PURPOSE:Astigmatism is one of the most common refractive conditions, with a large proportion of patients undergoing cataract surgery presenting with 1.0 D or more. Toric IOLs are the standard of care for astigmatism correction during cataract surgery. This overview of reviews synthesizes current evidence on the use of toric IOLs, focusing on clinical indications, surgical outcomes, and emerging technologies. DESIGN:Narrative review of reviews. METHODS:The following databases were searched from inception to 2 June 2025: MEDLINE, Embase, the Cochrane Library (including CENTRAL and the Cochrane Database of Systematic Reviews), KSR Evidence, and the Trip Database. Keywords included astigmatism, toric intraocular lenses, cataract surgery, intraocular lens implantation, and postoperative outcomes. Included studies were systematic and narrative reviews, meta-analyses, and clinical guidelines related to the use of toric IOLs in cataract surgery. RESULTS:Eighty-five reviews were included. This overview summarizes key topics including the prevalence and impact of astigmatism, toric IOL technology, preoperative assessment, power calculation methods, surgical considerations, and postoperative outcomes such as rotational stability and surgically induced astigmatism. Reporting standards, patient-reported outcome measures, adverse events, and considerations in special populations are also discussed. Knowledge gaps and debated areas are highlighted. CONCLUSIONS:Toric IOLs improve uncorrected visual acuity and refractive outcomes in cataract patients with significant astigmatism. Advances in diagnostics, lens design, calculation formulas, and intraoperative tools continue to enhance accuracy and patient satisfaction. Further research is needed to address unresolved questions and support best practices in diverse clinical settings.

Purpose: To characterize structural and biomechanical changes following ex vivo treatment of rabbit sclera with the bacteriochlorophyll derivative WST11 and near-infrared (NIR) light. Methods: Enucleated left scleras of 10 rabbits were cross-linked by a 20-min topical application of WST11 solution, followed by 30-min NIR irradiation (10 mW/cm(2)). Paired right eyes served as untreated controls. Scleral tangent modulus and ultimate tensile strength were obtained from tensile strip testing. Collagen molecular-level nanostructure was measured using wide-angle X-ray scattering (WAXS). Scleral fibrillar-level microstructure was assessed using second harmonic generation (SHG) and two-photon fluorescence (TPF) imaging. Results: WST11/NIR treatment increased scleral tangent modulus by an average of 79% for strains between 1.5% and 3% (p < 0.05), while ultimate tensile strength increased by 140% (control: 1.719 MPa, treated: 4.134 MPa, p < 0.01). WAXS indicated that collagen molecular spacing (control: 1.485 nm/treated: 1.480 nm, p = 0.65), spatial disorder (47.6 a.u./47.6 a.u., p > 0.99), and anisotropy (0.935 a.u./1.157 a.u., p = 0.09) were not significantly affected by treatment. No marked treatment effects on collagen fibril bundle organization were observable by SHG imaging. TPF imaging revealed additional crimped fibrous structures in the outer half of the tissue depth in treated specimens, indicative of enhanced collagen cross-linking. Conclusions: WST11/NIR treatment significantly increased the stiffness of the ex vivo rabbit sclera. The origin of the stiffening effect is consistent with the formation of collagen cross-links that are predominantly extrafibrillar in nature. Further research is needed to establish the full mechanism, efficacy, and safety of the method as a potential myopia treatment.

