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Patients with large iris defects not only suffer from functional disadvantages but also from aesthetic limitations. The aim of this study was to evaluate the aesthetic outcome of iris reconstruction using an artificial iris (AI). In this study, 82 eyes of 79 consecutive patients with mostly traumatic partial or total aniridia that underwent iris reconstruction surgery using a custom-made silicone AI (HumanOptics, Erlangen, Germany). Pre- and postoperative photographs of 66 patients were analysed subjectively and objectively. Subjective evaluation was based questionnaires. Objective evaluation included measurement of pupil centration and iris colour analysis. Averaged hues from iris areas were transferred to numerical values using the LAB-colour-system. Single parameters and overall difference value (ΔE) were compared between AI and remaining iris (RI), as well as AI and fellow eye iris (FI). Patients, eye doctors and laymen rated the overall aesthetic outcome with 8.9 ±1.4, 7.7 ±1.1 and 7.3 ±1.1 out of 10 points, respectively. Mean AI decentration was 0.35 ±0.24 mm. Better pupil centration correlated with a higher overall score for aesthetic outcome (p<0.05). The AI was on average 4.65 ±10 points brighter than RI and FI. Aniridia treatment using a custom-made artificial iris prosthesis offers a good aesthetic outcome. Pupil centration was a key factor that correlated with the amount of aesthetic satisfaction. The AI was on average slightly brighter than the RI and FI.

Ray propagation visualization and optical performance analysis of four different intraocular lenses (IOLs). In this laboratory study, four IOLs with different optical designs were assessed: a monofocal AcrySof IQ SN60WF [Alcon], a diffractive-refractive bifocal AcrySof IQ Restor SN6AD1 [Alcon], a diffractive trifocal AcrySof IQ PanOptix TFNT00 [Alcon], and a diffractive extended-depth-of-focus (EDOF) Symfony ZXR00 [Johnson&Johnson]. An experimental set-up with a water bath containing 0.01% fluorescein solution and monochromatic green laser light (532 nm) was used to visualize the propagation of light rays. Also, the optical performance of the IOLs was evaluated by measuring the modulation transfer function (MTF) values at a pupil sizes of 3.0 and 4.5 mm on the optical bench OptiSpheric® IOL PRO II (Trioptics GmbH, Germany). Both the diffractive-refractive bifocal IOL and the EDOF IOL showed two defined foci for distance and near vision. In the diffractive trifocal IOL, three distinct foci for distance, intermediate, and near vision could be visualized. The ray propagation visualization technique allows a qualitative assessment and comparison of light energy distribution between different IOL models. The measured Through-Focus Response (TFR) quantitatively confirmed the evaluated ray propagation behavior.

In this laboratory study, we assessed the resistance to microvacuole (glistening) formation in hydrophobic intraocular lenses (IOLs). Glistenings were induced in five lenses each of five different hydrophobic acrylic IOL models, using an established in vitro laboratory model: 800C (Rayner, Worthing, UK), AcrySof SN60WF (Alcon, Fort Worth, USA), Tecnis ZCB00 (Johnson & Johnson Vision, Santa Ana, USA), Vivinex XY1 (Hoya, Tokyo, Japan) and CT Lucia 611P (Zeiss, Oberkochen, Germany). We evaluated the number of microvacuoles per square millimeter (MV/mm 2 ) in the central part of each IOL. Results were analyzed statistically, and mean glistening numbers were ranked, with the highest in the SN60WF which had 66.0 (±45.5) MVs/mm, followed by the 611P with 30.7 (±8.4) MVs/mm 2 . The 800C and XY1 showed comparable values of 2.0 (±3.6) and 2.7 (±2.4) MVs/mm 2 , respectively. ZCB00 had the lowest number with 0.9 (±0.6) MVs/mm 2 . This study shows that the resistance to glistening formation differs depending on the hydrophobic acrylic copolymer composition of the IOL material. Some IOLs from current clinical use are still prone to develop glistenings whereas others, including the ZCB00, 800C and XY1 show high resistance to microvacuole formation.

