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Incidence of posterior capsular opacification requiring Nd:YAG capsulotomy after cataract surgery and implantation of enVista? MX60 IOL
摘要： Purpose. — To evaluate incidence of posterior capsule opacification requiring Nd:YAG capsulotomy over 3 years in a large series of eyes implanted with the enVista? MX60 Intraocular Lens (IOL). Methods. — A university-based, single-center, observational study of patients’ medical records was conducted. Uneventful cataract surgery patients with in-the-bag implantations of the enVista? MX60 IOL with a minimum of 24 months follow-up were included in the study. Exclusion criteria were insufficient follow-up (< 24 months), intraoperative complications and combined surgery. The primary outcome measure was rate of YAG laser capsulotomy, while secondary outcome measures were time to YAG laser capsulotomy and rate of glistenings. Results. — A total of 245 eyes of 143 patients received the MX60 IOL and were followed in the same center. Of these, 226 eyes were included in the study. Mean age was 80.7 ± 8.3 years and M/F ratio was 42/101 (29.4/70.6%). The mean preoperative distance (logMAR) visual acuity was 0.67 ± 0.5, while postoperatively it was 0.31 ± 0.5 at the last visit. The Mean follow-up time (min-max) was 35.2 ± 7.2, (24—48.4) months. The incidence of Nd:YAG capsulotomy over 3 years was 5/226 (2.2%). Average time between surgery and Nd:YAG capsulotomy was 32.17 months. Univariate analysis of age, gender, presence of comorbidity and baseline visual acuity found no predictive factors for capsulotomy. No glistenings were reported at any postoperative visit. Conclusion. — The three-year cumulative incidence of PCO requiring Nd:YAG laser capsulotomy was 2.2% for the enVista? MX-60 IOL, with no glistenings observed during follow-up. This low rate confirms the excellent safety profile of this IOL.
关键词： Cataract surgery,Intraocular lens,Posterior capsule opacification,MX60,Glistening
更新于2025-09-23 15:23:52
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[Lecture Notes in Computational Vision and Biomechanics] Computer Aided Intervention and Diagnostics in Clinical and Medical Images Volume 31 || Deep Neural Architecture for Localization and Tracking of Surgical Tools in Cataract Surgery
摘要： Over the last couple of decades, the quality of surgical interventions has improved owing to the use of computer vision and robotic assistance. One such application of computer vision, namely, detection of surgical tools in videos is gaining attention of the medical image processing community. The main motivation for detection, localization, and annotation of surgical tools is to develop applications for surgical workflow analysis. Such an analysis can aid in report generation, real-time decision support, etc. Cataract surgery is one of the common surgical procedure where surgeons do have direct visual access to the surgical site. Extremely small tools are used for this procedure and the surgeons observe the surgical site through a surgical microscope. In such cases, detecting the presence of tools can act an additional aid to the surgeon as well as other surgical staffs. We propose a framework consisting of a Convolutional Neural Network (CNN) which learns to distinguish and detect the presence of various surgical tools by learning robust features from the frames of a surgical video. Various deep neural architectures are hence evaluated for the task of detecting tools. The baseline models used for the purpose are pretrained on Imagenet dataset and they render upto 50% prediction accuracy. All the experiments have been validated on the dataset released as part of the Cataracts Grand Challenge. A framework for localization and detection of tools has also been proposed, which is capable of extracting visual features from glimpses of an image, by adaptively selecting and processing only the selected regions at high resolution.
关键词： Multiple tool detection,Cataract surgery,CNN,Glimpse network,Deep neural architectures,Class imbalance
更新于2025-09-23 15:23:52
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Biometry in cataract surgery
摘要： Purpose of review To review the literature in 2017 and 2018 pertaining to biometry for cataract surgery and report pertinent findings. Recent findings New devices using swept-source ocular coherence tomography can measure axial length in dense cataracts more frequently than common biometers. Computer-assisted registration may be superior to intraoperative aberrometry for toric intraocular lens (IOL) placement. Soft contact lenses may not require removal as long before biometry as previously thought. The Barrett Universal II IOL formula has been found to perform well at all axial lengths. Summary New swept-source ocular coherence tomography biometers are more frequently successful at measuring axial length in dense cataracts which promises to improve refractive outcomes. Accuracy in toric IOL placement is likely to increase with improved devices. It may not be necessary to have patients remove soft contact lens any more than 2 days prior to biometry. The Barrett Universal II IOL formula may be used confidently for most eyes. Advancements acknowledged, purchasing new equipment will not be necessary for all surgeons.
