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Purpose This study aimed to assess the optical quality of myopic and presbyopic IPCLs with different additional powers, and to investigate the effects of pupil size on the optical quality of these IPCLs using an in-vitro modulation transfer function (MTF) measurement system. Methods Linear scatter functions (LSFs) were recorded using the OPAL Vector system and an eye phantom consisting of wet cells filled with a balanced salt solution. A myopic IPCL or a presbyopic IPCL was placed in the posterior chamber of this model. The MTF was calculated from the LSF using the fast Fourier transform techniques. The effective apertures were set at 2.0 to 5.0 mm in 1.0 mm steps. Results The in-focus MTF values of the myopic IPCL and presbyopic IPCL with additional powers of + 2.0 and + 4.0 diopters at 100 cycles/mm for an effective aperture of 3.0 mm were 43%, 27%, and 24%, respectively. The in-focus MTF value of both myopic and presbyopic IPCLs was the highest when the effective aperture was set at 3.0 mm, and it gradually worsened when the effective aperture became larger than 3.0 mm at 20, 60, and 100 cycles/mm. Conclusions Both myopic and presbyopic IPCLs provided excellent MTF values, but the additional power profile can deteriorate optical performance in presbyopic IPCL-implanted eyes, even with a low additional power. Pupil size can influence visual quality in IPCL-implanted eyes for both myopia and presbyopia. Key Messages What is known: • Implantable phakic contact lens (IPCL) has been reported to be effective for the treatment of both myopia and presbyopia, with a noticeable advantage in reducing the patients’ cost burden. • The optical properties of IPCL have not yet been thoroughly investigated, neither for myopic IPCLs nor for presbyopic IPCLs. What is new: • The MTF of presbyopic IPCL was slightly lower than that of myopic IPCL even with a low additional power. • The MTF values of both myopic and presbyopic IPCLs were the highest for a 3.0 mm-pupil size, with gradually worsened for a larger pupil size.

To review the safety of the implantable phakic contact lens (IPCL V1, Caregroup Sight Solutions, India) for correction of myopia and myopic astigmatism. Retrospective interventional case series including 134 eyes which underwent IPCL implantation for correction of myopia and myopic astigmatism at a tertiary eye care hospital in South India. Intraoperative and postoperative complications were analyzed. The following parameters were analyzed at preoperative and 1, 6 and 12 month postoperative visits: visual acuity (in logMAR) and manifest refraction, slit lamp bio microscopy, dilated fundus examination, IOP and endothelial cell density measurement. No intraoperative complications were noted. Cataract was the most common postoperative complication, wherein three eyes (2.2%) underwent observation for visually insignificant anterior subcapsular cataract and one eye (0.7%) required surgical intervention. Four eyes developed transient increased IOP due to steroid response (3 eyes) and pupillary block glaucoma (1 eye). The endothelial cell loss noted over a 1-year follow-up was 2.01%±4.12% ( =0.71). One eye developed hypopyon on the third postoperative day, which resolved subsequently with an unaided vision of 20/20. No vision threatening complications were noted. The mean follow-up in the cohort was 25.66±16.45 months. The IPCL is a safe and effective treatment modality for correction of myopia and myopic astigmatism.

To investigate the dynamic pupil and vault changes in eyes with implantable phakic contact lens (IPCL) under photopic and scotopic settings, as well as during accommodation using the anterior segment optical coherence tomography (AS-OCT). A prospective observational study included consecutive 36 eyes of myopic patients who underwent IPCL V2.0 implantation. Under photopic and scotopic light settings, as well as during accommodation, all patients were scanned using CASIA OCT (CASIA2; TOMEY, Nagoya, Japan). The pupil size, the vault (distance between the back surface of the IPCL and the anterior lens capsule), ACD-lens (distance between the posterior corneal surface and the anterior lens surface), IPCL-lens (distance between the posterior corneal surface and the anterior IPCL surface), and lens thickness (LT) were the study parameters. The vault was significantly lower under photopic conditions ( -value<0.001). The pupil size was significantly smaller in photopic conditions ( -value<0.001). LT ( -value=0.975) and ACD-lens ( -value=0.917) were not significantly different between scotopic and photopic conditions, while the ACD-IPCL was significantly larger during photopic conditions ( -value=0.013). There were significant changes in all parameters between accommodative and non-accommodative conditions. The IPCL vault decreased significantly under photopic light conditions and accommodation.

