Efficacy and complications of cataract surgery in high myopia

Capsular Tension Ring Implantation for Intraocular Lens Power Calculation in Highly Myopic Eyes: Secondary Analysis of a Randomized Clinical Trial

Importance

Capsular tension ring (CTR) implantation has been shown to reduce intraocular lens (IOL) decentration and tilt in high myopia. However, the effect of CTR implantation in highly myopic eyes on IOL power calculation remains unclear, particularly in new-generation formulas.

Objective

To evaluate the influence of CTR implantation on IOL power calculation in highly myopic eyes.

Design, Setting, and Participants

This is a prespecified secondary analysis of outcomes of a randomized clinical trial conducted between November 2021 and September 2023 at the Zhongshan Ophthalmic Center in Guangzhou, China. Cataract patients with an axial length (AL) of 26 mm or longer were enrolled and stratified into 3 strata based on AL (stratum 1: AL 26-<28 mm; stratum 2: AL 28-<30 mm; stratum 3: AL ≥30 mm).

Interventions

Participants were stratified based on AL and randomized to the CTR group (a C-loop IOL combined with a CTR) or the control group (only a C-loop IOL) within each stratum.

Main Outcomes and Measures

Predictive outcomes of 6 new-generation formulas and 4 traditional formulas were evaluated. The arithmetic and absolute prediction error (PE) and the percentages of eyes within ±0.25 diopter (D), ±0.50 D, ±0.75 D, and ±1.00 D of PE were analyzed.

Results

A total of 186 eyes of 186 participants were randomized into the CTR group (93 eyes [50%]) or control group (93 eyes [50%]). Excluding a withdrawal case and 24 eyes with best-corrected visual acuity less than 20/40, 80 eyes in the CTR group (86.0%) and 81 eyes in the control group (87.1%) were analyzed. Of 161 participants analyzed, overall mean (SD) participant age was 56.7 (10.5) years, and 100 participants (62.1%) were female. No differences were observed in arithmetic PE between the CTR and control groups in any strata. The CTR group showed smaller absolute PE in all new-generation formulas and higher percentage of PE within ±0.50 D in the Emmetropia Verifying Optical 2.0, Hoffer QST, LISA, and Pearl-DGS formulas only for eyes with an AL of 30 mm or longer compared with the control group. In traditional formulas, no differences were observed between the 2 groups in any strata.

Conclusions and Relevance

In this secondary analysis, CTR implantation in highly myopic eyes did not affect the target refraction and can improve the prediction accuracy of new-generation IOL calculation formulas in eyes with AL of 30 mm or longer. These findings support use of CTR implantation in eyes with an AL of 30 mm or longer.

Trial Registration

ClinicalTrials.gov Identifier: NCT05161520.

Effect of Implanted Capsular Tension Ring on Postoperative Refractive Shift: A Systematic Review and Meta-Analysis

BACKGROUND

The capsular tension ring is a novel assistant tool for cataract surgery; however, controversy exists in its co-implantation. The potential for hyperopic or myopic shift resulting from the co-implantation of the capsular tension ring and intraocular lens remains unclear. This study aimed to determine the postoperative refractive prediction error and the direction of refractive shift in cataract patients who underwent capsular tension ring co-implantation.

METHODS

We conducted a systematic review and meta-analysis,searching electronic databases for studies of individuals diagnosed with cataracts receiving surgery with or without capsular tension ring implantation. Systematic searches were performed based on five databases: PubMed, Cochrane Library, Web of Science, Medline, and China National Knowledge Infrastructure. The primary outcome was the mean arithmetic refractive prediction error. Secondary outcomes were mean absolute refractive prediction error and the number of eyes within a certain refractive prediction error range. We applied a fixed-effectsmodel to pool effect sizes across trials using weighted mean differences (WMD) and risk ratios (RR) with their 95% confidence intervals (95% CI). Statistical heterogeneity scores were assessed with the I2statistic.

RESULTS

A total of 407 affected eyes were included in eight independent clinical studies. Meta-analysis suggested significant differences both in short-term (≤1 month) co-implantation (WMD = 0.16, p < .001, 95% CI: -0.13 ~ 0.19) and long-term (≥3 months) co-implantation between the capsular tension ring co-implantation group and the control group (WMD = 0.19, p < .001, 95% CI: 0.15 ~ 0.23). However, no significant difference was observed in the high myopia subgroup whether capsular tension ring co-implantation (WMD = 0.03, p = .083, 95% CI: -0.27 ~ 0.34). Heterogeneity was not found among the studies.

