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Qi J, Hu X, He W, Zhang K, Meng J, Lu Y, Zhu X. Effect of Capsular Tension Ring Implantation on Postoperative Rotational Stability and Visual Performance of a Multifocal Toric Intraocular Lens. Curr Eye Res 2025:1-8. [PMID: 40289675 DOI: 10.1080/02713683.2025.2495219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 04/07/2025] [Accepted: 04/14/2025] [Indexed: 04/30/2025]
Abstract
PURPOSE To investigate the effect of capsular tension ring (CTR) implantation on postoperative rotational stability and visual performance of a plate-haptic multifocal toric intraocular lens in highly and non-highly myopic eyes. METHODS Consecutive cataract patients intended for phacoemulsification and plate-haptic multifocal toric IOL (AT LISA 909 M) implantation were enrolled and randomized to receive either co-implantation of a CTR or not. Axial length (AL) ≥ 26 mm was defined as highly myopic (HM) eyes. At 3 months postoperatively, IOL rotation degree, residual astigmatism, visual acuity, higher-order aberrations, modulation transfer function, dysfunctional lens index (DLI), and quality of vision index (QVI) were assessed. RESULTS This prospective cohort study included 44 eyes with CTR implanted and 43 without. In HM eyes, the CTR group showed significantly smaller degree of IOL rotation and less residual astigmatism compared to the non-CTR group, however, no such differences were found in non-HM eyes (both p > 0.05). Furthermore, in HM eyes, despite no difference in visual acuity, the CTR group exhibited significantly lower spherical aberrations and higher DLI and QVI compared to the non-CTR group (all p < 0.05), although no such differences were observed in non-HM eyes (all p > 0.05). Multivariate analysis identified longer AL, larger white-to-white, and non-use of CTR as independent risk factors for greater IOL rotation. CONCLUSIONS The co-implantation of CTR improves the rotational stability of a multifocal toric IOL in HM eyes, hence subsequently enhancing visual quality.
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Affiliation(s)
- Jiao Qi
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key laboratory of Myopia and Related Eye Diseases; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xiaoxin Hu
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key laboratory of Myopia and Related Eye Diseases; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Wenwen He
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key laboratory of Myopia and Related Eye Diseases; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Keke Zhang
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key laboratory of Myopia and Related Eye Diseases; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jiaqi Meng
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key laboratory of Myopia and Related Eye Diseases; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yi Lu
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key laboratory of Myopia and Related Eye Diseases; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xiangjia Zhu
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key laboratory of Myopia and Related Eye Diseases; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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Shin JH, Lee JW, Lee JH, Lee HJ. Stability of a ZEISS LISA tri 839MP multifocal IOL with a missing haptic segment in a high myopic patient: A 3-year follow-up case report. Medicine (Baltimore) 2025; 104:e42042. [PMID: 40228284 PMCID: PMC11999393 DOI: 10.1097/md.0000000000042042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Accepted: 03/18/2025] [Indexed: 04/16/2025] Open
Abstract
RATIONALE The purpose of this study was to present the long-term outcomes of a monobloc multifocal intraocular lens (IOL) (ZEISS LISA tri 839MP) with a missing haptic segment in a patient with high myopia. PATIENT CONCERNS A 51-year-old female with high myopia presented for cataract surgery. DIAGNOSES The patient was diagnosed with cataracts in both eyes, with high myopia as a pre-existing condition. INTERVENTIONS Phacoemulsification with implantation of a ZEISS LISA tri 839MP multifocal IOL was performed. During surgery, 1 haptic was torn and removed. The remaining 3 haptics of the plate-haptic-designed IOL were positioned in the capsular bag. OUTCOMES Postoperative uncorrected distance visual acuity improved to 20/20 on the first day, with stable intraocular pressure and good centration of the IOL. Over the 3-year follow-up period, the IOL remained well-centered with no significant decentration, and the patient maintained stable visual acuity of 20/20. LESSONS The ZEISS LISA tri 839MP multifocal IOL demonstrated long-term stability and favorable visual outcomes despite the missing haptic segment, suggesting that conservative management may be effective in similar cases.
