PURPOSE:To introduce an open-source calculator for quantifying lens tilt and decentration using swept-source anterior segment optical coherence tomography (SS-AS-OCT) images, and to evaluate its reproducibility and independence from evaluator experience. SETTING:Department of Ophthalmology, Hospital of the Brothers of St. John of God, Vienna, Austria. DESIGN:Prospective interrater agreement study. METHODS:Patients scheduled for cataract surgery were screened for eligibility. Inclusion required age 21 years or older, written informed consent, and adequate fixation. Exclusion criteria included physical immobility or other limitations preventing imaging, prior pseudophakia in the fellow eye, contraindications to pharmacologic mydriasis, or tremor. Imaging was performed under pharmacologically induced mydriasis using SS-AS-OCT. Lens tilt and decentration were independently assessed by a novice (medical student) and an expert (ophthalmologist) using a self-developed open-source calculator. RESULTS:175 eyes from 88 patients, including 30 men (34%) and 58 women (66%) with a mean age of 72 years (range 30 to 91), were included. According to expert measurements, lens tilt averaged 5.65 degrees, with a consistent inferotemporal orientation (5.06 degrees temporal, 1.81 degrees inferior). Decentration averaged 146 µm and was primarily directed temporally (79.51 µm), with only a minor inferior component (2.93 µm). The intraclass correlation coefficient (ICC) was 0.972 (95% CI 0.962-0.979) for tilt and 0.914 (95% CI 0.886-0.935) for decentration, reflecting excellent agreement between raters. CONCLUSIONS:The evaluated open-source calculator enables accurate and reproducible measurement of lens tilt and decentration using SS-AS-OCT images. In this study, interrater agreement was excellent for both parameters, with ICC values above 0.9 and no evidence of systematic measurement bias.

PURPOSE:To evaluate visual performance of a novel full range of vision spiral intraocular lens (IOL) designed with artificial intelligence using preclinical and clinical metrics. METHODS:Preclinical visual performance was assessed in healthy individuals using a pseudophakic vision simulation device, comparing monocular corrected distance visual acuity, contrast sensitivity, defocus curve, halo/glare size, and subjective preference between the spiral RayOne Galaxy IOL and diffractive RayOne Trifocal IOL (Rayner). Additionally, postoperative clinical outcomes were subsequently analyzed from 10 sites following bilateral RayOne Galaxy IOL implantation. At 3 months postoperatively, key endpoints included subjective refraction, monocular and binocular uncorrected and corrected distance visual acuity at multiple distances, defocus curves, and patient-reported dysphotopsia. RESULTS:Preclinical evaluation demonstrated comparable range of focus between the Galaxy and diffractive Trifocal IOLs. However, the Galaxy IOL exhibited significantly less halo/glare, with nearly all participants preferring it across all distances. In the clinical study, mean monocular corrected distance visual acuities were -0.03 ± 0.08 logarithm of the minimum angle of resolution (logMAR) for distance, 0.05 ± 0.11 logMAR for intermediate, and 0.08 ± 0.14 logMAR for near, with further improvement observed binocularly. Monocular/binocular defocus curves demonstrated a smooth plateau with binocular defocus maintaining visual acuity of 20/32 (0.2 logMAR) or better from +1.00 to -2.80 diopters (35 cm). Halo and glare symptoms were generally minor (> 95% of patients), with no severe cases. CONCLUSIONS:The Galaxy IOL provides excellent monocular and binocular visual acuity across all tested distances, with a smooth and continuous defocus curve ensuring full-range vision. Preclinical testing demonstrated significantly fewer photic phenomena than the tested diffractive trifocal IOL, whereas clinical investigations found no indications of bothersome side effects, together demonstrating high visual comfort.