Background and Objectives: In this study, we aimed to compare the physical properties of hole-implantable collamer lenses (H-ICLs) and implantable phakic contact lenses (IPCLs) and investigate their flexural and cell adhesion characteristics. Materials and Methods: Transverse compression load to achieve lens flexion and static Young’s modulus were measured in H-ICLs and IPCLs using designated equipment. Load was measured both with and without restraining the optic section of the lenses. Adhesion of iHLEC-NY2 cells to the lens surfaces was examined using phase-contrast microscopy, and cell proliferation activity was evaluated using WST-8 assay. Results: The H-ICL showed a greater tendency for transverse compression load compared to IPCL, while the IPCL showed a higher Young’s modulus with respect to the force exerted on the center of the anterior surface of the optic section. The joint between the optic section and haptic support in the IPCL was found to mitigate the effects of transverse compression load. Both lens types showed minimal cell adhesion. Conclusions: Our findings indicate that H-ICLs and IPCLs exhibit distinct physical properties and adhesive characteristics. The IPCL demonstrated higher Young’s modulus and unique structural features, while the H-ICL required greater transverse compression load to achieve the flexion required to tuck the haptic supports into place behind the iris to fix the lens. The observed cell non-adhesive properties for both lens types are promising in terms of reducing complications related to cell adhesion. However, further investigation and long-term observation of IPCL are warranted to assess its stability and potential impact on the iris. These findings contribute to a better understanding of the performance and potential applications of H-ICLs and IPCLs in ophthalmology.

Evaluation of invasion depth is essential for the treatment strategy of esophageal squamous cell carcinoma (ESCC). However, the application of the Japanese Endoscopic Society classification system, based on the patterns of intravascular papillary cell layer (IPCL) and avascular area (AVA), requires a long-term training for endoscopists. We aimed to develop explainable semi-supervised models for predicting ESCC invasion depth based on the IPCL/AVA patterns. A total of 2,643 images of magnifying endoscopy with narrow-band imaging in the upstream task, self-supervised contrastive learning ( n  = 2,175), and the downstream task, fine-tuning ( n  = 468), were from Suzhou. In the fine-tuning, two approaches were adopted: the traditional blackbox or the explainable AI. Lastly, the models were evaluated in an external test dataset (Jintan, n  = 60), in comparison with two endoscopists. The primary outcome was 3-way classification of ESCC invasion depth. The metrics included accuracy, Matthew correlation coefficient, and Cohen’s kappa. Furthermore, Grad-CAM was for visualized explanation of images; local interpretation, feature importance, and partial dependence plots were conducted for classifiers; and t-SNE was for visualization of feature vectors. A Xception-backboned explainable model (accuracy 0.817) had exhibited better performance than other models and a junior endoscopist (0.733), even though it underperformed a senior (0.883) by 0.066 on accuracy. However, the endoscopists’ performance was improved by AI assistance (junior 0.833 and senior 0.917). The explainable semi-supervised framework empowers AI models to achieve improved transparentness and performance, facing the opacity of traditional supervised learning and limited amounts of labelled endoscopic images.

Abstract PurposeThe purpose of this study is to document clinical outcomes of 2 posterior chamber phakic intraocular lenses with a central hole, the implantable contact lens (IPCL V2.0) and the Visian implantable collamer lens V4c (ICL), in myopic and myopic-astigmatic patients.MethodsRetrospective study comprising 111 IPCL (60 toric) and 106 ICL implantations (59 toric) with a follow-up of 3 months to 2 years. Primary outcome was uncorrected distance visual acuity (UDVA) improvement; secondary outcomes were changes in corrected distance visual acuity (CDVA), and complications.ResultsAt 3 months postoperatively, 76% of plano targeted eyes in the IPCL group and 83% of eyes in the ICL group had a UDVA of 20/20 or better. Ninety-six percent of IPCL implanted eyes and 94% of ICL implanted eyes had a postoperative UDVA within 1 line of preoperative CDVA. One eye lost one line of CDVA after IPCL implantation, and no lines were lost after ICL implantation; 33.7% of IPCL eyes and 40.6% of ICL eyes gained at least 1 line of CDVA. Cataract extraction (none because of anterior subcapsular opacification) was performed after 4 ICL implantations, none after IPCL implantation. Endothelial cell loss was mild with both pIOLs. Mean IOP was not clinically significantly affected at 3 months or thereafter.ConclusionsWe observed equally excellent (statistically not different) results with the IPCL and ICL for the correction of myopia and myopic astigmatism, at least up to 2 years post implantation. Longer follow-up is needed to determine the stability of these results especially with the IPCL.

Phakic intraocular lenses (IOLs) have newly been introduced for presbyopia correction, with no studies to date directly comparing the various models to one another. This study assesses and compares the optical quality of two phakic IOLs - a diffractive IPCL (Care Group) with +2.5D added power and a refractive Artiplus (Ophtec) - in a laboratory setting. A custom-made insert contained a -3D phakic IOL and a 23D monofocal (Precizon Monofocal, Ophtec). Two samples of each phakic IOL were tested using OptiSpheric IOL PRO2 under spherical and chromatic-aberration conditions at 3 and 4.5mm apertures at near (40cm), intermediate (67cm) and far distances. Modulation transfer function (MTF) related variables, and the 1951 USAF resolution target images were compared. The MTFs at far distances, 67cm, and 40cm revealed minor differences between the two IOLs for a 3-mm pupil. Simulated visual acuity showed no disparity at distance but improved by 0.01 and 0.05 logMAR with Artiplus at intermediate and near points. Additionally, Artiplus exhibited a plateau in intermediate performance, while the IPCL demonstrated higher optical quality close to 50cm, corresponding to its secondary-focus location. Both lenses showed reduced optical quality with larger apertures. The USAF resolution target results supported these findings. Artiplus and IPCL (+2.5D add) showed good optical quality across the focus range, with Artiplus having a flatter simulated defocus curve. While the expected visual acuity differences were minimal, they may become more pronounced in patients with larger pupils, warranting further investigation.

