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To compare the effect of femtosecond laser-assisted cataract surgery on effective phacoemulsification time (EPT) with standard cataract surgery. This prospective clinical trial evaluated the feasibility of using a femtosecond laser system (Catalys Precision Laser System, OptiMedica) to perform capsulotomy and lens fragmentation in the treatment of patients with senile cataract. Patients were evaluated preoperatively with the Lens Opacities Classification System III (LOCS III). Fifty-two patients underwent standard cataract surgery and 57 patients underwent femtosecond laser-assisted cataract surgery in December 2011. Both groups underwent phacoemulsification using pulsed ultrasound energy and EPT was evaluated. Preoperative LOCS III grades were 3.4±0.9 in the femtosecond laser-assisted cataract surgery group and 3.1±0.9 in the standard group. In the femtosecond laser-assisted cataract surgery group, mean laser treatment time was 54.9 seconds and EPT was 0.16±0.21 seconds compared to 4.07±3.14 seconds in the standard group. The use of the femtosecond laser-assisted system in cataract surgery led to a lower EPT compared to the standard procedure.

Accurate alignment of an intraocular lens (IOL) is indispensable for achieving accurate postoperative refractive outcomes. Thus, we evaluated decentration and tilt of single- and three-piece IOLs, as well as anterior chamber depth (ACD), at 3 hours, 24 hours, 2 weeks, and 4 weeks after cataract surgery, using swept-source anterior segment optical coherence tomography. There was no significant difference in postoperative visual acuity between eyes with single- or three-piece IOLs. Absolute values of IOL decentration at 24 hours and 2 weeks after surgery were significantly larger ( P  = 0.008 and 0.046, respectively) in eyes with the single-piece IOL than in those with the three-piece IOL. Both single- and three-piece IOLs tended to tilt toward the inferotemporal direction; however, there was no significant difference in the absolute values of IOL tilt at any postoperative time point. ACD at 24 hours after surgery was significantly deeper ( P  = 0.009) in eyes with the three-piece IOL, compared with eyes with the single-piece IOL. Therefore, although both single- and three-piece IOL locations varied transiently after surgery, IOL locations were similar between both IOLs at 4 weeks after surgery and were not associated with any statistical difference in visual function.

Background The use of capsular tension ring (CTR) implantation to treat cataract patients with weak zonules is still controversial. The aim of this study was to examine the effects of CTR implantation on capsular stability after phacoemulsification in patients with weak zonules, especially patients who have undergone pars plana vitrectomy (PPV) or those who suffer from severe myopia. Methods A total of 42 patients who underwent phacoemulsification and received an intraocular lens (IOL) were randomized to undergo CTR implantation or not. The control and CTR groups were compared in terms of uncorrected distant visual acuity (UDVA), best corrected distant visual acuity (BCDVA), refractive prediction error, the area of anterior capsulorhexis, and IOL inclination angle. Follow-up visits were conducted postoperatively at 1 day, 1 week, 1 month and 3 months. Subgroup analyses were performed based on PPV and severe myopia. Results Surgery significantly improved UDVA and BCDVA to similar extents in CTR and control patients, and refraction prediction error was similar between the two groups at all follow-up times. At 3 months after surgery, the area of anterior capsulorhexis was significantly larger in CTR patients than in controls ( p  = 0.0199). These differences were also significant between the subgroups of patients with severe myopia. Vertical IOL inclination was less within CTR groups at 3 months after surgery, especially in patients with severe myopia ( p  = 0.0286). At 1 week postoperatively, the proportion of individuals whose posterior lens capsule that had completely adhered to the posterior IOL surface was significantly higher among CTR patients ( p  = 0.023). No serious surgical complications were observed. Conclusion CTR implantation can benefit cataract patients with weak zonules by maintaining the shape of the capsular bag, reducing capsule shrinkage and stabilizing IOL inclination. Trial registration Chinese Clinical Trial Registry ChiCTR-INR-17011217 , date of registration April 22, 2017, prospectively registered.