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Affiliation(s)
- Jae-Ho Shin
- Department of Ophthalmology, College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jong Won Lee
- Department of Ophthalmology, Seoul Ire eye clinic, Seoul, Korea
| | - Jong Ho Lee
- Department of Ophthalmology, Seoul Ire eye clinic, Seoul, Korea
| | - Hui Jae Lee
- Department of Ophthalmology, College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
- Department of Ophthalmology, Seoul Ire eye clinic, Seoul, Korea
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Eom Y, Jeon HS, Kim SJ, Kim DH, Song JS, Kim DB. Three-point flanged optic piercing intrascleral fixation of multifocal intraocular lenses. Indian J Ophthalmol 2025; 73:455-461. [PMID: 40007280 PMCID: PMC11994189 DOI: 10.4103/ijo.ijo_1960_24] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 11/10/2024] [Accepted: 11/28/2024] [Indexed: 02/27/2025] Open
Abstract
PURPOSE To evaluate the feasibility of a three-point flanged optic piercing intrascleral fixation technique for replacing a dislocated multifocal intraocular lens (IOL). DESIGN Retrospective cross-sectional study. METHODS In total, 13 eyes from 13 patients with a dislocated single-piece C-loop or double C-loop diffractive multifocal IOL were enrolled to undergo dislocated multifocal IOL replacement through three-point flanged optic piercing 120 degrees apart intrascleral fixation using 7-0 polypropylene sutures at 2.5 mm posterior to the limbus. Preoperative and postoperative uncorrected distance visual acuity (UDVA), postoperative uncorrected intermediate visual acuity (UIVA) at 66 cm, uncorrected near visual acuity (UNVA) at 40 cm, residual refractive errors, and the amount of IOL decentration were evaluated. RESULTS There were six multifocal IOLs and seven multifocal toric IOLs. There was a notable improvement in visual acuity, with the mean UDVA improving from 0.79 ± 0.72 logMAR preoperatively to 0.06 ± 0.08 logMAR postoperatively (P = 0.004). The mean postoperative UIVA and UNVA were 0.04 ± 0.05 and 0.10 ± 0.12 logMAR, respectively. The mean residual refractive sphere, cylinder, and spherical equivalent were -0.04 ± 0.48 D, -0.29 ± 0.25 CD, and -0.18 ± 0.47 D, respectively. The mean residual cylinder was -0.25 ± 0.25 CD in eyes with multifocal toric IOL fixation. The mean amount of IOL decentration was 0.22 ± 0.05 mm. CONCLUSION The three-point flanged optic piercing intrascleral fixation technique for dislocated multifocal IOLs could provide good distance, intermediate, and near vision alongside excellent IOL centration.
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Affiliation(s)
- Youngsub Eom
- Department of Ophthalmology, Korea University Ansan Hospital, Gyeonggi-do, Republic of Korea
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Sun Jeon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, Republic of Korea
| | - Seong-Jae Kim
- Department of Ophthalmology, Gyeongsang National University Hospital and Gyeongsang National University College of Medicine, Jinju, Republic of Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Dong Hyun Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jong Suk Song
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea
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Hu X, Qi J, Cheng K, He W, Zhang K, Zhao C, Lu Y, Zhu X. Effectiveness of prophylactic capsular tension ring implantation during cataract surgery in highly myopic eyes. J Cataract Refract Surg 2024; 50:1030-1036. [PMID: 39313860 DOI: 10.1097/j.jcrs.0000000000001495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/19/2024] [Indexed: 09/25/2024]
Abstract
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.
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Affiliation(s)
- Xiaoxin Hu
- From the Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China (Hu, Qi, Cheng, He, Zhang, Zhao, Lu, Zhu); NHC Key laboratory of Myopia and Related Eye Diseases; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China (Hu, Qi, Cheng, He, Zhang, Zhao, Lu, Zhu); Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China (Hu, Qi, Cheng, He, Zhang, Zhao, Lu, Zhu)
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Chang P, Hu Y, Wu X, Qian S, Li Y, Wang Y, Yang F, Zhao Y. Influence of Capsular Tension Rings on the IOL-Capsule Complex in Patients With Long Axial Length: A Clinical Observation Based on SS-OCT. J Refract Surg 2024; 40:e654-e661. [PMID: 39254247 DOI: 10.3928/1081597x-20240723-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
PURPOSE To evaluate the influence of a capsular tension ring (CTR) on the intraocular lens (IOL)-capsule complex after cataract surgery in patients with long axial length. METHODS This was a prospective study. Patients underwent phacoemulsification and IOL implantation, with or without CTR implantation. Swept-source optical coherence tomography was performed at 1 day, 1 week, 1 month, and 3 months postoperatively to determine the postoperative aqueous depth (PAD), capsular bend index (CBI), and IOL tilt and decentration. Spherical equivalent values were obtained through subjective refraction and autorefraction. Root mean square was adopted to evaluate the indices listed above. RESULTS Forty-three patients (56 eyes) were included in the study. Generalized estimating equation analysis of PAD showed a statistical difference between groups (P = .031). The RMS of the change in PAD was smaller in the CTR group than in the non-CTR group during the 3 months after surgery (P = .015). CBI in the CTR group increased more from 1 to 3 months after surgery than that in the non-CTR group (P = .025). The RMS of the change in vertical decentration was smaller in the CTR group than in the non-CTR group during the 3-month follow-up (P = .009). CONCLUSIONS CTR implantation can stabilize the axial position of the IOL within the capsular bag after cataract surgery in patients with long axial length without affecting the refractive stability. The formation of capsular bend may be slightly delayed in the early stage after CTR implantation, but it accelerates from 1 to 3 months after surgery. [J Refract Surg. 2024;40(9):e654-e661.].
