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To compare the short-term outcomes of a non-cavitating lensectomy device (MICOR) to phacoemulsification. This was a two-arm prospective open-label clinical trial. Patients with visually significant cataracts at a single academic center between March and December 2023 were consecutively enrolled to undergo cataract surgery using either MICOR or phacoemulsification for nuclear fragmentation and lens removal. Adverse events (AE), lensectomy time, fluid use, and ultrasound energy use were assessed intraoperatively. Visual acuity, refraction, and AE were assessed on postoperative day one. A total of 34 eyes of 23 patients were included in the MICOR arm and 50 eyes of 32 patients in the phacoemulsification arm. No difference (p = 0.727) in logMAR best corrected distance visual acuity was observed postoperatively between MICOR (0.14 ± 0.25) and phacoemulsification (0.16 ± 0.33), nor was any difference observed in AE rates [3% versus 8%, respectively (p = 0.644)]. Lens removal time was faster with MICOR [209 vs 255 s (p = 0.003)], including for grade 2 cataracts [203 vs 237 s (p = 0.008)]. Irrigation volume was less for MICOR [33 vs 62 mL (p < 0.001)], including for grade 2 [34 vs 60 mL (p < 0.001)] and 3 cataracts [36 vs 60 mL (p = 0.004)]. Mean cumulative dissipated energy for phacoemulsification was 8.7. Compared to phacoemulsification, MICOR has similar visual outcomes and adverse event rates while requiring less time, irrigation fluid, and ultrasound energy, suggesting MICOR is a viable alternative to phacoemulsification.

To investigate different measures for corneal astigmatism in the context of reconstructed corneal astigmatism (recCP) as required to correct the pseudophakic eye, and to derive prediction models to map measured corneal astigmatism to recCP. Retrospective single centre study of 509 eyes of 509 cataract patients with monofocal (MX60P) IOL. Corneal power measured with the IOLMaster 700 keratometry (IOLMK), and Galilei G4 keratometry (GK), total corneal power (TCP2), and Alpin's integrated front (CorT) and total corneal power (CorTTP). Feedforward shallow neural network (NET) and linear regression (REG) prediction models were derived to map the measured C0 and C45 power vector components to the respective recCP components. Both the NET and REG models showed superior performance compared to a constant model correcting the centroid error. The mean squared prediction errors for the NET/REG models were: 0.21/0.33 dpt for IOLMK, 0.23/0.36 dpt for GK, 0.24/0.35 for TCP2, 0.23/0.39 dpt for CorT and 0.22/0.36 dpt for CorTTP respectively (training data) and 0.27/0.37 dpt for IOLMK, 0.26/0.37 dpt for GK, 0.38/0.42 dpt for TCP2, 0.35/0.36 dpt for CorT, and 0.44/0.45 dpt for CorTTP respectively on the test data. Crossvalidation with model optimisation on the training (and validation) data and performance check on the test data showed a slight overfitting especially with the NET models. Measurement modalities for corneal astigmatism do not yield consistent results. On training data the NET models performed systematically better, but on the test data REG showed similar performance to NET with the advantage of easier implementation.

To investigate refractive, visual, and safety outcomes of cataract surgery performed after scleral buckling (SB) for retinal detachment (RD). A chart review at an academic medical center identified eyes with history of SB followed by subsequent cataract extraction between 2010 and 2022. Eyes with less than 3 weeks follow-up, silicone oil at time of biometry measurement, previous cornea surgery, or co-existing pathology impacting refractive outcomes were excluded. Predicted postoperative spherical equivalents (SE) were calculated with the Barrett Universal II (BU2), Kane, and SRK/T formulas for the implanted intraocular lens (IOL), and complications occurring within 1 year of surgery were abstracted. Sixty eyes of 60 patients met criteria for inclusion, and 40 (66.7%) had postoperative refraction recorded. Absolute prediction errors were 0.49, 0.45, and 0.52D with BU2, Kane, and SRK/T, respectively. Actual postoperative refraction was within 0.5 and 1.0 D of predicted in 26 (65.0%) and 36 (90.0%) using BU2, 23 (58%) and 37 (93%) using Kane, and 21 (52.5%) and 36 (90.0%) using SRK/T. In eyes with macula-on RD, corrected distance visual acuity (CDVA) of logMAR 0.301 (≈20/40) and logMAR 0.544 (≈20/70) or better was achieved in 12 (75.0%) and 15 (93.8%) of eyes. For macula-off RD eyes, these proportions were 19 (63.3%) and 24 (80.0%), respectively. Posterior capsular opacification requiring Nd: YAG capsulotomy was the most frequent complication in 30 (56.7%) eyes. Refractive outcomes of cataract surgery following SB may be modestly reduced, even when using modern formulas. Nevertheless, cataract surgery in this population results in favorable visual outcomes.