CONCLUSION

Compared to simple intraocular lens implantation, capsular tension ring co-implantation is more susceptible to developing hyperopic shifts in non-myopic cataract patients, probably related to anterior chamber depth. It requires careful consideration by clinicians when determining the target diopter preoperatively. However, interpretation is limited, because there is a lack of studies available for analysis. There still needs to be additional studies to expand the evidence base.

Sagittaria sagittifolia polysaccharide extract regulates Nrf2 to improve endoplasmic reticulum stress-mediated apoptosis in rat cataracts and HLEB3 cells

Age-related cataract (ARC) remains the leading cause of blindness worldwide. Sagittaria sagittifolia polysaccharide (SSP) extract, a key component of Sagittaria sagittifolia L., exhibits anti-oxidant and anti-apoptotic effects with potential applications in ARC. This study aimed to explore the therapeutic potential of SSP in ARC and the underlying mechanisms. In sodium selenite-induced cataracts in rats and hydrogen peroxide (H2O2)-induced human lens epithelial B3 (HLEB3) cells, SSP significantly improved lens opacity and pathological changes and alleviated apoptosis and endoplasmic reticulum stress (ERS)-related injury indicators (by inhibiting the intracellular Ca2+ and protein expression of Bcl-2-associated X, cleaved caspase-3, binding immunoglobulin heavy chain protein, protein kinase RNA-like kinase, inositol-requiring enzyme 1α, activating transcription factor 6, C/EBP homology protein, c-Jun N terminal kinase, caspase-12, and calpain-2). In addition, SSP increased the expression of nuclear factor erythroid 2-related factor 2 (Nrf2), heme oxygenase-1, sarco/endoplasmic reticulum-type calcium transport ATPase 2, and B-cell lymphoma-2. After applying Nrf2 knockdown technology by transferring short interfering RNA in HLEB3 cells, SSP demonstrated its protective role by activating Nrf2 and inhibiting ERS-mediated apoptosis. These findings indicate that SSP may protect against ARC by regulating Nrf2/ERS-mediated apoptosis, providing potential evidence for its use in preventing or delaying ARC.

Self-reported myopia and age-related cataract: a two-sample Mendelian randomization study

Our study aims to investigate whether there is evidence for a causal relationship between self-reported myopia and age-related cataract (ARC). A two-sample Mendelian randomization study was performed to identify the causal associations of self-reported myopia with ARC. We used summary-level genetic association data from the MR-Base (Mendelian Randomization-Base) platform on self-reported myopia and ARC. 26 single-nucleotide polymorphisms (SNPs) associated with self-reported myopia were used as instrumental variables. The inverse-variance weighted (IVW) method was applied to perform the primary analysis, and the weighted median method, MR-Egger regression, and Maximum likelihood methods were selected as supplementary analysis. To ensure the reliability of the results, we also performed the sensitivity analysis and MR-PRESSO analysis to assess the heterogeneity and horizontal pleiotropy. Our results provided evidence for a causal effect of self-reported myopia on ARC risk (IVW: OR 10.657, 95% CI (3.175-35.776), P < 0.001). The results of the weighted median method, MR-Egger regression and Maximum likelihood methods were consistent with the result of the IVW method. No evidence of heterogeneity and horizontal pleiotropy was found by the sensitivity analysis and MR-PRESSO analysis. This study demonstrated that self-reported myopia increases the risk of ARC and provided evidence to support public health interventions to prevent the onset and progress of myopia and develop new therapeutic strategies for myopia. Further large-scale prospective studies are required to validate our findings.

Visual Outcomes and IOL Stability After Panoptix Trifocal Intraocular Lens Implantation in Eyes With High Myopia

PURPOSE

To observe and explore the correlation between visual outcomes and intraocular lens (IOL) stability after tri-focal IOL implantation in eyes with high myopia.

METHODS

Patients with highly myopic cataract (axial length > 26 mm) were enrolled in this prospective study. Thirty-one eyes (31 patients) received implantation of a trifocal IOL (AcrySof IQ PanOptix TFNT00). Uncorrected distance, intermediate, and near visual acuity (UDVA 5 m, UIVA 60 cm, UNVA 40 cm) and refractive status were evaluated at 1 day, 1 week, 4 weeks, and 3 months postoperatively. The defocus curve was plotted 3 months postoperatively. The IOL tilt, IOL decentration, postoperative aqueous depth, and adhesion of the capsule with IOL were evaluated at 2 hours, 1 week, 4 weeks, and 3 months postoperatively. The correlation between postoperative visual outcomes and dynamic changes in IOL positioning was analyzed.