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Lin H, Zhang J, Zhang Y, Jin A, Zhang Y, Jin L, Xu Y, Xie X, Tan X, Luo L, Liu Y. Capsular Tension Ring Implantation for Intraocular Lens Decentration and Tilt in Highly Myopic Eyes: A Randomized Clinical Trial. JAMA Ophthalmol 2024; 142:708-715. [PMID: 38935400 PMCID: PMC11211984 DOI: 10.1001/jamaophthalmol.2024.2215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/02/2024] [Indexed: 06/28/2024]
Abstract
Importance Capsular tension rings (CTRs) can support weak zonules and inhibit capsular shrinkage, thus potentially reducing intraocular lens (IOL) decentration and tilt. However, it has been debated whether CTRs can reduce IOL decentration and tilt in highly myopic eyes and whether CTR implantation is necessary for all highly myopic eyes. Objective To evaluate the influence of CTR implantation on IOL decentration and tilt in highly myopic eyes. Design, Setting, and Participants This randomized clinical trial was conducted between November 2021 and September 2023 at the Zhongshan Ophthalmic Center, Guangzhou, China. Patients with cataract and an axial length (AL) of 26 mm or longer were enrolled. Interventions Participants were stratified into 3 groups based on the AL (stratum 1, 26 mm ≤ AL <28 mm; stratum 2, 28 mm ≤ AL <30mm; stratum 3, AL ≥30 mm), and further randomly assigned 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 IOL decentration at 3 months after cataract surgery was evaluated using anterior segment optical coherence tomography. Results A total of 186 eyes of 186 participants (mean [SD] age, 57.3 [10.9] years; 118 female [63.4%]) were randomized into the CTR group (93 [50%]) or control group (93 [50%]), with 87 eyes (93.6%) and 92 eyes (98.9%) completing follow-up at 3 months, respectively. The CTR group showed smaller IOL decentration (0.19 mm vs 0.23 mm; difference, -0.04 mm; 95% CI, -0.07 to -0.01 mm; P = .02) and tilt at 3 months, and lower proportions of clinically significant IOL decentration (≥0.4 mm) and tilt (≥7°) at 3 months compared with the control group. Similar results were only found in eyes with an AL of 30 mm or longer (IOL decentration: 0.20 mm vs 0.28 mm; difference, -0.08 mm; 95% CI, -0.14 to -0.02 mm; P = .01). Additionally, the CTR group showed a smaller change in IOL decentration from 1 week to 3 months, higher prediction accuracy, and better visual quality and patient satisfaction in this stratum. No differences were observed between the CTR and control groups in eyes with an AL less than 30 mm. Conclusions and Relevance CTR implantation reduced C-loop IOL decentration and tilt, increased position stability, and improved visual quality in eyes with an AL of 30 mm or longer. These findings support use of CTR implantation in eyes with an AL of 30 mm or longer and implanted with C-loop IOLs. Trial Registration ClinicalTrials.gov Identifier: NCT05161520.
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Affiliation(s)
- Haowen Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Jiaqing Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yifan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Aixia Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yu Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yifan Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiaohang Xie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xuhua Tan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Lixia Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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Lin X, Ma D, Yang J. Insights into the rotational stability of toric intraocular lens implantation: diagnostic approaches, influencing factors and intervention strategies. Front Med (Lausanne) 2024; 11:1349496. [PMID: 38414624 PMCID: PMC10896894 DOI: 10.3389/fmed.2024.1349496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/30/2024] [Indexed: 02/29/2024] Open
Abstract
Toric intraocular lenses (IOLs) have been developed to enhance visual acuity impaired by cataracts and correct corneal astigmatism. However, residual astigmatism caused by postoperative rotation of the toric IOL is an important factor affecting visual quality after implantation. To decrease the rotation of the toric IOL, significant advancements have been made in understanding the characteristics of toric IOL rotation, the factors influencing its postoperative rotation, as well as the development of various measurement techniques and interventions to address this issue. It has been established that factors such as the patient's preoperative refractive status, biological parameters, surgical techniques, postoperative care, and long-term management significantly impact the rotational stability of the toric IOL. Clinicians should adopt a personalized approach that considers these factors to minimize the risk of toric IOL rotation and ensure optimal outcomes for each patient. This article reviews the influence of various factors on toric IOL rotational stability. It discusses new challenges that may be encountered to reduce and intervene with rotation after toric IOL implantation in the foreseeable future.
