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Yan H, Li J, Wang C, Mei CQ. The predictive value of anterior segment optical coherence tomography for postoperative corneal edema in cataract patients. Int Ophthalmol 2024; 44:350. [PMID: 39150472 DOI: 10.1007/s10792-024-03255-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/28/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE To evaluate the predictive value of anterior segment optical coherence tomography (AS-OCT) for postoperative corneal edema in cataract patients. METHODS A retrospective cohort study of 144 cataract patients from December 2020 to December 2021 was conducted. Patients were divided into edema eyes (84 cases) and observation (60 cases) group based on postoperative corneal edema occurrence. Relevant indicators were compared between groups. Logistic regression identified risk factors for postoperative corneal edema. Receiver operating characteristic curves evaluated the predictive value. RESULTS The edema eyes group had significantly higher postoperative central corneal thickness (CCT) and lower postoperative endothelial cell density (ECD) than the observation group (P < 0.05). The edema eyes group also had significantly lower preoperative ECD, anterior chamber depth (ACD), anterior chamber angle (ACA), and preoperative lens position (LP) than the observation group (P < 0.05). Logistic regression analysis showed that preoperative ECD, ACD, ACA, and LP were independent risk factors for postoperative corneal edema (P < 0.05), all of which also showed good predictive value for postoperative corneal edema, with areas under the curve (AUCs) of 0.854, 0.812, 0.791, and 0.778, respectively, under the ROC curve analysis. CONCLUSION AS-OCT can provide useful information for predicting postoperative corneal edema in cataract patients. Preoperative ECD, preoperative ACD, preoperative ACA, and preoperative LP are important parameters that can be measured by AS-OCT and used as risk factors for postoperative corneal edema.
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Affiliation(s)
- Hui Yan
- Department of Ophthalmology, Ya'an People's Hospital, No.9, Ankang Road, Yucheng District, Ya'an City, 625000, Sichuan Province, China
| | - Jie Li
- Department of Ophthalmology, Chengdu Wodi Ophthalmology Hospital, Chengdu, China
| | - Cheng Wang
- Department of Ophthalmology, Chengdu Wodi Ophthalmology Hospital, Chengdu, China
| | - Cai-Qiu Mei
- Department of Ophthalmology, Ya'an People's Hospital, No.9, Ankang Road, Yucheng District, Ya'an City, 625000, Sichuan Province, China.
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Lin IC, Chen X, Cheng M, Miao H, Li B, Jiang Y, Lei Y, Xu Y, Wang X, Zhou X. Comparing the Early Changes in Classified Higher-Order Aberrations Before and After Non-Toric and Toric Implantable Collamer Lens V4c Implantation. Curr Eye Res 2024:1-7. [PMID: 38913085 DOI: 10.1080/02713683.2024.2366296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/06/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE This study aimed to compare early changes in classified higher-order aberrations (HOAs) pre- and postsurgery in patients who received nontoric versus toric implantable collamer lenses (ICL; ICL Model V4c; STAAR Surgical, Monrovia, CA, USA). METHODS This prospective study included 124 eyes of 64 patients: 49 eyes were treated using a nontoric implantable collamer lens (ICL), and 75 eyes were treated using a toric implantable collamer lenses (TICL). Refractive parameters and ocular aberrations were examined before and 1 month after surgery. RESULTS At one month, the safety indices were 1.24 ± 0.17 in the ICL group and 1.20 ± 0.25 in the TICL group (p = 0.39). The efficacy indices were 1.07 ± 0.17 in the ICL group and 1.15 ± 0.26 in the TICL group (p = 0.02). The root mean square (RMS) values of whole-eye total HOAs, trefoil, corneal total HOAs, spherical aberration, and intraocular spherical aberration significantly increased postoperatively in both groups. The RMS of intraocular total HOAs in the TICL group significantly increased 1 month postoperatively. No statistically significant differences were observed in HOA changes between the ICL and TICL groups. CONCLUSIONS The dominant increases in short-term aberrations after ICL and TICL V4c implantation were in corneal trefoil and intraocular spherical aberrations, which were related to the corneal incision and implanted lens. The HOA changes post-surgery were not statistically different between the two lens types.
