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Danzinger V, Schartmüller D, Lisy M, Schranz M, Schwarzenbacher L, Abela-Formanek C, Menapace R, Leydolt C. Intraindividual Comparison of an Enhanced Monofocal and an Aspheric Monofocal Intraocular Lens of the Same Platform. Am J Ophthalmol 2024; 261:95-102. [PMID: 37944686 DOI: 10.1016/j.ajo.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To compare intraindividual differences in visual performance of a monofocal and enhanced monofocal intraocular lens (IOL) of the same platform. DESIGN Prospective, interventional, fellow-eye comparison clinical study. METHODS In total, 55 patients (110 eyes) with bilateral age-related cataract were enrolled. All patients received a monofocal ZCB00 IOL in the dominant and an enhanced monofocal Eyhance ICB00 IOL in the nondominant eye. After 2 to 4 months, monocular best-corrected distant visual acuity (BCDVA), distance-corrected intermediate visual acuity (DCIVA), distance-corrected near visual acuity (DCNVA), contrast visual acuity, monocular defocus curves, internal higher-order aberrations (HOAs) and spherical aberrations (SA), decentration, and tilt were compared. RESULTS The monocular mean BCDVA, DCIVA at 80 cm and 66 cm, and DCNVA were -0.03 ± 0.07, 0.24 ± 0.12, 0.32 ± 0.13, and 0.50 ± 0.13 logarithm of the minimum angle of resolution for the enhanced ICB00 and -0.06 ± 0.06 (P = .014), 0.30 ± 0.11 (P = .005), 0.38 ± 0.12 (P = .004), and 0.55 ± 0.14 (P = .034) logarithm of the minimum angle of resolution for the ZCB00, respectively. Internal HOAs (P = .001) and negative SA (P < .001) were increased with the ICB00 at 3 mm and comparable at 5 mm (P > .05). Contrast acuity, tilt, and decentration were similar (P > .05). CONCLUSIONS Significantly increased monocular DCIVA at 80 cm and 66 cm and DCNVA at 40 cm were observed with the enhanced ICB00 IOL, and the ZCB00 IOL demonstrated better BCDVA. This would result in a mean gain of 2 to 3 Early Treatment of Diabetic Retinopathy Study letters at near and intermediate distance. Monocular defocus curves displayed highest differences of 5 Early Treatment of Diabetic Retinopathy Study letters at -1.25 diopters (D) and -1.50 D levels of defocus and a depth of focus of 1.23 D for the ICB00 IOL and 0.94 D for the ZCB00 IOL. Decentration, tilt, and HOAs were generally low.
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Affiliation(s)
- Victor Danzinger
- From the Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Daniel Schartmüller
- From the Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Marcus Lisy
- From the Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Markus Schranz
- From the Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Luca Schwarzenbacher
- From the Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Claudette Abela-Formanek
- From the Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Rupert Menapace
- From the Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Christina Leydolt
- From the Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria..
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Schartmüller D, Röggla V, Schwarzenbacher L, Meyer EL, Abela-Formanek C, Leydolt C, Menapace R. Influence of a Capsular Tension Ring on Capsular Bag Behavior of a Plate Haptic Intraocular Lens: An Intraindividual Randomized Trial. Ophthalmology 2024; 131:445-457. [PMID: 37914042 DOI: 10.1016/j.ophtha.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/03/2023] Open
Abstract
PURPOSE To evaluate the influence of a capsular tension ring (CTR) on rotational stability, decentration, tilt, and axial stability of an 11.0-mm plate haptic intraocular lens (IOL). DESIGN Intraindividual, randomized, double-masked, controlled clinical trial. PARTICIPANTS Patients scheduled for sequential same-day bilateral cataract surgery. METHODS All patients were randomized to receive a CTR and a plate haptic IOL in one eye and a plate haptic IOL in the fellow eye only. Intraocular lens axis assessment was performed at the end of surgery, 1 hour, 1 week, 1 month, and 6 months using a high-precision evaluation method. Decentration and tilt of the crystalline and pseudophakic lenses were assessed before surgery and at 1 week and 6 months using an anterior segment OCT. MAIN OUTCOME MEASURES Rotational stability from the end of surgery to 6 months and at all follow-up visits, decentration and tilt at 6 months, and differences in axial shift between 1 week and 6 months. RESULTS One hundred thirty eyes of 65 patients were included in the study. Absolute rotation from the end of surgery to 6 months was 2.8 ± 3.9° and 3.2 ± 5.3° for the CTR and control groups, respectively (P = 0.613). Intraocular lens decentration and IOL tilt at 6 months were 0.29 ± 0.1 mm and 0.24 ± 0.1 mm and 6.7 ± 2.8° and 5.6 ± 1.6° for the CTR and control groups, respectively (P = 0.058; P < 0.01). A posterior IOL shift of 0.31 ± 0.31 mm and 0.19 ± 0.14 mm was observed in the CTR and control groups, respectively. CONCLUSIONS Concomitant implantation of a CTR and a plate haptic IOL did not improve the overall rotational stability of the IOL compared with the control group. Against expectations, higher values of decentration, tilt, and axial shift were observed in the CTR group. The simultaneous use of a CTR and a plate haptic IOL in the absence of zonular weakness at the time of cataract surgery should be considered with caution. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Daniel Schartmüller
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
| | - Veronika Röggla
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Luca Schwarzenbacher
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Elias Laurin Meyer
- Section for Medical Statistics, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria; Berry Consultants, Vienna, Austria
| | | | - Christina Leydolt
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Rupert Menapace
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
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Schwarzenbacher L, Schmidt-Erfurth U, Schartmüller D, Röggla V, Leydolt C, Menapace R, Reiter GS. Long-term impact of low-energy femtosecond laser and manual cataract surgery on macular layer thickness: A prospective randomized study. Acta Ophthalmol 2024. [PMID: 38440865 DOI: 10.1111/aos.16667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 01/30/2024] [Accepted: 02/24/2024] [Indexed: 03/06/2024]
Abstract
PURPOSE To evaluate change in retinal layers 18 months after femtosecond laser-assisted cataract surgery (LCS) and manual cataract surgery (MCS) in a representative age-related cataract population using artificial intelligence (AI)-based automated retinal layer segmentation. METHODS This was a prospective, randomized and intraindividual-controlled study including 60 patients at the Medical University of Vienna, Austria. Bilateral same-day LCS and MCS were performed in a randomized sequence. To provide insight into the development of cystoid macular oedema (CME), retinal layer thickness was measured pre-operatively and up to 18 months post-operatively in the central 1 mm, 3 mm and 6 mm. RESULTS Fifty-six patients completed all follow-up visits. LCS compared to MCS did not impact any of the investigated retinal layers at any follow-up visit (p > 0.05). For the central 1 mm, a significant increase in total retinal thickness (TRT) was seen after 1 week followed by an elevated plateau thereafter. For the 3 mm and 6 mm, TRT increased only after 3 weeks and 6 weeks and decreased again until 18 months. TRT remained significantly increased compared to pre-operative thickness (p < 0.001). Visual acuity remained unaffected by the macular thickening and no case of CME was observed. Inner nuclear layer (INL) and outer nuclear layer (ONL) were the main causative layers for the total TRT increase. Photoreceptors (PR) declined 1 week after surgery but regained pre-operative values 18 months after surgery. CONCLUSION Low-energy femtosecond laser pre-treatment did not influence thickness of the retinal layers in any topographic zone compared to manual high fluidic phacoemulsification. TRT did not return to pre-operative values 18 months after surgery. The causative layers for subclinical development of CME were successfully identified.
