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Zhang J, Jin A, Han X, Chen Z, Diao C, Zhang Y, Liu X, Xu F, Liu J, Qiu X, Tan X, Luo L, Liu Y. The LISA-PPV Formula: An Ensemble Artificial Intelligence-Based Thick Intraocular Lens Calculation Formula for Vitrectomized Eyes. Am J Ophthalmol 2024; 262:237-245. [PMID: 38452920 DOI: 10.1016/j.ajo.2024.02.037] [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: 12/19/2023] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To investigate the relationship between effective lens position (ELP) and patient characteristics, and to further develop a new intraocular lens (IOL) calculation formula for cataract patients with previous pars plana vitrectomy (PPV). DESIGN Cross-sectional study. METHODS A total of 2793 age-related cataract patients (group 1) and 915 post-PPV cataract patients (group 2) who underwent phacoemulsification with IOL implantation were included. The ELP of 2 groups was compared and the association between ELP and patient characteristics was further evaluated using standardized multivariate regression coefficients. An ensemble artificial intelligence-based ELP prediction model was developed using a training set of 810 vitrectomized eyes, and a thick-lens IOL formula (LISA-PPV) was constructed and compared with 7 existing formulas on an external multi-center testing set of 105 eyes. RESULTS Compared to eyes with age-related cataract, vitrectomized eyes showed a similar ELP distribution (P = .19), but different standardized coefficients of preoperative biometry for ELP. The standardized coefficients also varied with the type of vitreous tamponade, history of scleral buckling, and ciliary sulcus IOL implantation. The LISA-PPV formula showed the lowest mean and median absolute prediction error (MAE: 0.63 D; MedAE: 0.44 D), and the highest percentages of eyes within ±0.5 D of prediction error (57.14%) in the testing dataset. CONCLUSIONS The ELP prediction required optimization specifically for vitrectomized eyes based on their biometric and surgical characteristics. The LISA-PPV formula is a useful and accurate tool for determining IOL power in cataract patients with previous PPV (available at http://ppv-iolcalculator.com/).
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Affiliation(s)
- Jiaqing Zhang
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science (J.Z., A.J., X.H., Y.Z., X.Q., X.T., L.L., Y.L.), Guangzhou, China; Guangdong Provincial Clinical Research Center for Ocular Diseases (J.Z., A.J., X.H., Y.Z., X.Q., X.T., L.L., Y.L.), Guangzhou, China
| | - Aixia Jin
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science (J.Z., A.J., X.H., Y.Z., X.Q., X.T., L.L., Y.L.), Guangzhou, China; Guangdong Provincial Clinical Research Center for Ocular Diseases (J.Z., A.J., X.H., Y.Z., X.Q., X.T., L.L., Y.L.), Guangzhou, China
| | - Xiaotong Han
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science (J.Z., A.J., X.H., Y.Z., X.Q., X.T., L.L., Y.L.), Guangzhou, China; Guangdong Provincial Clinical Research Center for Ocular Diseases (J.Z., A.J., X.H., Y.Z., X.Q., X.T., L.L., Y.L.), Guangzhou, China
| | - Zhixin Chen
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Affiliated Hospital of Jinan University (Z.C.), Shenzhen, China
| | - Chunli Diao
- Department Of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region and Institute of Ophthalmic Diseases, Guangxi Academy Of Medical Sciences (C.D.), Nanning, China; Department of Ophthalmology, The First Affiliated Hospital of Guangxi University of Chinese Medicine (C.D.), Nanning, China
| | - Yu Zhang
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science (J.Z., A.J., X.H., Y.Z., X.Q., X.T., L.L., Y.L.), Guangzhou, China; Guangdong Provincial Clinical Research Center for Ocular Diseases (J.Z., A.J., X.H., Y.Z., X.Q., X.T., L.L., Y.L.), Guangzhou, China; Cataract Department, Shanxi Eye Hospital (Y.Z., J.L.), Taiyuan, China
| | - Xinhua Liu
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Affiliated Hospital of Jinan University (Z.C.), Shenzhen, China
| | - Fan Xu
- Department Of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region and Institute of Ophthalmic Diseases, Guangxi Academy Of Medical Sciences (C.D.), Nanning, China
| | - Jiewei Liu
- Cataract Department, Shanxi Eye Hospital (Y.Z., J.L.), Taiyuan, China
| | - Xiaozhang Qiu
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science (J.Z., A.J., X.H., Y.Z., X.Q., X.T., L.L., Y.L.), Guangzhou, China; Guangdong Provincial Clinical Research Center for Ocular Diseases (J.Z., A.J., X.H., Y.Z., X.Q., X.T., L.L., Y.L.), Guangzhou, China
| | - Xuhua Tan
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science (J.Z., A.J., X.H., Y.Z., X.Q., X.T., L.L., Y.L.), Guangzhou, China; Guangdong Provincial Clinical Research Center for Ocular Diseases (J.Z., A.J., X.H., Y.Z., X.Q., X.T., L.L., Y.L.), Guangzhou, China.