To evaluate the efficacy of a femtosecond laser assisted astigmatic keratotomy (AK) nomogram (FemtoAK.com) for correction of astigmatism during cataract surgery. Consecutive patients underwent cataract extraction with AKs and insertion of a non-toric intraocular lens. Eyes with greater than 0.5 D of against-the-rule (ATR) or 1.0 D of with-the-rule (WTR) or oblique (OBL) astigmatism were treated in accordance with the nomogram. Optical biometry and manifest refraction were checked pre- and one-month post-operatively. Outcome measures included correction index (CI), index of success (IOS), and proportion of eyes with less than 0.5 and 1.0 D of astigmatism. Ninety-five eyes from 69 patients were included, of which 41 had ATR, 35 had WTR, and 19 had OBL astigmatism. Corneal CI (ATR = 0.86, WTR = 0.27) indicated a small and large under-correction of ATR and WTR astigmatism, respectively, while refractive CI revealed a near-ideal correction of WTR (ATR = 0.87, WTR = 1.02). The proportion of eyes with less than 0.5 and 1.0 D of refractive astigmatism increased from 28% and 54% pre-operatively to 56% and 92% post-operatively, respectively. The FemtoAK nomogram is effective at reducing corneal astigmatism at the time of cataract surgery. Astigmatic correction was more precise when evaluated by refractive rather than corneal measures.

To investigate the relative performance of modern intraocular lens (IOL) power calculation formulas over a wide range of biometric parameters. Through the concept of emmetropization there exists a mean keratometry, anterior chamber depth, lens thickness, and white-to-white for a given axial length (AL). Using a database of biometric values from 2721 surgery naïve eyes, these relationships were modeled and used to create an artificial dataset of 170 eyes with an anatomically realistic distribution of biometric parameters. Biometric values for each artificial eye were entered into the ESCRS IOL power calculation website. The emmetropic IOL power was calculated for Barrett Universal II, Cooke K6, Kane, PEARL-DGS, HofferQST, EVO v2.0, and Hill-RBF v3.0. Separately, emmetropic IOL powers were calculated for the Zeiss AI formula. The disparity between the formulas was evaluated to determine the ALs at which they diverged. For eyes with ALs between 22.5 and 28.1 mm, emmetropic IOL powers and spherical equivalent predictions differed by less than 0.25 D. Outside this range, spherical equivalent predictions differed by 0.25 D or more. At ALs < 19.5 mm the difference in emmetropic IOL power across the formulas exceeded 1.0 D. This work helped to identify an implementation error in Pearl-DGS, which was corrected in collaboration with the formula's author. Cataract surgeons should consider that formula choice still has a clinically meaningful impact on refractive outcomes in eyes with axial lengths of <22.5 mm and >28.1 mm. We estimate that this may represent more than 10% of the population.

To investigate the repeatability of a combined Dual-Scheimpflug placido disc corneal tomographer/topographer (Ziemer Galilei G4) with respect to keratometric indices used to monitor progression of keratoconus (KCN). Patients with KCN were prospectively enrolled. For each eye lacking history of corneal surgery, 5 measurements were taken in succession. Eyes in which 3 or more measurements could be obtained (defined by the device's 4 image quality metrics) were included in the analysis. The repeatability limits (RL) and interclass correlation coefficients (ICC) were calculated for various parameters. Thirty-two eyes from 25 patients met all image quality metrics, and 54 eyes from 38 patients met at least 3/4 criteria (all except the placido image quality metric). RLs for key parameters when 4/4 or ≥3/4 image quality metrics were met included: 0.37 and 0.77 diopters (D) for steep simulated keratometry, 0.79 and 1.65 D for maximum keratometry, 13.80 and 13.88 degrees for astigmatism axis, 0.64 and 0.56 µm for vertical coma magnitude, and 3.76 and 3.84 µm for thinnest pachymetry, respectively. The ICCs for all parameters were excellent (above 0.87) except for spherical aberration (0.77), which was still considered good. The dual-Scheimpflug placido disc corneal tomographer/topographer is highly repeatable in quantifying parameters used in monitoring KCN. Excellent placido images are difficult to capture in eyes with KCN, but when available, increase the reliability of the measurements. When clinicians find that a topographic index changes by more than the RLs defined herein, they can have confidence that this represents real change and may appropriately recommend interventions such as corneal cross-linking or intrastromal corneal ring segments.