To evaluate the long-term posterior capsule opacification (PCO) formation, and glistening rate of the HOYA Vivinex (XY1) IOL compared to Alcon AcrySof (SN60WF). In this prospective, multicentric, randomized, paired-eye, open-label study, we included 87 subjects that underwent cataract surgery with IOL implantation, with 67 patients completing the 3-year follow-up. The completer population consisted of 32 subjects implanted with XY1 and 35 implanted with SN60WF. Primary endpoints consisted of the evaluation of glistenings and measurement of PCO. Secondary outcomes included Best Corrected Distance Visual Acuity (BCVA), Contrast Acuity (CA), uncorrected visual acuities, subjective refraction, medical and lens complication rates, adverse events, and optical/visual symptoms. Follow-up visits occurred at 6-months, 1-, 2- and 3-years. At 3-years follow-up, mean PCO score was 0.121 ± 0.193 for eyes implanted with Vivinex versus 0.239 ± 0.463 for AcrySof ( p  = 0.026). The Vivinex IOL showed statistically significantly lower glistening occurrence through 3-years postoperatively (0.14 ± 0.26) compared to AcrySof (1.79 ± 1.43; p  < 0.0001). Postoperative visual acuities improved from baseline in both IOL groups ( p  < 0.0001), and remained stable through the 3-year follow-up period. Eyes implanted with a HOYA Vivinex IOL exhibited significantly lower occurrence of glistening at 3-years versus Alcon AcrySof ( p  < 0.0001). Incidence of PCO was very low and comparable in both Vivinex and AcrySof eyes.

A reproducible, examiner-independent, objective method was introduced that uses swept-source optical coherence tomography (SS-OCT) and compared with established methods. Glistenings were induced in-vitro in twenty-five IOLs, five different IOL models: AcrySof SN60WF, AcrySof MA60AC, Clareon CNA0T0, PY60AD and Vivinex XY1. We calculated the glistening density within each IOL using light microscopy and SS-OCT. Glare effects were quantified with a straylight meter device (Oculus C-Quant). Image-processing software provided an objective tool for glistening quantification. Correlation parameters were evaluated between results of the three methods by using linear regression analysis. The PY60AD showed the highest amount of glistenings, followed by the MA60AC and SN60WF, whereas the CNA0T0 and XY1 showed the lowest values. There was a moderate correlation (R 2  = 0.80) between the light microscopy and the straylight method. The analysis also showed a moderate correlation (R 2  = 0.77) between the SS-OCT and the straylight method. At the same time, we found a strong and proportional relationship (R 2  = 0.91) between the in-vitro reference method light microscopy and the SS-OCT method. We propose that SS-OCT can analyze glistenings precisely and allow objective estimation of the straylight induced by the glistenings within an IOL, permitting the clinician to measure pseudophakic patients’ glare symptoms.

Intraocular lens (IOL) exchange is performed to treat severe IOL-related complications. There is little published data on the impact of this procedure on the refractive outcomes and intra- and postoperative complications, especially in otherwise healthy eyes. We investigated the refractive outcome of IOL exchange surgery, including corneal aberrations; additionally, we assessed the influence of different IOL characteristics on intraoperative and postoperative complications. This prospective clinical study included 35 eyes with homogenous IOL calcification without other ocular pathologies. Using Pentacam AXL Wave (Oculus Optikgeräte GmbH, Wetzlar, Germany), corrected distance visual acuity (CDVA), target refraction compared to the postoperative spherical equivalent, corneal topography and lower and higher-order aberrations were assessed preoperatively and from 3 months after surgery. Intraoperative and postoperative complications were recorded and compared between different IOL characteristics. The secondary IOL in 53% of cases, was a retropupillary iris-fixated Artisan Aphakia (Ophtec BV, Groningen, Netherlands), 37% had a sulcus-fixated AR40e (Johnson & Johnson Vision, Irvine, USA), and 10% had a capsular bag IOL. The CDVA improved from 0.16 ± 0.14 to 0.07 ± 0.14 logMAR ( p  = 0.04). In most cases, the target refraction was within ± 1.0 D (Artisan: 71%, AR40e: 90%, Capsular: 100%). IOL exchange did not induce relevant change in corneal aberrations. Anterior (81%) and posterior (78%) vitrectomy were performed in most cases. The haptic design of the primary IOL did not impact intra- or postoperative complications. Although exchanging an IOL involves greater surgery compared to the initial IOL implantation, visual and refractive outcomes are good, and the exchange does not cause relevant change in aberrations. Intra- and postoperative complications are mostly mild and resolve without sequelae.

Cataract surgery, one of the most common surgical procedures worldwide, significantly improves visual acuity and quality of life for patients. However, recent studies suggest that it may have broader implications for ocular health, including changes in retinal perfusion. This prospective clinical study investigates the relationship between preoperative lens opacity and postoperative changes in macular perfusion using optical coherence tomography in 46 patients. Objective metrics were assessed automatically using a custom computer script. The analysis revealed significant increases in vessel density, diameter, and complexity across the superficial, intermediate, and deep retinal vascular plexuses, with the most pronounced changes occurring within the first postoperative week. A strong correlation was observed between preoperative nuclear lens opacity and the increase in macular perfusion, suggesting that reduced light transmission through dense cataracts may drive postoperative functional hyperemia. In contrast, surgical parameters such as phacoemulsification energy showed no significant association, and intraocular pressure reduction correlated only with subtle vascular perimeter changes. These findings indicate that enhanced light exposure following cataract removal—rather than just inflammation or mechanical factors—likely stimulates adaptive retinal metabolic responses. Clinically, this highlights the importance of preoperative lens opacity assessment as a predictor of vascular remodeling, potentially informing strategies to mitigate complications in the short and long term.

