Purpose: To determine the detection rate and associated factors of latent macular lesions using preoperative spectral-domain optical coherence tomography (SD-OCT) in Japanese patients scheduled for cataract surgery with no clinically confirmed macular abnormalities. Setting: Teine Keijinkai Hospital, Sapporo, Japan. Design: Retrospective observational study. Methods: 316 eyes of 316 Japanese patients with cataract scheduled for surgery between January 2023 and December 2024 who had no suspected macular pathology on slitlamp biomicroscopy were included. All patients underwent comprehensive ophthalmic examinations and SD-OCT, and the detection rate of latent macular lesions and their associated factors were investigated. Results: Latent macular lesions were detected in 30 eyes (9.5%) of 316 patients with a mean age of 76.8 +/- 8.8 years. The most frequent lesions were epiretinal membrane (15 eyes, 4.7%), followed by irregular elevation of the retinal pigment epithelium (10 eyes, 3.2%). Clinically significant lesions requiring immediate surgical modification or additional treatment were identified in 3 eyes (1.0%), including a full-thickness macular hole (1 eye) and neovascular age-related macular degeneration (2 eyes). Age was independently associated with latent macular lesions (odds ratio 1.10, 95% CI 1.04-1.16, P < .01). Conclusions: Preoperative OCT screening may contribute to the evaluation of latent macular lesions, particularly in elderly cohort, and lead to optimized surgical planning.
Purpose: To evaluate the effects of extracorporeal ultra-high-fluence corneal crosslinking (ECO-CAIRS) on the dehydration and rehydration behavior of porcine corneal stromal ring segments in an experimental model simulating the preparation of corneal allogenic intrastromal ring segments. Setting: ELZA Institute, Zurich, Switzerland. Methods: Corneal ring segments (2 per cornea) were prepared from freshly enucleated porcine corneas (n = 48) and randomly divided into 3 groups: controls (no corneal crosslinking [CXL], Jerky technique), extracorporeal ultra-high-fluence CXL at 30 J/cm2, and 60 J/cm2 (n = 32 each). After epithelial removal and ring preparation, segments in the control group were soaked in balanced salt solution, while those in the experimental groups were soaked in riboflavin solution (Ribo-Ker) for 10 minutes. Each group subsequently underwent a total dehydration period of 45 minutes, which included both UV-A irradiation and waiting phases for the CXL-treated groups, followed by a 10-minute rehydration phase using balanced salt solution. Segment thickness was measured by calibrated imaging at baseline, after dehydration, and after rehydration. Results: Baseline structural thickness values did not differ significantly between groups. Both CXL-treated groups demonstrated significantly greater dehydration (P < .01) and reduced rehydration (P < .01) when compared with controls. No significant differences were found between the 2 CXL-treated groups. Ultra-high-fluence crosslinking enhanced segment dehydration and slowed rehydration. Conclusions: ECO-CAIRS effectively modulates the dehydration and rehydration of corneal ring segments, which may improve handling and implantation characteristics during surgery. These findings support the potential clinical benefit of CXL in CAIRS procedures. Further in vivo studies are required to confirm long-term behavior and biomechanical impact.
Purpose: To evaluate the agreement in orientation and magnitude between corneal toricity and biomechanical anisotropy using optical coherence elastography (OCE). Setting: College of Optometry, University of Houston, Houston, Texas, USA. Design: Prospective cross-sectional study. Methods: Healthy participants with spherical refractive error or corneal astigmatism > 0.50D were included. Corneal radial mechanical wave propagation speed, a proxy for corneal shear modulus, was measured using air-pulse wave-based OCE imaging (30° intervals over 360°). Biomechanical principal meridian ( ) was defined as meridian with greatest wave speed, and its magnitude was calculated as difference between principal and orthogonal meridians. Likewise, astigmatic principal meridian ( ) was defined as steep corneal meridian from videokeratography, and its magnitude was defined as dioptric difference between orthogonal steep and flat meridians. To compare these different domains (biomechanical anisotropy and astigmatism) within and across subjects, both vector magnitudes were cohort-normalized. Directional alignment between and was assessed using polar double-angle plots. Vectorial difference between these measures quantified similarities in both orientation and magnitude. Results: 30 eyes from 30 subjects were studied. Corneal astigmatism ranged from 0.15 to 3.66D (1.4±0.8D; mean±SD). Corneal wave speed in steep meridian was faster (12.97±1.6m/s) compared to flat meridian(9.03±1.8m/s). Biomechanical anisotropy strongly correlated with astigmatism (R 2 = 0.88). Angular difference between and was 6.0°±7.1° among astigmatic eyes. Cohort-normalized magnitude difference between and was 0.06±0.07. Conclusions: In vivo human corneal wave-based OCE measurements demonstrate that corneal biomechanical anisotropy exhibits an orthogonal pattern, highly correlated in orientation and magnitude with corneal topography.
Purpose: To characterize determinants of intraocular thermal exposure during phacoemulsification—ultrasound modality, ophthalmic viscosurgical device (OVD) use, and delivered ultrasound energy—and to evaluate whether automated energy modulation (Thermal Sentry) reduces anterior chamber and corneal incision temperature. Setting: Masked for review Design: Controlled ex vivo laboratory investigation using a porcine eye model. Methods: Continuous phacoemulsification was performed for 90 seconds using the UNITY Vitreoretinal Cataract System (UNITY VCS; Alcon Vision LLC, Fort Worth, TX, USA) in 80 enucleated porcine eyes under standardized settings (intraocular pressure 37 mmHg, vacuum limit 50 mmHg, aspiration flow rate 18 cc/min, ultrasound power 100%). Anterior chamber and incision temperatures were compared across three modalities (4D, torsional, longitudinal) with Thermal Sentry ON or OFF (n = 10/group), and under OVD-assisted 4D-mode conditions with Thermal Sentry ON or OFF (n = 10/group). Delivered energy (Joules) and cumulative dissipated energy (CDE) were recorded. Results: Thermal exposure differed significantly among modalities (Thermal Sentry OFF), with longitudinal ultrasound producing the greatest elevation and 4D mode the smallest (all P < 0.001). OVD use increased thermal exposure during 4D-mode phacoemulsification. Temperature elevation correlated strongly with Joules (r = 0.857) and CDE (r = 0.860, both P < 0.001). Thermal Sentry reduced anterior chamber temperature elevation across all modalities and OVD conditions, and reduced incision temperature during torsional and longitudinal ultrasound, through reductions in delivered energy. Conclusions: Intraocular thermal exposure during phacoemulsification is influenced by ultrasound modality and OVD use and is closely associated with cumulative delivered energy. Automated ultrasound energy modulation is an effective strategy for limiting thermal exposure across the conditions tested.