RESULTS

In total, 29 eyes of 29 patients were available for analysis. UDVA, UIVA, and UNVA were 0.03 ± 0.01, 0.03 ± 0.01, and 0.02 ± 0.01 logarithm of the minimum angle of resolution (logMAR) at 3 months postoperatively (mean spherical equivalent [SE]: -0.10 ± 0.04 D). From 1 to 7 days postoperatively, UIVA (P = .031) and UNVA (P = .02) improved, SE shifted to myopic (P = .001), and the IOL moved forward (P < .001). A bimodal defocus curve showed that the visual acuity achieved 0.2 logMAR from +0.50 to -2.50 D, and the peaks were at plano and -2.50 D, reaching 0.04 ± 0.01 and 0.08 ± 0.01 logMAR. The capsular bend index reached 3.35 ± 0.06 at 3 months postoperatively. There were no significant changes in tilt and decentration during the postoperative follow-up period.

CONCLUSIONS

This trifocal IOL provides excellent visual acuity at far, intermediate, and near distance in high myopia eyes. The postoperative position of the IOL was relatively stable in eyes with highly myopic cataracts. [J Refract Surg. 2025;41(1):e56-e64.].

The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: Report 17, a risk factor model for posterior capsule rupture

BACKGROUND/OBJECTIVES

To create a risk factor model for posterior capsule rupture (PCR) during cataract surgery.

SUBJECTS/METHODS

Eligible operations between 01/04/2016 and 31/03/2022 from centres supplying data to the UK national cataract audit with complete data including patients' gender and age at surgery, anterior chamber depth (ACD) measurement and preoperative visual acuity (VA) were included. A logistic regression model was fitted to identify risk factors and calculate their odds ratios (OR) and 95% confidence intervals (CI) for PCR.

RESULTS

This analysis included 961,208 cataract operations performed on 682,381 patients from 136 participating centres by 3198 surgeons. 9730 (1.01%) of surgeries were complicated by PCR. The median age was 75.7 and 76.7 years for first and second eye surgery respectively, and 5154 (53.0%) were female. The highest risk factors for PCR were less experienced trainee surgeon (OR 3.75, 95% CI 3.33-4.24, p < 0.001), pseudoexfoliation/phacodonesis (OR 3.47, 95% CI 3.05-3.94, p < 0.001), younger males (OR 3.05, 95% CI 2.23-4.16, p < 0.001) and brunescent/white/mature cataract (OR 2.41, 95% CI 2.24-2.60, p < 0.001). Other risk factors identified were glaucoma, worse preoperative VA, previous intravitreal therapy, high myopia, previous vitrectomy, systemic diabetes, diabetic retinopathy, amblyopia, older age, shallower ACD and inability to lie flat and cooperate.

CONCLUSION

Various surgical, patient and ocular factors increase the risk of PCR during cataract surgery. This risk factor model permits estimation of individualised risks for patients and allows risk-adjustment for surgeons to evaluate their PCR rates based on case complexity.

Comparison of visual outcomes in patients with cataracts and high myopia after implantation of a zonal refractive multifocal or diffractive bifocal intraocular lens

This study compares the optical quality of zonal refractive multifocal and diffractive bifocal intraocular lenses (IOLs) and visual outcomes after implantation in 93 patients(93 eyes) with cataracts and high myopia. A retrospective analysis was conducted to measure visual acuity at far, intermediate, and near distances, defocus curves, wavefront aberrations, modulation transfer function (MTF), a Quality of Vision questionnaire (QoV) and visual quality self-evaluation were examined at 3 months. The results demonstrated the ZMB group showed better uncorrected near visual acuity (P < 0.01), and the MF15 group showed better uncorrected intermediate visual acuity (P < 0.001). The ZMB group provided better MTF than the MF15 group (P < 0.01) but demonstrated a worse QoV score, especially for the severity of glare, halo, and starburst (P < 0.05). The satisfaction score and spectacle independence rate in the ZMB group were higher than in the MF15 group (P < 0.01). LS-313MF15 and TecnisZMB00 offered excellent visual restoration, stable distance visual acuity, and good subjective visual function.