Organoids are mini-organs engineered to mimic the native tissue's organization, cellular structure, and function. Lacrimal gland organoids are considered a potential treatment for patients with dry eye, but the gland's complex heterogeneity has been difficult to replicate. This systematic review summarizes methods for creating lacrimal gland organoids, their characterization, and potential applications. Data collected included organoid source, composition of expansion or differentiation media, biomarkers, gene expression, responses to stimulants, and effects in animal models. The sources of lacrimal gland organoids were human induced pluripotent stem (hiPS) cell lines (n = 2) and tissue biopsies from humans, mice, or pigs (n = 5). Tissue-derived organoids from mice grew for 40 passages, while those from human biopsies lasted up to 20 passages. There is a need to optimize the culture protocol to preserve cell composition and support long-term growth. The organoids expressed epithelial markers (KRT5, KRT13, AQP), mesenchymal markers (Vimentin and α-SMA), and developmental markers (PAX6, TP63, and OCT3/4), though cellular proportions varied between studies. Stimulation studies showed increased calcium influx and β-glucosaminidase activity, indicating secretory capacity. RNA sequencing revealed unique gene expression patterns associated with stemness and functional maturity, including tear proteins and markers of ductal and myoepithelial cells. PAX6 knockout studies confirmed PAX6's essential role in organoid growth. Published studies lack data on epithelial polarity, the coexistence of ductal and acinar cells within organoids, and the in vivo secretory function of organoids. Transplanted organoids into animal models of dry eye disease (two immunosuppressed and two naïve) remained viable for 8 weeks and expressed tear-related markers (AQP5, KRT14, PAX6), although there was no data on tear film or ocular surface changes. Future research could explore the effects of transplantation on the ocular surface and host immune responses.

The aim of the study is to identify proteins with differential abundance among aqueous humor (AqH) samples from patients with mild or advanced Fuchs endothelial corneal dystrophy (FECD) compared to control subjects. Proteins were extracted from AqH samples and analyzed by liquid chromatography–mass spectrometry. A total of 455 proteins were identified across the three groups, of which 285 proteins were shared across all groups at the identification level and 104 were retained after proteomic filtering for quantitative analysis. Statistical analysis revealed that 48 proteins were significantly downregulated in mild, advanced, or both groups compared to controls, while one was upregulated. Functional enrichment analysis was performed on differentially expressed proteins (DEPs) and indicated that the main biological processes were associated with cell energy metabolism and cytoskeleton disorganization, known hallmarks of FECD pathology. Among all these, HSP60 was selected for further validation. Reduced HSP60 expression was confirmed in additional AqH samples and corneal endothelial tissue samples from FECD patients, supporting the proteomics findings. In conclusion, these results suggest that HSP60 is a disease-associated protein in FECD and a candidate for future functional studies, with possible relevance for biomarker discovery and therapeutic exploration.

High myopia is the leading cause of visual impairment worldwide, driven by excessive axial elongation resulting in biomechanical weakening of the sclera, and increasing the risk of complications such as posterior staphyloma, myopic macular degeneration, retinal detachment, cataract, and glaucoma. Conventional myopia management strategies aim to slow axial elongation in childhood, leaving patients with high myopia at risk of vision-threatening complications as they age. For these individuals, targeted therapies that strengthen the weakened sclera represent a promising, yet still experimental, approach. This review provides an overview of the role of the sclera in myopia progression, emphasizing changes in extracellular matrix composition, collagen organization, biomechanical integrity, and signaling pathways. Investigational scleral therapies are discussed, including posterior scleral reinforcement techniques, crosslinking modalities, pharmacological strategies, and tissue engineering approaches, with discussion of their mechanisms, preclinical and clinical evidence, and translational challenges. Particular attention is given to translational barriers, such as safe delivery to the posterior pole, retinal safety, and the absence of standardized outcome measures that link biomechanical reinforcement to functional benefit. Advances in imaging and in vivo biomechanical assessment, such as polarization-sensitive optical coherence tomography, Brillouin microscopy, and ultrasound-based elastography, hold promise for earlier risk stratification and treatment monitoring. By integrating insights from biomechanics, molecular biology, and therapeutic innovation, this review highlights the sclera as both a key driver of myopia pathology and a promising therapeutic target. Continued interdisciplinary collaboration will be essential to translate these experimental approaches into clinically viable treatments capable of reducing the growing burden of high myopia worldwide.

