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Purpose To investigate anterior segment changes after implantable collamer lens V4c (ICL-V4c; STAAR Surgical) implantation in eyes with low anterior chamber depth (ACD) and compare them with eyes with normal ACD. Methods This prospective, interventional case-control study included 96 eyes of 48 patients with a low ACD (< 2.8 mm) and 44 eyes of 22 patients with normal ACD (≥ 2.8 mm) receiving a 12.1-mm ICL. All patients underwent follow-up and comprehensive ophthalmic examinations preoperatively and at 1, 3, and 6 months after surgery. Anterior segment parameters, including ACD, anterior chamber width, crystalline lens rise, anterior chamber angle, trabecular-iris angle (TIA), angle opening distance, trabecular-iris space area, the distance from cornea to ICL, and vault were all conducted by optical coherence tomography. These parameters from the last follow-up (6 months postoperatively) were used for statistical analysis to assess changes in anterior segment structure and their relationship with vault height. Results The mean safety and efficacy index in eyes with low ACD were 1.23 ± 0.22 and 1.21 ± 0.08 respectively. In both groups, anterior chamber structure parameters become narrower compared to preoperatively (all P < .05). Preoperative ACD and C-ICL demonstrated significant correlations with ICL vault in eyes with low ACD (P < .001). Compared with eyes with normal ACD preoperatively, eyes with low ACD are more prone to have low vault (P < .01). There is a correlation between normal vault and corneal horizontal white-to-white distance (P = .032), ACD (P = .046), and temporal TIA500 (P = .016). Conclusions ICL-V4c surgery in eyes with low ACD is safe and efficacious. In patients with low ACD, the normal vault could be better anticipated by considering preoperative anterior chamber angle, white-to-white distance, and ACD. [J Refract Surg. 2025;41(4):e342–e355.]

Purpose: To compensate for Pentacam's (Oculus Optikgeräte GmbH) flaw in Implantable Collamer Lens (ICL; STAAR Surgical) vault assessment, which is the difficulty to clearly detect the ICL itself, for the improvement of Pentacam's performance in the follow-up after ICL implantation. Methods: One hundred fourteen eyes that had ICL implantation at Beijing Fenglian Eyecare Beau Care Clinic were pre-screened from January to December 2024 and were randomly divided into the formula establishment group (76 eyes) and the formula validation group (38 eyes). A regression formula was worked out with the perioperative variables measured by Pentacam to best correlate with postoperative ICL vault measured by anterior segment optical coherence tomography (AS-OCT) using Pearson correlations and multiple linear regressions in the formula establishment group, and it was then tested in the validation group. Results: ICL vault showed significant positive linear correlations with anterior chamber volume change (ΔACV) (r = 0.845, P < .001), anterior chamber depth (r = 0.441, P < .001), and white-to-white distance (r = 0.342, P < .01). However, there was no linear correlation between ICL vault and ICL size/direction/anterior chamber angle (P > .05). The estimation formula was: ICL vault (μm) = 1,710.94 – 157.81 × ICL size (mm) +13.20 × ΔACV (μL). The validation results showed that the mean absolute error, median absolute error, and root mean square error were 82.27, 77.54, and 99.31 μm, respectively. Conclusions: This study established the ICL vault estimation formula based on ΔACV measured by Pentacam to best correlate with vault measured by AS-OCT. It compensates for Pentacam's flaw in ICL vault assessment, which is the difficulty to clearly detect the ICL itself, and is especially valuable when AS-OCT is unavailable.

Purpose: To investigate the incidence, presentation, and outcomes of sterile anterior segment inflammation following sulcus-supported phakic IOL implantation (SASI-pIOL). Methods: The retrospective case series included consecutive patients diagnosed as having SASI-pIOL (early-onset: ⩽ 7 days; late-onset: > 7 days postoperatively) between July 2023 and July 2024 at two tertiary centers in China. All patients were followed up for at least 6 months after diagnosis. Results: SASI-pIOL occurred in 39 eyes (0.26%) out of 15,209 pIOL surgeries. Early-onset cases accounted for 26 eyes (66.7%), and late-onset for 13 eyes (33.3%). Anterior chamber inflammation and pIOL surface white deposits resolved completely with topical steroids. No eye lost one or more Snellen lines in corrected distance visual acuity. No significant changes were observed in intraocular pressure or endothelial cell density compared to baseline. Recurrence of white deposits on the pIOL occurred in 11 eyes (42.3%) in the early-onset group and 6 eyes (54.5%) in the late-onset group. A significant difference was observed in the proportion of early-onset versus late-onset SASI-pIOL cases relative to ophthalmic viscosurgical device use (P < .001, Fisher's exact test). Conclusions: SASI-pIOL is uncommon, responds well to topical corticosteroids, and is associated with favorable visual outcomes, yet requires long-term monitoring due to a notable recurrence rate.