Purpose: To study the effect of intraocular lens (IOL) implantation with and without ocular viscoelastic device (OVD) on posterior capsular opacification (PCO) in eyes with phacoemulsification. Methods: This prospective, comparative, and randomized case series included 70 patients (140 eyes) with senile cataracts scheduled for phacoemulsification and IOL implantation in a tertiary eye c are center. One eye of each patient was randomized to one of the two groups, namely, control and OVD. After phacoemulsification, the IOL was placed in the capsular bag under balanced salt solution (BSS) in the control group, whereas the IOL was placed under OVD in the OVD group. PCO was analyzed by an independent observer at 6, 12, and 18 months under slit-lamp illumination. Results: The mean age of the participants in the two groups was 61.2 (±9.9) years. Of the total participants, 68 (48.5%) were men and 72 (51.5%) were women. The mean keratometry (K1, K2) values of the OVD (44.26 ± 1.43, 44.93 ± 1.66) and control (44.51 ± 1.74, 44.69 ± 1.49) groups were similar. The mean IOL powers of the control and OVD groups were 21.25 (±1.94) and 21.53 (±1.86), respectively (P = 0.463). The mean best-corrected visual acuity (BCVA) of the control group at 6-, 12-, and 18-month follow-ups were 0.622 (±0.253), 0.315 (±0.203), and 0.063 (±0.163), respectively, whereas those of the OVD group were 0.592 (±0.253), 0.336 (±0.169), and 0.066 (±0.118), respectively (P = 0.922). None of the patients had postoperative raised intraocular pressure (IOP), uveitis, or endophthalmitis. Three and four eyes in the control and OVD groups, respectively, required neodymium-doped yttrium aluminum garnet (ND: YAG) capsulotomy at study termination (P = 0.999). Conclusion: The hydroimplantation technique of the placement of hydrophilic IOL did not reduce the PCO rate in the 18-month follow-up period. The ND: YAG capsulotomy rate did not differ between the groups.

Purpose: To study the effect of rotation of intraocular lens (IOL) on posterior capsular opacification (PCO) in eyes with phacoemulsification. Methods: This was a prospective, comparative, randomized case series. One eye of each patient was randomized to one of two groups. The 360-degree rotation of IOL was carried out after its placement in the capsular bag (rotation group). The control group had no rotation of IOL. PCO was analyzed by an independent observer on EPCO computer analysis system at 6, 12, 24, and 36 months. Results: The study included 50 patients (100 eyes) with senile cataracts scheduled for phacoemulsification and IOL implantation. The median age in 2 groups was 66 years. 25% quartile age in both the group was 62 years (P = 0.06). There were 30 males, and 20 females. The median PCO score at 6, 12 and 24 months was significantly low in the rotation group (0.15, 0.13, 0.22) compared to the control group (0.22, 0.23, 0.25). There was no significant difference in PCO score between the two groups from 24-36 months. The median PCO score at 36 months was 0.2 in both the groups. At the end of three years, 4 eyes (8%) in the rotation group, and 10 eyes (20%) in the control group needed Nd:YAG capsulotomy (P = 0.04). Conclusion: Rotation of IOL in the capsular bag decreases PCO and Nd:YAG capsulotomy rate.

Purpose: To evaluate the rotational stability of toric intraocular lens (IOL) when co-implanted with a capsular tension ring (CTR) as compared to that of a toric IOL without a CTR. Methods: This was a prospective randomized clinical trial performed in a tertiary care centre in India. Fifty adult human eyes with visually significant cataract and regular corneal astigmatism ≥1.5D divided into two groups of 25 eyes each, A and B by simple randomization. Eyes with corneal pathology, lens subluxation, and a specular endothelial cell count <2000/mm2 were excluded from the study. The eyes in both the groups underwent standard phacoemulsification and were implanted with a toric IOL. In Group A, a CTR was put in the bag before IOL implantation. The groups were called for follow-up on day 1, 1 week, 1 month, and 3 months, postoperatively. The axis of the toric IOL on each visit was measured by slit lamp imaging in retroillumination and analyzed digitally. Results: Mean rotation of toric IOL at 3 months postoperatively was 1.85 ± 1.72° in Group A and 4.02 ± 2.04° in Group B. The difference was statistically significant (P = 0.003). Conclusion: Coimplantation of a CTR is a safe and effective technique for ensuring better rotational stability of toric IOLs.

PurposeTo evaluate circular neodymium: YAG laser incision in cases of anterior capsular contraction syndrome (ACCS) by comparing it to radial Neodymium: YAG laser incision as for efficacy and safety.SettingsOphthalmology Department, Benha University Hospitals.MethodsThe study was done on 74 eyes of 66 patients with symptomatic ACCS. Eyes were randomly allocated to one of the two groups. Group I were treated by circular YAG laser anterior capsulotomy. Group II were treated by radial YAG laser anterior capsulotomy. All cases passed a full ophthalmic examination before laser capsulotomy, 1 week, 1 month, 6 months and 12 months after laser.ResultsBCVA at the 1st week and the 1st month after the capsulotomy did not show any significant difference between the two groups; however at the 3rd and 6th months, the circular group showed better visual acuity than the radial group (p 0.001 and < 0.001, respectively). All post-YAG UCVA and BCVA were significantly higher than pre-YAG UCVA and BCVA in both groups. IOL decentration occurred in two cases in radial group. Circular group had significantly higher percentage of contraction relief (94.4%) than the radial group (66.7%) with p value 0.003.ConclusionCircular Nd:YAG anterior capsulotomy is more effective and safe than radial capsulotomy in 1-year follow-up.