Crosslinking strengthens the sclera and holds potential as a treatment for myopia. This study aims to identify optimal crosslinking parameters in guinea pigs using WST11 with dextran followed by near-infrared (NIR) illumination. Guinea pig eyes were incubated in WST11 with 2, 5 or 10% dextran, and penetration depth was assessed by fluorescence microscopy. Crosslinking efficacy was measured as thermal stability using a thermal degradation assay, following incubation in WST11 + 10% dextran (WST-D) for 30 min and NIR irradiation at 10 mW/cm2 or 20 mW/cm2 for 10, 20 and 30 min. The optimized parameters were then applied in vivo in 6-month-old guinea pigs. Ex vivo treatment using the optimal crosslinking parameters (WST-D, 30 min; NIR, 10 mW/cm2, 30 min) resulted in the highest thermal degradation midpoint (ΔT50: 6.8), significantly higher than untreated controls (p = 0.0006), with WST-D penetration limited to the sclera. Efficacy was greater in eyes obtained from older compared to younger guinea pigs (p = 0.02). In vivo, WST-D/NIR treatment resulted in significant crosslinking compared to untreated controls (equatorial, ΔT50: 3.7, p < 0.0001; posterior, ΔT50: 3.4, p = 0.01). WST-D/NIR treatment effectively induces scleral crosslinking, with age-related differences suggesting the need for personalized treatment.

Fuchs endothelial corneal dystrophy (FECD) is an age-related condition distinguished by the degeneration of the corneal endothelium. An intronic CTG18.1 repeat in the transcription factor 4 (TCF4) gene has been associated with a 78-fold increased risk of developing the disease when at least one copy of the CTG18.1 expands above 50 repeats. Employing patient-derived material, we applied a dual CRISPR/Cas9-mediated editing approach to rescue the expansion. Combining non-homologous end-joining (NHEJ) and homologous direct repair (HDR) events, we generated two FECD-derived +/+(CTG)8 induced pluripotent stem cell (iPSC) lines, which were then successfully characterized, providing relevant isogenic controls for disease-modelling purposes.

The cornea, a transparent tissue composed of multiple layers, allows light to enter the eye. Several single-cell RNA-seq (scRNA-seq) analyses have been performed to explore the cell states and to understand the cellular composition of the human cornea. However, inconsistences in cell state annotations between these studies complicate the application of these findings in corneal studies. To address this, we integrated scRNA-seq data from four published studies and created a human corneal cell state meta-atlas. This meta-atlas was subsequently evaluated in two applications. First, we developed a machine learning pipeline cPredictor, using the human corneal cell state meta-atlas as input, to annotate corneal cell states. We demonstrated the accuracy of cPredictor and its ability to identify novel marker genes and rare cell states in the human cornea. Furthermore, cPredictor revealed the differences of the cell states between pluripotent stem cell-derived corneal organoids and the human cornea. Second, we integrated the scRNA-seq-based cell state meta-atlas with chromatin accessibility data, conducting motif-focused and gene regulatory network analyses. These approaches identified distinct transcription factors (TFs) driving cell states of the human cornea. The novel marker genes and TFs were validated by immunohistochemistry. Overall, this study offers a reliable and accessible reference for profiling corneal cell states, which facilitates future research in cornea development, disease, and regeneration.