关键词： swept-source ocular coherence tomography,toric,cataract,biometry
更新于2025-09-23 15:23:52
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Simulateur de chirurgie de cataracte EyeSi?: validité de construction des modules capsulorhexis, phacoémulsification et aspiration des masses cristalliniennes
摘要： Introduction. — Le but de notre étude est de tester la capacité du simulateur EyeSi à discriminer les chirurgiens novices des chirurgiens expérimentés lors de la réalisation des exercices de 3 modules de formation à la chirurgie de cataracte, afin de confirmer sa validité de construction pour ceux-ci. Matériels et méthode. — Nous avons inclus 18 chirurgiens répartis en 3 groupes : les ? novices ? (6 internes n’ayant jamais opéré de cataracte), les ? intermédiaires ? (6 internes ayant opéré entre 1 et 10 cataractes) et les ? experts ? (6 chirurgiens ayant opéré plus de 500 cataractes). Nous avons sélectionné 3 modules d’entra?nement du simulateur, le capsulorhexis, la phacoémulsification-cracking et l’aspiration des masses cristalliniennes résiduelles. Douze exercices de difficulté croissante ont été réalisés 2 fois de suite par chaque participant. Nous avons comparé les résultats du 2ème essai en stratifiant sur l’expérience du chirurgien. Résultats. — Pour le module capsulorhexis, dans l’exercice 1, les experts obtiennent des scores plus élevés que les 2 autres groupes (p = 0,0102). Pour le module phacoémulsification-cracking, les experts ont des scores significativement supérieurs dans l’exercice 8 (p = 0,0495) et il existe une tendance à la significativité dans les exercices 3 (p = 0,0934) et 5 (p = 0,0938). Le temps de réalisation de l’exercice décro?t également en fonction du niveau d’expérience dans les exercices 1 (p = 0,0444), 4 (p = 0,06) et 5 (p = 0,0189). Conclusion. — Nos résultats mettent en évidence de meilleurs résultats du groupe experts pour 4 exercices des modules capsulorhexis et phacoémulsification-cracking. Ceci confirme la validité de construction du simulateur EyeSi pour la chirurgie de cataracte déjà mise en évidence par d’autres travaux. Notre étude permettra de contribuer à la réalisation de programmes de formation pertinents sur simulateur pour les internes en ophtalmologie.
关键词： Irrigation and aspiration,Capsulorhexis,Cataract surgery,EyeSi cataract surgery simulator,Construct validity,Phacoemulsification,Systematic training program
更新于2025-09-23 15:22:29
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Preoperative automatic visual behavioural analysis as a tool for intraocular lens choice in cataract surgery
摘要： Purpose: Cataract is the main cause of blindness, affecting 18 million people worldwide, with the highest incidence in the population above 50 years of age. Low visual acuity caused by cataract may have a negative impact on patient quality of life. The current treatment is surgery in order to replace the natural lens with an artificial intraocular lens (IOL), which can be mono- or multifocal. However, due to potential side effects, IOLs must be carefully chosen to ensure higher patient satisfaction. Thus, studies on the visual behavior of these patients may be an important tool to determine the best type of IOL implantation. This study proposed an anamnestic add-on for optimizing the choice of IOL. Methods: We used a camera that automatically takes pictures, documenting the patient’s visual routine in order to obtain additional information about the frequency of distant, intermediate, and near sights. Results: The results indicated an estimated frequency percentage, suggesting that visual analysis of routine photographic records of a patient with cataract may be useful for understanding behavioural gaze and for choosing visual management strategy after cataract surgery, simultaneously stimulating interest for customized IOL manufacturing according to individual needs.
