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 exchange or explantation post cataract surgery

AIM:To report incidence,indications,and visual outcomes of intraocular lens(IOL)exchange/explantation surgery.METHODS:Retrospective analysis of 60 eyes requiring IOL exchange/explantation surgery between 1^(st) January 2017 and 31^(st) December 2022.The overall outcomes as well as comparison between the trainee versus experienced surgeons were analyzed.RESULTS:Out of 39778 cataract surgeries(with no preexisting ocular co-morbidities)during a six-year period(2017-2022),60(0.15%)needed IOL exchange/explantation.Surgeons-under-training performed 36/60 cases(60%)while 24/60(40%)were by experienced surgeons.The commonest indication was subluxated IOL in 26(43.3%),followed by dislocated IOL in 20(33.3%),postoperative refractive surprise in 7(11.6%),IOL induced uveitis in five and broken haptic in two eyes.Twenty-four(40%)eyes had intraoperative complications during primary surgery.Posterior chamber IOL(PCIOL)was the commonest secondary IOL in 21(35%)eyes,scleral fixated in 20(31.6%),anterior chamber IOL(ACIOL)in 13(21.6%),iris fixated IOL in three(5%)and three eyes(5%)were left aphakic.The mean time between primary and secondary surgery was 168d(168±338.8).Best corrected visual acuity(BCVA)of>20/60 was obtained in 43 eyes(71.66%),20/80-20/200 in 14(23.33%),20/250 in two and hand movements in one.No statistically significant difference in visual outcome was noted at post-op one month between trainees versus experienced surgeons(UCVA 0.45±0.29 vs 0.53±0.32,P=0.20,BCVA 0.34±0.25 vs 0.37±0.26,P=0.69).CONCLUSION:IOL subluxation as the commonest indication and posterior capsular rupture is the commonest intraoperative risk factor.This complication can be effectively addressed with selection of the appropriate secondary IOL achieving good visual outcomes in over 70% of patients.

Early clinical outcome with lens position adjustment following implantable collamer lens surgery

AIM:To observe early clinical outcome with lens position adjustment following the implantable collamer lens(ICL)surgery.METHODS:Sixty patients were selected for this retrospective study.One eye from each patient received Toric ICL for astigmatism correction,and the other received non-astigmatic ICL surgery using horizontal position.Patients with higher postoperative arch height were selected,and their non-astigmatic eye clinical outcome were observed after ICL surgery at 1wk,1,and 3mo.The clinical measurements included uncorrected visual acuity(UCVA),intraocular pressure(IOP),refractive state,corneal endothelium cell count,and arch height.Three months later,the ICL in each patient’s non-astigmatic eye was adjusted to the vertical from the horizontal position.The results were compared before and 1wk,1,and 3mo after adjustment.RESULTS:UCVA and IOP were significantly reduced 1wk after position adjustment compared to 1wk after ICL implantation(P<0.05).The patients demonstrated significantly reduced arch height and corneal endothelium cell count 1wk,1,and 3mo after adjusting position compared to 1wk,1,and 3mo after ICL implantation(P<0.05).However,there was no significant difference in refraction between 1wk,1,and 3mo after ICL implantation and position adjustment(P>0.05).CONCLUSION:Early positioning adjustment postphakic ICL implantation can benefit patients with adjusted arch height or higher IOP.Despite the good clinical effects,the doctors should pay attention to the potential for adverse effects on UCVA and corneal endothelium cells following early position adjustment after posterior chamber phakic ICL implantation.

Evaluating the Effects of Graviton Redshift upon Spiral Galaxy Rotation Curves, Surface Brightness Magnitudes and Gravitational Lensing

The effects of the gravitational redshift of gravitons upon spiral galaxy rotation energy are compared to the standard mass to light analyses in obtaining rotation curves. The derivation of the total baryonic matter compares well with the standard theory and the rotation velocity is matched to a high precision. The stellar mass distributions obtained from the fit with graviton energy loss are used to derive the surface brightness magnitudes for the galaxies, which agree well with the observed measurements. In a new field of investigation, the graviton theory is applied to the observations of gravitational lenses. The results of these applications of the theory suggest that it can augment the standard methods and may eliminate the need for dark matter.