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Affiliation(s)
- Luca Schwarzenbacher
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
- Laboratory for Ophthalmic Image Analysis, Medical University of Vienna, Vienna, Austria
| | - Daniel Schartmüller
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Veronika Röggla
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Christina Leydolt
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Rupert Menapace
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Gregor S Reiter
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
- Laboratory for Ophthalmic Image Analysis, Medical University of Vienna, Vienna, Austria
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Danzinger V, Schartmüller D, Schwarzenbacher L, Röggla V, Abela-Formanek C, Menapace R, Leydolt C. Clinical prospective intra-individual comparison after mix-and-match implantation of a monofocal EDOF and a diffractive trifocal IOL. Eye (Lond) 2024; 38:321-327. [PMID: 37524833 PMCID: PMC10811191 DOI: 10.1038/s41433-023-02682-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVES To assess intra-individually visual acuity (VA) and subjective outcome after mix-and-match implantation of a monofocal EDOF IOL and a diffractive trifocal IOL. METHODS The monofocal EDOF Isopure IOL was implanted in the dominant eye and the trifocal FineVision HP IOL in the non-dominant eye. Postoperative evaluation included VA at various distances, contrast acuity, monocular defocus curves, decentration and tilt, wavefront aberrometry, VF-7 questionnaire and a halo and glare simulator. RESULTS 50 eyes of 25 subjects were enroled. The trifocal IOL performed better at monocular DCNVA (p < 0.01) and at defocus levels of -1.5D to -4.0D (p < 0.01), the monofocal EDOF IOL was better at -0.5D (p = 0.013). No differences in monocular BCDVA, DCIVA, contrast acuity, decentration or tilt were observed (p > 0.05). Wavefront analysis revealed lower HOAs in the trifocal group at 5 mm (p < 0.01) and no difference (p = 0.107) at 3 mm pupil aperture. The monofocal EDOF IOL displayed increased negative SA at 5 mm (p < 0.01) and 3 mm (p < 0.01) pupil diameter. Low values of optical phenomena and satisfying results of the VF-7 questionnaire were obtained. CONCLUSION Excellent visual performance and low rates of optical phenomena were achieved after mix-and-match implantation of the monofocal EDOF Isopure IOL and the trifocal FineVision HP IOL. Trifocal IOL implantation in the non-dominant eye may decrease optical disturbing phenomena. Similar results were observed for monocular distance, intermediate and contrast VA. The trifocal IOL provided better monocular near VA. Decentration and tilt and HOAs were low.
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Affiliation(s)
- Victor Danzinger
- Medical University of Vienna, Department of Ophthalmology and Optometry, Vienna, Austria
| | - Daniel Schartmüller
- Medical University of Vienna, Department of Ophthalmology and Optometry, Vienna, Austria
| | - Luca Schwarzenbacher
- Medical University of Vienna, Department of Ophthalmology and Optometry, Vienna, Austria
| | - Veronika Röggla
- Medical University of Vienna, Department of Ophthalmology and Optometry, Vienna, Austria
| | | | - Rupert Menapace
- Medical University of Vienna, Department of Ophthalmology and Optometry, Vienna, Austria
| | - Christina Leydolt
- Medical University of Vienna, Department of Ophthalmology and Optometry, Vienna, Austria.
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Röggla V, Langenbucher A, Leydolt C, Schartmüller D, Schwarzenbacher L, Hoffmann P, Menapace R. Best fit formula approach in delayed sequential bilateral cataract surgery. Clin Exp Ophthalmol 2023; 51:559-565. [PMID: 37264533 DOI: 10.1111/ceo.14261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/09/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND We evaluated whether the best-fit intraocular lens (IOL) power formula for the first operated eye (BF1) was also the most accurate formula for the second eye. METHODS This was a retrospective study of 152 patients who underwent uncomplicated delayed bilateral cataract surgery with a minimum delay of 3 weeks using only one 1-piece IOL (HOYA, Vivinex) at the Medical University of Vienna, Austria. Seven different formulae (Barrett Universal II, Castrop, Haigis, Hoffer Q, Holladay 1, Kane, and SRK/T) were investigated to test the formula selection approach with regard to the calculated mean and median absolute prediction errors (MAE/MedAE). RESULTS The mean intraindividual difference in axial length was 0.2 mm (±0.3 mm). BF1 coincided with the best-fit formula for the second eye (BF2) in 56% of patients (p < 0.05). Using BF1 for the second eye led to a lower MedAE (0.22 dioptre, D) than using a formula at random (0.33 D) and was less accurate than using the best-fit formula for each eye separately (0.1 D). The MedAEs of all formulae were generally low, ranging from 0.28 to 0.35 D. CONCLUSION Using BF1 for the second eye led to a lower MedAE than the random selection of a formula. Therefore, BF1 can be used for the second eye if the surgeon is unsure of the choice of formula.
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Affiliation(s)
- Veronika Röggla
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Achim Langenbucher
- Institut Für Experimentelle Ophthalmologie, Saarland University, Homburg, Germany
| | - Christina Leydolt
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Daniel Schartmüller
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Luca Schwarzenbacher
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Peter Hoffmann
- Department of Ophthalmology, Augen-und Laserklinik, Castrop-Rauxel, Germany
| | - Rupert Menapace
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
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Röggla V, Schartmüller D, Schwarzenbacher L, Leydolt C, Menapace R. Rotational Stability, Decentration, and Tilt of a New Hydrophobic Acrylic Intraocular Lens Platform. Am J Ophthalmol 2023; 250:149-156. [PMID: 36754132 DOI: 10.1016/j.ajo.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE To evaluate rotational stability, decentration and tilt of the monofocal intraocular lens (IOL) Nanex (NC1-SP; HOYA Surgical Optics). DESIGN Prospective interventional case series. METHODS The study was performed at the Department of Ophthalmology, Medical University of Vienna. The study population comprised 130 eyes of 68 patients with age-related cataract who underwent cataract surgery with implantation of a Nanex IOL. Baseline image for rotational stability evaluation was obtained at the end of surgery (EoS) and compared to retroillumination images taken at 1 hour, 1 week, 1 month, and 6 months after surgery. Axis alignment was assessed using nonmovable landmarks on the sclera and the optic-haptic junctions of the IOL. Anterior segment OCT images were performed to evaluate decentration and tilt. The main outcome measure was absolute rotation from EoS to 6 months postoperatively. RESULTS Median IOL rotation of all eyes from EoS to 6 months was 1.9° (interquartile range 0.1°-37.5°). Ten eyes (9.71%) rotated more than 5° and 2 eyes (1.94%), more than 10°. IOL rotation did not correlate with axial eye length (Spearman r = -0.042, P = .46), crystalline lens thickness (Spearman r = 0.134, P = .19), and crystalline lens equatorial diameter (Spearman r = 0.101, P = .325). IOL rotation positively correlated with anterior fibrosis severity (Spearman r = 0.321, P = .002). Preoperative decentration (0.2 ± 0.12 mm) and tilt (5.7 ± 1.6°) did not change significantly after surgery (0.22 ± 0.12 mm and 5.62 ± 1.49°, respectively). CONCLUSION The investigated IOL presented good rotational stability and low decentration and tilt values. Nevertheless, anterior capsule fibrosis development led to a higher tendency of IOL rotation after 1 week.
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Affiliation(s)
- Veronika Röggla
- From the Medical University of Vienna, Department of Ophthalmology and Optometry, Vienna, Austria
| | - Daniel Schartmüller
- From the Medical University of Vienna, Department of Ophthalmology and Optometry, Vienna, Austria
| | - Luca Schwarzenbacher
- From the Medical University of Vienna, Department of Ophthalmology and Optometry, Vienna, Austria
| | - Christina Leydolt
- From the Medical University of Vienna, Department of Ophthalmology and Optometry, Vienna, Austria
| | - Rupert Menapace
- From the Medical University of Vienna, Department of Ophthalmology and Optometry, Vienna, Austria..
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Schwarzenbacher L, Schartmüller D, Leydolt C, Menapace R. Prostaglandin Release After Low-Energy Femtosecond Laser-Assisted Cataract Surgery Without Anti-Inflammatory Drug Premedication. Am J Ophthalmol 2022; 238:103-109. [PMID: 35033540 DOI: 10.1016/j.ajo.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/28/2021] [Accepted: 01/01/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare prostaglandin E2 (PGE-2) levels in the aqueous and pupil diameter in patients undergoing low-pulse energy femtosecond laser-assisted cataract surgery (LCS) without non-steroidal anti-inflammatory (NSAID) pretreatment with either fragmentation or capsulotomy performed first. DESIGN Prospective, randomized, fellow-eye controlled comparison. METHODS This study was undertaken at the Department of Ophthalmology, Medical University of Vienna. The population consisted of 140 eyes of 70 patients with bilateral age-related cataract. Bilateral same-day LCS with either anterior capsulotomy before lens fragmentation (Caps-First) in one eye or vice versa (Frag-First) in a random sequence were performed. Aqueous was tapped 5 minutes after LCS and PGE-2 concentration was analyzed. Pupil diameters were recorded immediately before and after femtosecond laser pretreatment. The main outcome measure was PGE-2 concentrations in picograms/milliliter and pupil diameter in millimeters. RESULTS Mean PGE-2 concentrations were 42.0 ± 63.7 pg/mL in the Caps-First group versus 71.8 ± 160.7 pg/mL with the Frag-First group (P = .186). Mean pupil diameters before and after pretreatment were 7.6 ± 0.8 mm and 7.6 ± 0.8 mm, respectively (P = .871). Mean PGE-2 concentrations and pupil diameters did not show any significant difference between time points or groups. CONCLUSIONS Low-energy femtosecond laser pretreatment did not increase PGE-2 levels in the absence of NSAID pretreatment. This was independent of whether capsulotomy or fragmentation was performed first. Moreover, no pupillary miosis was observed.
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Affiliation(s)
- Luca Schwarzenbacher
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Vienna, Austria (L.S, D.S, C.L, R.M)
| | - Daniel Schartmüller
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Vienna, Austria (L.S, D.S, C.L, R.M)
| | - Christina Leydolt
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Vienna, Austria (L.S, D.S, C.L, R.M)
| | - Rupert Menapace
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Vienna, Austria (L.S, D.S, C.L, R.M).
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Schwarzenbacher L, Seeböck P, Schartmüller D, Leydolt C, Menapace R, Schmidt‐Erfurth U. Automatic segmentation of intraocular lens, the retrolental space and Berger's space using deep learning. Acta Ophthalmol 2022; 100:e1611-e1616. [PMID: 35343651 DOI: 10.1111/aos.15141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 12/11/2022]
Abstract
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.
