711-1719. [PMID: 36418805 PMCID: PMC10149477 DOI: 10.1007/s10792-022-02571-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/12/2022] [Indexed: 11/25/2022]
Abstract
Abstract
Purpose
To investigate the advantages/disadvantages of a 1.0 D toric IOL vs spherical IOL after regular phacoemulsification in eyes with preoperative astigmatism ≤ 1 D.
Methods
Retrospective comparative series involving pseudophakic eyes with preoperative topographic astigmatism ≤ 1.0 D implanted either with monofocal 1.0 D Toric IOL (T-group), or with spherical IOL (S-group). The postoperative refractive astigmatism (PRA, i.e. surgically induced + corneal) was the main outcome; also considered in the analyses were the uncorrected and best-corrected distance visual acuity (VA). The data were referred to the last postoperative follow-up visit, 2 to 4 months after surgery.
Results
A total of 60 eyes were included: 30 in the T-group and 30 in the S-group, matched for patient’s age, laterality, and axial length. Before surgery, the mean corneal astigmatism was 0.62 ± 0.39 D in the T-group and 0.54 ± 0.33 D in the S-group (p = 0.4). In the S-group, PRA was 0.73 ± 0.37 D, higher than the corresponding preoperative corneal astigmatism (p = 0.040). In the T-group, PRA was 0.58 ± 0.31 D; the variation was not statistically significant. Uncorrected VA was significantly better in the T-group vs the S-group (p = 0.007), and the best-corrected VA was comparable in the two groups.
Conclusion
The present study indicated that in eyes with very low preoperative astigmatism, 1.0 D toric IOLs were able to limit the increase of the PRA instead of those observed with the spherical IOLs. This could support the better uncorrected VA recorded in the T-group.
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Affiliation(s)
- Carlo Bellucci
- Ophthalmology Unit, Department of Medicine and Surgery, University of Parma - Via Gramsci 14, 43126, Parma, Italy.
| | - Angela Panico
- San Giuseppe E Melorio Hospital, Santa Maria Capua Vetere, Italy
| | - Salvatore A Tedesco
- Ophthalmology Unit, Department of Medicine and Surgery, University of Parma - Via Gramsci 14, 43126, Parma, Italy
| | - Arturo Carta
- Ophthalmology Unit, Department of Medicine and Surgery, University of Parma - Via Gramsci 14, 43126, Parma, Italy
| | - Stefano Gandolfi
- Ophthalmology Unit, Department of Medicine and Surgery, University of Parma - Via Gramsci 14, 43126, Parma, Italy
| | | | - Paolo Mora
- Ophthalmology Unit, Department of Medicine and Surgery, University of Parma - Via Gramsci 14, 43126, Parma, Italy
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Næser K, Kjærgaard SM. Accuracy, trueness, and precision for refractive surgery to correct astigmatism: which metrics should be used? J Cataract Refract Surg 2022; 48:1217-1218. [PMID: 36179352 DOI: 10.1097/j.jcrs.0000000000000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 06/22/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Kristian Næser
- From the Department of Ophthalmology, Randers Regional Hospital, Randers, Denmark
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Langenbucher A, Szentmáry N, Cayless A, Gasazza M, Weisensee J, Hoffmann P, Wendelstein J. Surgically induced astigmatism after cataract surgery - a vector analysis. Curr Eye Res 2022; 47:1279-1287. [PMID: 35380484 DOI: 10.1080/02713683.2022.2052108] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background: Surgically induced astigmatism (SIA) has been widely discussed in the literature as the change in corneal astigmatism resulting from corneal incision. The purpose of this study was to investigate the change in corneal refractive power preoperative to postoperative using a vector analysis of keratometry, total keratometry, and corneal back surface data from a modern optical biometerMethods: The analysis was based on a dataset of 122 eyes of 122 patients with preoperative and 1 month postoperative measurements performed with the IOLMaster 700 biometer from 1 clinical centre and a standardised surgical technique involving a corneal 2.5 mm 45°-incision made from the superior direction. Keratometry, total keratometry and corneal back surface data were processed in 3 vector components (spherical equivalent power SEQ and astigmatism considered in 0°/90° (C0°) and in 45°/135° (C45°) meridian), and the changes in corneal power vectors were analysed, comparing preoperative to postoperative values.Results: The mean corneal power of total keratometry reduced slightly after cataract surgery (-0.05 dpt), resulting mostly from a decrease in back surface power (-0.04 dpt). The astigmatism vector component C0° of total keratometry reduced by -0.28 dpt, mostly due to a decrease at the corneal front surface (-0.26 dpt). With the corneal incision at 12 o'clock position this flattening in the 90° meridian refers to a SIA of around ¼ dpt. The change in C0° and the C45° astigmatic vector components for both keratometry and total keratometry show a large variation ranging between 0.24 and 0.33 dpt (standard deviations), indicating a poor predictability of the change in astigmatism due to cataract surgery.Conclusion: Cataract surgery locally flattens the cornea in the incision meridian. This flattening shows a large individual variation and therefore a poor predictability. Our study indicates that SIA in modern cataract surgery with standardised corneal incision is in a range of 1/4 dpt.