Clinical prediction of insufficient vaults after implantable collamer lens implantation

AIM:To determine the factors related to preoperative ocular characters that are predictive of insufficient vault(<250μm)after implantable collamer lens(ICL V4c;STAAR Surgical)implantation.METHODS:The participants underwent ICL surgery and were divided into the low(<250μm)and normal(250-1000μm)vault groups based on the postoperative vault at 3mo.The preoperative biometric parameters and clinical outcomes were compared between the two groups.The relationship between the 3-month vault values and preoperative ocular parameters were evaluated by Generalized estimating equations.RESULTS:Sixteen(23 eyes)and 36 patients(63 eyes)were in the low and normal vault groups,respectively.All implantation procedures were uneventful with no cataract formation in the early postoperative period.The sulcusto-sulcus lens rise(STSL)and iris ciliary angle(ICA)were correlated with vault at 3mo after surgery.Every 0.1 mm increase in STSL was associated with 38.9μm decrease in the postoperative 3-month vault.A rise of 1 degree in ICA is associated with a reduction of 4μm in vault.CONCLUSION:Eyes with a narrow ciliary sulcus are associated with a higher rate of low vault after ICL implantation,suggesting a need for adjustments to the ICL size in these patients.Evaluating the characteristics of the ciliary sulcus contributes valuable information to predict low vault after surgery.

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.

Impact of multifocal gas-permeable lens designs on short-term choroidal response, axial length, and retinal defocus profile

AIM:To investigate the impact of multifocal gas permeable contact lens(MFGPCL)in various add power and distance/near area allocation on short-term changes of choroidal thickness(ChT),axial length(AL),and retinal defocus profile in young adults.METHODS:Seventeen young adults(2 males and 15 females;age 23.17±4.48y)were randomly assigned to wear two designs binocularly with a one-week washout period in between.Total of four MFGPCL designs were assessed.All designs were distance-center that varied in two add power(+1.50 and 3.00 D)and/or two distance zone(DZ)diameters(1.50 and 3.00 mm;design A:DZ 1.5/add 3.0,B:DZ 1.5/add 1.5,C:DZ 3.0/add 3.0,D:DZ 3.0/add 1.5).ChT,AL,and peripheral refraction data were collected on each subject at baseline,on days 1 and 7 of MFGPCL daily wear.ChT was assessed in four quadrants using a spectraldomain optical coherence tomography.RESULTS:AL was shortened by-26±44μm with lens C,-18±27μm with lens D,-13±29μm with lens A,and-8±30μm with lens B(all P<0.05).A significant overall increase in ChT was observed with all 4 designs(lens A:+6±6μm,B:+3±7μm,C:+8±7μm,and D:+8±7μm).Temporal and superior choroid exhibited more choroidal thickening associated with MFGPCL.All designs induced significant relative peripheral myopia(RPM)beyond the central 20o across the horizontal meridian in both nasal and temporal fields(P<0.05).CONCLUSION:MFGPCLs show a significant influence on ChT and AL,which are associated with significant increase in RPM after short-term wear.The reliability and feasibility of quantifying short-term changes in ChT support its use as a promising marker for the long-term efficacy of myopia-controlling treatments.

Rhegmatogenous retinal detachment in highly myopic eyes with implantable collamer lens

AIM:To investigate the clinical characteristics,treatment methods and outcomes of rhegmatogenous retinal detachment(RRD)in highly myopic eyes with implantable collamer lens(ICL).METHODS:High myopia patients who received treatment for nontraumatic RRD after ICL implantation surgery at the Retinal Department of Zhongshan Ophthalmic Center from Jan 2018 to Dec 2022 were reviewed.Comprehensive ophthalmologic examinations including visual acuity measurement and digital fundus photography were performed in each patient.RESULTS:A total of nine RRD eyes from nine patients who received V4c-ICL implantation were included.The mean time from ICL implantation surgery to the diagnosis of RRD was 32.44±22.56mo(range,1-60mo).At the initial visit for RRD,giant retinal tear(GRT),horseshoe tear,simple round hole,and horseshoe tear combined with round hole were detected in 3,3,2,and 1 eye(s),respectively,with maculaoff in eyes.Eight patients received surgical treatment,and one patient was treated by retinal laser photocoagulation alone.The ICL was preserved in 7 eyes.At the last followup,the mean best corrected visual acuity(BCVA)improved significantly from 1.76±1.06 logMAR at presentation to 0.81±1.01 logMAR(P=0.035),and no case of recurrent retinal detachment was found.CONCLUSION:The morphological presentation of retinal breaks is diverse in this study.The ICL can be preserved in most cases during the course of retinal detachment repair surgery in our data,companied with acceptable visual and anatomical outcomes.