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Affiliation(s)
- Luca Schwarzenbacher
- Department of Ophthalmology and Optometry Medical University of Vienna Vienna Austria
| | - Philipp Seeböck
- Department of Ophthalmology and Optometry Medical University of Vienna Vienna Austria
| | - Daniel Schartmüller
- Department of Ophthalmology and Optometry Medical University of Vienna Vienna Austria
| | - Christina Leydolt
- Department of Ophthalmology and Optometry Medical University of Vienna Vienna Austria
| | - Rupert Menapace
- Department of Ophthalmology and Optometry Medical University of Vienna Vienna Austria
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Menapace R, Schartmüller D, Röggla V, Reiter GS, Leydolt C, Schwarzenbacher L. Ultrasound energy consumption and macular changes with manual and femtolaser-assisted high-fluidics cataract surgery: a prospective randomized comparison. Acta Ophthalmol 2022; 100:e414-e422. [PMID: 34543523 PMCID: PMC9290836 DOI: 10.1111/aos.14983] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 05/27/2021] [Accepted: 07/01/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of the study was to compare ultrasound (US) consumption and central macular thickness (CMT) and volume changes with manual and femtosecond laser (FSL)-assisted cataract nucleus workup. METHODS Sixty patients scheduled for immediate sequential bilateral surgery underwent a prospective randomized intraindividual comparison of nucleus sector fragmentation performed manually in one eye and with low-energy FSL assistance in the partner eye, followed by high-fluidics phacoaspiration with a maximum US power of 30%. Ultrasound (US) energy consumption and macular thickness and volume were compared as measured by intraoperative effective phacoemulsification time (EPT) and high-resolution spectral domain optical coherence tomography pre- and 1 week, 3 weeks and 6 weeks postoperatively. Results are presented as means ± SD or medians [min; max]. RESULTS Fifty-two patients completed the full follow-up. For the manual and FSL-assisted groups, nuclear hardness was almost identical with a mean LOCS III grade of 2.44 ± 1.08 and 2.50 ± 1.00 (p = 0.371). Median EPT was 1.40 [0.2; 8.3] and 1.25 [0.2; 9.4] seconds. Median preoperative CMT was 276.50 [263.25; 289.75] µm and 276.00 [262.00; 290.00] µm. Median postoperative CMT was 278.00 [260.50; 288.00] versus 275.50 [264.00; 290.50] µm at 1 week, 279.50 [266.75; 292.25] versus 280.00 [266.50; 294.50] µm at 3 weeks and 280.50 [268.00, 293.75] versus 279.50 [264.75; 295.25] µm at 6 weeks. Differences in CMT and total macular volume between the groups were not statistically significant at any point in time. CONCLUSION Femtosecond laser (FSL) prefragmentation of the nucleus into six sectors did not reduce US energy consumption compared with manual splitting of the nucleus into four quadrants in this particular surgical setting. Sectorial FSL-prechopping with the low-energy FSL used had no additional impact on postoperative macular thickness and volume.
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Affiliation(s)
- Rupert Menapace
- Department of Ophthalmology Medical University of Vienna Vienna Austria
| | | | - Veronika Röggla
- Department of Ophthalmology Medical University of Vienna Vienna Austria
| | - Gregor S. Reiter
- Department of Ophthalmology Medical University of Vienna Vienna Austria
- Christian Doppler Laboratory for Ophthalmic Image Analysis Department of Ophthalmology and Optometry Medical University of Vienna Vienna Austria
| | - Christina Leydolt
- Department of Ophthalmology Medical University of Vienna Vienna Austria
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Schartmüller D, Schwarzenbacher L, Schriefl S, Röggla V, Steiner I, Abela-Formanek C, Leydolt C, Menapace R. Rotational Stability of Intraocular Lenses: A Standardized Method for More Accurate Measurements in Future Studies. Am J Ophthalmol 2021; 231:200-207. [PMID: 34116009 DOI: 10.1016/j.ajo.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the reliability and reproducibility of a new semiautomated evaluation method, "Rotix," for intraocular lens (IOL) rotation and to define a standardized evaluation method for future toric IOL studies. DESIGN Reliability and reproducibility study. METHODS Setting: Department of Ophthalmology, Medical University of Vienna. PATIENT POPULATION A dataset of 25 patients with 2 consecutive follow-up visits was created to test the intra- and interrater reliability. A data test set of 10 patients including 30 pictures taken 5 minutes apart was created to test the short-term reproducibility. INTERVENTION Evaluation of IOL rotational stability using nontoric implants in 25 × 2 consecutive follow-up visits. Two experienced graders performed axis evaluation 3 times in a randomized order. One experienced grader performed axis evaluation for the short-term reproducibility study. Reference landmarks at the end of operation were used to assess the IOL axis. MAIN OUTCOME MEASURES Intra- and interrater reliability and short-term reproducibility of axis measurements. RESULTS Mean standard deviation for intrarater reliability was 0.16 degrees. The intraclass correlation coefficients were 0.97 for grader 1 and 0.96 for grader 2. A very high interrater correlation of 0.95 was found. The mean individual difference between grader 1 and grader 2 was 0.061 ± 0.28 degrees. Short-term reproducibility showed a mean standard deviation of 0.22 ± 0.14 degrees. CONCLUSION The novel semiautomated evaluation method showed an accurate inter- and intrarater reliability. Short-term reproducibility was below 0.25 degrees. The method of using nonmovable reference landmarks showed reliable results and should be used as a standard in future toric IOL studies.
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Affiliation(s)
- Daniel Schartmüller
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Vienna, Austria (D.S., L.S., S.S., V.R., C.A.F., C.L., R.M.)
| | - Luca Schwarzenbacher
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Vienna, Austria (D.S., L.S., S.S., V.R., C.A.F., C.L., R.M.)
| | - Sabine Schriefl
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Vienna, Austria (D.S., L.S., S.S., V.R., C.A.F., C.L., R.M.)
| | - Veronika Röggla
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Vienna, Austria (D.S., L.S., S.S., V.R., C.A.F., C.L., R.M.)
| | - Irene Steiner
- Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria (I.S.)
| | - Claudette Abela-Formanek
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Vienna, Austria (D.S., L.S., S.S., V.R., C.A.F., C.L., R.M.)
| | - Christina Leydolt
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Vienna, Austria (D.S., L.S., S.S., V.R., C.A.F., C.L., R.M.)
| | - Rupert Menapace
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Vienna, Austria (D.S., L.S., S.S., V.R., C.A.F., C.L., R.M.).