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Affiliation(s)
- I-Chun Lin
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- National Health Commission Key Lab of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xun Chen
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- National Health Commission Key Lab of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Mingrui Cheng
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- National Health Commission Key Lab of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Huamao Miao
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- National Health Commission Key Lab of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Boliang Li
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- National Health Commission Key Lab of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yinjie Jiang
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- National Health Commission Key Lab of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yadi Lei
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- National Health Commission Key Lab of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yilin Xu
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- National Health Commission Key Lab of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaoying Wang
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- National Health Commission Key Lab of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- National Health Commission Key Lab of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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Kanclerz P, Bazylczyk N, Przewłócka K, Khoramnia R, Atchison DA, Tuuminen R. Risk Factors for Corneal Monochromatic Aberrations and Implications for Multifocal and Extended Depth-of-Focus Intraocular Lens Implantation. J Refract Surg 2024; 40:e420-e434. [PMID: 38848055 DOI: 10.3928/1081597x-20240416-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
PURPOSE To discuss factors influencing corneal aberrations that might influence the optical quality after intraocular lens (IOL) implantation. METHODS PubMed and Scopus were the main resources used to search the medical literature. An extensive search was performed to identify relevant articles concerning factors influencing the level of corneal aberrations as of August 27, 2023. The following keywords were used in various combinations: corneal, aberrations, defocus, astigmatism, spherical aberration, coma, trefoil, quadrafoil, intraocular lens, and IOL. RESULTS Conclusive evidence is lacking regarding the correlation between age and changes in corneal aberrations. Patients with astigmatism have greater corneal higher-order aberrations than those with minimal astigmatism, particularly concerning trefoil and coma. Increased levels of corneal higher-order aberrations are noted following contact lens wear, in patients with dry eye disease, and with pterygium. Increased higher-order aberrations have been reported following corneal refractive surgery and for 3 months following trabeculectomy; regarding intraocular lens surgery, the results remain controversial. CONCLUSIONS Several factors influence the level of corneal higher-order aberrations. Multifocal and extended depth-of-focus IOLs can share similarities in their optical properties, and the main difference arises in their design and performance with respect to spherical aberration. Preoperative evaluation is critical for proper IOL choice, particularly in corneas with risk of high levels of aberrations. [J Refract Surg. 2024;40(6):e420-e434.].
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Han Y, Qi N. Numerical study of critical straight, frown, and chevron incisions in small incision cataract surgery. Front Bioeng Biotechnol 2023; 11:1283293. [PMID: 37929200 PMCID: PMC10623057 DOI: 10.3389/fbioe.2023.1283293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction: When an intraocular lens (IOL) injector is inserted through a pre-cut corneal incision (e.g., an empirical size of 2.2 mm) during small incision cataract surgery, uncontrollable tearing to the corneal tissue may occur, which is highly associated with the incision shape, size, and location. The goal of this numerical study was to investigate the optimal incision scheme amongst three typical shapes, i.e., straight, frown, and chevron incisions using mechanical modeling and finite element analysis. Methods: Assuming that the damage is caused by the tissue fracture at the incision tips and is governed by the classical energy release rate (ERR) theory which compares the current ERR value subject to IOL injection and the material's intrinsic parameter, critical ERR G c. Results: It was found that for chevron incisions, the incision shape with an angle of 170° was superior which induced minimal ERR value, while for frown incisions, the shape with a central angle of 6° was optimal. Both chevron and frown incisions could allow a larger size of injector to inject through than a straight pre-cut. In particular, the frown incision performed the best due to its lowest corresponding ERR and easy operation. Discussion: It was also observed that regions where the embedded fibrils are more dispersed and exhibit high isotropy were more favorable. If necessary, the chevron incision was recommended to be more aligned with the direction exhibiting a larger modulus, for example, along the circumferential direction near the limbus. This study provides useful knowledge in operation design and a deep insight into mechanical damage to corneal wounds in small incision cataract surgery.
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Affiliation(s)
- Yang Han
- Research Center for Mathematics and Interdisciplinary Sciences, Shandong University, Qingdao, Shandong, China
- Institute of Marine Science and Technology, Shandong University, Qingdao, China
| | - Nan Qi
- Research Center for Mathematics and Interdisciplinary Sciences, Shandong University, Qingdao, Shandong, China
- Frontiers Science Center for Nonlinear Expectations, Shandong University, Qingdao, Shandong, China
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Yang S, Huang T, Wang Y, Ning K, Long Q, Wang Z, Li Y, Chen D. Short-Term Impact of Different Corneal Incision Positions on Postoperative Astigmatism and Visual Quality After SMILE Surgery. Ophthalmol Ther 2023; 12:2453-2464. [PMID: 37328617 PMCID: PMC10441924 DOI: 10.1007/s40123-023-00748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION This study aimed to evaluate the short-term impact of different incision positions on astigmatism and visual quality after small incision lenticule extraction (SMILE) surgery. METHODS This prospective study enrolled patients who decided to have SMILE to correct myopia. Patients were randomly allocated into three groups of different incision positions (group A, B, and C with incision position at 90°, 120°, and 150° respectively). Preoperative and postoperative visual acuity, spherical equivalent, and high-order aberrations (HOAs) were measured and compared among groups. Astigmatism was analyzed with the ASSORT Group Analysis Calculator based on the Alpins method. RESULTS A total of 148 eyes were included for analysis (48 eyes in group A, 50 eyes in group B, and 50 eyes in group C). At 1 month postoperatively, the mean uncorrected distance visual acuity (UDVA) logMAR in group A, B, and C was - 0.03, - 0.03, and - 0.04, respectively. The mean corrected distance visual acuity (CDVA) logMAR in group A, B, and C was - 0.03, - 0.04, and - 0.04, respectively (P > 0.05). The mean postoperative spherical equivalent (SE) values were - 0.01 ± 0.38, - 0.07 ± 0.39, and - 0.16 ± 0.49 (D) in group A, B, and C, respectively (P > 0.05). There was no statistically significant difference in preoperative and postoperative magnitude of astigmatism among different groups (P > 0.05). Significant differences were found in the distribution of astigmatism axis among the three groups at 1 day (P = 0.02) and 1 week (P = 0.02) postoperatively. However, such differences were no longer significant at 1 month after surgery (P > 0.05). No significant differences were found in HOAs among different groups 1 month after surgery (P > 0.05). CONCLUSION Different incision positions have no effect on postoperative astigmatism and visual quality 1 month after SMILE surgery, though differences were found in the distribution of the astigmatism axis within 1 week after the surgery.
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Affiliation(s)
- Shan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Tianze Huang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Yuchen Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Ken Ning
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Qing Long
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Zhonghai Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Ying Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Di Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China.
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Borkenstein AF, Packard R, Dhubhghaill SN, Lockington D, Donnenfeld ED, Borkenstein EM. Clear corneal incision, an important step in modern cataract surgery: a review. Eye (Lond) 2023; 37:2864-2876. [PMID: 36788364 PMCID: PMC10516977 DOI: 10.1038/s41433-023-02440-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/29/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
A clear corneal incision (CCI) is the most commonly used entrance site in modern phacoemulsification cataract surgery. Despite some initial concerns about increased endophthalmitis rates through a self-sealing CCI, recent literature suggests that the risk of infection with proper wound construction and all other necessary precautions is minimal. The technique of creating a clear corneal incision has, with recent developments in corneal imaging, undergone critical appraisal leading to a better understanding of incision architecture. Many surgeons operate through smaller incisions, and they have a wide choice of surgical instruments to create their corneal incisions. The aim of this review is to discuss the history and the current status of clear corneal incision creation, the design and materials of surgical blades, and the current trends in manufacturing and sustainability. Although disposable instruments have some advantages and are very popular, recycling, if possible, and avoiding unnecessary plastic waste are important considerations. In any case, the step of CCI is a small one for the surgeon, but a big one for the eye. That is why it has to be done with the utmost precision and in-depth knowledge is important.
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Affiliation(s)
- Andreas F Borkenstein
- Borkenstein and Borkenstein, Private Practice at Privatklinik Kreuzschwestern, Graz, Austria.
| | | | | | - David Lockington
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | | | - Eva-Maria Borkenstein
- Borkenstein and Borkenstein, Private Practice at Privatklinik Kreuzschwestern, Graz, Austria
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Liu W, Yang L, Liu J. The Impact of Posterior Corneal Astigmatism on Surgically Induced Astigmatism in Cataract Surgery. Int J Gen Med 2022; 15:8417-8425. [PMID: 36465271 PMCID: PMC9718375 DOI: 10.2147/ijgm.s382774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/14/2022] [Indexed: 11/05/2023] Open
Abstract
PURPOSE This study aimed to evaluate the changes in posterior corneal astigmatism after cataract surgery and provide a theoretical basis to accurately evaluate the total corneal astigmatism (TA) to be corrected before toric intraocular lens (IOL) implantation. PATIENTS AND METHODS Sixty-two patients (89 eyes) who underwent phacoemulsification combined with toric IOL implantation (AcrySof IQ Toric SN6AT2-T9) at Shanxi Eye Hospital between January 2017 and September 2018 were enrolled. Surgically induced astigmatism of the posterior cornea (SIAPA) was analysed using vector analysis during pentacam examination. RESULTS The vector variances of keratometric astigmatism (KA), TA, and posterior corneal astigmatism (PA) preoperatively and postoperatively in the "with-the-rule (WTR) astigmatism" group and "overall patient" group were statistically significant (P < 0.05). A statistically significant difference was observed between surgically induced KA (SIAKA) and surgically induced astigmatism of the total cornea (SIATA) for all patients, including those with WTR astigmatism. For all patients, SIAKA was less than SIATA by 0.05 ± 0.21 D, and for patients with WTR astigmatism, SIAKA was less than SIATA by 0.09 ± 0.22 D. For patients in the "against-the-rule (ATR) astigmatism" group, there were no statistically significant differences between SIAKA and SIATA, although SIAKA was greater than SIATA by 0.03 ± 0.18 D. When PA ≤0.4 D or KA ≤2.0 D, SIAPA can be ignored. However, when PA >0.4 D or KA >2.0 D, ignoring SIAPA caused by cataract surgery incision will cause SIAKA in patients with WTR astigmatism to underestimate SIATA, while SIAKA in patients with ATR astigmatism will cause an overestimation of SIATA. CONCLUSION SIA on the posterior corneal astigmatism may have a significant role on more precise planning of toric IOL implantation, especially in cases with higher preoperative anterior or posterior corneal astigmatism.
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Affiliation(s)
- Wenjie Liu
- Cataract Department, Shanxi Eye Hospital, Taiyuan, Shanxi Province, People’s Republic of China
| | - Lichun Yang
- Cataract Department, Shanxi Eye Hospital, Taiyuan, Shanxi Province, People’s Republic of China
| | - Jiewei Liu
- Cataract Department, Shanxi Eye Hospital, Taiyuan, Shanxi Province, People’s Republic of China
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Qi N, Lockington D, Wang L, Ramaesh K, Luo X. Estimations of Critical Clear Corneal Incisions Required for Lens Insertion in Cataract Surgery: A Mathematical Aspect. Front Physiol 2022; 13:834214. [PMID: 35464073 PMCID: PMC9023857 DOI: 10.3389/fphys.2022.834214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
In a routine cataract operation cornea tissue may be damaged when an intra-ocular lens (IOL) injector of diameter between 1.467 and 2.011 mm is inserted through an empirically designed 2.2 mm corneal incision. We aimed to model and estimate the minimal length of the incision required to avoid wound tear. It was assumed that the damage was caused by tissue fracture at the tips of the incision, and this fracture could be studied using damage and fracture mechanics. The criterion of the damage was caused by a tear governed by the critical energy release rate (ERR) Gc, which is tissue dependent. Analytical and numerical studies were both conducted indicating the possibility of a safe and effective incision in cataract surgery. Six commonly used IOL injection systems were examined. Our results suggested that the recommended 2.2 mm incision cannot be treated as a universal threshold. Quicker IOL insertion may reduce wound damage. It was also recommended to advance IOL injector via its minor axis, and to cut the tear preferably along the circumferential direction due to tissue orthotropy. This study provides useful information and a deeper insight into the potential for mechanical damage to the corneal wound in cataract surgery.
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Affiliation(s)
- Nan Qi
- Institute of Marine Science and Technology, Shandong University, Qingdao, China
- *Correspondence: Nan Qi,
| | - David Lockington
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, United Kingdom
| | - Lei Wang
- Beijing National Center for Applied Mathematics, Academy for Multidisciplinary Studies, Capital Normal University Beijing, Beijing, China
| | - Kanna Ramaesh
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, United Kingdom
| | - Xiaoyu Luo
- School of Mathematics and Statistics, University of Glasgow, Glasgow, United Kingdom
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