PURPOSE. This study aims to elucidate on changes in biological pathways in rabbit corneas induced by two methods of light-activated corneal stiffening: topical application of riboflavin with dextran (RF-D) or WST11 with dextran (WST-D) followed by ultraviolet A (UVA) or near-infrared (NIR) illumination, respectively. METHODS. Rabbit corneas were mechanically de-epithelialized, then left untreated (N = 3) or treated with either RF-D/UVA (N = 3) or WST-D/NIR (N = 3). After one week, quantitative proteomics was performed on untreated, RF-D/UVA- and WST-D/NIR-treated corneas. Pathway enrichment analysis was performed to identify the biological processes associated with the treatments. To identify the abundance and spatial distribution of lipids in the untreated, WST-D/NIR- and RF-D/UVA-treated corneal stroma, lipid mass spectrometry imaging was performed together with hematoxylin and eosin staining. R ESULTS. Between RF-D/UVA- and WST-D/NIR-treated corneas, 37 and 39 proteins, respectively, were differentially expressed compared to untreated corneas (P < 0.05). Pathway enrichment analysis showed the effect of RF-D/UVA treatment on cell metabolism and terminal differentiation of keratocytes, while WST-D/NIR modified extracellular matrix regulation and the mitogen-activated protein kinase signaling cascade. When comparing the RF-D/UVA and WST-D/NIR treatment, 74 proteins were differentially expressed, affecting cellular metabolism and respiration, complement activation, the activation of matrix metalloproteinases, and lipoprotein metabolism. The lipid profile for the RF-D/UVA- and WST-D/NIR-treated stromas were similar, whereas differences were observed comparing both treatments to untreated corneal stroma. CONCLUSIONS. Proteomics indicated a metabolic shift from oxidative phosphorylation to glycolysis and hypoxia after RF-D/UVA treatment. In contrast, WST-D/NIR stiffening maintained normal respiration and involved extracellular matrix remodeling.

Corneal diseases are among the leading causes of blindness worldwide and the standard treatment is the transplantation of corneal donor tissue. Treatment for cornea-related visual impairment and blindness is, however, often constrained by the global shortage of suitable donor grafts. To alleviate the shortage of corneal donor tissue, new treatment options have been explored in the last decade. The discovery of induced pluripotent stem cells (iPSCs), which has revolutionized regenerative medicine, offers immense potential for corneal repair and regeneration. Using iPSCs can provide a renewable source for generating various corneal cell types, including corneal epithelial cells, stromal keratocytes, and corneal endothelial cells. To document the recent progress towards the clinical application of iPSC-derived corneal cells, this review summarizes the latest advancements in iPSC-derived corneal cell therapies, ranging from differentiation protocols and preclinical studies to the first clinical trials, and discusses the challenges for successful translation to the clinic.

An expanded CTG repeat in intron 2 of the transcription factor 4 (TCF4) gene is the main cause of Fuchs endothelial corneal dystrophy (FECD), a complex corneal disease. The prevailing paradigm is that the expanded repeat exerts toxic effects, resulting in corneal endothelium degeneration. Here we explored the use of CRISPR/Cas9-mediated, non-homologous end-joining (NHEJ) for disease-modeling purposes, by performing a biallelic excision of the CTG18.1 expansion in two FECD- and one control-derived induced pluripotent stem cell lines (iPSCs). The three Δ/Δ CTG18.1 lines generated by this study provide a platform to investigate the CTG18.1 contribution to FECD pathogenesis.

Acanthamoeba keratitis (AK) is a sight-threatening corneal infection that is challenging to diagnose and treat due to the resistance of Acanthamoeba to standard antimicrobial agents. Current detection methods have limitations. This study aimed to develop and validate a sensitive viability PCR (v-PCR) assay using a photoreactive dye to distinguish viable from non-viable Acanthamoeba for rapid identification of viable Acanthamoeba trophozoites and cysts. Propidium monoazide (PMAxx) was used as a photoreactive dye. Mixtures containing decreasing percentages of viable Acanthamoeba, including reference strains Acanthamoeba polyphaga trophozoites and cysts, Acanthamoeba castellanii trophozoites, and Acanthamoeba castellanii trophozoites from a clinical sample, were prepared. Disinfectant efficacy against Acanthamoeba was also assessed. Samples were divided into PMAxx-treated and non-PMAxx-treated parts, and v-PCR assay was applied to both. The difference in viable Acanthamoeba was determined by subtracting the cycle threshold (Ct) value of the PMAxx-treated sample from the non-PMAxx-treated sample. Mixtures with decreasing concentrations of viable Acanthamoeba trophozoites and cysts showed increasingly lower delta Ct values as the percentage of viable Acanthamoeba decreased, as expected. This relationship was observed across all tested samples. Menicon Progent effectively eliminated A. polyphaga trophozoites and cysts, while propamidine, chlorhexidine, or their combination resulted in approximately 2-log reductions in A. polyphaga trophozoites and cysts. In the current study, a rapid v-PCR assay was developed that can distinguish between viable and non-viable Acanthamoeba, for both trophozoites and cysts, across multiple species. The presence of viable Acanthamoeba, as determined by v-PCR, allows monitoring of treatment response and efficacy in AK.IMPORTANCEThe development of a sensitive viability PCR (v-PCR) assay using propidium monoazide (PMAxx) as a photoreactive dye marks a significant advancement in the diagnosis and treatment of Acanthamoeba keratitis (AK), a severe corneal infection notorious for its resistance to conventional antimicrobials. This innovative assay offers a rapid and accurate method to distinguish viable from non-viable Acanthamoeba trophozoites and cysts, addressing a critical need in the field. By effectively distinguishing between viable and non-viable Acanthamoeba, this test enables monitoring of treatment response and efficacy, essential for guiding clinical interventions in AK cases. The successful validation of this v-PCR assay across various Acanthamoeba species and its ability to assess disinfectant efficacy further underline its potential as a valuable tool for improving diagnostic precision and therapeutic outcomes in the treatment of AK.