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Röggla V, Schartmüller D, Schwarzenbacher L, Chbib RA, Leydolt C, Menapace R. Comparison of Axis Determination With Different Toric Intraocular Lens Power Calculation Methods. J Refract Surg 2021; 37:642-647. [PMID: 34506242 DOI: 10.3928/1081597x-20210712-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the axis position of the measured total corneal astigmatism (TCA) with the axis of the anterior keratometry and the calculated axis position of different toric intraocular lens (IOL) calculators. METHODS A total of 163 astigmatic eyes of 163 patients were retrospectively analyzed. The axis of the actual TCA, measured with anterior segment optical coherence tomography, was compared to the anterior keratometric value (Group I) and three different methods of TCA calculation for toric IOL power determination: Abulafia-Koch regression formula (Group II), Barrett Toric Calculator V2.0 (Group III), and Barrett Toric Calculator V2.0 including measured posterior keratometric value (Group IV). Eyes were assigned to three subgroups: with-the-rule, against-the-rule, and oblique astigmatism. RESULTS The mean deviation calculated from measured TCA was +0.56° (Group I), -0.32° (Group II), -0.37° (Group III), and -1.00° (Group IV). For with-the-rule astigmatism, the TCA axis agreed most with Group I (6.5% outliers > 5° deviation). For against-the-rule astigmatism, Group IV and Group II were closest to the measured TCA axis (1.5% and 3% outliers with > 5° deviation). CONCLUSIONS The means of the calculated axis were similar to the measured TCA, but the proportion of outliers with an axis deviation of greater than 5° showed remarkable differences. Isolated anterior keratometric value measurements showed the fewest outliers in with-the-rule astigmatism. In against-the-rule astigmatism, Abulafia-Koch calculation should be used for axis determination. [J Refract Surg. 2021;37(9):642-647.].
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Wendelstein JA, Hoffmann PC, Schwarzenbacher L, Fischinger IR, Hirnschall N, Menapace R, Langenbucher A, Findl O, Bolz M. Lasting Effects: Seven Year Results of the Castrop Nomogram for Femtosecond Laser-Assisted Paired Corneal Arcuate Incisions. Curr Eye Res 2021; 47:225-232. [PMID: 34464547 DOI: 10.1080/02713683.2021.1975761] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Long-term results of arcuate incisions are rarely reported. This is unfortunate as long-term stability of astigmatic correction is of great interest to surgeons performing astigmatic correction. This study investigates the 7 year stability of results after application of femtosecond laser-assisted arcuate incisions with the Castrop nomogram. METHODS Prospective interventional case series at the Augen- und Laserklinik, Castrop-Rauxel, Germany. Single site, single surgeon study. Seven year results of cataract patients with low to moderate corneal astigmatism receiving femtosecond laser-assisted arcuate incisions using a TechnolasVictus SW 2.7 (Bausch & Lomb Inc, Dornach, Germany) were assessed and compared to 1 year results. Outcome evaluation was based on astigmatic vector analysis, manifest refraction, and visual acuity. RESULTS The study analyzed 19 eyes of 19 patients 7 years after surgery. Ocular residual astigmatism changed from -0.26 to -0.39 D. Preoperative corneal astigmatism was -1.51 D. Correction Index changed from 1.0 to 1.16. The magnitude of difference vector changed from 0.26 to 0.39 D. The index of success changed from 0.20 to 0.29. Spherical equivalent remained stable. A slight tendency to change toward astigmatic overcorrection was mainly observed for patients with preoperative with the rule astigmatism, but not with patients with against the rule astigmatism. CONCLUSIONS The Castrop nomogram showed stable results 7 years after surgery. Similar to toric IOL surgery, it is advisable to be less aggressive when correcting with the rule astigmatism, to avoid overcorrection over a long period.
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Affiliation(s)
- Jascha A Wendelstein
- Department of Ophthalmology and Optometry, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - Peter C Hoffmann
- Department of Ophthalmology, Augen-und Laserklinik, Castrop-Rauxel, Germany
| | - Luca Schwarzenbacher
- Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria
| | - Isaak R Fischinger
- Department of Ophthalmology and Optometry, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria.,Department of Ophthalmology, Augentagesklinik Spreebogen Berlin, Berlin, Germany
| | - Nino Hirnschall
- Department of Ophthalmology, Viros - Vienna Institute for Research in Ocular Surgery, Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
| | - Rupert Menapace
- Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria
| | - Achim Langenbucher
- Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany
| | - Oliver Findl
- Department of Ophthalmology, Viros - Vienna Institute for Research in Ocular Surgery, Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
| | - Matthias Bolz
- Department of Ophthalmology and Optometry, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
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Schartmüller D, Röggla V, Schwarzenbacher L, Leydolt C, Menapace R. Rotational Stability of a New Hydrophobic Acrylic IOL With Modified C-loop Haptics. J Refract Surg 2021; 37:112-118. [PMID: 33577697 DOI: 10.3928/1081597x-20201216-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/23/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To assess rotational stability, axial stability, decentration, and tilt of the Rayner RAO800C single-piece hydrophobic acrylic intraocular lens (IOL) (Rayner Intraocular Lenses Ltd) from end of surgery to 4 to 7 months postoperatively. METHODS Surgeries were performed at the Department of Ophthalmology at the Medical University of Vienna. A total of 130 eyes of 68 patients received an aspheric hydrophobic Rayner RAO0800C IOL. IOLs were randomly implanted to the 0 ± 10, 45 ± 10, 90 ± 10, or 135 ± 10 degree axis. Baseline measurement was performed with the patient still supine on the operating table. Axis alignment after 1 hour, 1 week, 1 month, and 4 months was evaluated by retroillumination pictures. Postoperative IOL decentration, tilt, and aqueous depth at 4 months were assessed using an anterior segment swept-source optical coherence tomography. RESULTS Absolute median IOL rotation from end of surgery to 4 months was 2.4 degrees (range: 0.0 to 85.0 degrees). Median IOL rotation from end of surgery to 1 hour, 1 hour to 1 week, 1 week to 1 month, and 1 month to 4 months was 1.6 (range: 0.0 to 86.2), 1.1 (range: 0.0 to 28.8), 0.6 (range: 0.0 to 5.2), and 0.7 (range: 0.0 to 2.6) degrees. Respective proportions of IOLs rotating more than 5, 10, and 20 degrees from end of surgery to 4 months were 23.9%, 11.0%, and 6.4%. Horizontal and vertical decentration at 4 months was -0.09 ± 0.14 and 0.09 ± 0.14 mm, respectively. Horizontal and vertical tilt at 4 months was -4.78 ± 1.36 and -1.58 ± 1.10 degrees, respectively. A posterior axial shift of 0.052 ± 0.055 mm was observed from 1 week to 4 months. CONCLUSIONS Although median IOL rotation appeared to be low, a significant proportion of IOLs rotated postoperatively. Decentration and tilt values were generally low. A minimal posterior optic shift was observed after 1 week. [J Refract Surg. 2021;37(2):112-118.].