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Affiliation(s)
- Achim Langenbucher
- Department of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
| | - Nóra Szentmáry
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg/Saar, Germany.,Department of Ophthalmology, Semmelweis-University, Mária u. 39, 1085 Budapest, Hungary
| | - Alan Cayless
- School of Physical Sciences, The Open University, Milton Keynes, United Kingdom
| | - Marina Gasazza
- Augen- und Laserklinik Castrop-Rauxel, Castrop-Rauxel, Germany
| | - Johannes Weisensee
- Department of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
| | - Peter Hoffmann
- Department of Ophthalmology, Johannes Kepler University Linz, Austria
| | - Jascha Wendelstein
- Department of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany.,Augen- und Laserklinik Castrop-Rauxel, Castrop-Rauxel, Germany
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Abulafia A, Rein AP, Weill Y, Zadok D, Mourits MP, Lapid-Gortzak R. Comparison of corneal surgically induced astigmatism calculations based on keratometry measurements made by 2 biometric devices. J Cataract Refract Surg 2021; 47:1542-1547. [PMID: 33974371 DOI: 10.1097/j.jcrs.0000000000000671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/06/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare calculated corneal surgically induced astigmatism (SIA) by means of anterior-based keratometry (K) and total keratometry (TK) measurements made by 2 biometric devices. SETTING Ophthalmology Department, Shaare Zedek Medical Center, Jerusalem, Israel. DESIGN Retrospective, consecutive case series. METHODS The medical records of patients who had undergone cataract surgery through a 2.4 mm temporal clear corneal incision by a single surgeon between March 2018 and November 2020 were retrospectively reviewed. Patients for whom there were preoperative and postoperative K measurements assessed by 2 biometric devices, optical low-coherence reflectometry (OLCR) (Lenstar LS900, Haag-Streit, software v. eye suite i/9.1.0.0) and swept-source optical coherence tomography (SS-OCT) (IOLMaster700, Carl Zeiss Meditec AG, software v. 1.80.6.60340), were identified. Corneal SIA (mean vector value) was calculated by vector analysis for 3 groups: SS-OCT(K), SS-OCT(TK), and OLCR(K). Bivariate analyses were applied for comparisons. RESULTS 147 eyes of 123 patients (73 right eyes and 74 left eyes) were enrolled in the study. The right eye corneal SIA values were 0.09 diopters (D) @ 136 degrees, 0.09 D @ 141 degrees, and 0.07 D @ 123 degrees for the SS-OCT(K), SS-OCT(TK), and OLCR, respectively. The corresponding left eye corneal SIA values were 0.13 D @ 120 degrees, 0.11 D @ 123 degrees, and 0.08 D @ 120 degrees. There were no statistically significant differences between the mean vector value and variance of the corneal SIA for the right (P = .78 and P = .65) and the left (P = .75 and P = .37) eyes of the 3 groups. CONCLUSIONS Corneal SIA values were low (0.07 to 0.13 D) and similar for the SS-OCT and the OLCR biometric devices with standard K measurements. TK measurements yielded similar corneal SIA values compared with anterior corneal-based measurements.
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Affiliation(s)
- Adi Abulafia
- Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated to the Hebrew University, Jerusalem, Israel (Abulafia, Rein, Weill, Zadok); Department of Ophthalmology, Amsterdam UMC, location AMC, University of Amsterdam, the Netherlands (Mourits, Lapid-Gortzak)
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Reply: Refractive and keratometric outcomes of supervised novice surgeon performed limbal relaxing incisions: one-year results. J Cataract Refract Surg 2021; 47:1247-1248. [PMID: 34468472 DOI: 10.1097/j.jcrs.0000000000000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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