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PurposeTo introduce a modified procedure of ICL implantation, to summarize the perioperative problems and their corresponding treatment after myopia correction with Implantable Collamer Lens (ICL), and to compare the difference of complications between the no-hole ICL and hole ICL.MethodsWe searched all articles on ICL-related perioperative problems and their corresponding treatment in Scopus, Embase, PubMed and Web of Science databases for the last 22 years.ResultsICL implantation is safe, effective, stable and predictable in the correction of myopia, hyperopia and astigmatism, but can also cause a series of perioperative problems, including intraoperative and postoperative complications.ConclusionThere are many kinds of complications related to ICL, but the common intraoperative and postoperative complications mainly include abnormality of arch height, abnormal position of ICL, loss of corneal endothelial cells and corneal decompensation, high intraocular pressure and secondary glaucoma, cataract and night vision symptoms. Compared with ICL without central pore, the incidence of complications such as loss of corneal endothelial cells and corneal decompensation, high intraocular pressure and secondary glaucoma and cataract was relatively lower in central hole ICL, while postoperative complications such as night vision symptoms were obvious.

AimsTo predict the vault and the EVO-implantable collamer lens (ICL) size by artificial intelligence (AI) and big data analytics.MethodsSix thousand two hundred and ninety-seven eyes implanted with an ICL from 3536 patients were included. The vault values were measured by the anterior segment analyzer (Pentacam HR). Permutation importance and Impurity-based feature importance are used to investigate the importance between the vault and input parameters. Regression models and classification models are applied to predict the vault. The ICL size is set as the target of the prediction, and the vault and the other input features are set as the new inputs for the ICL size prediction. Data were collected from 2015 to 2020. Random Forest, Gradient Boosting and XGBoost were demonstrated satisfying accuracy and mean area under the curve (AUC) scores in vault predicting and ICL sizing.ResultsIn the prediction of the vault, the Random Forest has the best results in the regression model (R2=0.315), then follows the Gradient Boosting (R2=0.291) and XGBoost (R2=0.285). The maximum classification accuracy is 0.828 in Random Forest, and the mean AUC is 0.765. The Random Forest predicts the ICL size with an accuracy of 82.2% and the Gradient Boosting and XGBoost, which are also compatible with 81.5% and 81.8% accuracy, respectively.ConclusionsRandom Forest, Gradient Boosting and XGBoost models are applicable for vault predicting and ICL sizing. AI may assist ophthalmologists in improving ICL surgery safety, designing surgical strategies, and predicting clinical outcomes.

Objective To evaluate the clinical efficacy of a novel ophthalmic viscosurgical device-free method using an anterior chamber maintainer for intraocular collamer lens implantation in eyes with myopia. Methods Forty patients underwent bilateral intraocular collamer lens implantation, with one eye receiving the traditional implantation method using an ophthalmic viscosurgical device and the other eye undergoing the anterior chamber maintainer method. Preoperative and postoperative parameters, including uncorrected distance visual acuity, best-corrected distance visual acuity, spherical equivalent, intraocular pressure, aberrations, subjective visual quality, corneal endothelial cell density, operation time, and complications, were compared between and within the two groups. Results In the traditional group, 10% of eyes had intraocular pressure >22 mmHg at 2 h postoperatively, compared with 0% in the anterior chamber maintainer group (P < 0.001). The anterior chamber maintainer group showed better uncorrected and best-corrected distance visual acuity, spherical equivalent, total and low-order aberrations, and defocus at 1 day postoperatively (all P < 0.05), as well as shorter operation time (2.85 ± 0.30 vs. 4.37 ± 0.66 min, P < 0.001). No complications were observed except early intraocular pressure elevation in the traditional group. Conclusion The anterior chamber maintainer intraocular collamer lens implantation method provides faster visual recovery, a shorter operation time, and more stable intraocular pressure. It offers a convenient alternative to the traditional approach, avoiding ophthalmic viscosurgical device-related complications without introducing new ones.

In clinical practice, the effect of a high vault on corneal endothelial cells after implantable collamer lens (ICL) implantation remains unclear. Many clinicians theoretically assume that a high postoperative vault leads to rapid endothelial damage, but no study has yet proven this hypothesis. We conducted a paired-eye study to compare changes in corneal endothelial cell density (ECD) between high and low postoperative vault groups. This retrospective study included 150 eyes of 75 patients with bilateral postoperative vault levels differing by more than 200 μm after ICL implantation. Patients were followed up for 7 years with ECD measurements, and changes in ECD were assessed between 6 months and 7 years post-surgery. Over the 7-year follow-up period, the percentage of ECD loss was 15.04% and 14.45% in the high- and low-vault groups, respectively. The bilateral paired-eye comparison revealed a significant reduction in ECD in the high-vault group at 3, 5, and 7 years postoperatively (P-value < 0.001). In this paired-eye comparison of long-term observations, a higher vault was associated with greater ECD loss. Our study confirms that a high vault level may be an important risk factor for ECD loss following ICL implantation.