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Menapace R, Schwarzenbacher L. Reply: Intraindividual comparison of cytokine and prostaglandin levels with and without low-energy, high-frequency femtosecond laser cataract pretreatment after single-dose topical NSAID application. J Cataract Refract Surg 2021; 47:281. [PMID: 33901151 DOI: 10.1097/j.jcrs.0000000000000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Langenbucher A, Szentmáry N, Leydolt C, Cayless A, Schwarzenbacher L, Zsolt Nagy Z, Menapace R. Calculation of ocular magnification in phakic and pseudophakic eyes based on anterior segment OCT data. Ophthalmic Physiol Opt 2021; 41:831-841. [PMID: 33945638 DOI: 10.1111/opo.12822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 02/05/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE The purpose of this study is to develop a straightforward mathematical concept for determination of object to image magnification in both phakic and pseudophakic eyes, based on biometric measures, refractometry and data from an anterior segment optical coherence tomography (OCT). METHODS We have developed a strategy for calculating ocular magnification based on axial length measurement, phakic anterior chamber and lens thickness, keratometry and crystalline lens front and back surface curvatures for the phakic eye, and axial length measurement, anterior chamber and lens thickness, keratometry and intraocular lens power, refractive index and shape factor for the pseudophakic eye. Comparing the magnification of both eyes of one individual yields aniseikonia, while comparing the preoperative and postoperative situation of one eye provides the gain or loss in ocular magnification. The applicability of this strategy is shown using a clinical example and a small case series in 78 eyes of 39 patients before and after cataract surgery. RESULTS For the phakic eye, the refractive index of the crystalline lens was adjusted to balance the optical system. The pseudophakic eye is fully determined and we proposed three strategies for considering a potential mismatch of the data: (A) with spherical equivalent refraction, (B) with intraocular lens power and (C) with the shape factor of the lens. Magnification in the phakic eye was -0.00319 ± 0.00014 and with (A) was -0.00327 ± 0.00013, with (B) was -0.00323 ± 0.00014 and with (C) was -0.00326 ± 0.00013. With A/B/C, the magnification of the pseudophakic eye was on average 2.52 ± 2.83%/1.31 ± 2.84%/2.14 ± 2.80% larger compared with the phakic eye. Magnification changes were within a range of ±10%. CONCLUSIONS On average, ocular magnification does not change greatly after cataract surgery with implantation of an artificial lens, but in some cases, the change could be up to ±10%. If the changes are not consistent between the left and right eyes, then this could lead to post-cataract aniseikonia.
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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 Deficiency 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, UK
| | | | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis-University, Budapest, Hungary
| | - Rupert Menapace
- Department of Ophthalmology, Vienna University, Vienna, Austria
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Schwarzenbacher L, Schartmüller D, Röggla V, Meyer E, Leydolt C, Menapace R. One-Year Results of Arcuate Keratotomy in Patients With Low to Moderate Corneal Astigmatism Using a Low-Pulse-Energy Femtosecond Laser. Am J Ophthalmol 2021; 224:53-65. [PMID: 33309694 DOI: 10.1016/j.ajo.2020.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/11/2020] [Accepted: 11/25/2020] [Indexed: 01/23/2023]
Abstract
PURPOSE To investigate corneal astigmatism (CA) reduction and corneal optical quality after surface-penetrating femtosecond laser arcuate keratotomies (Femto AK) considering anterior (CAant) and posterior corneal curvature (CApost), total corneal refractive power astigmatism (CAtot), and corneal higher-order aberrations (HOAs) through 1 year. DESIGN Prospective interventional case series. METHODS Setting: Department of Ophthalmology, Medical University of Vienna. PatientPopulation: Forty-three eyes of 43 patients with age-related cataract and CAtot between 1 and 3 diopters (D). INTERVENTION Paired keratotomies were created with a low-energy femtosecond laser (LDV Z8; Ziemer Ophthalmic Systems, Port, Switzerland) and combined with an astigmatic neutral manual posterior-limbal cataract incision. CA and HOAs measurements were obtained preoperatively and after 1 month, 3 months, and 1 year. MainOutcomeMeasure: Change of CA and HOAs after low-energy Femto AK through 1 year. RESULTS Mean preoperative CAant and CAtot (1.62 ± 0.49 D and 1.58 ± 0.44 D) were significantly reduced, to 0.66 ± 0.38 and 0.50 ± 0.30 D (P < .001) 1 year after surgery, respectively. CApost showed no significant change, from 0.31 ± 0.19 D preoperatively to 0.31 ± 0.13 D (P = .732) at the 1-year follow-up period. Astigmatism as calculated by vector astigmatism analysis stayed stable at 1 month, 3 months, and 1 year. Corneal wavefront HOAs significantly improved at 1 month, 3 months, and 1 year. CONCLUSIONS Paired surface-penetrating keratotomies created by a low-energy femtosecond laser showed efficient and stable CA reduction within 1 year after surgery. The optical quality of the cornea was preserved with lower HOAs than preoperatively.
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Affiliation(s)
| | | | - Veronika Röggla
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Elias Meyer
- Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Christina Leydolt
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Rupert Menapace
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
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Röggla V, Leydolt C, Schartmüller D, Schwarzenbacher L, Meyer E, Abela-Formanek C, Menapace R. Influence of Artificial Tears on Keratometric Measurements in Cataract Patients. Am J Ophthalmol 2021; 221:1-8. [PMID: 32828877 DOI: 10.1016/j.ajo.2020.08.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess the influence of artificial tears of different viscosity on K-readings prior to cataract surgery. DESIGN Prospective randomized crossover, before-and-after clinical study. METHODS Setting: Department of Ophthalmology, Medical University of Vienna. PATIENT POPULATION A total of 123 eyes of 80 patients prior to cataract surgery were assigned to 2 groups based on normal and dry eyes. INTERVENTION Two native baseline keratometries were followed by instillation of either high- or low-viscosity eye drops. Keratometry was repeated 30 seconds, 2 minutes, and 5 minutes after instillation. MAIN OUTCOME MEASURES Influence of eye drops of different viscosity in normal and dry eyes on short time K-readings. RESULTS Repeatability between native baseline measurements was high (standard deviation = 0.02 mm in normal and in dry eyes). In normal and dry eyes, a statistically significant increase in measurement variability after instillation of both low-viscosity and high-viscosity eye drops was observed (P < .01). Measurement variability was most pronounced between baseline measurement and 30 seconds and diminished over time. Variability of K-readings appeared higher in dry eyes compared with normal eyes. Astigmatism changed more than 0.5 diopters in 13.2% of normal eyes and 34.4% in dry eyes using eye drops of high viscosity. CONCLUSION Tear film-stabilizing eye drops prior to keratometry measurements influenced K-readings significantly, especially in dry eyes. A time period of more than 5 minutes should be allowed to pass after instillation of eye drops. The higher the viscosity of the eye drops, the stronger the influence and the longer its persistence.