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Affiliation(s)
- Xuanqiao Lin
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia, Fudan University, and Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Dongmei Ma
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia, Fudan University, and Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jin Yang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia, Fudan University, and Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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Montrimas A, Žemaitienė R, Yao K, Grzybowski A. Chord mu and chord alpha as postoperative predictors in multifocal intraocular lens implantation. Graefes Arch Clin Exp Ophthalmol 2024; 262:367-380. [PMID: 37278907 DOI: 10.1007/s00417-023-06098-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 06/07/2023] Open
Abstract
PURPOSE With the aging population, the prevalence of presbyopia and the popularity of multifocal intraocular lenses is also growing worldwide. Unfortunately, in some cases, they are still associated with postoperative visual disturbances. Recent literature started to evaluate angle kappa- and angle alpha-derived metrics of chord mu and chord alpha as possible predictive values for visual outcomes after multifocal intraocular lens implantation but the published results are inconsistent between studies. Thus, this article aims to review the role of chord mu and chord alpha as postoperative predictors after multifocal intraocular lens implantation and lay the foundation for further research. METHODS Relevant articles were identified using the following keywords: "presbyopia," "multifocal intraocular lens," "angle kappa," "angle alpha," "Chord mu," and "Chord alpha" up to June 2022. An attempt was made to present the majority of publications that addressed the topic. CONCLUSIONS Chord mu and chord alpha have a predictive role on the outcomes after multifocal intraocular lens implantation but to a different extent. Cataract surgeons should take them into consideration and avoid implanting a multifocal intraocular lens for patients with speculated critical values of chord mu and alpha above 0.5-0.6 mm, depending on the device used for measurement and the multifocal intraocular lens implanted. Currently, chord alpha seems to be a more stable, more widely applicable, and reliable determinant in predicting postoperative outcomes and in patient selection prior to multifocal intraocular lens implantation when compared to chord mu. To draw conclusions on the topic, a controlled study is needed.
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Affiliation(s)
- Andrius Montrimas
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 50161, Kaunas, Lithuania.
| | - Reda Žemaitienė
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 50161, Kaunas, Lithuania
| | - Ke Yao
- Eye Center of the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, People's Republic of China
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 60-836, Poznan, Poland
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Cetinkaya S, Ucar F. Comparison of Capsular Tension Ring Implantation before vs. after Toric Intraocular Lens for Rotational Stability. Klin Monbl Augenheilkd 2024; 241:186-191. [PMID: 36796415 DOI: 10.1055/a-1964-7552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
PURPOSE To compare the effect of implanting the capsular tension ring (CTR) before or after a toric intraocular lens (IOL) on rotational stability in patients with cataract and astigmatism. METHODS This is a randomized retrospective study. Patients who underwent phacoemulsification combined with toric IOL implantation due to cataract and astigmatism between February 2018 and October 2019 were enrolled in the study. Group 1 consisted of 53 eyes of 53 patients in whom the CTR was placed into the capsular bag after the implantation of the toric IOL. On the other hand, group 2 consisted of 55 eyes of 55 patients in whom the CTR was placed into the capsular bag before implantation of the toric IOL. The two groups were compared in terms of preoperative and postoperative astigmatism, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and postoperative IOL rotation degree. RESULTS There were no significant differences between the two groups related to age and sex (p > 0.05) or the mean preoperative spherical value, UCVA, BCVA, and corneal astigmatism (p > 0.05). Although the mean postoperative residual astigmatism of the first group (- 0.29 ± 0.26) was lower than that of the second (- 0.43 ± 0.31), the difference was not statistically significant (p = 0.16). The mean degree of rotation was 0.75 ± 2.66° in group 1 and 2.90 ± 6.57° in group 2, which was found to be statistically significant (p = 0.02). CONCLUSION The implantation of CTR after a toric IOL provides further rotational stability and more effective astigmatic correction.
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Affiliation(s)
| | - Fikret Ucar
- Ophthalmology, Private Konyagoz Hospital, Konya, Turkey
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Ameku KA, Berggren CC, Pedrigi RM. Implantation of a capsular tension ring during cataract surgery attenuates predicted remodeling of the post-surgical lens capsule along the visual axis. Front Bioeng Biotechnol 2024; 11:1300830. [PMID: 38312508 PMCID: PMC10834774 DOI: 10.3389/fbioe.2023.1300830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/26/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction: Cataract surgery permanently alters the mechanical environment of the lens capsule by placing a hole in the anterior portion and implanting an intraocular lens (IOL) that has a very different geometry from the native lens. We hypothesized that implant configuration and mechanical interactions with the post-surgical lens capsule play a key role in determining long-term fibrotic remodeling. Methods: We developed the first finite element-growth and remodeling (FE-G&R) model of the post-surgical lens capsule to evaluate how implantation of an IOL with and without a capsular tension ring (CTR) impacted evolving lens capsule mechanics and associated fibrosis over time after cataract surgery. Results: Our models predicted that implantation of a CTR with the IOL into the post-surgical lens capsule reduced the mechanical perturbation, thickening, and stiffening along the visual axis in both the remnant anterior and posterior portions compared to implantation of the IOL alone. Discussion: These findings align with patient studies and suggest that implantation of a CTR with the IOL during routine cataract surgery would attenuate the incidence of visually-debilitating capsule fibrosis. Our work demonstrates that use of such modeling techniques has substantial potential to aid in the design of better surgical strategies and implants.