Abstract Introduction: We present a case of a patient with osteogenesis imperfecta (OI) and keratoglobus (KG) who had a near-total rupture of Descemet’s membrane followed by spontaneous corneal clearing. This case is unique in that it demonstrates the potentially excellent outcome of conservative treatment for Descemet’s rupture in patients with KG and illustrates the impressive migratory potential of healthy endothelial cells. Case Presentation: An 11-year-old girl with OI and KG who had rupture and near-total detachment of Descemet’s membrane presented for evaluation. This was managed conservatively and resulted in the eventual spontaneous clearing of the cornea. A similar process happened in the fellow eye some years later. Given the result of conservative management originally, the patient was once again treated conservatively, with significant improvement in corneal edema and visual acuity. Conclusion: Given the size of the ruptures, this case highlights the dynamic nature of the corneal endothelium and provides an extreme example of the migratory potential of corneal endothelial cells.

Objectives To investigate the effect of adjunct micro-interventional pre-treatment for nucleus disassembly on the surgical efficiency of non-cavitating lensectomy during cataract surgery. Methods and analysis 12 surgeons performed 512 consecutive cataract extractions using a sonic cavitation-free lensectomy with or without adjunct pre-treatment for nucleus disassembly. There were 2 interventional arms including (1) lensectomy without adjunct pre-treatment and (2) lensectomy with micro-interventional miLOOP pre-treatment. Results Successful lensectomy was achieved in all eyes using cavitation-free sonic lensectomy. Average baseline cataract density was 2.28 and 2.39 in the three groups, respectively. Compared to no pre-treatment, nucleus evacuation time was 24% (p = < 0.001) faster with micro-interventional nucleus disassembly. Irrigation/aspiration (I/A) time was 14% faster with the micro-interventional pre-treatment (p = < 0.001). Irrigation fluid use was 24% less with micro-interventional. There was a low rate of capsular tear of 1 case across 512 cases with no other unanticipated complications. Conclusion Micro-interventional pre-treatment for nucleus disassembly was associated with improved lensectomy time and fluidic efficiency compared to no pre-treatment. Non-cavitating lensectomy with the miCOR lens pen achieved effective fragmentation and extraction in all grades of cataract.

The purpose of this study was to compare the Barrett (BTC) and Emmetropia Verifying Optical (EVO) Toric Calculators' performance with regards to prediction of residual post-operative astigmatism after cataract surgery. This was a secondary analysis of de-identified data that was collected as part of a prospective multicenter clinical trial in which 109 eyes from 109 patients were implanted with a monofocal toric intraocular lens (IOL). Post-operative biometry was used to calculate the predicted post-operative residual astigmatism for each eye using the two different calculators. The vector difference between the actual and predicted residual astigmatism was calculated. The mean absolute astigmatism prediction errors were 0.59 ± 0.38 D and 0.59 ± 0.36 D for the BTC and EVO calculators, respectively (p = 0.98). The centroid of the prediction errors were 0.18 D @ 89° ± 0.68 D and 0.20 D @ 89° ± 0.66 D, respectively (p = 0.21). The proportion of eyes in which the astigmatism prediction error was ≤0.5 D was 50% for BTC and 46% for EVO (p = 0.28). The proportion of eyes in which the post-operative astigmatism orientation was correctly predicted as being against-the-rule, with-the-rule, or oblique was 81% for BTC and 77% for EVO (p = 0.15). The Barrett and Emmetropia Verifying Optical Toric Calculators had similar performance with regards to their astigmatism prediction accuracy.

To compare predictability of postoperative refractive astigmatism (RA) using the Emmetropic Verifying Optical (EVO) Toric Formula v2.0 to one that accounts only for anterior corneal astigmatism. This is a secondary analysis of de-identified data from a clinical trial including 9 sites across the United States. Preoperative biometry was used to predict postoperative RA with the implanted toric IOL using legacy enVista and EVO online calculators. The RA prediction error was computed between back-calculated postoperative RA and predicted residual RA. Outcome measures included vector (centroid) and arithmetic mean RA prediction error. Comparison of calculators was based on 109 eyes, 97 (89%) of which were implanted with a toric IOL with an effective astigmatism power of 1.4 D or less. Centroid of the RA prediction errors was 0.37 D @ 178 and 0.17 D @ 090 for the legacy and EVO calculators, respectively (p < 0.0001). The proportion of eyes with an absolute RA prediction error ≤0.5 was 47.3% and 49.1% (p = 0.78), while the proportion of eyes ≤1.0 D was 82.7% and 89.1% (p = 0.03). Differences in the proportions ≤0.5 D existed for WTR (p = 0.015) but not ATR (p = 0.75) eyes. The proportion in which orientation of the predicted RA (ATR, WTR, or oblique) matched the actual RA was 62% and 78% for legacy and EVO calculators, respectively (p = 0.0029). The EVO Toric Formula v2.0 out-performed the legacy calculator with regards to predictions in eyes with low astigmatism.