关键词： Sickness impact profile,Cataract/psychology,Cataract extraction,Vision, ocular,Visual acuity,Lenses, intraocular,Quality of life
更新于2025-09-23 15:22:29
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Comparison of Clinical Outcomes between Torsional and Longitudinal Phacoemulsification
摘要： Purpose: To compare the clinical outcomes during phacoemulsification when using recently improved longitudinal (Stellaris?, Bausch & Lomb, Rochester, NY, USA) and torsional (Infiniti Ozil?, Alcon, Fort Worth, TX, USA) ultrasound. Methods: The present study included 74 eyes of 59 patients undergoing cataract surgery. Operated eyes with mild cataract (nuclear sclerosis grade 1 and 2), moderate cataract (nuclear sclerosis grade 3) and hard cataract (nuclear sclerosis grade 4 and 5) were compared in terms of the total phacoemulsification (phaco) time, average phaco power, total phaco energy and amount of fluid used during cataract surgery between the 2 modalities. Endothelial cell density, corneal edema, central corneal thickness (CCT), surgically induced astigmatism (SIA) and best-corrected visual acuity (BCVA) were also evaluated preoperatively and up to 3 month postoperatively. Results: In mild cataracts, the operative parameters and corneal changes were similar between the 2 modalities. In moderate cataracts, the total phaco time was significantly higher in the torsional group than the longitudinal group, but the average phaco power, total phaco energy, and amount of fluid were not significantly different. In patients with hard cataract, the torsional group showed higher total phaco time (27.50 ± 17.77 sec vs. 97.08 ± 12.67 sec), average phaco power, total phaco energy, persistent corneal edema at 1 week postoperatively and more endothelial cell loss at 3 month postoperatively (16.33 ± 15.50% vs. 38.71 ± 26.49%). Postoperative CCT, SIA and BCVA were not significantly different in hard cataracts between the 2 modalities. Conclusions: In mild and moderate cataracts, the efficiency of phaco and corneal changes were similar between the 2 modalities. However, recently improved longitudinal phaco showed superior efficiency for hard cataracts and induced less endothelial cell loss than torsional phaco.
关键词： Longitudinal,Cataract surgery,Phacoemulsification,Nuclear density,Torsional
更新于2025-09-23 15:22:29
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An In Vitro Human Lens Capsular Bag Model Adopting a Graded Culture Regime to Assess Putative Impact of IOLs on PCO Formation
摘要： PURPOSE. To develop a culture regime for the in vitro human lens capsular bag model that better reflects clinical events following cataract surgery and to use this refined model to evaluate the putative impact of IOLs on PCO formation. METHODS. Capsulorhexis and lens extraction were performed on human donor eyes to generate capsular bags attached to the ciliary body by the zonules. Preparations were secured by pinning the ciliary body to a silicone ring and maintaining in 6 mL serum-free EMEM for 28 days or in a graded culture system (days 1–3, 5% human serum and 10 ng/mL TGFb2; days 4–7, 2% human serum and 1 ng/mL TGFb2; days 8–14, 1% human serum and 0.1 ng/mL TGFb2; days 15–28, serum-free EMEM), which better mimics clinical changes. Preparations were monitored with phase-contrast and modified-dark-field microscopy. Cell coverage and light scatter were quantified using image analysis software. The transdifferentiation marker, a-SMA and matrix component, fibronectin were assessed by immunocytochemistry. To assess IOLs in the model, Alcon Acrysof or Hoya Vivinex IOLs were implanted in match-paired capsular bags. RESULTS. Match-paired experiments showed that graded culture enhanced growth, facilitated matrix contraction, increased transdifferentiation, and promoted matrix deposition relative to serum-free culture. The graded culture protocol was applied to match-paired bags implanted with a Hoya Vivinex or an Alcon Acrysof IOL. The Vivinex demonstrated a lag in growth across the posterior capsule. However, by day 28, coverage was similar, but light-scatter was greater with Acrysof implanted. Cell growth on the Acrysof IOL anterior surface was significantly greater than Vivinex. CONCLUSIONS. The graded culture human capsular bag model serves as an excellent system to evaluate and develop intraocular lenses. The Hoya Vivinex IOL showed an overall better level of performance against postsurgical wound healing and PCO than the Alcon Acrysof using this model.