Purpose: To investigate intraretinal changes and central millimeter thickness (CMMT) after successful uncomplicated cataract surgery in patients with asymptomatic epiretinal membrane (ERM). Design: prospective, single-center, interventional case series. Methods: Thirty eyes from 26 patients with cataract and ERM (ERM group) and fifteen consecutive eyes with senile cataract with a healthy macula (control group) were included. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) as well as biomicroscopy were performed at baseline, one week, one month and three months after cataract surgery. OCT raster scans were further analyzed regarding CMMT and structural changes in the retinal morphology. Results: The baseline mean visual acuity improved significantly three months after cataract surgery in both groups (p < 0.05). CMMT in the ERM group was 342 (±53 μm) at baseline and increased significantly to 356 (±57) μm after three months (p < 0.05). One patient in the ERM group developed temporary cystoid macular edema one week after cataract surgery that resolved under topical treatment within three months. CMMT in the control group increased significantly three months after cataract surgery as well but no structural changes in the retinal morphology were observed in this group. Conclusions: This study provides evidence that cataract surgery in eyes with asymptomatic pre-existing ERM can be considered as safe and effective, resulting in good visual acuity outcomes. However, an increase in CMMT and temporary mild changes in retinal morphology may occur.

PURPOSE:To analyze the cataract package variability in 1 country, Austria.SETTING:Austrian Departments of Ophthalmology.DESIGN:Cross-sectional study.METHODS:The cataract package components of 3 different Austrian hospitals were weighed and life cycle assessment on each product performed. This data was then extrapolated to the sales figures of the main Austrian cataract package suppliers to estimate the carbon footprint of all cataract packages used in Austria in 2021.RESULTS:There were 55 different cataract package compositions in use with an average weight of 0.7 kg. These compositions differ significantly in weight and composition considering that the smallest package was 57% lighter than the largest package. The size of the surgical drapes also showed considerable variation, with a difference of up to 71%. This is substantial, considering that drapes and covers account for about 53% of the package weight.CONCLUSIONS:There was a considerable variation in package composition and product size, which could provide opportunities to save carbon dioxide emissions in cataract surgery. If all Austrian eye departments were to reduce the material quantities and drape sizes to the lower third of the cataract packages used in the Austria in 2021, cataract package associated CO 2 emissions could be reduced by 34%.

PURPOSE:To assess visual and refractive outcomes and patient satisfaction after bilateral sequential implantation of a primary capsular bag intraocular lens (IOL) and a supplementary sulcus-fixated trifocal IOL. METHODS:All patients had bilateral implantation of a mono-focal IOL in the capsular bag followed by a supplementary trifocal IOL (Sulcoflex 703F, Rayner Intraocular Lenses Limited) in the sulcus. Patients were evaluated for monocular uncorrected and corrected distance visual acuity, binocular uncorrected and corrected distance, intermediate and near visual acuity, photopic and mesopic contrast sensitivity, defocus curves, visual symptoms, spectacle independence, and patient satisfaction at 1 and 6 months postoperatively. RESULTS:Forty eyes of 20 patients were evaluated. Six months after surgery, mean binocular uncorrected visual acuity was -0.07 ± 0.06 logMAR for distance vision (range: -0.2 to 0.0 logMAR), -0.03 ± 0.17 logMAR for intermediate vision (range: -0.1 to 0.6 logMAR), and 0.09 ± 0.08 logMAR for near vision (range: -0.1 to 0.2 logMAR). All patients reported full spectacle independence after 6 months and no adverse events were reported for any of the patients. CONCLUSIONS:Sequential implantation of a monofocal IOL in the capsular bag and a supplementary trifocal IOL in the sulcus provides a safe and effective choice for patients who desire spectacle independence after cataract surgery. [J Refract Surg. 2021;37(2):105-111.].

A new forceps-needle to facilitate intrascleral haptic fixation surgery is described. In an initial series of 10 cases, the forceps-needle was used to grasp and externalize the haptic of a 3-piece intraocular lens (IOL) for transscleral fixation. The site of perforation was marked at 180 degrees 2.0 mm away from the limbus. Then, the IOL with polypropylene haptics was folded and implanted partially into the anterior chamber. A transconjunctival, scleral tunnel of about 2.0 mm length parallel to the limbus was prepared with the forceps-needle on 1 side, with the second hand holding the leading haptic through a side-port incision. The end of the first haptic was grasped and externalized after which the end of the haptic was flanged. Subsequently, a second scleral tunnel was prepared with the forceps-needle, and the second haptic was externalized and flanged. All procedures could be performed without any intraoperative complication.