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Röggla V, Langenbucher A, Leydolt C, Schartmüller D, Schwarzenbacher L, Abela-Formanek C, Menapace R. Accuracy of common IOL power formulas in 611 eyes based on axial length and corneal power ranges. Br J Ophthalmol 2020; 105:1661-1665. [PMID: 32998904 DOI: 10.1136/bjophthalmol-2020-315882] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/14/2020] [Accepted: 09/13/2020] [Indexed: 11/04/2022]
Abstract
AIMS To provide clinical guidance on the use of intraocular lens (IOL) power calculation formulas according to the biometric parameters. METHODS 611 eyes that underwent cataract surgery were retrospectively analysed in subgroups according to the axial length (AL) and corneal power (K). The predicted residual refractive error was calculated and compared to evaluate the accuracy of the following formulas: Haigis, Hoffer Q, Holladay 1 and SRK/T. Furthermore, the percentages of eyes with ≤±0.25, ≤±0.5 and 1 dioptres (D) of the prediction error were recorded. RESULTS The Haigis formula showed the highest percentage of cases with ≤0.5 D in eyes with a short AL and steep K (90%), average AL and steep cornea (73.2%) but also in long eyes with a flat and average K (65% and 72.7%, respectively). The Hoffer Q formula delivered the lowest median absolute error (MedAE) in short eyes with an average K (0.30 D) and Holladay 1 in short eyes with a steep K (Holladay 1 0.24 D). SRK/T presented the highest percentage of cases with ≤0.5 D in average long eyes with a flat and average K (80.5% and 68.1%, respectively) and the lowest MedAE in long eyes with an average K (0.29 D). CONCLUSION Overall, the Haigis formula shows accurate results in most subgroups. However, attention must be paid to the axial eye length as well as the corneal power when choosing the appropriate formula to calculate an IOL power, especially in eyes with an unusual biometry.
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Affiliation(s)
- Veronika Röggla
- Department of Ophthalmology and Optometry, Medical University of Vienna, Austria
| | - Achim Langenbucher
- Institut Für Experimentelle Ophthalmologie, Saarland University, Saarbrucken, Germany
| | - Christina Leydolt
- Department of Ophthalmology and Optometry, Medical University of Vienna, Austria
| | - Daniel Schartmüller
- Department of Ophthalmology and Optometry, Medical University of Vienna, Austria
| | - Luca Schwarzenbacher
- Department of Ophthalmology and Optometry, Medical University of Vienna, Austria
| | | | - Rupert Menapace
- Department of Ophthalmology and Optometry, Medical University of Vienna, Austria
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Leydolt C, Schartmüller D, Schwarzenbacher L, Röggla V, Schriefl S, Menapace R. Posterior Capsule Opacification With Two Hydrophobic Acrylic Intraocular Lenses: 3-Year Results of a Randomized Trial. Am J Ophthalmol 2020; 217:224-231. [PMID: 32335056 DOI: 10.1016/j.ajo.2020.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the incidence and intensity of posterior capsule opacification (PCO) and neodymium-yttrium-aluminum-garnet (Nd:YAG) capsulotomy rates between 2 similar open-loop single-piece hydrophobic acrylic intraocular lenses (IOLs) that differ in the proprietary material characteristics and design features, over a period of 3 years. DESIGN Randomized, prospective, patient- and examiner-masked clinical trial with intraindividual comparison. METHODS Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. PATIENT POPULATION Eighty patients (160 eyes) had bilateral cataract surgery and received a Vivinex XY1 IOL in 1 eye and an AcrySof SN60WF IOL in the other eye. OBSERVATION PROCEDURES Follow-up examinations were performed 3 years after surgery. Digital retroillumination images were taken of each eye. The amount of PCO (score: 0-10) was assessed subjectively at the slit lamp and objectively using automated image analysis software (AQUA). MAIN OUTCOME MEASURE PCO score (scale, 0-10). RESULTS The mean objective PCO score of the Vivinex XY1 IOLs was 0.9 ± 0.8 compared to the PCO score of 1.4 ± 1.1 for the AcrySof SN60WF IOLs (P < .001). Three years postoperatively, 11.4% of patients had an Nd:YAG capsulotomy in the Vivinex XY1 eye and 18.6% had a capsulotomy in the AcrySof SN60WF eye (P = .23). CONCLUSION The new hydrophobic acrylic Vivinex XY1 IOL showed significantly lower PCO rates and lower YAG rates compared to the AcrySof SN60WF IOL. The interaction of various factors such as hydrophobic material, smooth optic surface, and sharp posterior optic edge plays a key role in PCO development.