PURPOSE:Cataract surgery is the most frequently performed surgical procedure worldwide, but postoperative endophthalmitis remains a serious complication that can lead to vision loss. While intracameral (IC) antibiotics are well established in significantly reducing the risk of postoperative infections, there is no consensus on the use of postoperative topical antibiotics. This systematic review and meta-analysis aimed to evaluate the efficacy of topical antibiotics in preventing endophthalmitis in patients already receiving IC antibiotics. METHODS:A comprehensive search of PubMed, Scopus and Cochrane databases yielded 31 studies that met the inclusion criteria, involving patients who underwent cataract surgery via phacoemulsification. The patients were divided into two groups: those receiving IC antibiotics alone and those receiving additional postoperative topical antibiotics. The primary outcome was the incidence of postoperative endophthalmitis. RESULTS:A total of 1 235 051 eyes were included in the meta-analysis, with 608 302 in the IC + T group, which received intraoperative intracameral antibiotics combined with postoperative topical antibiotics, and 626 749 in the IC group, which received intracameral antibiotics alone. The pooled analysis revealed no statistically significant difference in the incidence of endophthalmitis between the two groups (p = 0.97), with an incidence of 0.0004 (95% CI: 0.0003-0.0005) in both groups. These results suggest that the addition of topical antibiotics does not provide further benefit in preventing infections beyond IC antibiotics alone. CONCLUSIONS:IC antibiotics as a sole prophylactic measure may be sufficient, and the routine use of postoperative topical antibiotics could be unnecessary. Reducing the use of topical antibiotics may also help mitigate the risk of antimicrobial resistance.

PURPOSE:To introduce a newly developed digital platform and compare its reliability and agreement with paper-based questionnaires for assessing quality of vision before and after cataract surgery. SETTING:University-affiliated ophthalmology department and private clinic. DESIGN:Prospective, randomized trial with parallel design of 1:1 allocation ratio without masking. METHODS:Between 11/2021 and 6/2023, patients from a preoperative cataract clinic, aged ≥21 years, with cataracts in both eyes and internet access were randomly assigned by "ALEA" software to complete Catquest-9SF and Quality-of-Vision (QoV) questionnaires before surgery and after second eye surgery via paper or a newly developed digital European Registry of Quality Outcomes in Cataract and Refractive Surgery (EUREQUO) platform. Statistical analyses evaluated agreement between methods, and validation was by Rasch analysis. RESULTS:Half (183/364, 50.3%) of the enrolled patients were allocated to digital questionnaires. After exclusion due to technical issues, missing questions, and withdrawal, 307/364 patients remained, of whom 159 (51.8%) filled in digital questionnaires. Half of all patients (n=154) underwent sequential surgeries on both eyes after a minimum one-month interval. Seventy-two (72/154, 46.8%) completed postoperative questionnaires. Comparative analysis found no significant differences between paper and digital methods. Catquest-9SF and QoV questionnaires demonstrated good precision and reliability (Rasch analysis). Postoperative vision improved at an average of 2.82 logits. CONCLUSION:The newly developed digital EUREQUO platform for patient assessment of quality of vision before and after cataract surgery with the Catquest-9SF and QoV questionnaires, offers a reliable alternative to traditional paper-based questionnaires, enhancing convenience for patients and providers.