Clinical evaluation of the visual outcomes after implantation of a small-aperture extended depth of focus (EDOF) intraocular lens (IOL) and a segmental refractive bifocal lens. In this prospective study, 13 patients with cataract received a small-aperture IC-8 IOL (AcuFocus, Irvine, CA) in one eye and a segmental-refractive Lentis Mplus LS-313 MF20 IOL (Oculentis, Berlin, Germany) in the fellow eye. The clinical examination included measurements of uncorrected (UDVA) and corrected (CDVA) distance visual acuity, uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuity, and uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity. Additionally, a defocus curve was obtained from +2.00 to -5.00 diopters (D) and a Salzburg Reading Desk was used to assess the patients' reading acuity at intermediate and near distances. A halo and glare simulator was used to evaluate the postoperative perception of dysphotopsia. At 5 months postoperatively, the mean binocular visual results demonstrated UDVA, UIVA, and UNVA values of -0.04 ± 0.11, 0.00 ± 0.10, and 0.11 ± 0.08 logMAR, respectively. The binocular distance-corrected reading performance test also confirmed the improved visual function, with an intermediate reading acuity of 0.12 logMAR at 69.21 cm and a near reading acuity of 0.19 logMAR at 41.63 cm. The mean halo size was 32.54 ± 22.38, mean halo intensity was 34.46 ± 21.95, mean glare size was 9.00 ± 17.47, and mean glare intensity was 9.92 ± 16.84. The new concept of a combined implantation of a small-aperture IOL and a segmental-refractive bifocal lens showed good results in far and intermediate distances and functional results at near distance, while causing minimal photic phenomena. [J Refract Surg. 2019;35(9):551-558.].

This multicenter, open-label study aimed to determine the safety and functional outcome of a high-addition segmented refractive bifocal intraocular lens (IOL) in late inactive age-related macular degeneration (AMD). Twenty eyes of 20 patients were enrolled and followed until 12 months after the intervention. Patients underwent cataract surgery with implantation of a LS-313 MF80 segmented refractive bifocal intraocular lens with a near addition of +8.0 D (Teleon Surgical Vertriebs GmbH, Berlin, Germany). The main outcome measures were distance corrected near visual acuity (DCNVA) and safety as determined by intra- and post-operative complications. Secondary outcomes included distance corrected visual acuity (CDVA), uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), the need for magnification to read newspaper, preferred reading distance, speed and performance (logRAD), as well as patient satisfaction. Mean DCNVA improved from 0.95 (±0.19) to 0.74 (±0.35) logMAR, until 6 months after surgery, P<0.05. CDVA improved from 0.70 (±0.23) to 0.59 (±0.30) logMAR, UDVA from 0.94 (±0.25) to 0.69 (±0.34) logMAR, UNVA from 1.08 (±0.19) to 0.87 (±0.43) logMAR. The mean need for magnification decreased from 2.9- to 2.3-fold, preferred reading distance from 23 to 20 cm. No intraoperative complications occurred during any of the surgeries. One patient lost > 2 lines of CDVA between 6 and 12 months, in another case, the study IOL was exchanged for a monofocal one due to dysphotopsia and decreased CDVA. Implantation of a segmented refractive bifocal IOL with +8.0 D addition improves near and distance vision in patients with late AMD and has a satisfactory safety profile.

Ophthalmic viscosurgical device (OVD) is used during intraocular surgery to protect ocular tissue. It requires complete removal from the eye by the end of surgery to avoid postoperative complications. This study compares the interaction of a cohesive OVD with two different intraocular lenses (IOLs) of different equilibrium water content. In this laboratory study on porcine cadaver eyes, the capsular bags and anterior chambers of each eye were filled with fluorescein-stained OVD. Following implantation of 10 IOLs each of Clareon CNA0T0 and AcrySof SN60WF (Alcon Laboratory, Fort Worth, USA) IOLs, the OVD was removed using the irrigation/aspiration mode. The OVD removal was timed and differences between the both IOL groups were compared. OVD removal time ranged from 18 to 40 s (mean ± SD, 26.4 ± 6.8 s) and from 16 to 39 s (mean ± SD, 23.6 ± 6.6 s) for eyes implanted with a CNA0T0 and a SN60WF IOL, respectively, without a statistically significant difference between the groups, P > 0.05. Cohesive OVD removal times were similar between the CNA0T0 and SN60WF groups. Surgeons should experience no differences regarding the interaction between cohesive OVDs and IOLs made from the new Clareon material compared to the established AcrySof material.