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Schartmüller D, Schriefl S, Schwarzenbacher L, Leydolt C, Kundi M, Pieh S, Menapace R, Kriechbaum K. Posterior capsule opacification and Nd:YAG laser rates with two hydrophobic acrylic single-piece IOLs. Eye (Lond) 2020; 34:857-863. [PMID: 31485039 PMCID: PMC7182578 DOI: 10.1038/s41433-019-0569-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/26/2019] [Accepted: 08/07/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To evaluate the development of posterior capsule opacification (PCO) and Nd:YAG capsulotomy rates following implantation of two hydrophobic acrylic IOLs. METHODS In a randomized, controlled trial, 80 patients with bilateral senile cataract were implanted with the hydrophobic acrylic single-piece intraocular Lenses (IOLs) EyeCee One in one eye and iMics1 in the other. Outcomes of 39 patients (78 eyes) were evaluated after 3 years. Automated Quantification of After-Cataract (AQUA; for PCO occurrence), visual acuity, anterior fibrosis, capsule-optic edge interaction and distance between anterior and posterior capsule IOL surface were analysed. RESULTS After a mean follow-up of 38 ± 1.95 months, Nd:YAG capsulotomy occurred at a rate of 15.4% and 46.2% in the EyeCee One and iMics1 groups, respectively (p < 0.01). Respective mean PCO scores measured by AQUA were 1.57 ± 1.63 and 2.45 ± 1.44 (p = 0.019). A distinct gap between the anterior capsule and the IOL optic was present in 89% of eyes implanted with EyeCee One and 13% of iMics1 eyes. A gap between the posterior capsule and the posterior surface of the lens was observed in 76% of EyeCee One eyes and 35% of iMics1 eyes. CONCLUSIONS Study findings suggest that PCO and Nd:YAG capsulotomy rates are significantly lower in eyes implanted with the EyeCee One IOL compared to the iMics1 IOL. Optic sharpness and lens material seem to be the decisive factors, while the stepped edge beneath the haptic junction appeared to be ineffective.
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Affiliation(s)
- Daniel Schartmüller
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Sabine Schriefl
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Luca Schwarzenbacher
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Christina Leydolt
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Michael Kundi
- Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
| | - Stephan Pieh
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Rupert Menapace
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Katharina Kriechbaum
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
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Leydolt C, Schartmüller D, Schwarzenbacher L, Schranz M, Schriefl S, Menapace R. Comparison of posterior capsule opacification development with 2 single-piece intraocular lens types. J Cataract Refract Surg 2019; 43:774-780. [PMID: 28732611 DOI: 10.1016/j.jcrs.2017.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/07/2017] [Accepted: 03/23/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the differences in the incidence of posterior capsule opacification (PCO) and visual and optical performance between 2 hydrophobic acrylic single-piece sharp-edged intraocular lenses (IOLs) over 3 years. SETTING Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. DESIGN Prospective randomized case series. METHODS Patients with bilateral cataract were prospectively randomized to receive an Eyecee One IOL (IOL A) or an Acrysof SN60WF IOL (IOL B) and were followed for 36 months. The corrected distance visual acuity (CDVA) and IOL decentration and tilt were measured. The PCO was quantified by analysis of standardized retroillumination images. RESULTS The study comprised 160 eyes of 80 patients. The PCO incidence was low for both IOLs at all follow-up visits. Three years postoperatively, the median objective PCO score was 1.4 (range 0 to 5.6) for IOL A and 1.5 (range 0 to 5.0) for IOL B (P = .67). The neodymium:YAG (Nd:YAG) capsulotomy rate 3 years after surgery was 16.4% and 6.0% (P = .06), respectively. Visual acuity and contrast sensitivity outcomes were also comparable at all follow-up visits. CONCLUSIONS Both IOLs showed good capsular bag performance and low PCO rates 3 years after surgery. Both IOLs also showed comparable results for visual acuity, contrast sensitivity, decentration and tilt, PCO score, slitlamp examination, and Nd:YAG capsulotomy rates.
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Affiliation(s)
- Christina Leydolt
- From the Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Daniel Schartmüller
- From the Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Luca Schwarzenbacher
- From the Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Markus Schranz
- From the Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Sabine Schriefl
- From the Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Rupert Menapace
- From the Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
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Schultz T, Schwarzenbacher L, Dick HB. Comparing Femtosecond Laser-Assisted Cataract Surgery Before and After Phakic Intraocular Lens Removal. J Refract Surg 2018; 34:343-346. [PMID: 29738591 DOI: 10.3928/1081597x-20180301-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/21/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate two approaches for femtosecond laser-assisted cataract surgery (FLACS) in patients with phakic intraocular lenses (IOLs). METHODS Anterior capsulotomy and lens fragmentation were performed with an image-guided femtosecond laser. Laser treatment was performed under sterile conditions prior to (technique 1, 5 cases) or after (technique 2, 5 cases) phakic IOL explantation. RESULTS In technique 1, gas accumulated between the phakic IOL and the anterior capsule. In 2 (40%) of these cases, an anterior capsule tear occurred during phacoemulsification. In both cases, no anterior vitrectomy was necessary and the IOL was implanted into the capsular bag. In technique 2, no anterior capsule tears or other complications occurred. CONCLUSIONS Laser treatment prior to phakic IOL explantation has a risk for anterior capsule tears. Potentially, the laser beam is deflected by the optic of the phakic IOL and gas between the anterior capsule and the phakic IOL induces radial forces. [J Refract Surg. 2018;34(5):343-346.].
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Schartmüller D, Schriefl S, Schwarzenbacher L, Leydolt C, Menapace R. True rotational stability of a single-piece hydrophobic intraocular lens. Br J Ophthalmol 2018; 103:186-190. [PMID: 29666120 DOI: 10.1136/bjophthalmol-2017-311797] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/16/2018] [Accepted: 03/29/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND To evaluate rotation and its influencing factors of an aspheric one-piece hydrophobic acrylic intraocular lens (IOL) Vivinex XY1 during 6 months after operation. METHODS In this institutional trial, 122 eyes of 66 patients were implanted with a non-toric aspheric IOL Vivinex XY1 (Hoya Corporation, Tokyo, Japan). IOL alignment was assessed at the end of surgery, 1 hour, 1 week, 1 month and 6 months after implantation. Confounding factors such as axial length, presence of anterior fibrosis and randomised implantation in four different intended axes (0°, 45°, 90°, 135°) were evaluated. Decentration and tilt were measured using a Purkinje metre. RESULTS Assessment of rotational stability was possible for 103 of 122 implanted IOLs 6 months after eye surgery. The median absolute rotation was 1.1° (range: 0°-5°). Rotation was significantly increased within the first hour after operation compared with later time-points (p<0.001). No correlation was found with axial length and rotation (Spearman's r=0.048, p=0.63). No significant difference was observed regarding different implantation axes (p=0.75). Rotation was not influenced by the presence of anterior fibrosis (p=0.98). CONCLUSION Assessing the true IOL position at the end of surgery is crucial for the evaluation of rotational stability of IOLs. No IOL rotation exceeding 5° could be detected 6 months after surgery.
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Affiliation(s)
- Daniel Schartmüller
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Sabine Schriefl
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Luca Schwarzenbacher
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Christina Leydolt
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Rupert Menapace
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
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