Objective The aim of the study was to assess the visual and refractive outcomes and patient satisfaction after bilateral implantation of a primary capsule-fixed intraocular lens (IOL) and a supplementary sulcus-fixed trifocal IOL. Setting Academic Teaching Hospital of St. John, department of ophthalmology, Vienna, Austria Design Prospective case series. Methods All patients underwent bilateral implantation of a monofocal IOL in the capsular bag followed by implantation of a supplementary Sulcoflex Trifocal IOL (0 D model 703F, Rayner, West Sussex, UK) in the sulcus ciliaris in the same procedure. Patients were evaluated by testing the monocular uncorrected and best corrected distance visual acuity, binocular uncorrected and corrected distance, intermediate and near visual acuity, photopic and mesopic contrast sensitivity, defocus curves, visual symptoms, spectacle independence and patient satisfaction 3 months postoperatively. Results A total of 15 patients were evaluated. The mean binocular uncorrected visual acuity 3 months after surgery was -0.06 & x202f;logMAR & x202f;+/- 0.05 (SD) for distance vision (range -0.3 to 0.0 & x202f;logMAR), -0.02 & x202f;+/- 0.17 & x202f;logMAR for intermediate (range -0.1 to 0.6 & x202f;logMAR), and 0.09 & x202f;+/- 0.08 & x202f;logMAR for near vision (range -0.1 to 0.2 & x202f;logMAR). In one patient the Sulcoflex Trifocal IOLs had to be explanted after 3 months due to strong glare and halos. All other patients reported full spectacle independence after 3 months and no adverse events were observed for these patients. Conclusion The implantation of a monofocal intracapsular IOL in combination with simultaneous implantation of a supplementary trifocal IOL into the sulcus ciliaris provides a safe and efficient choice for patients who desire spectacle independence after cataract surgery with the advantage of low-risk reversibility.

Purpose: The purpose of this report is to describe a case of lipemia retinalis due to decompensating hyperlipidemia that occurred during chemotherapy in a patient with metastatic colon carcinoma. Methods: Retrospective case report. Results: A 55-year-old non–insulin-dependent diabetic man with well-controlled hyperlipidemia presented himself with temporarily blurred vision in both eyes occurring during chemotherapy. He was found to have lipemia retinalis in his both eyes. Blood tests revealed elevated cholesterol and triglyceride levels exceeding 8,200 mg/dL. He received six cycles of FOLFIRI/bevacizumab and accompanying dexamethasone because of colon cancer with pulmonary metastases. Lipemia retinalis had resolved after a 6-week follow-up when chemotherapy was finished, and the patients' triglyceride and glucose levels decreased to normal values. Conclusion: Lipemia retinalis associated with visual impairment may occur during chemotherapy under accompanying treatment with dexamethasone. Even if patients with hyperlipidemia are metabolically well-controlled with oral medication, treatment with dexamethasone can potentially lead to decompensation of hyperlipidemia causing secondary lipemia retinalis.

Purpose: To compare the efficacy of a topical nonsteroidal antiinflammatory drug, topical corticosteroid, and a combination of both drugs to prevent the occurrence of cystoid macular edema (CME) after cataract surgery in nondiabetic patients. Setting: Twelve European study centers. Design: Randomized clinical trial. Methods: Nondiabetic patients having uneventful cataract surgery were included in this study. Patients were randomized to receive topical bromfenac 0.09% twice daily for 2 weeks or dexamethasone 0.1% 4 times daily with 1 drop less per day every following week, or a combination of both. The primary outcome was the difference in central subfield mean macular thickness 6 weeks postoperatively. Secondary outcome measures included corrected distance visual acuity as well as the incidence of CME and clinically significant macular edema (CSME) within 6 weeks and 12 weeks postoperatively. Results: This study comprised 914 patients. Six weeks postoperatively, the central subfield mean macular thickness was 288.3 gm, 296.0 gm, and 284.5 gm in the bromfenac group, dexamethasone group, and combination treatment group, respectively (overall P = .006). The incidence of clinically significant macular edema within 12 weeks postoperatively was 3.6%, 5.1%, and 1.5%, respectively (overall P = .043). Conclusion: Patients treated with a combination of topical bromfenac 0.09% and dexamethasone 0.1% had a lower risk for developing CSME after cataract surgery than patients treated with a single drug. (C) 2018 ASCRS and ESCRS