Effectiveness and safety of early lens extraction during par plana vitrectomy for proliferative diabetes retinopathy with mild cataract:a randomized clinical trial

●AIM:To evaluate the effectiveness and safety of early lens extraction during pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR)compared to those of PPV with subsequent cataract surgery.●METHODS:This multicenter randomized controlled trial was conducted in three Chinese hospitals on patients with PDR,aged>45y,with mild cataracts.The participants were randomly assigned to the combined(PPV combined with simultaneously cataract surgery,i.e.,phacovitrectomy)or subsequent(PPV with subsequent cataract surgery 6mo later)group and followed up for 12mo.The primary outcome was the change in best-corrected visual acuity(BCVA)from baseline to 6mo,and the secondary outcomes included complication rates and medical expenses.●RESULTS:In total,129 patients with PDR were recruited and equally randomized(66 and 63 in the combined and subsequent groups respectively).The change in BCVA in the combined group[mean,36.90 letters;95%confidence interval(CI),30.35–43.45]was significantly better(adjusted difference,16.43;95%CI,8.77–24.08;P<0.001)than in the subsequent group(mean,22.40 letters;95%CI,15.55–29.24)6mo after the PPV,with no significant difference between the two groups at 12mo.The overall surgical risk of two sequential surgeries was significantly higher than that of the combined surgery for neovascular glaucoma(17.65%vs 3.77%,P=0.005).No significant differences were found in the photocoagulation spots,surgical time,and economic expenses between two groups.In the subsequent group,the duration of work incapacity(22.54±9.11d)was significantly longer(P<0.001)than that of the combined group(12.44±6.48d).●CONCLUSION:PDR patients aged over 45y with mild cataract can also benefit from early lens extraction during PPV with gratifying effectiveness,safety and convenience,compared to sequential surgeries.

Design and fabrication of compound varifocal lens driven by polydimethylsiloxane film elastic deformation

A compound varifocal lens based on electromagnetic drive technology is designed and fabricated, where the polydimethylsiloxane(PDMS) film acts as a driving component, while the PDMS biconvex lens and the plane-concave lens form a coaxial compound lens system. The plane-concave lens equipped with driving coils is installed directly above the PDMS lens surrounded by the annular magnet. When different currents are applied, the annular magnet moves up and down, driving the PDMS film to undergo elastic deformation, and then resulting in longitudinal movement of the PDMS lens. The position change of the PDMS lens changes the focal length of the compound lens system. To verify the feasibility and practicability of this design, a prototype of our compound lens system is fabricated in experiment. Our proposed compound lens shows that its zoom ability reaches 9.28 mm when the current ranges from -0.20 A to 0.21 A.

Overexpression of TRPV1 activates autophagy in human lens epithelial cells under hyperosmotic stress through Ca^(2+)-dependent AMPK/mTOR pathway

●AIM:To explore whether autophagy functions as a cellular adaptation mechanism in lens epithelial cells(LECs)under hyperosmotic stress.●METHODS:LECs were treated with hyperosmotic stress at the concentration of 270,300,400,500,or 600 mOsm for 6,12,18,24h in vitro.Polymerase chain reaction(PCR)was employed for the mRNA expression of autophagyrelated genes,while Western blotting detected the targeted protein expression.The transfection of stub-RFP-sens-GFPLC3 autophagy-related double fluorescence lentivirus was conducted to detect the level of autophagy flux.Scanning electron microscopy was used to detect the existence of autolysosome.Short interfering RNA of autophagy-related gene(ATG)7,transient receptor potential vanilloid(TRPV)1 overexpression plasmid,related agonists and inhibitors were employed to their influence on autophagy related pathway.Flow cytometry was employed to test the apoptosis and intracellular Ca^(2+)level.Mitochondrial membrane potential was measured by JC-1 staining.The cell counting kit-8 assay was used to calculate the cellular viability.The wound healing assay was used to evaluate the wound closure rate.GraphPad 6.0 software was utilized to evaluate the data.●RESULTS:The hyperosmotic stress activated autophagy in a pressure-and time-dependent manner in LECs.Beclin 1 protein expression and conversion of LC3B II to LC3B I increased,whereas sequestosome-1(SQSTM1)protein expression decreased.Transient Ca^(2+)influx was stimulated caused by hyperosmotic stress,levels of mammalian target of rapamycin(mTOR)phosphorylation decreased,and the level of AMP-activated protein kinase(AMPK)phosphorylation increased in the early stage.Based on this evidence,autophagy activation through the Ca^(2+)-dependent AMPK/mTOR pathway might represent an adaptation process in LECs under hyperosmotic stress.Hyperosmotic stress decreased cellular viability and accelerated apoptosis in LECs and cellular migration decreased.Inhibition of autophagy by ATG7 knockdown had similar results.TRPV1 overexpression increased autophagy and might be crucial in the occurrence of autophagy promoted by hyperosmotic stress.●CONCLUSION:A combination of hyperosmotic stress and autophagy inhibition may be a promising approach to decrease the number of LECs in the capsular bag and pave the way for improving prevention of posterior capsular opacification and capsular fibrosis.