PurposeWe describe a patient after customized crosslinking (CXL) for progressive keratoconus who developed corneal edema with spontaneous resolution.ObservationsA 24-year-old male with progressive keratoconus of the left eye underwent a customized CXL procedure with a total energy of 10 J/cm2 for 16.4 minutes. Preoperative corrected distance visual acuity (CDVA) was 20/30 with a maximum keratometry (K)-value of 58.6 diopter (D) and the thinnest point measured 414 μm. The preoperative endothelial cell density (ECD) was 2414 cells/mm2. During treatment, corneal thickness was 325 μm after epithelial debridement and 375 μm after the application of 0.1% riboflavin containing HPMC. After the treatment, antibiotic and steroid drops were prescribed for 5 days and 3 weeks, respectively. At the 1-month post-CXL visit the patient had no complaints, visual acuity and clinical examination showed no irregularities. At the 4-months post-CXL visit the patient complained of blurry vision. The CDVA was 20/100 and slit-lamp examination showed microcystic corneal edema. The corneal thickness at the thinnest point measured 440 μm. One month later the edema had resolved spontaneously and CDVA had restored to 20/25. Corneal thickness at the thinnest point measured 415 μm, the ECD was 1514 cells/mm2 and confocal microscopy showed normal structural changes in the anterior stroma after CXL, with the demarcation line located at a depth of 414 μm, just above the corneal endothelium.Conclusions and ImportanceWe report a case of corneal edema following customized CXL with endothelial cell loss that resolved spontaneously. We recommend either adhering to a minimal stromal thickness of 400 μm before administering UV-A irradiation, using a contact lens or adjusting the irradiation to prevent this complication.

ABSTRACT Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19). Commonly used methods for both clinical diagnosis of SARS-CoV-2 infection and management of infected patients involve the detection of viral RNA, but the presence of infectious virus particles is unknown. Viability PCR (v-PCR) uses a photoreactive dye to bind non-infectious RNA, ideally resulting in the detection of RNA only from intact virions. This study aimed to develop and validate a rapid v-PCR assay for distinguishing intact and compromised SARS-CoV-2. Propidium monoazide (PMAxx) was used as a photoreactive dye. Mixtures with decreasing percentages of intact SARS-CoV-2 (from 100% to 0%) were prepared from SARS-CoV-2 virus stock and a clinical sample. Each sample was divided into a PMAxx-treated part and a non-PMAxx-treated part. Reverse transcription-PCR (RT-PCR) using an in-house developed SARS-CoV-2 viability assay was then applied to both sample sets. The difference in intact SARS-CoV-2 was determined by subtracting the cycle threshold ( Ct ) value of the PMAxx-treated sample from the non-PMAxx-treated sample. Mixtures with decreasing concentrations of intact SARS-CoV-2 showed increasingly lower delta Ct values as the percentage of intact SARS-CoV-2 decreased, as expected. This relationship was observed in both high and low viral load samples prepared from cultured SARS-CoV-2 virus stock, as well as for a clinical sample prepared directly from a SARS-CoV-2 positive nasopharyngeal swab. In this study, a rapid v-PCR assay has been validated that can distinguish intact from compromised SARS-CoV-2. The presence of intact virus particles, as determined by v-PCR, may indicate SARS-CoV-2 infectiousness. IMPORTANCE This study developed a novel method that can help determine whether someone who has been diagnosed with coronavirus disease 2019 (COVID-19) is still capable of spreading the virus to others. Current tests only detect the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA, but cannot tell whether the particles are still intact and can thus infect cells. The researchers used a dye that selectively blocks the detection of damaged virions and free RNA. They showed that this viability PCR reliably distinguishes intact SARS-CoV-2 capable of infecting from damaged SARS-CoV-2 or free RNA in both cultured virus samples and a clinical sample. Being able to quickly assess contagiousness has important implications for contact tracing and safely ending isolation precautions. This viability PCR technique provides a simple way to obtain valuable information, beyond just positive or negative test results, about the actual risk someone poses of transmitting SARS-CoV-2 through the air or surfaces they come into contact with.