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Affiliation(s)
| | | | - Ryan M. Pedrigi
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States
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Zhou Y, Dai M, Sun L, Tang X, Zhou L, Tang Z, Jiang J, Xia X. The accuracy of intraocular lens power calculation formulas based on artificial intelligence in highly myopic eyes: a systematic review and network meta-analysis. Front Public Health 2023; 11:1279718. [PMID: 38026369 PMCID: PMC10670805 DOI: 10.3389/fpubh.2023.1279718] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To systematically compare and rank the accuracy of AI-based intraocular lens (IOL) power calculation formulas and traditional IOL formulas in highly myopic eyes. Methods We screened PubMed, Web of Science, Embase, and Cochrane Library databases for studies published from inception to April 2023. The following outcome data were collected: mean absolute error (MAE), percentage of eyes with a refractive prediction error (PE) within ±0.25, ±0.50, and ±1.00 diopters (D), and median absolute error (MedAE). The network meta-analysis was conducted by R 4.3.0 and STATA 17.0. Results Twelve studies involving 2,430 adult myopic eyes (with axial lengths >26.0 mm) that underwent uncomplicated cataract surgery with mono-focal IOL implantation were included. The network meta-analysis of 21 formulas showed that the top three AI-based formulas, as per the surface under the cumulative ranking curve (SUCRA) values, were XGBoost, Hill-RBF, and Kane. The three formulas had the lowest MedAE and were more accurate than traditional vergence formulas, such as SRK/T, Holladay 1, Holladay 2, Haigis, and Hoffer Q regarding MAE, percentage of eyes with PE within ±0.25, ±0.50, and ±1.00 D. Conclusions The top AI-based formulas for calculating IOL power in highly myopic eyes were XGBoost, Hill-RBF, and Kane. They were significantly more accurate than traditional vergence formulas and ranked better than formulas with Wang-Koch AL modifications or newer generations of formulas such as Barrett and Olsen. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022335969.
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Affiliation(s)
- Yi Zhou
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Minhui Dai
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lingyu Sun
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiangyi Tang
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ling Zhou
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhiyao Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jian Jiang
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaobo Xia
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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He W, Cheng K, Zhao L, Liu S, Huang Z, Zhang K, Du Y, Zhou X, Lu Y, Zhu X. Long-Term Outcomes of Posterior Capsular Opacification in Highly Myopic Eyes and Its Influencing Factors. Ophthalmol Ther 2023; 12:1881-1891. [PMID: 37138195 PMCID: PMC10287617 DOI: 10.1007/s40123-023-00711-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 04/04/2023] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION The purpose of this study was to evaluate the long-term outcomes of posterior capsular opacification (PCO) in highly myopic eyes and its influencing factors. METHODS Patients undergoing phacoemulsification with intraocular lens implantation and followed up for 1-5 years were included in this prospective cohort study. The severity of PCO was evaluated using EPCO2000 software system, with the area of central 3.0 mm (PCO-3 mm) and within the capsulorhexis (PCO-C) both being analyzed. Percentage of eyes after Nd:YAG capsulotomy, as well as clinically significant PCO (defined as eyes with visual-impairing PCO or after capsulotomy), were also included as outcome variables. RESULTS A total of 673 highly myopic eyes [axial length (AL) ≥ 26 mm] and 224 control eyes (AL < 26 mm) were analyzed. The mean follow-up time was 34.0 ± 9.0 months. PCO was more severe in highly myopic eyes compared with controls with regard to higher EPCO scores (P < 0.001 for both PCO-3 mm and PCO-C), higher capsulotomy rate (P = 0.001), higher clinically significant PCO rate (P < 0.001) and shorter PCO-free survival time (P < 0.001). Extreme myopia (AL ≥ 28 mm) would further aggravate PCO in terms of higher EPCO scores (PCO-3 mm: P = 0.017; PCO-C: P = 0.013) and higher clinically significant PCO rate (P = 0.024) compared with other myopic eyes. In highly myopic eyes, AL [odds ratio (OR) 1.124, P = 0.004] and follow-up duration (OR 1.082, P < 0.001) were independent risk factors for clinically significant PCO after cataract surgery. CONCLUSION Highly myopic eyes had more severe PCO in the long term. Longer AL and follow-up duration were associated with higher risk of PCO. CLINICAL TRIAL REGISTRATION The study was registered at ClinicalTrials.gov (NCT03062085).