Refractive outcomes after V4c Toric collamer lens implantation over 1y of follow-up

AIM:To evaluate refractive outcomes and corneal astigmatism changes after Toric implantable collamer lens with a central port(V4c T-ICL)implantation over 1y of follow-up.METHODS:A retrospective study was performed including 50 eyes of 50 patients that underwent V4c T-ICL implantation.Uncorrected(UDVA)and corrected(CDVA)distance visual acuities,refraction,refractive and corneal astigmatism changes and corneal coupling correction were evaluated preoperatively,1 and 12mo postoperatively.Vector analysis was used for astigmatism changes.Coefficient of adjustment(CAdj)was calculated for corneal coupling analysis.RESULTS:The mean UDVA achieved was 0.03 logMAR at 1mo and remained unchanged throughout the whole follow-up(P=0.193).At the last visit,84%of the eyes achieved a CDVA of 0.00 logMAR or better.Regarding spherical equivalent refraction(SEQ),96%of eyes were ranges of±1.00 D and 84%of them within±0.50 D.Also,94%of eyes had a remaining refractive cylinder within±1.00 D and 78%of them within±0.50 D.Both,SEQ and refractive cylinder,remain stable over the postoperative follow-up(P=1.000 and P=0.660,respectively).In terms of surgically induced astigmatism(SIA),no statistically significant differences were found over the follow-up(P=0.102)and under correction was found with a correction index lower than the unit at each visit.A keratometric astigmatism induced of 0.59±0.53(vector mean:0.26×73º)D was reached at the last visit.No significant changes in terms of corneal astigmatism orientation were reported over post-surgery visits(P=0.129 and P=0.097 at 1 and 12mo respectively).No clinical significance was found for CAdj on with-the-rule astigmatism.No postoperative complications resulting from the surgery were found.CONCLUSION:Refractive outcomes suggest that the V4c T-ICL implantation for correction of myopic astigmatism was satisfactory in terms of effectiveness,safety,and stability during 1y of follow-up.Corneal astigmatism induced by the incision around 0.5 D is achieved according to the remaining refractive cylinder found at one-year post-surgery.Corneal coupling analysis results in no unexpected spherical change.

Large-field objective lens for multi-wavelength microscopy at mesoscale and submicron resolution

Conventional microscopes designed for submicron resolution in biological research are hindered by a limited field of view,typically around 1 mm.This restriction poses a challenge when attempting to simultaneously analyze various parts of a sample,such as different brain areas.In addition,conventional objective lenses struggle to perform consistently across the required range of wavelengths for brain imaging in vivo.Here we present a novel mesoscopic objective lens with an impressive field of view of 8 mm,a numerical aperture of 0.5,and a working wavelength range from 400 to 1000 nm.We achieved a resolution of 0.74μm in fluorescent beads imaging.The versatility of this lens was further demonstrated through high-quality images of mouse brain and kidney sections in a wide-field imaging system,a confocal laser scanning system,and a two-photon imaging system.This mesoscopic objective lens holds immense promise for advancing multi-wavelength imaging of large fields of view at high resolution.

SIRT1 inhibits apoptosis of human lens epithelial cells through suppressing endoplasmic reticulum stress in vitro and in vivo

AIM:To explore the effect of silent information regulator factor 2-related enzyme 1(SIRT1)on modulating apoptosis of human lens epithelial cells(HLECs)and alleviating lens opacification of rats through suppressing endoplasmic reticulum(ER)stress.METHODS:HLECs(SRA01/04)were treated with varying concentrations of tunicamycin(TM)for 24h,and the expression of SIRT1 and C/EBP homologous protein(CHOP)was assessed using real-time quantitative polymerase chain reaction(RT-PCR),Western blotting,and immunofluorescence.Cell morphology and proliferation was evaluated using an inverted microscope and cell counting kit-8(CCK-8)assay,respectively.In the SRA01/04 cell apoptosis model,which underwent siRNA transfection for SIRT1 knockdown and SRT1720 treatment for its activation,the expression levels of SIRT1,CHOP,glucose regulated protein 78(GRP78),and activating transcription factor 4(ATF4)were examined.The potential reversal of SIRT1 knockdown effects by 4-phenyl butyric acid(4-PBA;an ER stress inhibitor)was investigated.In vivo,age-related cataract(ARC)rat models were induced by sodium selenite injection,and the protective role of SIRT1,activated by SRT1720 intraperitoneal injections,was evaluated through morphology observation,hematoxylin and eosin(H&E)staining,Western blotting,and RT-PCR.RESULTS:SIRT1 expression was downregulated in TMinduced SRA01/04 cells.Besides,in SRA01/04 cells,both cell apoptosis and CHOP expression increased with the rising doses of TM.ER stress was stimulated by TM,as evidenced by the increased GRP78 and ATF4 in the SRA01/04 cell apoptosis model.Inhibition of SIRT1 by siRNA knockdown increased ER stress activation,whereas SRT1720 treatment had opposite results.4-PBA partly reverse the adverse effect of SIRT1 knockdown on apoptosis.In vivo,SRT1720 attenuated the lens opacification and weakened the ER stress activation in ARC rat models.CONCLUSION:SIRT1 plays a protective role against TM-induced apoptosis in HLECs and slows the progression of cataract in rats by inhibiting ER stress.These findings suggest a novel strategy for cataract treatment focused on targeting ER stress,highlighting the therapeutic potential of SIRT1 modulation in ARC development.