This study introduces an innovative surgical instrument, the “wolf-toothed forceps,” and evaluates its clinical application in conjunction with the Z.S. fixation technique for managing aphakic eyes with significant corneal astigmatism lacking lens capsule support. This was a pilot, case series, and interventional study. The novel “wolf-toothed forceps,” integrated with the Z.S. fixation technique, was applied to astigmatic aphakic eyes requiring secondary toric intraocular lens (IOL) implantation. Ophthalmological examinations were performed in all patients, including slit-lamp photography and swept-source optical coherence tomography, for quantitative assessment of toric IOL position. The visual acuity measurements were converted to the logarithm of the minimum angle of resolution (log MAR) units for analysis. Eleven eyes of 11 patients with significant corneal astigmatism (1.58 ± 0.52 diopters [D]) lacking lens capsule support were enrolled. At 1-month visit postoperatively, the outcomes demonstrated significant visual improvement, with the uncorrected distance visual acuity (UDVA) of 0.47 ± 0.26 log MAR, and the best-corrected visual acuity (BCVA) of 0.29 ± 1.23 log MAR. Refractive outcomes showed excellent astigmatic correction, reducing mean whole-eye residual astigmatism to 0.30 ± 0.28 D ( P  < 0.001). The swept-source optical coherence tomography showed favorable stability (tilt: 5.12 ± 1.27°; decentration: 0.25 ± 0.14 mm). During the 6-month follow-up period, no severe complications related to the novel “wolf-toothed forceps” or Z.S. fixation technique were found. Our pilot study demonstrates that the wolf-toothed forceps combined with Z.S. fixation technique provides effective and safe single-piece toric IOL scleral fixation in complex aphakic eyes with significant corneal astigmatism lacking lens capsule support, achieving predictable refractive correction and stable visual rehabilitation without serious postoperative complications. The technique shows particular promise for cases where traditional IOL scleral fixation is not feasible.

Though several procedures of IOL implantation have been described (sutured scleral fixation, intra-scleral fixation, angle-supported anterior chamber, and anterior chamber or retropupillary iris-claw IOLs), there are no randomized trials which are comparing different techniques. Hence, the surgical treatment of aphakia still remains controversial and challenging. The purpose of this study was to compare the long-term efficacy and the rate of complications of anterior versus posterior Iris-claw intraocular lenses (IOL) implantation to correct for the treatment of aphakia without sufficient capsule support. Consecutive eyes having secondary implantation of aphakic iris-fixated IOLs with a follow-up of at least 5 years were considered. Mean correct distance visual acuity (CDVA) changes, percentage of eyes with CDVA improvement, mean corneal endothelial cell density (CECD) loss and the rate of other complications were used for statistical analysis. The study evaluated a total of 180 eyes (Group A: 87 anterior chamber iris-claw fixation, Group B: 93 retropupillary iris-claw implantation) of 180 consecutive different patients, with aphakia of various reasons. CDVA improved significantly in both groups after surgery (P<0.001, ANOVA), and was remarkably higher than baseline in both groups from first week and during the entire follow-up (P<0.001, Tukey's Honest Significant Difference). There was no statistically significant difference in CDVA between the two groups during each follow-up visits (P = NS, unpaired t-test) and in the CDVA improvement percentage between the two groups (P = 0.882, Chi-square test). No significant changes in CECD were noted after surgery in both groups (ANOVA Group A: P = 0.067, Group B: P = 0.330P). No intra-operative complications occurred in both groups. There was no statistically significant difference in the rate of complications between the two groups (P = NS, Chi-square test), except for pigment precipitates which were higher in Group A (P<0.05, Chi-square test). Five-year follow-up shows that secondary implantation of aphakic IOLs is effective and safe for the correction treatment of aphakia in eyes without capsule support.

Permanent surgical treatment for presbyopia remains the hereto unconquered 'last frontier' in anterior segment surgery. Over the years, continuing innovations like Phaco, Radial Keratotomy, LASIK, and premium intraocular lenses have pushed toward this ultimate goal, but now anterior segment surgery is closer than ever with the advent of modern laser-assisted presbyopic lens implantation. Let Refractive Lens Exchange: A Surgical Treatment for Presbyopia , the first book of its kind, be your guide to this fifth wave of innovation in the surgical treatment of presbyopia. Dr. Ming X. Wang, MD, PhD, joined by Associate Editor Dr. Tracy S. Swartz, OD, MS, FAAO and more than 30 expert contributors, compiled this remarkable book. Never before has there been a book dedicated to all aspects of refractive lens exchange as a permanent treatment for presbyopia, both medically and surgically. Highlights of Refractive Lens Exchange include: Overview of all surgical treatments for presbyopia Dysfunctional lens syndrome and pathophysiology Patient education and preoperative assessment Marketing refractive lens exchange as a surgical treatment for presbyopia New technologies in assessing dysfunctional lens syndrome New technologies in mapping cornea and lens for refractive lens exchange Retinal issues related to refractive lens exchange Presbyopic lens types, indications, and contraindications for refractive lens exchange Lens- and cornea-based astigmatism correction Intraocular calculations for post refractive surgery eyes for refractive lens exchange Intraoperative wavefront technology 3D high-definition microsurgical visualization and positioning technology Femtosecond laser application in refractive lens exchange Postoperative care and complication management YAG capsulotomy after refractive lens exchange: indications and alternatives Postoperative care and complication management Keratorefractive enhancement Designed for newcomers as well as seasoned eyecare professionals, Refractive Lens Exchange: A Surgical Treatment for Presbyopia is the first book to guide ophthalmic surgeons, optometrists, and technicians through this exciting new field that is emerging as a safe and effective primary surgical treatment for presbyopia.