Aims: The purpose of this study is to translate and validate a Hebrew version of the Catquest-9SF questionnaire, an efficient patient-reported outcome measure (PROM), for the assessment of cataract surgery outcome Methods: This is a prospective questionnaire validation study. The Catquest-9SFquestionnaire was translated from English to Hebrew following a standard procedure. The study population included candidates for cataract extraction surgery in both eyes. They were 21 years of age or older, Hebrew-speaking, and had Internet access. They completed the questionnaire in 2 stages, once before the surgery on the first eye and again 4-6 weeks following the surgery on the second eye. A Rasch analysis was performed to validate the Hebrew version of the questionnaire, and a sensitivity analysis was performed for the patients who completed both the preoperative and postoperative questionnaire. Results: Of the 133 patients included in the study, 125 completed the first questionnaire, and 24 also completed the second questionnaire by the time of study closure. The Hebrew translation of Catquest-9SF demonstrated 1-dimensionality, ordered response categories and good person separation. The sensitivity analysis on the 24 paired Catquest-9SF questionnaires showed good effect size (1.85). Conclusions: The Hebrew versions of the Catquest-9SF questionnaire is valid and reliable with psychometric properties of good quality and good effect size. It is applicable to Hebrew-speaking cataract patients for clinical assessment and research purposes

PURPOSE: To compare the prediction accuracy of toric intraocular lens calculations using estimated vs measured posterior corneal astigmatism (PCA). DESIGN: Retrospective case series. center dot METHODS: A total of 110 eyes of 110 patients with uncomplicated toric intraocular lens implantation were included in this study. Predicted postoperative refractive astigmatism was calculated with the Barrett Toric Calculator using the estimated PCA (E-PCA), the measured IOLMaster 700 PCA (I-PCA), and the measured Pentacam PCA (P-PCA). Refractive astigmatism prediction errors (RA-PEs), including their trimmed (tr-) centroid (mean vector), spread (precision), tr-mean absolute RAPE (accuracy), and percentage within a certain threshold, were determined using vector analysis and compared between groups. SETTING: University Eye Clinic, Maastricht University Medical Center + , the Netherlands. RESULTS: The tr-centroid RA-PEs of the E-PCA (0.02 diopter [D] at 82.2 degrees), the I-PCA (0.08 D at 35.5 degrees), and the P-PCA (0.09 D at 69.1 degrees) were significantly different from each other ( P < .01), but not significantly different from zero ( P = .75, P = .05, and P = .05, respectively). The E-PCA had the best precision (tr-mean 0.40 D), which was not significantly lower than the I-PCA (0.42 D, P = .53) and P-PCA (0.43 D, P = .06). The EPCA also had the best accuracy (0.40 D), which was not significantly different from the I-PCA (0.42 D, P = .26) and significantly better than the P-PCA (0.44 D, P < .01). The precision and accuracy of the I-PCA did not significantly differ from those of the P-PCA. There were no statistically significant differences in the percentage of eyes within a certain absolute RA -PE threshold. CONCLUSIONS: The Barrett Toric Calculator using the E-PCA, I-PCA, or P-PCA showed a comparable prediction of postoperative refractive astigmatism in standard clinical practice. (Am J Ophthalmol 2024;262: 107113. (c) 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ ))