Sutured scleral fixation of existing subluxated/dislocated acrylic one-piece intraocular lenses

AIM:To evaluate the visual and refractive outcomes in cases after sutured scleral fixation of existing subluxated or dislocated acrylic one-piece intraocular lenses(IOLs).METHODS:This study retrospectively enrolled a consecutive series of patients who underwent a surgery of sutured existing subluxated or dislocated IOLs from October 2018 to June 2020.All patients underwent comprehensive preoperative and postoperative ophthalmologic examination,and data were collected including age,sex,surgical indications,best-corrected visual acuity,refractive error,intraocular pressure.Presence of intraoperative and postoperative surgical complications was documented.RESULTS:A total of 20 consecutive cases were enrolled for analysis with mean final follow-up period 9.8±5.3mo.Visual acuity improved from a mean of 0.35(0.46±0.32 logMAR)preoperatively to 0.61(0.21±0.18 logMAR)at the 3-month follow-up(P=0.002).The mean amount of preoperative keratometric astigmatism and total postoperative refractive astigmatism was-1.24±0.80 diopters(D)and-1.42±0.97 D,respectively.There was no statistically significant difference between preoperative and postoperative astigmatism(P=0.156).The mean IOL-induced astigmatism was-0.23±0.53 D.The mean spherical equivalent at the 3-month follow-up was-0.1±0.94 D.No major complications were noted during the follow-up period.CONCLUSION:Surgical techniques using sutured scleral fixation of existing subluxated or dislocated acrylic one-piece IOLs result in favorable visual and refractive outcomes without major complications.

Intraocular lens selection in diabetic patients:How to increase the odds for success

The incidence of cataracts is significantly higher in diabetic individuals,particularly in younger age groups,with rates quadrupled in those under 65 and doubled in those over 65 compared to non-diabetics.Cataract surgery in diabetic patients poses many challenges:Poor epithelial healing,decreased corneal sensitivity,increased central corneal thickness,decreased endothelial cell count,variable topography,poor pupillary dilatation,anterior capsular phimosis,posterior capsular opacification(PCO),chances of progression of diabetic retinopathy(DR),zonular weakness,and vitreous prolapse and diabetic macular edema.Selection of an appropriate intraocular lens(IOL)is crucial for visual rehabilitation and monitoring DR.The choice of IOL in diabetic cataract patients is a challenging scenario.Square-edge IOLs are favored for their capacity to mitigate PCO,whereas hydrophilic counterparts may incur calcification in the setting of proliferative DR.The advisability of premium IOLs for achieving spectacle independence warrants judicious evaluation,particularly in the presence of advanced retinopathy.Optimal IOL placement within the capsular bag is advocated to minimize postoperative complications.Rigorous preoperative assessment and informed patient counseling regarding IOL options are indispensable for optimizing surgical outcomes.This review article covers various aspects regarding the choice of IOLs in different case scenarios and complications in the diabetic population.

IOL Master 700与Lenstar LS900对高度近视合并白内障患者术前生物测量及人工晶状体计算的比较

目的:比较IOL Master 700与Lenstar LS900对高度近视合并白内障患者术前眼生物测量的差异性、相关性、一致性及人工晶状体(IOL)度数计算的准确性。方法:回顾性研究。收集2021-03/2023-03于陆军特色医学中心眼科行白内障超声乳化联合IOL植入手术的高度近视合并白内障患者136例136眼,平均年龄57.38±8.08岁。根据眼轴长度(AL)将患者分为3组:A组(26 mm≤AL≤28 mm)41眼,B组(28 mm30 mm)52眼。术前分别使用两种仪器测量AL、平均角膜曲率(Km)、前房深度(ACD)、晶状体厚度(LT)和白到白距离(WTW)。所有患者均采用Barrett UniversalⅡ公式计算IOL度数,个性化选择适宜的预留屈光度,比较两种仪器的预测屈光误差(PE)和绝对屈光误差(AE)。结果:三组患者中Lenstar LS900测量的AL和ACD均大于IOL Master 700测量值(均P<0.05),且两种仪器测量AL的平均差值C组>B组>A组。两种仪器测量LT、Km与WTW值均无差异(均P>0.05)。两种仪器所得各组生物参数均具有正相关性(均r>0.9,P<0.05)且一致性较好(95%LoA范围较窄)。两种仪器计算的AE无差异(P>0.05),但IOL Master 700计算的PE小于Lenstar LS900(P<0.05),且前者远视偏移百分比更低。结论:在高度近视合并白内障患者中,Lenstar LS900测量AL值大于IOL Master 700,且该差异随着AL的增加而增大,两种仪器对IOL的计算均具有良好的预测性,但IOL Master 700术后屈光误差更小,远视偏移百分比更低。

Clinical Effect Analysis of Posterior Chamber Intraocular Lens Implantation for Correcting High Myopia and Astigmatism

Objective:To explore the corrective effect of posterior chamber intraocular lens implantation with phakic eyes in the treatment of high myopia and astigmatism.Methods:From May 2023,the hospital began to collect the case data of diagnosis and treatment of high myopia and astigmatism.By May 2024,310 cases were included,all of which were treated with posterior chamber intraocular lens implantation.The visual acuity,astigmatism and axial position of the intraocular lens were observed before and after treatment.Results:At different time points after the operation,the patient’s vision was significantly improved compared with that before the operation(P<0.05),and the vision level was equal to or greater than the best-corrected vision before the operation.At different time points after the operation,the average rotation of the intraocular lens was less than 5 degrees.Astigmatism was significantly lower than that before the operation(P<0.05).After the operation,the intraocular pressure increased in 11 cases,accounting for 3.55%,with no adverse complications such as lens turbidity,glare and obvious halo occurring.Conclusion:The posterior chamber intraocular lens implantation with phakic eyes has an ideal correction effect in the treatment of high myopia and astigmatism,which can effectively improve the vision level of patients and reduce the degree of astigmatism,and has high effectiveness and safety.

Systematic bibliometric analysis of research hotspots and trends on the application of premium IOLs in the past 2 decades

AIM:To analysis of research hotspots and trends on the application of premium intraocular lens(PIOLs)in the past 2 decades.METHODS:The literature search was performed on the Web of Science and included PIOLs studies published between January 2000 and December 2022.The retrieved literature was collated and analyzed by R-tool’s Bibliometrix package,CitNetExplorer,CiteSpace and other software.RESULTS:A total of 1801 articles about PIOLs were obtained,most of which were published in Spain and the United States.The organization that published the most articles was the University of Valencia in Spain.Alió JL,and Montés-Micó R,from Spain were the most influential authors in this field.The Journal of Cataract and Refractive Surgery and Journal of Refractive Surgery were the core journals for this field;the top 10 cited articles mainly focus on postoperative satisfaction with multifocal intraocular lens(IOLs)and postoperative results of toric IOLs.Through the keyword analysis,we found that trifocal IOLs,astigmatism and extended depth of focus(EDoF)IOLs are the most discussed topics at present,and the importance of astigmatism and the clinical application of the new generation of PIOLs are the emerging research trends.CONCLUSION:Bibliometric analysis can effectively help to identify multilevel concerns in PIOLs research and the prevailing research trends in the realm of PIOLs encompass the adoption of EDoF IOLs,trifocal IOLs,and their respective Toric models.

Rotational stability of plate haptic toric intraocular lenses after combined 25-gauge vitrectomy and cataract surgery

AIM:To evaluate the postoperative intraocular lens(IOL)rotational stability and residual refractive astigmatism following combined 25-gauge vitrectomy and cataract surgery with implantation of a plate haptic toric IOL.METHODS:In this retrospective case series,32 eyes of 32 patients underwent a combined 25-gauge vitrectomy and phacoemulsification for vitreoretinal diseases and cataract with regular corneal astigmatism of at least 1 diopter(D).A plate haptic toric IOL(AT Torbi 709M,Carl Zeiss Meditec AG)was implanted in all eyes.The outcome measures were rotational stability and refractive astigmatism up to 6mo postoperatively as well as the best corrected visual acuity(BCVA).RESULTS:Preoperative refractive astigmatism was 2.14±1.17 D,which was significantly reduced to 0.77±0.37 D six to eight weeks postoperatively and remained stable throughout the observation period(0.67±0.44 D at three months and 0.75±0.25 D at six months;for all groups:P<0.0001 compared to baseline).BCVA improved significantly from 0.36±0.33 logMAR preoperatively to 0.10±0.15 logMAR following surgery(P=0.02).Mean IOL axis deviation from the target axis was 3.4°±2.9°after six to eight weeks and significantly decreased over time(2.4°±2.6°six months after surgery;P=0.04).In one patient IOL,re-alignment was performed.CONCLUSION:Corneal astigmatism is significantly reduced following combined 25-gauge vitrectomy and cataract surgery.The plate haptic toric IOL position and axis remain stable during the observation period of six months.

Flapless one-knot suture:a novel surgical technique for transscleral fixation of C-loop intraocular lenses

AIM:To describe a novel suture approach for transscleral fixation of C-loop intraocular lenses(IOL)and to compare the surgical outcomes with the four-haptics posterior chamber(PC)-IOL technique.METHODS:We retrospectively analyzed 16 eyes of 16 patients who underwent transscleral fixation of C-loop PCIOLs using a flapless one-knot suture technique,which were followed up for longer than 17mo.In this technique,the capsulorless IOL was suspended using a single suture for transscleral fixation of four feet.Then we compared its surgical outcomes and complications with the four-haptics PC-IOLs using the Student's t test and Chi-square test.RESULTS:Sixteen patients of 16 eyes with a mean age of 58.3±10.1y(42-76y)who received transscleral C-loop IOL implantation due to trauma,vitrectomy,or cataract surgery with inadequate capsule support showed improved visual acuity.The difference was not significant between two IOLs except the surgery time(P>0.05).The mean operation times of C-loop IOL surgery was 24.1±1.83min and 31.3±4.47min of the four-haptics PC-IOL method(P<0.0001).In the C-loop IOLs group,there was statistical difference between the preoperative and the postoperative UCVA(log MAR,1.20±0.50 vs 0.57±0.32,P=0.0003).There was no statistical difference between the preoperative and the postoperative BCVA(log MAR,0.66±0.46 vs 0.40±0.23,P=0.056).However,there was no statistically significant difference in postoperative UCVA and BCVA between the two IOLs(P>0.05).We did not detect any optic capture,IOL decentration or dislocation,suture exposed,or cystoid macular edema in patients underwent C-loop IOLs surgery.CONCLUSION:The novel flapless one-knot suture technique for transscleral fixation of C-loop IOL is a simple,reliable,and stable technique.

Surgical outcome comparisons of multifocal IOLs of Lentis Comfort LS-313 MF15 and Tecnis Eyhance DIB00V

AIM:To compare the surgical outcomes of a multifocal intraocular lens(IOL;Lentis Comfort LS-313 MF15)with those of an enhanced monofocal IOL(Tecnis Eyhance DIB00V).METHODS:This retrospective study included patients who underwent cataract surgery with LS-313 MF15 or Eyhance IOL implantation.Data regarding patient demographics,surgical records,and ophthalmic examination before the cataract surgery and one and three months postoperatively were collected.Visual acuities,refractive values,defocus curves,contrast sensitivities and subjective symptoms were evaluated.RESULTS:Among the 71 eyes(47 patients)included in this study,32 eyes(20 patients)underwent LS-313 MF15 IOL implantation,and 39 eyes(27 patients)underwent Eyhance IOL implantation.No significant differences were observed in age,axial length,or refractive error between the two groups preoperatively.Furthermore,the distancecorrected and uncorrected distance visual acuities one month postoperatively did not differ between the groups,and both groups had sufficient visual acuities at the distances of 5,1 m,70,50,and 30 cm.Other ophthalmic data,including subjective symptoms based on the 14-item Visual Function Index Questionnaire,monocular defocus curves,contrast sensitivities,and halo and glare,did not differ between the groups three months postoperatively.Moreover,both groups had good outcomes.The spherical equivalent one month postoperatively was significantly myopic in the LS-313 MF15 group compared with that in the Eyhance group(P=0.033);however,this difference was not observed three months postoperatively(P=0.471).CONCLUSION:Comparison of the surgical outcomes of LS-313 MF15 with those of Eyhance with different optical properties reveal that both IOLs show good postoperative outcomes,with no significant differences being noted between the two IOLs.

Pupillary capture following sutureless scleral-fixated intraocular lens in children with Marfan syndrome

AIM:To compare the clinical outcomes between two approaches for sutureless scleral-fixated intraocular lens(SFIOL)in children with Marfan syndrome(MFS).METHODS:The study included 15 children(26 eyes)with lens subluxation due to MFS.These children underwent lensectomy,anterior vitrectomy,and sutureless SFIOL.According to the position of placement of intraocular lens(IOL)haptics,two study groups were reviewed for best corrected visual acuity(BCVA)and postoperative complications:group A,14 eyes with haptics fixated at 2.0 mm from the limbus;group B,12 eyes with the haptics fixated at 2.5 mm from the limbus.RESULTS:The mean axial length for all patients was 25.66±2.35 mm.Postoperative BCVA in logMAR were significant improved in both groups(0.77±0.32 to 0.17±0.12 in group A,0.66±0.25 to 0.24±0.12 in group B,both P<0.001)while no significant difference between two groups(P>0.05).Pupillary capture was main postoperative complication,occurring between 3d and 18mo.It occurred in 7 eyes in group A and one eye in group B(P=0.02).CONCLUSION:Sutureless SFIOL is an effective treatment approach for lens subluxation in children with MFS.Pupillary capture is the main postoperative complication.Fixated IOL haptics at 2.5 mm from the limbus can reduce the occurrence of pupillary capture.

Clinical comparative analysis of the outcomes with a yellow- and a violet-tinted intraocular lens

Dear Sir,I am Dr. Peter Mojzis from Premium Clinic in Teplice （Czech Republic）. I write to present the results of a comparative study of clinical outcomes obtained with two different types of tinted intraocular lenses （IOLs）, yellow-vs violet-tinted IOLs. IOLs containing a yellow chromophore that filters simultaneously ultra violet （UV） and blue light were developed several years ago in the attempt of avoiding that blue and violet visible light reached the retina in the pseudophakic eye.

Etiology, pathogenesis, and management of acute intraocular lens opacification: a systematic review

Millions of cataract surgeries with intraocular lens(IOL) implantation are performed worldwide. Although cataract surgery brings many benefits to the patients, the risk of various complications is still a concern. One of the infrequent adverse events but potentially affecting on patients’ visual acuity and contrast sensitivity is losing the transparency of IOL. IOL opacification may lead to IOL removal or exchange, which is unpleasant to both the patient and the surgeon. Several reports of acute IOL clouding are available in the literature describing various etiologies of this phenomenon, however, the exact mechanism remained unclear in some cases. Herein, we aimed to review the causes and outcomes of intraoperative and early postoperative IOL opacification.

Objective electrophysiological contrast sensitivity with monofocal and multifocal intraocular lenses:a prospective clinical study

Background:To compare objective electrophysiological contrast sensitivity function(CSF)in patients implanted with either multifocal intraocular lenses(MIOLs)or monofocal intraocular lenses(IOLs)by pattern reversal visual evoked potentials(prVEP)measurements.Methods:Fourty-five cataract patients were randomly allocated to receive bilaterally:apodized diffractive-refractive Alcon Acrysof MIOL(A),full diffractive AMO Tecnis MIOL(B)or monofocal Alcon Acrysof IOL(C).Primary outcomes:1-year differences in objective binocular CSF measured by prVEP with sinusoid grating stimuli of 6 decreasing contrast levels at 6 spatial frequencies.Secondary outcomes:psychophysical CSF measured with VCTS-6500,photopic uncorrected distance(UDVA),and mesopic and photopic uncorrected near and intermediate visual acuities(UNVA and UIVA respectively).Results:Electrophysiological CSF curve had an inverted U-shaped morphology in all groups,with a biphasic pattern in Group B.Group A showed a lower CSF than group B at 4 and 8 cpd,and a lower value than group C at 8 cpd.Psychophysical CSF in group A exhibited a lower value at 12 cpd than group B.Mean photopic and mesopic UNVA and UIVA were worse in monofocal group compared to the multifocal groups.Mesopic UNVA and UIVA were better in group B.Conclusions:Electrophysiological CSF behaves differently depending on the types of multifocal or monofocal IOLs.This may be related to the visual acuity under certain conditions or to IOL characteristics.This objective method might be a potential new tool to investigate on MIOL differences and on subjective device-related quality of vision.

三种不同IOL植入术后短期的视力和视觉干扰现象及脱镜率的对比

目的:对比分析单眼植入三焦点、多焦点及连续视程人工晶状体(IOL)术后短期的视力、视觉干扰现象及脱镜率。方法:回顾性分析2019-03/2022-12行超声乳化白内障吸除联合IOL植入术的白内障患者67例67眼。35例35眼植入Symfony连续视程IOL;21例21眼植入AcrySof IQ ReSTOR+3D多焦点IOL;11例11眼植入AcrySof IQ PanOptix三焦点IOL。记录术前及术后3 mo裸眼远视力(UDVA)、中视力(UIVA)、近视力(UNVA),术后3 mo离焦曲线、视觉干扰现象及脱镜率。结果:术后3 mo,三组间UDVA无差异(P>0.05);Symfony组及PanOptix组UIVA优于ReSTOR组(均P<0.01);ReSTOR组及PanOptix组UNVA优于Symfony组(均P<0.01)。离焦曲线显示,在中视力区间(-1.00--1.50 D),Symfony组视力优于ReSTOR组(P<0.05);在近视力区间(-2.50--3.50 D),ReSTOR组视力优于Symfony组(P<0.05);PanOptix组在近视力区间(-2.00--3.50 D)的视力优于Symfony组(P<0.05),同时在中视力区间(-1.00--2.00 D)的视力优于ReSTOR组(P<0.05)。三组间眩光或光晕的发生率及双眼相互干扰现象发生率均无差异(P>0.05)。PanOptix组和ReSTOR组脱镜率比Symfony组高(P<0.0167)。结论:与Symfony连续视程IOL和ReSTOR多焦点IOL相比,PanOptix三焦点IOL能够兼顾远中近视力,眩光和光晕发生率不高,脱镜率较高;单眼植入老视矫正型IOL仍需慎重。

Lenstar LS900与IOLMaster测量眼前节生物参数及人工晶状体度数的比较

目的精确的眼生物测量对人工晶状体(intraocular lens,IOL)度数计算至关重要,尤其是眼轴及角膜曲率的测量。本研究将对比新一代光学低相干反射生物测量仪Lenstar LS900(Haag-Streit)与IOLMaster对眼前节参数及IOL测算的差异。方法应用Lenstar LS900和IOLMaster分别对30例(60眼)老年性白内障患者进行眼轴长度、前房深度、角膜曲率和散光轴方面的测量比较;分别利用2种设备计算IOL度数,均选用SRK/T计算公式和SA60AT(Alcon)IOL,在确定同一度数的前提下比较目标屈光度的差异。结果 Lenstar LS900和IOLMaster测量眼轴长度、前房深度、平均角膜曲率、陡峭轴角膜曲率之间差异均无统计学意义(均为P>0.05),且均具有良好的相关性(相关系数分别为0.999、0.955、0.936、0.845),而两种设备测得陡峭轴之间相关欠佳(r=0.579)。Lenstar LS900和IOLMaster所获得的术后目标屈光度值分别为(-0.02±0.17)D和(-0.07±0.23)D,差异无统计学意义(P>0.05)。Bland-Altman分析显示,2种设备获得的目标屈光值具有良好的一致性。结论 Lenstar LS900和IOLMaster两种设备测量眼前节参数及IOL度数具有良好的一致性。同时,Lenstar LS900还可以快速、准确的为白内障患者和屈光医师提供更多的眼生物参数。