Effectiveness of prophylactic capsular tension ring implantation during cataract surgery in highly myopic eyes

PURPOSE

To assess the effectiveness of prophylactic capsular tension ring (CTR) implantation during cataract surgery in highly myopic eyes.

SETTING

Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.

DESIGN

Prospective cohort study.

METHODS

Consecutive highly myopic patients treated with cataract surgery were recruited and randomized to undergo CTR implantation or not. The outcomes compared between the 2 groups included axial lens position (ALP), intraocular lens (IOL) decentration and tilt, area of anterior capsule opening, severity of anterior capsular opacification (ACO), and posterior capsular opacification (PCO) at 1 year postoperatively.

RESULTS

A total of 55 highly myopic eyes with CTRs implanted and 55 without were included in the analysis. At 1 year postoperatively, no significant differences were detected between the CTR and non-CTR groups for the mean ALP, IOL decentration, or tilt (all P > .05). However, the CTR group had a significantly larger area of anterior capsule opening (23.62 ± 3.30 mm2 vs 21.85 ± 2.30 mm2, P = .003), and less severe ACO (P = .033) and PCO (PCO-3 mm: 0.06 ± 0.13 vs 0.13 ± 0.20, P = .038; PCO-C: 0.15 ± 0.18 vs 0.25 ± 0.26, P = .026) than the non-CTR group. The corrected distance visual acuity, prediction error, and higher-order aberrations did not differ between the 2 groups (all P > .05).

CONCLUSIONS

In highly myopic eyes, although prophylactic CTR implantation can reduce the severity of capsular contraction and opacification, it does not significantly affect postoperative IOL stability or visual outcomes.

Complications of high myopia: An update from clinical manifestations to underlying mechanisms

Background

High myopia is one of the major causes of visual impairment and has an ever-increasing prevalence, especially in East Asia. It is characterized by excessive axial elongation, leading to various blinding complications that extend beyond mere refractive errors and persist immovably after refractive surgery, presenting substantial public health challenge.

Main text

High myopia-related complications include lens pathologies, atrophic and tractional maculopathy, choroidal neovascularization, peripheral retinal degenerations and retinal detachment, and glaucoma and heightened susceptibility to intraocular pressure (IOP) elevation. Pathological lens changes characteristic of high myopia include early cataractogenesis, overgrowth of lens, weakened zonules, and postoperative capsular contraction syndrome, possibly driven by inflammatory pathogenesis, etc. Dome-shaped macula and cilioretinal arteries are two newly identified protective factors for central vision of highly myopic patients. These patients also face risks of open-angle glaucoma and IOP spike following intraocular surgery. Morphologic alternations of optic nerve in high myopia can complicate early glaucoma detection, necessitating comprehensive examinations and close follow-up. Anatomically, thinner trabecular meshwork increases this risk; conversely lamina cribrosa defects may offer a fluid outlet, potentially mitigating the pressure. Notably, anxiety has emerged as the first recognized extra-ocular complication in high myopia, with an underlying inflammatory pathogenesis that connects visual stimulus, blood and brain.

Conclusions

High myopia induces multiple ocular and potential mental health complications, underscoring the need to develop more effective strategies to improve both physical and emotional well-being of these patients, among which anti-inflammation might possibly represent a promising new target.

Comparison of macular changes and visual outcomes between femtosecond laser-assisted cataract surgery and conventional phacoemulsification surgery for high myopic cataract patients

BACKGROUND

To evaluate differences in log MAR best-corrected visual acuity (BCVA) improvement and postoperative central foveal thickness (CFT) and choroidal thickness (CT) changes between conventional phacoemulsification surgery (CPS) and femtosecond laser-assisted cataract surgery (FLACS) for high-myopia cataracts.

METHODS

This was a retrospective and observational study. One hundred and two eyes of 102 patients with high-myopia cataracts were examined. CPS was performed in 54 eyes, and FLACS was performed in 48 eyes. All eyes underwent logMAR BCVA, CFT and CT of three different sectors preoperatively and one week and six months postoperatively.

RESULTS

The logMAR BCVA improved significantly after surgery in both groups (both P < 0.001), but no difference was observed in BCVA improvement between the groups (P = 0.554). Moreover, no significant differences were reflected in the changes in CFT, nasal 1 mm CT or temporal 1 mm CT between the two groups, and only subfoveal choroidal thickness (SFCT) in the CPS group decreased significantly compared with that in the FLACS group at any postoperative time (P = 0.003 and 0.026). AL, preoperative logMAR BCVA, and CT of the three regions exhibited a notable correlation with postoperative BCVA (all P < 0.05) according to univariate logistic regression analysis. However, only the AL, preoperative logMAR BCVA and SFCT remained significant in the multivariate model. Postoperative logMAR BCVA revealed a positive correlation with AL and preoperative logMAR BCVA but a negative correlation with SFCT.