Background and Objectives: Posterior chamber phakic implantable contact lenses (Phakic-ICL) are widely used for refractive correction due to their efficacy and safety, including minimal corneal endothelial cell loss. The Collamer-based EVO+ Visian implantable contact lens (ICL), manufactured from Collamer, which is a blend of collagen and hydroxyethyl methacrylate (HEMA), has demonstrated excellent long-term biocompatibility and optical clarity. Recently, hydrophilic acrylic Phakic-ICLs, such as the Implantable Phakic Contact Lens (IPCL), have been introduced. This study investigated the material differences among Phakic-ICLs and their interaction with fibronectin (FN), which has been reported to adhere to intraocular lens (IOL) surfaces following implantation. The aim was to compare Collamer, IPCL, and LENTIS lenses (used as control) in terms of FN distribution and cell adhesion using a small number of explanted Phakic-ICLs. Materials and Methods: Three lens types were analyzed: a Collamer Phakic-ICL (EVO+ Visian ICL), a hydrophilic acrylic IPCL, and a hydrophilic acrylic phakic-IOL (LENTIS). FN distribution and cell adhesion were evaluated across different regions of each lens. An in vitro FN-coating experiment was conducted to assess its effect on cell adhesion. Results: All lenses demonstrated minimal FN deposition and cellular adhesion in the central optical zone. A thin FN film was observed on the haptics of Collamer lenses, while FN adhesion was weaker or absent on IPCL and LENTIS surfaces. Following FN coating, Collamer lenses supported more uniform FN film formation; however, this did not significantly enhance cell adhesion. Conclusions: Collamer, which contains collagen, promotes FN film formation. Although FN film formation was enhanced, the low cell-adhesive properties of HEMA resulted in minimal cell adhesion even with FN presence. This characteristic may contribute to the long-term transparency and biocompatibility observed clinically. In contrast, hydrophilic acrylic materials used in IPCL and LENTIS demonstrated limited FN interaction. These material differences may influence extracellular matrix protein deposition and biocompatibility in clinical settings, warranting further investigation.

To evaluate the effect of a novel technique to correct presbyopia. A phakic IOL (presbyopic IPCL; implantable phakic contact lens) with a diffractive optic is implanted and its impact on visual acuity, refraction, patient satisfaction in patients striving for spectacle-independence is evaluated. Retrospective noncomparative open-label clinical trial. Sixteen eyes of 8 patients (average age 47 years) had a presbyopic IPCL implanted in the posterior chamber. The visual acuity on different distances, refractive status, corneal topography, endothelial cell density, anterior chamber depth, white-to-white, mesopic pupil size and intraocular pressure (IOP) were measured before implantation of this novel phakic IOL with diffractive optic and four weeks after surgery. At follow-up four weeks after surgery, 9 of the 16 eyes were emmetropic and uncorrected distance visual acuity was at least 0.8. Near vision was excellent in all patients without the need to wear reading glasses. There was neither a significant change in IOP nor a significant surgical impact on endothelial cells. Patient satisfaction was high. There was no major complaint of halos or glare. The presbyopic IPCL can provide the presbyopic patient with good visual acuity and spectacle-independence for far and near distance. We found this novel technique to have a good safety profile during the surgical procedure and our short follow-up period. Further long-term follow-up is mandatory.

Purpose: To compare clinical outcomes following implantation of two types of posterior chamber phakic intraocular lenses: Visian™ Implantable Collamer Lens with Centraflow (ICL, V4C Staar Surgical, Nidau, Switzerland) and Implantable Phakic Contact Lens (IPCL, V1, Caregroup Sight Solution, India) for the correction of myopia and myopic astigmatism. Methods: This retrospective case series included eyes which underwent phakic intraocular lens implantation with a minimum follow-up period of 1 year. Visual outcomes including safety, efficacy, refractive predictability, and stability were compared at 1 week and at 1, 6, and 12 months' postoperative visit. Complications and adverse events were analyzed. Results: The study included 119 and 203 eyes in the IPCL and ICL groups, respectively. At 1-year postoperative visit, median corrected distance visual acuity was 0.10 (interquartile range [IQR] 0,0.10) and 0 (IQR 0,0) in the IPCL and ICL cohorts, respectively (P = 0.066). An uncorrected visual acuity of 20/32 or better was achieved in 86.5% and 88.67% of the eyes, respectively (P = 0.574). Ninety and 94% of the eyes achieved a postoperative manifest spherical equivalent within ± 0.5D (P = 0.169, χ2 test). Three eyes (2.52%) in the IPCL group versus one eye (0.49%) in the ICL group developed visually significant cataract requiring surgical intervention (P = 0.113). No vision-threatening complications were noted in either cohort. The mean follow-up period was 94.69 ± 32.45 and 102.67 ± 61.82 weeks, respectively. Conclusion: Both groups demonstrated similar efficacy and safety profile. The IPCL is an effective and economically viable option for the correction of myopia.