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Affiliation(s)
- Wenwen He
- Department of Ophthalmology, Eye and Ear, Nose and Throat, Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- Eye Institute, Eye and Ear, Nose, and Throat, Hospital of Fudan University, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, People's Republic of China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, People's Republic of China
- State Key Laboratory of Medical Neurobiology, Shanghai, 200032, People's Republic of China
| | - Kaiwen Cheng
- Department of Ophthalmology, Eye and Ear, Nose and Throat, Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- Eye Institute, Eye and Ear, Nose, and Throat, Hospital of Fudan University, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, People's Republic of China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, People's Republic of China
- State Key Laboratory of Medical Neurobiology, Shanghai, 200032, People's Republic of China
| | - Liangliang Zhao
- Department of Ophthalmology, The Second Hospital of Jilin Univesity, Changchun, 120021, People's Republic of China
| | - Shuyu Liu
- Department of Ophthalmology, Eye and Ear, Nose and Throat, Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- Eye Institute, Eye and Ear, Nose, and Throat, Hospital of Fudan University, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, People's Republic of China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, People's Republic of China
- State Key Laboratory of Medical Neurobiology, Shanghai, 200032, People's Republic of China
| | - Zhiqian Huang
- Department of Ophthalmology, Eye and Ear, Nose and Throat, Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- Eye Institute, Eye and Ear, Nose, and Throat, Hospital of Fudan University, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, People's Republic of China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, People's Republic of China
- State Key Laboratory of Medical Neurobiology, Shanghai, 200032, People's Republic of China
| | - Keke Zhang
- Department of Ophthalmology, Eye and Ear, Nose and Throat, Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- Eye Institute, Eye and Ear, Nose, and Throat, Hospital of Fudan University, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, People's Republic of China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, People's Republic of China
- State Key Laboratory of Medical Neurobiology, Shanghai, 200032, People's Republic of China
| | - Yu Du
- Department of Ophthalmology, Eye and Ear, Nose and Throat, Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- Eye Institute, Eye and Ear, Nose, and Throat, Hospital of Fudan University, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, People's Republic of China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, People's Republic of China
- State Key Laboratory of Medical Neurobiology, Shanghai, 200032, People's Republic of China
| | - Xingtao Zhou
- Department of Ophthalmology, Eye and Ear, Nose and Throat, Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- Eye Institute, Eye and Ear, Nose, and Throat, Hospital of Fudan University, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, People's Republic of China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, People's Republic of China
- State Key Laboratory of Medical Neurobiology, Shanghai, 200032, People's Republic of China
| | - Yi Lu
- Department of Ophthalmology, Eye and Ear, Nose and Throat, Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.
- Eye Institute, Eye and Ear, Nose, and Throat, Hospital of Fudan University, Shanghai, 200031, People's Republic of China.
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, People's Republic of China.
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, People's Republic of China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, People's Republic of China.
- State Key Laboratory of Medical Neurobiology, Shanghai, 200032, People's Republic of China.
| | - Xiangjia Zhu
- Department of Ophthalmology, Eye and Ear, Nose and Throat, Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.
- Eye Institute, Eye and Ear, Nose, and Throat, Hospital of Fudan University, Shanghai, 200031, People's Republic of China.
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, People's Republic of China.
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, People's Republic of China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, People's Republic of China.
- State Key Laboratory of Medical Neurobiology, Shanghai, 200032, People's Republic of China.
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Ucar F, Turgut Ozturk B. Effectiveness of toric IOL and capsular tension ring suturing technique for rotational stability in eyes with long axial length. Int Ophthalmol 2023; 43:2917-2924. [PMID: 36930361 DOI: 10.1007/s10792-023-02694-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
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.
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Affiliation(s)
- Fikret Ucar
- Department of Ophthalmology, Konyagoz Eye Hospital, Sancak Mah. Unluer Sok. No: 13, Selcuklu, 42100, Konya, Turkey.
| | - Banu Turgut Ozturk
- Department of Ophthalmology, Faculty of Medicine, Selcuk University, Konya, Turkey
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Chassain C, Hallak MK, Lesaffre M. Rotational stability and clinical outcomes after implantation of a new monofocal toric intraocular lens with double C-loop design. J Fr Ophtalmol 2023:S0181-5512(22)00420-X. [PMID: 37179129 DOI: 10.1016/j.jfo.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 05/15/2023]
Abstract
PURPOSE To investigate rotational stability and visual outcomes of patients unilaterally or bilaterally implanted with a new monofocal toric intraocular lens (IOL). SETTING Ophthalmology service, clinique Beausoleil, avenue de Lodève, Montpellier. DESIGN Single-center retrospective study. METHODS This study included patients who underwent routine cataract surgery with the PODEYE toric (BVI/PhysIOL SA, Liège, Belgium) IOL using the ZEISS CALLISTO eye®. Biometry and keratometry data, refractive outcomes, rotational stability, and astigmatism correction were recorded. IOL rotation was evaluated using an image analysis technique. Postoperative assessments were performed at 1 week, 1 month, and 4 to 6 months after surgery. RESULTS Clinical outcomes of 102 patients (136 eyes) were analyzed. Patients had a mean age of 74 years. Of the included eyes, 25% had an axial length greater than 24.5mm. Median postoperative IOL rotation from baseline (surgery) was 2̊. With the exception of one outlier (15̊ rotation), IOL rotation was ≤ 6̊ (1 month) and ≤ 10̊ (4-6 months) in 100% of the eyes. No surgical IOL re-positioning was required. Median postoperative corrected distance visual acuity was -0.08 logMAR, and median postoperative subjective cylinder was between 0.25 and 0.50 D. CONCLUSION The PODEYE toric IOL showed high rotational stability, allowing for correction of corneal astigmatism during cataract surgery.