CONCLUSIONS

FLACS was not superior to CPS in improving BCVA but had less impact on SFCT in the treatment of high-myopia cataracts. Eyes with a longer AL, worse preoperative logMAR BCVA and thinner SFCT had a high risk of worse postoperative BCVA.

Biometry challenges in the longest eyes we have encountered to date

Purpose

This report aims to present biometry challenges and solutions for a patient with the longest eyes we have encountered to date.

Observations

A 41-year-old woman with a history of Crouzon syndrome, extreme axial myopia, and posterior segment staphylomas was referred for cataract evaluation. Optical biometry was attempted using two partial coherence interferometry and optical low-coherence reflectometry devices that were available in 2011. Neither device could measure the axial length (AL) of either eye, unfortunately. We were able to measure them by A scan ultrasound, however, with results of 40.59 mm for the right eye and 38.29 mm for the left eye. Shortly thereafter, she underwent uncomplicated phacoemulsification with posterior chamber intraocular lens implantation under topical anesthesia. Twelve years later, she returned for repeat optical biometry with 3 newer generation devices, 2 of which utilized swept-source optical coherence tomography (SS-OCT). Only 1 SS-OCT device, the Argos biometer, was able to obtain AL measurements, and they were 40.54 mm and 40.84 mm for the right and left eyes, respectively.

Conclusions and importance

Biometry measurement using optical biometers on a patient with ALs greater than 40 mm was impossible in 2011 because of the relatively short gate for acceptable readings. Ultrasound biometry can also be challenging due to the presence of posterior staphylomas. However, a newer SS-OCT with a longer AL measurement capability enabled readings to be obtained more recently.

New Designs of Spectacle Lenses for the Control of Myopia Progression: A Scoping Review

Myopia control with new designs of spectacle lenses is a flourishing area of research. The present work reviews the effectiveness of new designs (DIMSs, defocus-incorporated multiple segments; CARE, cylindrical annular refractive element; HALs/SALs, highly/slightly aspherical lenslets; DOT, diffusion optics technology) aiming at slowing myopia progression. A search through the PubMed database was conducted for articles published between 1 January 2003 and 28 February 2023. Publications were included if they documented baseline central refraction (SER) and/or axial length (AL) data, and the change in these parameters, in myopic children wearing new designs of spectacle lenses (treatment group) compared to myopic children using single-vision lenses, SVLs (control group). The selection process revealed nine suitable articles. Comparing the mean and standard error values of the treatment and control groups, the highest differences in the change in the SER and AL were -0.80 (1.23) D [95% CI: -1.053 to -0.547; p < 0.001] and 0.35 (0.05) mm [95% CI: 0.252 to 0.448; p < 0.001], respectively; the effect of treatment provided by a HAL design, compared to SVLs, led to a deceleration of 54.8% in the SER and 50.7% in the AL. However, the heterogeneity of the results prevents reaching strong conclusions about the effectiveness of these new designs.

The relationships between lens diameter and ocular biometric parameters: an ultrasound biomicroscopy-based study

Purpose

This study aims to explore the relationships between lens diameter (LD) measured with ultrasound biomicroscopy (UBM) and ocular biometric parameters.

Methods

Ocular biometric parameters including axial length (AL), white-to-white distance (WTW), anterior chamber depth (ACD), lens thickness (LT) and anterior segment length (ASL) were measured with IOL-Master 700, and the direct measurement of LD was conducted through UBM (ArcScan Insight 100). Relationships between LD and ocular biometric parameters were then investigated. Eyes with AL ≥ 28 mm were defined as eyes with extreme myopia, and eyes with AL < 28 mm were defined as eyes without extreme myopia.

Results

A total of 194 eyes from 194 subjects were included. The mean LD was 9.58 ± 0.49 mm, ranging from 8.60 to 10.96 mm. According to univariate analysis, larger LD was associated with elder age, male gender, larger WTW, ACD and ASL (all p < 0.05). Meanwhile, the LD was positively correlated with AL in eyes without extreme myopia (p < 0.05), but not in eyes with extreme myopia (p > 0.05). Backward stepwise regressions revealed that a larger LD was associated with larger WTW, ASL and AL in eyes without extreme myopia (all p < 0.05), while ASL was the only significant variable in eyes with extreme myopia (p < 0.05).