To assess the efficacy and clinical outcome of Tenon's patch graft (TPG) in corneal perforation and descemetocele. In this retrospective study, medical records of 83 patients (85 eyes) who underwent TPG for corneal perforation (58, 68) or descemetocele (27, 32) between July 2018 and October 2021 were reviewed. Clinical examination and anterior segment optical coherence tomography (AS-OCT) were performed on every follow-up visit. Anatomical success was considered as the restoration of the structural integrity with the formation of scar and anterior chamber (AC). The mean size of the corneal lesions (corneal perforation or descemetocele) was 4.20 ± 1.01 mm. The mean follow-up period was 9.2 ± 5.48 months. The common underlying etiologies were infectious keratitis in 48 and autoimmune disorders in 35 of cases. TPG successfully restored the globe integrity in 74 (87) eyes (83 in perforation and 96 in descemetocele). Anatomical failure occurred in 11 eyes (13). The failures were due to graft dehiscence (8 eyes), graft ectasia (1 eye), and scarring with flat AC (2 eyes). The median time to epithelialization and scar formation were 3 and 15 weeks, respectively. Logistic regression analysis showed few predictors for a successful outcome: descemetoceles, noninfective causes, viral keratitis in infectious etiology, and paracentral or peripheral lesions. TPG can be considered an effective and inexpensive treatment for restoring the structural integrity in the eyes with perforations and descemetoceles, particularly when the donor tissue is unavailable. AS-OCT is a valuable noninvasive tool for monitoring the graft status.

Purpose: To assess the intraobserver repeatability and interobserver reproducibility of central vault and anterior chamber angle (ACA) measurements obtained with the YG-100K (TowardPi Medical Technology Ltd), a new full-range swept-source optical coherence tomography (SS-OCT) device, in eyes after Implantable Collamer Lens (ICL) implantation, and to evaluate their agreement with the established CASIA 2 anterior segment SS-OCT device (Tomey). Methods: This prospective study enrolled 78 myopic eyes (78 patients) after ICL implantation. Central vault, trabecular iris angle (TIA), angle opening distance, and trabecular iris space area were measured using the YG-100K and CASIA 2 devices. The automatic software of each device identified scleral spur and angle recess positions for ACA measurements. Repeatability and reproducibility were assessed using the within-subject standard deviation, test–retest repeatability, coefficient of variation (CoV), and intraclass correlation coefficient (ICC). Inter-device agreement was analyzed using paired t-tests and Bland-Altman plots. Results: The YG-100K demonstrated good to excellent repeatability and reproducibility for vault and ACA measurements, with CoVs ranging from 2.35% to 8.17% and ICCs between 0.888 and 0.997. The vault measured by the YG-100K was 15.38 ± 22.38 µm higher than the CASIA 2, with 95% limits of agreement (LoA) ranging from −28.48 to 59.24 µm. ACA measurements, except for TIA500, showed significant differences between devices, accompanied by wide 95% LoA ranges. Conclusions: The YG-100K provided reliable repeatability and reproducibility measurements in eyes after ICL implantation. Vault measurements showed good agreement with the CASIA 2, whereas discrepancies in ACA measurements indicated that these parameters should not be used interchangeably between devices.

Background Anterior chamber depth (ACD) is becoming a hot topic and plays an important role in correcting the refractive errors (REs) after cataract surgery. The aim of this study was to assess the ACD changes and their relationship with the REs after phacoemulsification and intraocular lens (IOL) implantation in patients with age-related cataracts. Methods One hundred forty-five eyes of 125 age-related cataract patients from the Department of Ophthalmology, Tangdu Hospital, China, were recruited. IOL Master was used for axial length (AL) and the IOL power calculation measurements, and the Pentacam HR device was used for the ACD and lens thickness (LT) measurements. Every patient underwent uncomplicated phacoemulsification by a single surgeon using a single technique. Postoperative refraction results were obtained at 1 month. The appropriate formula used for the IOL power calculation was chosen depending on the AL, specifically the Hoffer Q (AL < 22.0 mm), SRK/T (22.0 mm ≤ AL ≤ 30.0 mm), and Haigis (AL > 30.0 mm) formulas. Results The postoperative ACD was deepened and tended to stabilize gradually after 2 weeks. A concurrent hyperopic shift (0.57 ± 0.47 D) was observed when the change in the ACD was less than 1.65 mm, whereas a myopic shift (− 0.18 ± 0.62 D) occurred contrarily, and the difference between the two groups was statistically significant ( P  < 0.0001). The change in ACD was significantly larger in the shallow anterior chamber (1.92 ± 0.40 mm) than in the deep chamber (1.33 ± 0.42 mm) ( P  < 0.0001). Similarly, the change in ACD was larger in the short AL (2.12 ± 0.37 mm) than in the long AL (1.32 ± 0.49 mm). The postoperative ACD and refractive changes were correlated with the preoperative ACD and AL ( P  < 0.0001), respectively. Two regression formulas were proposed: postoperative ACD = 3.524 + 0.294 × preoperative ACD and postoperative ACD = 3.361 + 0.228× (preoperative ACD + 1/2 LT). Conclusions The results of this study showed that the ACD deepened and was associated with a concurrent RE after cataract surgery. Postoperative changes in the ACD were related to the preoperative ACD and AL, which determined the refraction status and visual quality. The regression formula of the postoperative ACD could provide a theoretical basis for predicting refractive errors in the clinic.

Purpose To evaluate the relationship between anterior chamber biometric parameters (angle-to-angle diameter [ATA] and anterior chamber width [ACW]) and the sulcus-to-sulcus diameter (STS) in myopic patients with varying axial length (AL). Methods A 50-MHz ultrasound biomicroscopy (UBM) device measured STS at the 0° and 90° meridians in the right eyes of 77 Chinese patients with high myopia and an anterior chamber depth greater than 2.80 mm. Swept-source optical coherence tomography device (CASIA2; Tomey) measured ATA and ACW at the 0°, 45°, 90°, and 135° meridians, whereas corneal topography measured the horizontal white-to-white diameter (WTW-0°). Results Vertical STS, ATA, and ACW measurements were significantly longer than their horizontal counterparts (P < .001). Differences in STS and ACW between vertical and horizontal meridians were comparable (P = .503), whereas ATA differences was more pronounced than that of STS (P = .032). Both STS-0° and STS-90° were significantly greater than WTW-0°, ATA, and ACW at their respective meridians (P ⩽ .016), except for STS-0° versus ACW-0° (P = .127). Correlations between STS-0°/STS-90° and WTW-0° were weaker than those with ACW or ATA. STS-0° exhibited the strongest correlation with ACW-0°, whereas STS-90° correlated best with ACW-45°. For patients with AL shorter than 28.5 mm, no significant differences existed between STS-0° and WTW-0°/ATA-0°/ACW-0°. In contrast, for those with AL greater than 28.5 mm, only ACW-0° was comparable to STS-0°. At the vertical meridian, only ACW had no significant differences compared to STS for patients with different ranges of AL. Conclusions In Chinese patients who are potential candidates for Implantable Collamer Lens implantation, ACW shows better concordance with STS than ATA and WTW-0°. The reliability of WTW-0° for estimating STS decreases with increased AL, making ACW more suitable for STS estimation in patients with AL greater than 28.5 mm, especially at non-horizontal meridians.

To establish the effects of anterior chamber inflammation (ACI) on the corneal endothelium parameters and central corneal thickness (CCT). We conducted a comprehensive literature review using medical databases (PubMed, EMBASE, VHL, and medRxiv) on March 8, 2023, for studies that included patients with ACI who had undergone specular microscopy or pachymetry. Case series with >10 patients, cross-sectional, case-control, and cohort studies were included. The risk of bias was assessed using CLARITY tools and validated scales such as those by Hassan Murad et al. and Hoy et al. A narrative synthesis and a quantitative standardized mean difference meta-analysis, I2 heterogeneity assessment, and publication bias tests were conducted. The study was registered in PROSPERO (CRD42023420148) and approved by the Universidad del Rosario ethical committee (DVO005 2277- CV1712). Thirty-four studies, encompassing 1,388 eyes with ACI, were included. Compared with healthy controls, overall, ACI eyes show significant mean differences in endothelial parameters (endothelial cell density (ECD), coefficient of variation (CV), and hexagonality (HEX)) (P < 0.05). In the subgroup analysis compared with healthy controls, both active and chronic-recurrent ACI demonstrated a reduced ECD. An increased CV was observed in active, inactive, and chronic-recurrent ACI. Lower HEX was evident in inactive, acute, and chronic-recurrent ACI, while both active and acute ACI exhibited high CCT. ACI leads to significant alterations in endothelial parameters and CCT. The primary contributors to these changes are increased IOP, uveitis duration, and intraocular surgeries. Further studies are needed to explore the impact of ACI etiology on the endothelium, potential biases in IOP measurements during acute ACI episodes, and the potential necessity for monitoring the endothelial parameters and CCT in patients with chronic ACI.

Anterior chamber depth (ACD) is a quantitative trait associated with primary angle closure glaucoma (PACG). Although ACD is highly heritable, known genetic variations explain a small fraction of the phenotypic variability. The purpose of this study was to identify additional ACD-influencing loci using strains of mice. Cohorts of 86 N2 and 111 F2 mice were generated from crosses between recombinant inbred BXD24/TyJ and wild-derived CAST/EiJ mice. Using anterior chamber optical coherence tomography, mice were phenotyped at 10–12 weeks of age, genotyped based on 93 genome-wide SNPs, and subjected to quantitative trait locus (QTL) analysis. In an analysis of ACD among all mice, six loci passed the significance threshold of p = 0.05 and persisted after multiple regression analysis. These were on chromosomes 6, 7, 11, 12, 15 and 17 (named Acdq6 , Acdq7 , Acdq11 , Acdq12 , Acdq15 , and Acdq17 , respectively). Our findings demonstrate a quantitative multi-genic pattern of ACD inheritance in mice and identify six previously unrecognized ACD-influencing loci. We have taken a unique approach to studying the anterior chamber depth phenotype by using mice as genetic tool to examine this continuously distributed trait.