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Affiliation(s)
- C Chassain
- Clinique Beau Soleil, 119, avenue de Lodève, 34070 Montpellier, France.
| | - M Kamal Hallak
- Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - M Lesaffre
- Clinique Beau Soleil, 119, avenue de Lodève, 34070 Montpellier, France
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15
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Pan Y, Liu Z, Zhang H. Research progress of lens zonules. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2023; 3:80-85. [PMID: 37846380 PMCID: PMC10577871 DOI: 10.1016/j.aopr.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 10/18/2023]
Abstract
Background The lens zonule, a circumferential system of fibres connecting the ciliary body to the lens, is responsible for centration of the lens. The structural, functional, and positional abnormalities of the zonular apparatus can lead to the abnormality of the intraocular structure, presenting a significant challenge to cataract surgery. Main text The lens zonule is the elaborate system of extracellular fibers, which not only centers the lens in the eye but also plays an important role in accommodation and lens immunity, maintains the shape of the lens, and corrects spherical aberration. The zonules may directly participate in the formation of cataract via the immune mechanism. Abnormal zonular fibers that affect the position and shape of the lens may play an important role in the pathogenesis of angle closure disease and increase the complexity of the surgery. Capsular tension rings and related endocapsular devices are used to provide sufficient capsular bag stabilization and ensure the safety of cataract surgery procedures. Better preoperative and intraoperative evaluation methods for zonules are needed for clinicians. Conclusions The microstructure, biomechanical properties, and physiological functions of the lens zonules help us to better understand the pathogenesis of cataract and glaucoma, facilitating the development of safer surgical procedures for cataract. Further studies are needed to carefully analyze the structure-function relationship of the zonular apparatus to explore new treatment strategies for cataract and glaucoma.
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Affiliation(s)
- Yingying Pan
- Department of Ophthalmology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Zhaoqiang Liu
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Han Zhang
- Department of Ophthalmology, Shandong Provincial Hospital, Shandong University, Jinan, China
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Sugita T, Aomatsu M, Yoshida M, Kaneko T, Hasegawa Y, Oshika T. Clinical and laboratory studies on the effects of capsular tension ring on surgical outcomes of trifocal intraocular lens implantation. J Cataract Refract Surg 2023; 49:400-404. [PMID: 36975012 DOI: 10.1097/j.jcrs.0000000000001111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/28/2022] [Indexed: 03/29/2023]
Abstract
PURPOSE To assess the influence of capsular tension ring (CTR) on surgical outcomes of trifocal intraocular lens (IOL) implantation in femtosecond laser-assisted cataract surgery. SETTING Sugita Eye Clinic, Tokyo, and University of Tsukuba, Ibaraki, Japan. DESIGN Prospective, randomized, paired-eye clinical study and laboratory study. METHODS In the clinical study involving 44 eyes of 22 patients with no risk of zonular instability, 1 eye received IOL alone and the contralateral eye received IOL with CTR. Preoperative capsular bag diameter and postoperative IOL tilt/decentration were measured using anterior segment optical coherence tomography. In the laboratory study, IOL and CTR were implanted into an artificial capsular bag of 10 mm in diameter, and IOL centration was evaluated. RESULTS Throughout the 12-month follow-up period, there was no significant difference in refractive and visual outcomes between groups. The amount of IOL decentration was significantly larger in eyes with CTR than in eyes without CTR at 12 months postoperatively (P = .037). There was a significant negative correlation between capsular bag diameter and the amount of IOL decentration in eyes with CTR (P = .038), but not in eyes without CTR (P = .873). The laboratory study indicated that interference between CTR eyelets and IOL haptics significantly increased IOL decentration (P < .001). CONCLUSIONS The use of CTR did not affect refractive and visual outcomes of trifocal IOL implantation in eyes without the risk of zonular weakness. CTR coimplantation increased IOL decentration possibly due to the interference between CTR eyelets and IOL haptics.
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Affiliation(s)
- Toru Sugita
- From the Sugita Eye Clinic, Tokyo, Japan (Sugita, Yoshida); Sugita Eye Clinic Annex, Tokyo, Japan (Aomatsu, Kaneko); Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Hasegawa, Oshika)
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Ma D, Yu W, Cai L, Shen J, Guo T, Chen X, Dong J, Zeng Q, Wang A, Hua Z, Zhu X, Zheng T, Lu Y, Yang J. Optimal Timing of Repositioning Surgery for a Plate-Haptic Toric Intraocular Lens: A Multicenter Retrospective Study. J Refract Surg 2023; 39:120-126. [PMID: 36779462 DOI: 10.3928/1081597x-20221221-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
PURPOSE To evaluate risk factors for significant rotation and determine optimal timing for repositioning surgery following a plate-haptic toric intraocular lens (IOL) implantation. METHODS This retrospective study enrolled patients who underwent the plate-haptic toric IOL implantation at seven hospitals in Shanghai. IOL rotation and residual astigmatism were compared before and after repositioning surgery. Risk factors for significant IOL rotation after cataract surgery were identified by stepwise multiple linear regression analysis. Spearman's and linear regression analyses were performed to identify factors associated with IOL rotation after repositioning. The receiver operator characteristic (ROC) curve was used to analyze the optimal timing for repositioning surgery. RESULTS Among 2,745 eyes implanted with the toric IOL, 46 eyes (1.68%) of 45 patients underwent repositioning surgery. Axial length and lens thickness were significantly associated with IOL rotation before repositioning. After repositioning surgery, IOL rotation and residual astigmatism were significantly reduced (all P < .001). IOL rotation after repositioning was negatively associated with the timing of repositioning surgery (all P < .001). The ROC curve showed that the optimal cut-off for the timing of repositioning surgery was 15 days or greater. CONCLUSIONS The prevalence of repositioning surgery after the plate-haptic toric IOL implantation was 1.68%, and the optimal timing for repositioning surgery was recommended to be 2 to 3 weeks after cataract surgery. [J Refract Surg. 2023;39(2):120-126.].