Conclusion

Larger WTW, ASL and AL in eyes without extreme myopia, as well as longer ASL in eyes with extreme myopia indicated a larger LD, which provides guidance in personalized surgical choice and promises ideal visual outcomes.

Impact of axial length on visual outcomes and complications in phacoemulsification surgery: a multicenter database study

PURPOSE

To analyze the impact of axial length (AL) on the visual outcome and rate of perioperative complications in phacoemulsification surgery.

DESIGN

Retrospective clinical database study.

METHODS

Cataract surgery data of 217,556 eyes was extracted from the electronic medical records of 8 ophthalmic centers in the United Kingdom from July 2003 to March 2015. A total of 88,774 eyes without ocular co-pathologies were grouped eyes according to AL (mm): short AL (< 22), average AL (22-26; reference group), and long AL (> 26).

MAIN OUTCOMES AND MEASURES

We analyzed visual acuity (VA) outcomes at 4 weeks, 4-12 weeks, and 12-24 weeks postoperatively, as well as the incidence of posterior capsular rupture (PCR), torn iris (TI), cystoid macular edema (CME), and retinal detachment (RD).

RESULTS

Mean pre-operative VA (logMAR) was the worst in eyes with long AL compared to average and short AL eyes (VA 0.59 vs. 0.58 and 0.56; p < 0.001). However, post-operative VA at 4-12 weeks was slightly better in the long AL group (0.14 in short and average AL; 0.12 in long AL, p < 0.001). We observed an increased odds of TI in the short AL group (OR 2.09, 95% CI 1.60-2.75). There was increased risk of RD in long AL eyes (p < 0.001). However, PCR and CME rates were not different.

CONCLUSION

In the absence of any coexisting ocular pathology, AL alone did not have an impact on VA improvement or the risk of encountering PCR or CME. The risk of TI was greater in the short AL group, and the risk of RD was higher in the long AL group.

Challenges of refractive cataract surgery in the era of myopia epidemic: a mini-review

Myopia is the leading cause of visual impairment in the world. With ever-increasing prevalence in these years, it creates an alarming global epidemic. In addition to the difficulty in seeing distant objects, myopia also increases the risk of cataract and advances its onset, greatly affecting the productivity of myopes of working age. Cataract management in myopic eyes, especially highly myopic eyes is originally more complicated than that in normal eyes, whereas the growing population of cataract with myopia, increasing popularity of corneal and lens based refractive surgery, and rising demand for spectacle independence after cataract surgery all further pose unprecedented challenges to ophthalmologists. Previous history of corneal refractive surgery and existence of implantable collamer lens will both affect the accuracy of biometry including measurement of corneal curvature and axial length before cataract surgery, which may result in larger intraocular lens (IOL) power prediction errors and a compromise in the surgical outcome especially in a refractive cataract surgery. A prudent choice of formula for cataract patients with different characteristics is essential in improving this condition. Besides, the characteristics of myopic eyes might affect the long-term stability of IOL, which is important for the maintenance of visual outcomes especially after the implantation of premium IOLs, thus a proper selection of IOL accordingly is crucial. In this mini-review, we provide an overview of the impact of myopia epidemic on treatment for cataract and to discuss new challenges that surgeons may encounter in the foreseeable future when planning refractive cataract surgery for myopic patients.

Role of Optic Nerve Head Characteristics in Predicting Intraocular Pressure Spikes after Cataract Surgery in Highly Myopic Eyes

INTRODUCTION

To evaluate the characteristics of optic nerve head (ONH) in highly myopic eyes and its role in predicting intraocular pressure (IOP) spikes after cataract surgery.

METHODS

Patients who are highly myopic and were scheduled for cataract surgery were enrolled in this prospective case series study. IOP was measured preoperatively and at 1 day and 3 days postoperatively. ONH characteristics including area, tilt ratio, lamina cribrosa (LC) thickness, and depth, and the presence of LC defects were evaluated with enhanced depth imaging optical coherence tomography. Factors influencing LC defects and early IOP spike were investigated using multivariate stepwise logistic regression.