PurposeIntraocular lens designs are constantly evolving, trying to obtain more spectacle independence after cataract surgery. This advantage can be linked to some disadvantages, such as optical quality decrease. For that reason, it is important to assess, not only the amount of vision provided but also the quality of vision once they are implanted. The purpose of the present work was to compare the visual performance between two monofocal intraocular models: a standard model and a monofocal with enhanced intermediate vision lens.MethodsProspective, randomized, comparative study. Sixty adult subjects scheduled to undergo bilateral cataract surgery and IOL implantation were randomized to receive one of the two IOLs in both eyes at Miranza IOA, Madrid, Spain (group A: monofocal with enhanced intermediate vision lens and group B: standard monofocal lens). Monocular outcomes (right eyes) determined 1 and 3 months postoperatively were photopic corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), perceived halo, corrected intermediate-distance contrast sensitivity, and higher-order aberrations. The impact of the new IOL in the postoperative management with autorefraction devices was also evaluated.ResultsNo differences were found in CDVA between the two groups. Significant differences were detected between the two lenses evaluated in both total HOA (p = 0.028) and internal HOA (p = 0.037). Contrast sensitivity and halometry results obtained at 1 month were similar across the two IOL groups.ConclusionIn patients undergoing cataract surgery, monofocal with enhanced intermediate vision IOL offered similar distance performance and contrast sensitivity along with perceived HOA and halos compared with the standard monofocal IOLs tested.

This retrospective observational multicentre cohort study compared the rate of postoperative cystoid macular oedema (CME) between two intraocular lens (IOL) scleral fixation (SFIOL) techniques: a flanged IOL fixation technique (Yamane technique) and a suture IOL transscleral fixation technique (conventional technique). The study included 207 eyes with postoperative CME that had undergone SFIOL and were observed for > 12 weeks between January 2019 and January 2021. The primary endpoint was a comparison of the rate of postoperative CME at 3 months between groups. Secondary endpoints were a comparison of postoperative best-corrected visual acuity (BCVA) at 3 months between groups and an analysis of characteristics associated with postoperative CME in the Yamane technique group. The Yamane technique group developed postoperative CME in 13.0% of eyes at 3 months, compared with 1.9% in the conventional technique group (odds ratio: 7.99, P  = 0.045). Postoperative BCVA was consistently significantly higher in the Yamane technique group. Although many retinal surgeons have performed the Yamane technique because of its convenience for SFIOL, our findings suggest that the Yamane technique carries an increased risk of postoperative CME compared with the conventional suture method. Therefore, careful management of postoperative CME is needed after SFIOL.

Purpose With the aging population, the prevalence of presbyopia and the popularity of multifocal intraocular lenses is also growing worldwide. Unfortunately, in some cases, they are still associated with postoperative visual disturbances. Recent literature started to evaluate angle kappa- and angle alpha-derived metrics of chord mu and chord alpha as possible predictive values for visual outcomes after multifocal intraocular lens implantation but the published results are inconsistent between studies. Thus, this article aims to review the role of chord mu and chord alpha as postoperative predictors after multifocal intraocular lens implantation and lay the foundation for further research. Methods Relevant articles were identified using the following keywords: “presbyopia,” “multifocal intraocular lens,” “angle kappa,” “angle alpha,” “Chord mu,” and “Chord alpha” up to June 2022. An attempt was made to present the majority of publications that addressed the topic. Conclusions Chord mu and chord alpha have a predictive role on the outcomes after multifocal intraocular lens implantation but to a different extent. Cataract surgeons should take them into consideration and avoid implanting a multifocal intraocular lens for patients with speculated critical values of chord mu and alpha above 0.5–0.6 mm, depending on the device used for measurement and the multifocal intraocular lens implanted. Currently, chord alpha seems to be a more stable, more widely applicable, and reliable determinant in predicting postoperative outcomes and in patient selection prior to multifocal intraocular lens implantation when compared to chord mu. To draw conclusions on the topic, a controlled study is needed.