PURPOSE:To describe a case of unilateral acute idiopathic maculopathy (UAIM) response to intravitreal therapy with aflibercept (Eylea).METHODS:Retrospective case report.RESULTS:A 36-year-old woman with sudden visual impairment and central scotoma was found to have a UAIM in her left eye. Three weeks after continuous worsening of her visual acuity and central scotoma, the patient was treated with intravitreal injections of aflibercept. The visual acuity increased and the macula lesion regressed, causing macula scarring after 2 injections.CONCLUSIONS:Intravitreal injections of aflibercept could be a therapy option in patients with UAIM without signs of spontaneous resolution of the clinical manifestations and visual improvement.

PURPOSE:To assess capsular bag and sulcus intraocular lens (IOL) centration in eyes that had implantation of a sulcus-fixated supplementary IOL anterior to a preexisting capsular bag IOL. SETTING:Academic Teaching Hospital of St. John, Vienna, Austria. DESIGN:Retrospective case series. METHODS:A sulcus-fixated supplementary IOL (Sulcoflex) was implanted anterior to a preexisting capsular bag IOL. The geometric center of preexisting capsular bag IOLs and newly implanted sulcus-fixated IOLs was evaluated at least 12 months postoperatively and in relation to the geometric center of the pupil and limbus. RESULTS:The study comprised 48 eyes of 43 patients with a mean follow-up of 25 months (range 12 to 84 months). The mean decentration of the capsular bag-fixated IOL was 0.29 mm ± 0.02 (SEM) when compared with the limbus and 0.29 ± 0.03 mm when compared with the dilated pupil. The mean decentration of the sulcus-fixated IOL was 0.23 ± 0.02 mm in relation to the limbus and 0.22 ± 0.02 mm when in relation to the dilated pupil. Sulcus-fixated supplementary IOLs showed significantly better centration than bag-fixated IOLs when compared with the limbus and with the pupil (both P = .03, paired t test). CONCLUSIONS:Implantation of a sulcus-fixated supplementary IOL resulted in good centration of capsular bag-fixated IOLs and ciliary sulcus-fixated IOLs. However, ciliary sulcus-fixated IOLs achieved significantly better centration.

PURPOSE:To evaluate and compare the 5-year postoperative anterior (ACO) and posterior capsule opacification (PCO), the occurrence of glistenings, and the level of anterior capsule retraction after implantation of 2 designs of 1-piece hydrophobic acrylic IOLs. SETTING:Hospital St. John, Vienna, Austria. DESIGN:Randomized controlled prospective case series. METHODS:Patients had an Acrysof SA60AT IOL (Group A) implanted in 1 eye and a Tecnis ZCB00 IOL (Group B) implanted in the fellow eye. At 1, 3, and 5 years, the PCO level was evaluated with the Evaluation of Posterior Capsule Opacification software. The level of ACO and capsule retraction was graded subjectively. Glistenings were scored as present or not present. RESULTS:Fifty eyes of 25 patients were evaluated after 5 years. No significant differences in PCO scores were found between the 2 groups at all follow-up visits (1 year: 0.06 ± 0.12 [SD] versus 0.07 ± 0.13, P = .35; 3 years: 0.23 ± 0.36 versus 0.22 ± 0.32, P = .66; 5 years: 0.36 ± 0.41 versus 0.36 ± 0.54, P = .98). A significant increase in PCO score was found between 3 and 5 years (P < .01). Anterior capsule opacification was present in Group A and Group B in 18.0% and 2.7% of eyes (P = .03), in 92.0% and 24.0% of eyes, and in 100% and 52% of eyes (P < .01) at 1, 3, and 5 years, respectively. Glistenings (5 years 100%) were observed in Group A. CONCLUSION:Both IOLs had a comparable PCO rate 5 years after surgery, although more ACO and retraction as well as glistenings were observed in Group A.