RESULTS

In total, 200 highly myopic eyes of 200 patients were analyzed: 35.00% had small ONH, 53.00% had ONH tilt, and 14.00% had LC defects. Multivariate analysis demonstrated female patients with larger ONH area and deeper LC tended to have LC defects (all P < 0.05). As to postoperative IOP, IOP change, and incidence of IOP spikes, eyes with small ONH, ONH tilt, and LC defects had similar (all P > 0.05), higher (all P < 0.05), and lower (all P < 0.05) outcomes compared with those without the corresponding characteristic, respectively. Multivariate analysis showed that presence of LC defects and thicker LC were protective factors for early IOP spikes, and axial length > 28 mm was a risk factor (all P < 0.05).

CONCLUSION

Female patients with larger ONH area and deeper LC tend to have LC defects, which, together with thicker LC, was correlated with less IOP spikes in highly myopic eyes.

TRIAL REGISTRATION

This study was conducted as part of a larger project, the Shanghai High Myopia Study, registered at www.

CLINICALTRIALS

gov (accession number NCT03062085).

Effectiveness of toric IOL and capsular tension ring suturing technique for rotational stability in eyes with long axial length

OBJECTIVE

To evaluate the efficacy of the toric intraocular lens (IOL) and capsular tension ring (CTR) suturing technique in eyes with long axial length (AL) with a high risk of toric IOL rotation.

METHODS

This is a retrospective observational case series. The data files of patients who underwent a one-piece acrylic toric IOL (Tecnis Toric IOL and Acrysof IQ Toric IOL) implantation with the toric IOL and CTR suturing technique for cataract and astigmatism or toric IOL repositioning were analyzed. Inclusion criteria were a regular total corneal astigmatism of ≥ 1.5 D and an AL of ≥ 26.0 mm. Preoperative and postoperative astigmatism, uncorrected distance visual acuity (UDVA), IOL rotation, intraoperative, and postoperative complications were evaluated.

RESULTS

A total of 30 eyes of 29 patients were included in this study. The mean AL was 27.82 ± 1.53 mm (range, 26.08-31.07). UDVA revealed a statistically significant improvement from 0.84 ± 0.20 logMAR preoperatively to 0.04 ± 0.06 logMAR postoperatively (p < 0.001). The mean preoperative corneal astigmatism was 3.08 ± 1.01 D reduced to the postoperative residual astigmatism of 0.59 ± 0.32 D which was found also statistically significant (p < 0.001). Only 2 eyes (6.2%) had postoperative toric IOL rotation of 5° and 10°, respectively. The mean degree of postoperative rotation was 0.50 ± 2.01.

CONCLUSION

This technique provided excellent rotational stability even in eyes with longer AL and did not require additional intervention.

Selenium intake help prevent age-related cataract formation: Evidence from NHANES 2001-2008

Introduction

Cataract is one of the leading causes of blindness and visual impairment, about 16 million people around the world. Trace elements play an important role in a variety of the processes in human body. This study aimed to investigate the association between daily dietary intake of trace elements and age-related cataract incidence based on data from the National Health and Nutrition Examination Survey (NHANES) 2001-2008.

Methods

Iron, zinc, copper, and selenium were conducted in this study among subjects aged 50 years and older for African Americans and 55 and older in US adults. Multivariate logistic regression analysis was used in different models to investigate the association of trace elements intake and cataract.

Results

After screening, 7,525 subjects were ultimately included in this study. A significant negative association was found between selenium intake and cataract incidence in adjusted models using multivariate logistic regression analysis (model 1: OR = 0.998, 95% CI = 0.997-1.000; model 2: OR = 0.997, 95% CI = 0.995-1.000; and model 3: OR = 0.998, 95% CI = 0.995-1.000). After dividing selenium intake into quintiles, significant negative associations between selenium intake and cataract were observed in the first quintile of model 3, the fourth and fifth quintiles of all models. In subgroup analyses adjusted for age and sex, a significant negative association was observed only in women aged 65-74 years.

Discussion

Our study points out that maintaining daily dietary selenium intake at higher levels is helpful for cataract prevention, and that increasing daily dietary selenium intake in American women aged 65-74 years may contribute to the prevention of age-related cataract. The intakes of iron, zinc, copper may not be associated with age-related cataract.

Advances in artificial intelligence models and algorithms in the field of optometry

The rapid development of computer science over the past few decades has led to unprecedented progress in the field of artificial intelligence (AI). Its wide application in ophthalmology, especially image processing and data analysis, is particularly extensive and its performance excellent. In recent years, AI has been increasingly applied in optometry with remarkable results. This review is a summary of the application progress of different AI models and algorithms used in optometry (for problems such as myopia, strabismus, amblyopia, keratoconus, and intraocular lens) and includes a discussion of the limitations and challenges associated with its application in this field.