PURPOSE: To ascertain whether the refractive, visual, and intraocular optical quality outcomes of a rotationally asymmetric multifocal intraocular lens (IOL) are enhanced by the use of a capsular tension ring. METHODS: Ninety consecutive eyes from 53 patients (age range: 36 to 82 years) were divided into two groups: the no ring group comprised 43 eyes implanted with the multifocal rotationally asymmetric Lentis Mplus LS-312 (Oculentis GmbH) without a capsular tension ring; and the ring group comprised 47 eyes with the same IOL with a capsular tension ring. Distance and near visual acuity and refractive outcomes were evaluated pre- and postoperatively. Contrast sensitivity, intraocular aberrations, and defocus curve were evaluated postoperatively. RESULTS: Significant postoperative differences between groups were found in sphere, spherical equivalent refraction, and near addition (Significant postoperative differences between groups were found in sphere, spherical equivalent refraction, and near addition ( P ⩽.02). Regarding defocus curve, significantly better visual acuity was present in eyes with the capsular tension ring for intermediate vision conditions ( P ⩽.05). Intraocular aberrometry did not differ significantly between groups ( P ⩾.09). CONCLUSIONS: Refractive predictability and intermediate visual outcomes with the Lentis Mplus LS-312 IOL improved significantly when implanted in combination with a capsular tension ring.

Aims To compare the clinical results and the intraoperative and postoperative performance of an additional sulcus-fixated multifocal intraocular lens (IOL) with a conventional multifocal IOL implanted in the capsular bag. Methods In this prospective, randomised, monocentric study, the intraoperative and postoperative outcomes after implantation of an additional sulcus-fixated multifocal IOL (group A; 29 eyes) and a conventional, multifocal posterior chamber IOL (group B; 25 eyes) are compared. 1-year postoperatively, visual acuity, contrast sensitivity and defocus curve were determined. Patients implanted bilaterally with the same IOL filled in a questionnaire to assess patient satisfaction. Results Between the groups, only slight differences were found in visual acuity at all distances. All patients achieved an uncorrected distance visual acuity of 0.1 LogMAR or better and an uncorrected intermediate/near visual acuity of 0.3 LogMAR or better. Slightly better results in contrast sensitivity were achieved in group A at high spatial frequencies under almost all lighting conditions. Patient survey showed a higher degree of satisfaction of patients in group B, while a smaller proportion of group A stated to have disturbing light phenomena. Conclusions Only small functional differences between the examined methods were found. Both types of multifocal IOL performed well at all distances. There were no intraoperative and postoperative complications in the add-on IOL group which affirms the high safety level such as with conventional multifocal IOL in the capsular bag.

Background/ObjectivesPosterior Capsule Opacification (PCO) is the most common long-term post-operative adverse occurrence after cataract surgery often requiring treatment with YAG laser posterior capsulotomy. This study aimed to identify potential risk factors, known at the time of cataract surgery, that influence the development of PCO.Subject/MethodsA retrospective study of publicly funded cataract surgery from The Royal College of Ophthalmologists’ National Ophthalmology Database. Eligible for analysis were 500,872 cataract operations performed in 41 participating centres.ResultsThe 500,872 operations were performed on 243,167 (48.5%) left eyes and 257,705 (51.5%) right eyes from 373,579 patients by 2196 surgeons. Post-cataract PCO was recorded for 61,778 (12.3%) eyes and the six month, one, three, five and nine year observed rates of PCO were 2.3%, 4.4%, 19.7%, 34.0% and 46.9% respectively. Different PCO profiles were observed between IOL materials and the identified risk factors that increased the risk of developing PCO included hydrophilic IOL material, axial length >26 mm, the presence of high myopia and implantation of lower IOL powers and previous vitrectomy surgery, along with younger age and female gender.ConclusionsMany factors influence the development of PCO relating to the patient, the eye, the lens and the surgery. Some factors are modifiable such as IOL material, therefore the opportunity exists to attempt to reduce PCO rates, benefitting patients and the UK NHS.