关键词： model,IOL,lens,posterior capsule opacification,human,cataract
更新于2025-09-23 15:22:29
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Intrapersonal comparison of initial axial length, keratometric readings, and intraocular lens power over a 6-month interval using an IOLMaster device
摘要： Purpose: In order to improve current biometry practice, we investigated changes in axial length (AL), keratometry (K), and intraocular lens (IOL) power measured by the IOLMaster in adults within a 6-month period at the outpatient eye clinic, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Patients and methods: This was a nonrandomized prospective cohort study. The AL, steepest K, flattest K, and IOL power of nondilated eyes were measured at the initial examination and later at 6 months by the IOLMaster. Changes in AL, K, and IOL power using the SRK (Sanders, Retzlaff, and Kraff)-T formula within 6 months were compared using the paired-sample t-test. Results: The study comprised 90 eyes from 90 patients. The mean age of the patients was 62.99±13.95 years (range 28–87 years). Mean values and standard deviation for AL, steepest K, flattest K, and IOL power at initial visit and 6 months later were 23.56±1.51 mm and 23.56±1.52 mm (P=1.0; 95% confidence interval [CI] -0.01 to 0), 44.94±1.37 D and 44.98±1.43 D (P=0.96; 95% CI -0.13 to 0.04), 43.85±1.43 D and 43.89±1.36 D (P=0.93; 95% CI -0.02 to 0.07), and 20.27±4.12 D and 20.15±4.51 D (P=0.99; 95% CI -0.05 to 0.29), respectively. Conclusion: There was no statistically significant difference in AL (P=1.0), both K (P=0.96, P=0.93), or IOL power (P=0.99) within the 6-month period using the IOLMaster. Remeasurement at 6 months may be required in some cases, but should not be routine.
关键词： IOLMaster,keratometry,IOL power,axial length,cataract
更新于2025-09-23 15:22:29
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Rotational Stability and Patient Satisfaction after Implantation of a New Toric IOL
摘要： Purpose: To evaluate rotational stability, astigmatism correction, visual outcomes, and patient satisfaction after implantation of the toric intraocular lens (IOL) Torica-aA following cataract extraction over a 6-month follow-up period. Methods: This prospective observational study enrolled 40 eyes of 26 patients presenting with preexisting corneal astigmatism of 1.00 to 2.60 D. The rotational stability of the IOL was evaluated using retroillumination photographs taken within 24 hours after surgery and 1 week and 6 months postoperatively. Other main study outcomes were assessed 6 months postoperatively and included uncorrected and distance-corrected visual acuities, astigmatism correction, and patient satisfaction. Results: Six months postoperatively, mean absolute IOL rotation was 1.99 ± 1.88° (range 0.10-7.40°) and secondary repositioning was not required. The IOL rotation was <3° in 85% of eyes, ≤5° in 94% of eyes, and <8° in 100% of eyes. Mean residual refractive cylinder was -0.57 ± 0.34 D. The magnitude of the J0 vector was significantly decreased postoperatively (p<0.0001). The mean J45 vector was close to zero preoperatively and postoperatively (p = 0.27). Mean monocular uncorrected distance visual acuity (UDVA) was 0.09 ± 0.12 logMAR and 97% of eyes achieved UDVA of 20/40 or better including 66% of eyes having 20/25 or better. The good UDVA resulted in high levels of spectacle independence and patient satisfaction. conclusions: Implantation of the Torica-aA IOL was safe and effective in reducing low to moderate preexisting corneal astigmatism and provided good rotational stability and refractive outcomes, which led to a high degree of patient satisfaction.
关键词： Hydrophilic acrylic,Astigmatism,Intraocular lens,Toric IOL,Cataract,Rotational stability
更新于2025-09-23 15:21:21
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Neue Intraokularlinsendesigns f??r die Femtosekundenlaser-assistierte Kataraktoperation; New intraocular lens designs for femtosecond laser-assisted cataract operations;
摘要： The perfection and high reproducibility of capsulotomy in femtosecond laser-assisted cataract surgery (FLACS) lead to the possibility of new intraocular lens (IOL) designs for capsulotomy fixed implantation. Currently four different types of femtolenses for capsulotomy fixation are described in the literature or are commercially available. The first described was the lens in the bag or Tassignon IOL, which was developed for secondary cataract prevention, the second was the Masket IOL for reduction of negative dysphotopsia and third the 90F designed by Dick. All three types are or will be produced by Morcher. The fourth lens is the Femtis from Oculentis. All lenses are characterized by a high level of safety during implantation, The Tassignon lens leads to reduction of secondary cataract, especially in juvenile cataract because of the additional posterior capsulotomy. In studies the Masket IOL could show a decrease of negative dysphotopsia. In comparison to standard lenses, the 90F and Femtis in particular showed better results with respect to tilt, rotation and decentration. The new IOL designs for capsulotomy fixation show a safe implantation procedure and indications for a very stable position in the capsular sac. Further studies must be carried out to confirm the possible advantages in comparison to standard IOL with respect to postoperative results for refraction, tilt, rotation and decentration and possible induction of aberrations.
关键词： Femtolens,Femtosecond laser-assisted cataract surgery,Capsulotomy,Decentration,Tilt
更新于2025-09-23 15:21:01