| | - Lixia Luo
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science (J.Z., A.J., X.H., Y.Z., X.Q., X.T., L.L., Y.L.), Guangzhou, China; Guangdong Provincial Clinical Research Center for Ocular Diseases (J.Z., A.J., X.H., Y.Z., X.Q., X.T., L.L., Y.L.), Guangzhou, China.
| | - Yizhi Liu
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science (J.Z., A.J., X.H., Y.Z., X.Q., X.T., L.L., Y.L.), Guangzhou, China; Guangdong Provincial Clinical Research Center for Ocular Diseases (J.Z., A.J., X.H., Y.Z., X.Q., X.T., L.L., Y.L.), Guangzhou, China
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Lee Y, Choi HI, Bae S, Chung HS, Kim JY, Lee H. Analysis of intraocular lens decentration and tilt after femtosecond laser-assisted cataract surgery using swept-source anterior optical coherence tomography. Heliyon 2024; 10:e29780. [PMID: 38699005 PMCID: PMC11064088 DOI: 10.1016/j.heliyon.2024.e29780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/21/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024] Open
Abstract
Objective To evaluate and compare the magnitude of intraocular lens (IOL) decentration and tilt following conventional and femtosecond laser-assisted cataract surgery (FLACS) using swept-source anterior optical coherence tomography (SS-OCT). Methods In this retrospective observational study, we enrolled patients who underwent conventional cataract surgery or FLACS with the implantation of hydrophobic 1-piece monofocal IOL. The magnitude of IOL decentration and tilt were measured using SS-OCT. Visual acuity, intraocular pressure, spherical equivalent, axial length, contrast sensitivity, and satisfaction questionnaire were evaluated before and one-month post-surgery. Additionally, postoperative internal cylinder measurements were obtained using a wavefront aberrometer. Correlation factors between each parameter and IOL decentration or tilt were analyzed. Results This study included 100 eyes from 100 patients. Mean IOL decentration and tilt were 0.21 ± 0.13 mm and 5.01 ± 1.49°, respectively. Conventional cataract surgery (versus FLACS, P = 0.001) and male sex (versus female, P = 0.047) were significantly correlated with higher postoperative decentration. Preoperative lens diameter (P < 0.001), preoperative lens tilt (P = 0.007), and preoperative intraocular pressure (P = 0.027) were correlated with higher postoperative tilt. Fifty eyes that underwent FLACS demonstrated mean postoperative decentration of 0.21 ± 0.13 mm and tilt of 4.64 ± 1.48°. Compared with the conventional surgery group, the FLACS group significantly differed in postoperative decentration (0.30 ± 0.12 mm, P < 0.001) but not in tilt (5.03 ± 1.35°, P = 0.173). Postoperative visual acuity did not significantly differ between the two groups. Conclusion Patients who underwent FLACS demonstrated better IOL decentration and tilt than those who underwent conventional cataract surgery one-month post-surgery. However, differences in IOL decentration and tilt did not affect postoperative visual acuity.
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Affiliation(s)
- Yunhan Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hoon Il Choi
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seonha Bae
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho Seok Chung
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hun Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Department of Ophthalmology, Brain Korea 21 Project, University of Ulsan College of Medicine, Seoul, South Korea
- Center for Cell Therapy, Asan Medical Center, Seoul, South Korea
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Fan Z, Wang M, Peng Y, Wang X, Li D, Ding Y, Zhang J, Huang Y. Observation on the tilt and decentration of multifocal intraocular lens with optic capture in Berger space for pediatric cataract. Int Ophthalmol 2024; 44:203. [PMID: 38671195 DOI: 10.1007/s10792-024-03130-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
PURPOSE This study aimed to observe the tilt and decentration of multifocal intraocular lens (IOL) with optic capture in Berger space within 2 years after pediatric cataract surgery. METHODS This is a prospective observational study. The implantation of multifocal IOL (Tecnis ZMB00) with optic capture in Berger space was performed on 33 patients (48 eyes) with pediatric cataract at Qingdao Eye Hospital. Tilt and decentration of IOL was measured using Scheimpflug system (Pentacam) at 1 month and 2 years postoperatively. RESULTS All the multifocal IOLs were successfully implanted in Berger space with optic capture and no visually significant complications were detected during the follow-up. The mean tilt of IOLs was 2.779° ± 0.950° in the vertical plane and 2.399° ± 0.898° in the horizontal plane at 1 month postoperatively, and the mean length of the decentration was 0.207 ± 0.081 mm in vertical plane and 0.211 ± 0.090 mm in the horizontal plane. Compared with 1 month after surgery, the angle of tilt decreased by a mean of 0.192° and decentration increased by a mean of 0.014 mm at the vertical meridian at 2 years postoperatively (P = 0.37 and P = 0.27, respectively), meanwhile, tilt increased by 0.265° and decentration increased by 0.012 mm at the horizontal meridian (P = 0.11 and P = 0.22, respectively). CONCLUSIONS The follow-up results suggest the tilt and decentration of multifocal IOL implantation with optic capture in Berger space remain stable in an acceptable range within 2 years after cataract surgery in children above the age of 5. TRIAL REGISTRATION The study was approved by the Ethics Committee of Qingdao Eye Hospital, and registered on Chinese Clinical Trial Registry (ChiCTR identifier: 1900023155).
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Affiliation(s)
- Zheng Fan
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, 5 Yanerdao Road, Qingdao, 266071, Shandong, China
- Hebei Eye Hospital, Xingtai, China
| | - Menghan Wang
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, 5 Yanerdao Road, Qingdao, 266071, Shandong, China
- Jiangsu Province Hospital, Nanjing, China
| | - Yusu Peng
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, 5 Yanerdao Road, Qingdao, 266071, Shandong, China
| | - Xiaoyun Wang
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, 5 Yanerdao Road, Qingdao, 266071, Shandong, China
| | - Dongfang Li
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, 5 Yanerdao Road, Qingdao, 266071, Shandong, China
| | - Yichao Ding
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, 5 Yanerdao Road, Qingdao, 266071, Shandong, China
| | - Jing Zhang
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, 5 Yanerdao Road, Qingdao, 266071, Shandong, China
| | - Yusen Huang
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, 5 Yanerdao Road, Qingdao, 266071, Shandong, China.
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Wu K, Shi J, Zong Y, Xu G, Zhu H, Jiang C. Outcomes of Secondary Intracapsular Intraocular Lens Implantation in Patients following Rhegmatogenous Retinal Detachment. J Clin Med 2023; 12:7749. [PMID: 38137820 PMCID: PMC10743941 DOI: 10.3390/jcm12247749] [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: 11/02/2023] [Revised: 12/02/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
This study reports the outcomes of a secondary IOL implantation technique in patients that suffered from rhegmatogenous retinal detachment combined with a cataract, which included reopening the capsular bag, enabling secondary intracapsular intraocular lens (IOL) implantation. We included consecutive cases with rhegmatogenous retinal detachment (RRD) treated with vitrectomy and silicone oil tamponade, and subsequent secondary IOL implantation during silicone oil removal between September 2019 and June 2022. Demographics, pre- and postoperative clinical data, and complications were collected. Visual and refractive outcomes and IOL position were evaluated. Thirty eyes were included and followed up for a mean of 24.2 ± 5.06 months. Compared with the preoperative values, no significant changes were observed in the intraocular pressure (p = 0.170) and endothelial cell density (p = 0.336); however, the best-corrected visual acuity (Snellen: 20/83 vs. 20/38; logMAR: 0.66 ± 0.23 vs. 0.37 ± 0.32; p < 0.001) and spherical equivalent (p < 0.001) improved significantly. The mean prediction error (ME) was -0.45 ± 0.68 D (-1.9-0.54 D), and the mean absolute prediction error (MAE) was 0.62 ± 0.52 D (0.01-1.9 D). The macula-on subgroup demonstrated significantly better refractive outcomes than the macula-off subgroup (ME, p = 0.046; MAE, p = 0.008). The IOL was well positioned, with a mean horizontal and vertical tilt and decentration of 0.53 ± 0.49° and 0.21 ± 0.16 mm, and 0.54 ± 0.45° and 0.22 ± 0.16 mm, respectively. Secondary intracapsular IOL implantation provided a good and stable IOL position and satisfactory refractive outcomes, and is a feasible treatment option for patients with RRD.
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Affiliation(s)
- Kaicheng Wu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai 200031, China; (K.W.); (J.S.); (Y.Z.); (G.X.)
- Key Laboratory of Myopia of the State Health Ministry, Shanghai 200031, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai 200031, China
| | - Jiemei Shi
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai 200031, China; (K.W.); (J.S.); (Y.Z.); (G.X.)
- Key Laboratory of Myopia of the State Health Ministry, Shanghai 200031, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai 200031, China
| | - Yuan Zong
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai 200031, China; (K.W.); (J.S.); (Y.Z.); (G.X.)
- Key Laboratory of Myopia of the State Health Ministry, Shanghai 200031, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai 200031, China
| | - Gezhi Xu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai 200031, China; (K.W.); (J.S.); (Y.Z.); (G.X.)
- Key Laboratory of Myopia of the State Health Ministry, Shanghai 200031, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai 200031, China
| | - Haohao Zhu
- Department of Ophthalmology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai 200240, China
| | - Chunhui Jiang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai 200031, China; (K.W.); (J.S.); (Y.Z.); (G.X.)
- Key Laboratory of Myopia of the State Health Ministry, Shanghai 200031, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai 200031, China
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Cameron NW, Karadaghy A, Mitchell MK, Ajlan RS. Optic inversion of scleral-fixated intraocular lens after vitrectomy with fluid-air exchange: case series and review of the literature. J Surg Case Rep 2023; 2023:rjad600. [PMID: 38026751 PMCID: PMC10640673 DOI: 10.1093/jscr/rjad600] [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: 08/11/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Lens dislocation is a significant complication after cataract surgery. Scleral fixation of 3-piece intraocular lens provides favorable visual outcome and can spare patients the need for lens exchange. Two patients presented with dislocated 3-piece lenses implanted over 10 years earlier. Both patients underwent pars plana vitrectomy and dropped lens rescue with scleral fixation. Postoperatively, the lens optic was found flipped nearly 90° at the optic-haptic junctions secondary to fluid-air exchange performed during vitrectomy. Both patients underwent intraocular lens exchange with a four point sclera fixated lens. Our study found that air tamponade is better avoided during rescue of old dislocated 3-piece lens implants. Intraocular lens exchange is preferred, when possible, to avoid complications associated with old dislocated lenses. Larger studies are needed to determine the effect of time on dislocated lens implants materials.
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Affiliation(s)
- Nathaniel W Cameron
- Department of Ophthalmology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Amin Karadaghy
- Department of Ophthalmology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Mary K Mitchell
- Department of Ophthalmology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Radwan S Ajlan
- Department of Ophthalmology, University of Kansas Medical Center, Kansas City, KS, United States
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Zhang J, Han X, Chen X, Liu Z, Zhang Y, Qiu X, Tan X, Luo L, Liu Y. Choice of intraocular lens calculation formula for cataract patients with prior pars plana vitrectomy. J Cataract Refract Surg 2023; 49:956-963. [PMID: 37440441 DOI: 10.1097/j.jcrs.0000000000001253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE To determine the optimal intraocular lens (IOL) calculation formula for vitrectomized eyes with diverse surgical and biometric characteristics. SETTING Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. DESIGN Retrospective consecutive case series study. METHODS This study included 974 vitrectomized eyes (974 patients) scheduled for phacoemulsification with IOL implantation. 11 formulas were evaluated: Barrett Universal II (BUII), Emmetropia Verifying Optical, Hoffer-QST, Kane, Ladas Super Formula, Pearl-DGS, Radial Basis Function (RBF), Haigis, HofferQ, Holladay1, and SRK/T. Risk factors for prediction error (PE) exceeding 1 diopter (D) were determined using multiple logistic regression. Subgroup analyses were performed based on surgical history and biometric parameters. RESULTS The risk of hyperopic PE (>1 D) was higher in patients with silicone oil tamponade (odds ratio [OR], 1.82) and longer axial length (AL) (OR, 1.55), while patients with previous scleral buckling (OR, 2.43) or ciliary sulcus IOL implantation (OR, 6.65) were more susceptible to myopic PE (<-1 D). The Kane formula had the highest overall prediction accuracy, and also the best in silicone oil-filled eyes and the flat cornea subgroup. The BUII and RBF displayed the optimal performance in eyes with previous scleral buckle and steep cornea, respectively. In eyes with an AL ≥ 26 mm, the Holladay1 with the nonlinear version of the Wang-Koch AL adjustment (Holladay1-WKn) showed the lowest absolute PE and highest percentage within ± 1.0 D of PE. CONCLUSIONS The Kane achieved the highest overall prediction accuracy in vitrectomized eyes. The optimal formula for eyes with previous scleral buckle, steep cornea, or long AL was BUII, RBF, and Holladay1-WKn, respectively.
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Affiliation(s)
- Jiaqing Zhang
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China (J. Zhang, Han, Chen, Z. Liu, Y. Zhang, Qiu, Tan, Luo, Y. Liu); Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China (J. Zhang, Han, Chen, Z. Liu, Y. Zhang, Qiu, Tan, Luo, Y. Liu)
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Lou W, Chen Z, Huang Y, Jin H. Flapless and Conjunctiva-Sparing Technique for Transscleral Fixation of Intraocular Lens to Correct Refractive Errors in Eyes without Adequate Capsular Support. J Ophthalmol 2023; 2023:4032011. [PMID: 37124064 PMCID: PMC10132900 DOI: 10.1155/2023/4032011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/05/2023] [Accepted: 03/22/2023] [Indexed: 05/02/2023] Open
Abstract