Technique of using Cionni-modified capsular tension ring in the management of severely traumatic lens subluxation

AIM:To investigate the effect of Cionni-modified capsular tension ring(CTR)implantation in patients with severely traumatic subluxated cataracts.METHODS:All patients who totally had traumatic cataracts and lost zonule support and underwent cataract surgery were retrospectively analyzed.Corrected distance visual acuity(CDVA),extent of zonulysis,intraocular lens(IOL)position,intraoperative presentation,and complications were assessed.The primary outcomes included IOL centration stability and other postoperative complications.RESULTS:Twenty patients(20 eyes)were included in this study.The mean age in this study was 58.0±11.3y,and the average follow-up time was 17.3±12.8mo.Capsule bags were saved by Cionni-modified CTR.Nine eyes(45%)underwent simultaneously anterior vitrectomy due to the presence of vitreous in the anterior chamber.The preoperative mean CDVA was 0.83±0.24 log MAR,and the postoperative average CDVA was 0.23±0.30 log MAR(P<0.05).The horizontal and vertical IOL decentration after surgery was 0.27±0.12 mm and 0.41±0.19 mm,respectively;the vertical and horizontal IOL tilt after surgery was 5.5°±2.5°and 6.1°±2.2°,respectively.None of the eyes had obvious IOL decentration during the follow-up time.Eight eyes(40%)had posterior capsule opacification(PCO)that was severe enough to cause poor vision.Neodymium:YAG laser capsulotomy were performed on these eyes when the CTR was stabilized.CONCLUSION:With the help of Cionni-modified CTR,capsular bag preservation and better IOL concentration can be achieved without major complications in patients with severely traumatic subluxated cataracts.

Optical biometry intraocular lens power calculation using different formulas in patients with different axial lengths

AIM: To investigate the predictability of intraocular lens (IOL) power calculation using the IOLMaster and different IOL power calculation formulas in eyes with various axial length (AL). METHODS: Patients were included who underwent uneventful phacoemulsification with IOL implantation in the Department of Ophthalmology, Far Eastern Memorial Hospital, Taipei, Taiwan, China from February 2007 to January 2009. Preoperative AL and keratometric values (Ks) were measured by IOLMaster optical biometry. Patients were divided into 3 groups based on AL less than 22mm (Group 1), 22-26mm (Group 2), and more than 26mm (Group 3). The power of the implanted IOL was used to calculate the predicted postoperative spherical equivalence (SE) by various formulas: the Haigis, Hoffer Q, Holladay 1, and SRK/T. The predictive accuracy of each formula was analyzed by comparing the difference between the actual and predicted postoperative SE (MedAE, median absolute error). All the patients had follow-up periods exceeding 3 months. RESULTS: Totally, there were 200 eyes (33 eyes in Group 1, 92 eyes in Group 2, 75 eyes in Group 3). In all patients, the Haigis had the significantly lower MedAE generated by the other formulas (P【0.05). In Group 1 to 3, the MedAE calculated by the Haigis was either significantly lower or comparable to those calculated by the other formulas.CONCLUSION: Compared with other formulas using IOLMaster biometric data, the Haigis formula yields superior refractive results in eyes with various AL.

Long-term vision-threatening complications of phakic intraocular lens implantation for high myopia

AIMTo report the long-term vision-threatening complications in patients who underwent phakic intraocular lens (pIOLs) implantation for high myopia.