TGF-β2 levels in the aqueous humor are elevated in the second eye of high myopia within two weeks after sequential cataract surgery

Transforming growth factor-β (TGF-β) is the critical regulator of physiological and pathological conditions in lens. The TGF-β signaling pathway is closely associated with high myopia patients. Thirty eyes from fifteen patients with high myopia who received sequential cataract surgery were enrolled in this prospective study. Ten cataract patients with non-myopia were chosen as a control group. Aqueous humor (AH) samples were used to detect the levels of TGF-β1, TGF-β2, and TGF-β3 in both groups. Compared with the non-myopic cataracts patient group, the highly myopic cataracts group had a significantly higher TGF-β2 (P = 0.019). Besides, the level of TGF-β2 of the second eye was significantly higher than that in the first eye in high myopia cataract patients group (P = 0.037). And TGF-β1 showed significant differences with age and axial length of high myopia cataract patients. Therefore, TGF-β2 may contribute to the development of high myopia and cataract surgery increased the expression of TGF-β2.

Influence of IOL Weight on Long-Term IOL Stability in Highly Myopic Eyes

Purpose

This study aimed to investigate the influence of intraocular lens (IOL) weight on long-term IOL stability in highly myopic eyes.

Materials and Methods

A total of 205 highly myopic cataract eyes of 205 patients implanted with the MC X11 ASP (Group A, 86 eyes) or 920H IOL (Group B, 119 eyes) were included in this retrospective study. Eyes were divided into 3 subgroups according to the IOL power: low (≥-5 to <5 D), medium (≥5 to <14 D), and high (≥14 D) IOL power. At 3 years after surgery, IOL decentration and tilt, high-order aberrations, and anterior capsular opening (ACO) area were measured. The influence of IOL weight on long-term IOL stability was evaluated.

Results

Group B had a significantly greater IOL weight than Group A (Group B vs. Group A: 28.31 ± 2.01 mg vs. 25.71 ± 4.62 mg, P < 0.001). Correspondingly, Group B presented significantly greater overall and inferior decentration than Group A, especially for low and medium IOL power (all P < 0.05). In both groups, overall and vertical decentration was significantly correlated with IOL weight (all P < 0.05). Group B showed a significantly greater ACO area than Group A (P < 0.05). Multivariate analysis showed that decentration in Group A was affected by IOL weight, while decentration in Group B was affected by IOL weight and AL.

Conclusions

Higher IOL weight may lead to greater long-term IOL decentration in highly myopic eyes, while the haptic design may play a role in anterior capsular contraction.

Posterior vitreous detachment after cataract surgery in eyes with high myopia: an optical coherence tomography study

PURPOSE

To compare the progression of posterior vitreous detachment (PVD) after cataract surgery in eyes with high myopia with that in eyes without high myopia.

STUDY DESIGN

Prospective observational study.

METHODS

Eighty eyes of 80 patients with high myopia and 160 eyes of 160 patients without high myopia scheduled for phacoemulsification were recruited. PVD status was examined using swept-source optical coherence tomography at 2 days postoperatively (baseline) and at 3, 6, and 12 months postbaseline and classified into 5 stages: 0 (no PVD), 1 (paramacular PVD), 2 (perifoveal PVD), 3 (peripapillary PVD), and 4 (complete PVD). The PVD stage and incidence of progression to complete PVD of the 2 groups were compared.

RESULTS

The mean PVD stage did not differ significantly between the groups at baseline or at 3 months postbaseline but was significantly more progressed in the high myopia group than in the nonhigh myopia group at 6 months and 12 months postbaseline (P ≤ 0.0201). The Kaplan-Meier survival rate for complete PVD was significantly lower in the high myopia group (P = 0.0129). After adjusting for age, sex, and baseline PVD stage, the hazard ratio for complete PVD was 1.68-fold higher in the high myopia group than in the nonhigh myopia group (P = 0.0326, 95% CI 1.04-2.70).

CONCLUSION

After cataract surgery, PVD progressed significantly faster in eyes with high myopia than in eyes without high myopia, and the relative risk for complete PVD was 1.68-fold higher in eyes with high myopia, suggesting that highly myopic eyes are at considerably high risk for retinal disease postoperatively.