Purpose To evaluate refractive outcomes, intraocular lens (IOL) power calculation, and IOL position following a novel conjunctiva-sparing transscleral fixation technique. Methods Forty-one eyes of 40 patients managed with a flapless transscleral-sutured technique were included. Preoperative and postoperative refractive errors (spherical equivalents, SE) were compared. IOL position was assessed on the Scheimpflug images. IOL power was calculated by SRK/T, Holladay 1, and Hoffer Q formulas. Results The mean age was 57.39 ± 14.83 years (range: 26 to 79 years), and the mean follow-up was 7.46 ± 6.42 months (range: 1 to 24 months). Surgical indications were aphakia (n = 14), subluxated lenses (n = 3), and IOL dislocation (n = 24). The SE was 4.50 ± 6.38 diopter (D) (range: -3.75 to 13.75 D) preoperatively and -1.68 ± 1.57 D (range: -5.50 to 1.13 D) postoperatively (P < 0.001). The mean tilt angle and decentration were 2.90° ± 1.93° (range: 0.39° to 9.10°) and 0.23 ± 0.19 mm (range: 0.02 to 0.94 mm) vertically, and 1.75° ± 1.41° (range: 0.24° to 7.65°) and 0.18 ± 0.19 mm (range: 0.02 to 1.06 mm) horizontally, which were clinically insignificant. All three IOL formulas produced myopic errors (range: -0.29 to -0.50 D). The SRK/T had the lowest median absolute error (0.55 D), followed by the Holladay 1 (0.70 D) and the Hoffer Q (0.74 D). The three formulas had the same percentage of prediction errors (PEs) within ±0.5 D (43.48%), while the Hoffer Q had the highest percentage of PEs within ±1.0 D (82.61%). Conclusion The present technique can serve as an alternative approach for transscleral IOL fixation and refractive correction in eyes with compromised capsular support, ensuring the stability of IOLs and reasonable IOL power calculation accuracy.
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Affiliation(s)
- Wei Lou
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ziang Chen
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Huang
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haiying Jin
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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Zhang J, Han X, Zhang M, Liu Z, Chen X, Qiu X, Lin H, Li J, Liu B, Zhang C, Wei Y, Jin G, Tan X, Luo L. Predicting the risk of clinically significant intraocular lens tilt and decentration in vitrectomized eyes. J Cataract Refract Surg 2022; 48:1318-1324. [PMID: 35786811 PMCID: PMC9622369 DOI: 10.1097/j.jcrs.0000000000000997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To identify predictors and develop a prognostic nomogram for clinically significant intraocular lens (IOL) tilt and decentration in vitrectomized eyes. SETTING Zhongshan ophthalmic center, Guangzhou, China. DESIGN Prospective observational study. METHODS Patients with previous pars plana vitrectomy who underwent phacoemulsification with IOL implantation were enrolled in this study. The tilt and decentration of the lens and IOL were assessed by a swept-source anterior segment optical coherence tomography (CASIA2). Multiple logistic regression analysis and prognostic nomogram models were used to explore factors associated with clinically significant IOL tilt and decentration (defined as tilt ≥7 degrees and decentration ≥0.4 mm). RESULTS 375 patients (375 eyes) with a mean age of 56.1 ± 9.81 years were included. Lens tilt (odds ratio [OR] = 1.44), lens decentration (OR = 1.74), lens diameter (OR = 0.49), and hydrophilic IOL (OR = 2.36) were associated with IOL tilt over 7 degrees (all P &lt; .05). Lens tilt (OR = 1.24), lens decentration (OR = 2.30), and incomplete capsulorhexis-IOL overlap (OR = 2.44) increased the risk of IOL decentration over 0.4 mm (all P &lt; .05). Preoperative lens tilt together with lens decentration was identified as the strongest predictor of incident clinically significant IOL tilt (area under the curve [AUC] = 0.82, 95% CI, 0.76-0.88) and decentration (AUC: 0.84, 95% CI, 0.78-0.89), and the nomogram was constructed accordingly. CONCLUSIONS The tilt and decentration of the crystalline lens, hydrophilic IOL, and incomplete capsulorhexis-IOL overlap were risk factors for clinically significant IOL misalignment. Clinicians could use a prognostic nomogram model based on the preoperative lens position to make a strategy for higher-risk patients.
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