High order aberration and straylight evaluation after cataract surgery with implantation of an aspheric,aberration correcting monofocal intraocular lens

·AIM: To evaluate the quality of vision in respect to high order aberrations and straylight perception after implantation of an aspheric, aberration correcting,monofocal intraocular lens(IOL).·METHODS: Twenty-one patients(34 eyes) aged 50 to83 y underwent cataract surgery with implantation of an aspheric, aberration correcting IOL(Tecnis ZCB00,Abbott Medical Optics). Three months after surgery they were examined for uncorrected(UDVA) and corrected distance visual acuity(CDVA), contrast sensitivity(CS)under photopic and mesopic conditions with and without glare source, ocular high order aberrations(HOA, Zywave II) and retinal straylight(C-Quant).· RESULTS: Postoperatively, patients achieved a postoperative CDVA of 0.0 log MAR or better in 97.1% of eyes. Mean values of high order abberations were +0.02±0.27(primary coma components) and-0.04 ±0.16(spherical aberration term). Straylight values of the C-Quant were 1.35±0.44 log which is within normal range of age matched phakic patients. The CS measurements under mesopic and photopic conditions in combination with and without glare did not show any statistical significance in the patient group observed(P ≥0.28).· CONCLUSION: The implantation of an aspherical aberration correcting monofocal IOL after cataractsurgery resulted in very low residual higher order aberration(HOA) and normal straylight.

Predictive factors for photic phenomena after refractive,rotationally asymmetric,multifocal intraocular lens implantation

AIM： To investigate the independent factors associated with photic phenomena in patients implanted with refractive,rotationally asymmetric,multifocal intraocular lenses（MIOLs）.METHODS： Thirty-four eyes of 34 patients who underwent unilateral cataract surgery,followed by implantation of rotationally asymmetric MIOLs were included.Distance and near visual acuity outcomes,intraocular aberrations,preferred reading distances,preoperative and postoperative refractive errors,mesopic and photopic pupil diameters,and the mesopic and photopic kappa angles were assessed.Patients were also administered a satisfaction survey.Photic phenomena were graded by questionnaire.Independent-related factors were identified by correlation and bivariate logistic regression analyses.RESULTS： The distance from the photopic to the mesopic pupil center（pupil center shift） was significantly associated with glare/halo symptoms [odds ratio（OR）=2.065,95% confidence interval（CI）=0.916-4.679,P=0.006] and night vision problems（OR=1.832,95% CI=0.721-2.158,P=0.007）.The preoperative photopic angle kappa was significantly associated with glare/halo symptoms（OR=2.155,95% CI=1.065-4.362,P=0.041）.The photopic angle kappa was also significantly associated with glare/halo symptoms（OR=2.155,95% CI=1.065-4.362,P=0.041） and with night vision problems（OR=1.832,95% CI=0.721-2.158,P=0.007） in patients implanted with rotationally asymmetric MIOLs.CONCLUSION： A large pupil center shift and misalignment between the visual and pupillary axis（angle kappa）may play a role in the occurrence of photic phenomena after implantation of rotationally asymmetric MIOLs.

Effect of lens constants optimization on the accuracy of intraocular lens power calculation formulas for highly myopic eyes

AIM: To evaluate the effect of different lens constant optimization methods on the accuracy of intraocular lens(IOL) power calculation formulas for highly myopic eyes.METHODS: This study comprised 108 eyes of 94 consecutive patients with axial length(AL) over 26 mm undergoing phacoemulsification and implantation of a Rayner(Hove, UK) 920H IOL. Formulas were evaluated using the following lens constants: manufacturer’s lens constant, User Group for Laser Interference Biometry(ULIB) constant, and optimized constant for long eyes. Results were compared with Barrett Universal II formula, original Wang-Koch AL adjustment method, and modified Wang-Koch AL adjustment method. The outcomes assessed were mean absolute error(MAE) and percentage of eyes with IOL prediction errors within ±0.25, ±0.50, and ±1.0 diopter(D). The nonparametric method, Friedman test, was used to compare MAE performance among constants.RESULTS: Optimized constants could significantly reduce the MAE of SRK/T, Hoffer Q, and Holladay 1 formulas compared with manufacturer’s lens constant, whereas the percentage of eyes with IOL prediction errors within ±0.25, ±0.50, and ±1.0 D had no statistically significant differences. Optimized lens constant for long eyes alone showed non-significant refractive advantages over the ULIB constant. Barrett Universal II formula and formulas with AL adjustment showed significantly higher accuracy in highly myopic eyes(P<0.001). CONCLUSION: Lens constant optimization for the subset of long eyes reduces the refractive error only to a limited extent for highly myopic eyes.