Effect of capsule treatment on visual acuity and quality after phacoemulsification lens implantation in myopic patients with cataract

BACKGROUND Cataracts pose a significant clinical burden due to their complex pathogenesis.In recent years,an increase in cataracts coexisting with myopia has heightened the incidence of retinopathy and posterior vitreous detachment.Additionally,symptoms of ocular axis elongation,lens nucleus hardening,and vitreous liquefaction have become more prevalent.While conventional extracapsular cataract extraction is commonly employed,it often yields suboptimal visual outcomes.Subsequent advancements in cataract phacoemulsification and lens implantation surgeries have gained widespread acceptance for their ability to improve refraction and significantly improve uncorrected visual acuity.AIM To investigate the effect of capsular treatment after phacoemulsification lens implantation in myopic patients with cataract.METHODS We selected 110 patients(with 134 eyes)with myopia and cataracts treated.These patients were categorized into two groups:an observation group(57 patients with 70 eyes)and a control group(53 patients with 64 eyes).The control group underwent cataract phacoemulsification and lens implantation,while the observation group received a refined capsular treatment based on the control group’s procedure.We assessed the differences in visual acuity and quality between the two groups before and after surgery.RESULTS At six months post-operation,the observation group exhibited significantly improved far vision,intermediate vision,near vision,lower objective scattering index,higher Modulation transfer function cut-off frequency,and overall vision metrics at different contrast levels(100%,20%and 9%)compared to the control group(P<0.05).The total score of the National Eye Institute Visual Function Questionnaire in the observation group at 6 months after operation was significantly higher than that in the control group(P<0.05).No significant difference in the incidence of adverse reactions was observed between the observation group and control group(P>0.05).CONCLUSION Capsular treatment demonstrates efficacy in improving visual acuity and quality after phacoemulsification lens implantation in myopic patients with cataracts,warranting its clinical application.

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.

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。

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.

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.

Transient vacuolar changes of the crystalline lens in patients using a dispersive ophthalmic viscosurgical device

AIM:To report the clinical prognosis and pathological findings of accidental lens vacuolar changes in eyes with intraoperative exposure to a dispersive ophthalmic viscosurgical device(OVD).METHODS:Two patients who developed transient lens vacuolar changes during uneventful persistent pupillary membrane(PPM)removal surgery were presented and followed up.This event was speculated to be associated with an intraoperative dispersive OVD DisCoVisc(hyaluronic acid 1.6%-chondroitin sulfate 4.0%)exposure.Then,to provide the pathological basis for our speculation,another four cataract patients were randomly exposed to different OVDs,and their anterior lens capsules were investigated with transmission electron microscopy(TEM).RESULTS:After months,the subcapsular vacuoles in both PPM cases were gradually disappeared without visual deterioration.For the cataract patients,similar lens changes were observed intraoperatively in those exposed to a dispersive DisCoVisc but not a cohesive OVD IVIZ(sodium hyaluronate gel 1.0%).In addition,marked ultrastructural changes,including chromatin condensation,extensive cytoplasmic vacuoles,and obvious intercellular space between lens epithelial cells in the anterior lens capsules of all eyes exposed to DisCoVisc,were observed by TEM.CONCLUSION:The lens vacuolar changes may be associated with a dispersive OVD exposure.Therefore,it is not preferable to use dispersive OVDs in patients with transparent lenses or without the intention of lens extraction.In addition,close follow-ups instead of immediate lens extraction are recommended for the occurrence of similar lens lesions.