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Zhang J, Han X, Zhang M, Liu Z, Chen X, Qiu X, Lin H, Li J, Liu B, Zhang C, Wei Y, Jin G, Tan X, Luo L. Predicting the risk of clinically significant intraocular lens tilt and decentration in vitrectomized eyes. J Cataract Refract Surg 2022; 48:1318-1324. [PMID: 35786811 PMCID: PMC9622369 DOI: 10.1097/j.jcrs.0000000000000997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To identify predictors and develop a prognostic nomogram for clinically significant intraocular lens (IOL) tilt and decentration in vitrectomized eyes. SETTING Zhongshan ophthalmic center, Guangzhou, China. DESIGN Prospective observational study. METHODS Patients with previous pars plana vitrectomy who underwent phacoemulsification with IOL implantation were enrolled in this study. The tilt and decentration of the lens and IOL were assessed by a swept-source anterior segment optical coherence tomography (CASIA2). Multiple logistic regression analysis and prognostic nomogram models were used to explore factors associated with clinically significant IOL tilt and decentration (defined as tilt ≥7 degrees and decentration ≥0.4 mm). RESULTS 375 patients (375 eyes) with a mean age of 56.1 ± 9.81 years were included. Lens tilt (odds ratio [OR] = 1.44), lens decentration (OR = 1.74), lens diameter (OR = 0.49), and hydrophilic IOL (OR = 2.36) were associated with IOL tilt over 7 degrees (all P &lt; .05). Lens tilt (OR = 1.24), lens decentration (OR = 2.30), and incomplete capsulorhexis-IOL overlap (OR = 2.44) increased the risk of IOL decentration over 0.4 mm (all P &lt; .05). Preoperative lens tilt together with lens decentration was identified as the strongest predictor of incident clinically significant IOL tilt (area under the curve [AUC] = 0.82, 95% CI, 0.76-0.88) and decentration (AUC: 0.84, 95% CI, 0.78-0.89), and the nomogram was constructed accordingly. CONCLUSIONS The tilt and decentration of the crystalline lens, hydrophilic IOL, and incomplete capsulorhexis-IOL overlap were risk factors for clinically significant IOL misalignment. Clinicians could use a prognostic nomogram model based on the preoperative lens position to make a strategy for higher-risk patients.
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Müller-Kassner A, Kohnen T, Shajari M. [Preliminary Examination Before Cataract Surgery]. Klin Monbl Augenheilkd 2022. [PMID: 35970194 DOI: 10.1055/a-1907-2580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
To plan and execute a successful and safe cataract surgery one must conduct a structured, goal- and patient-oriented examination. The medical history provides crucial information regarding the planning of the anesthetic procedure, lens selection and possible intraoperative complications. Visual acuity and refraction measurements are essential for both documentation and discussion of the selected target refraction. Multifocal lenses have various contraindications to which attention must be paid during slit lamp examination and other imaging diagnostics. These include epithelial basement membrane dystrophy, Fuchs' endothelial dystrophy, zonular weakness, and progressive retinal diseases such as progressive AMD. Tomography reveals corneal irregularities as well as possible refractive laser treatments that have been performed previously. Lens calculation is complicated in these cases. Additionally, an endothelial cell count, aberrometry to rule out higher order aberrations, pupillometry and an analysis of the tear film can provide further information. The patient must be informed verbally about the severity of the procedure and the risks relevant for him with sufficient distance to the surgery.
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Müller-Kassner A, Kohnen T, Shajari M. Voruntersuchung bei Kataraktoperation. AUGENHEILKUNDE UP2DATE 2022. [DOI: 10.1055/a-1645-7453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
ZusammenfassungDie Kataraktoperation stellt mit etwa 800 000 Operationen pro Jahr eine der häufigsten Operationen in Deutschland dar; aufgrund des demografischen Wandels ist von einem Anstieg in den
nächsten Jahrzehnten auszugehen. Daneben erweitern sich die diagnostischen und operativen Möglichkeiten. Ziel dieses Beitrags ist, eine strukturierte, ziel- und patientenorientierte
Voruntersuchung zu planen und individuelle Besonderheiten aufzuzeigen.
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Matsuura K, Miyoshi T, Yoshida H, Shimowake T. How to Manage the Cortex After CTR Insertion. Clin Ophthalmol 2022; 16:1085-1089. [PMID: 35422609 PMCID: PMC9005133 DOI: 10.2147/opth.s359319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/22/2022] [Indexed: 11/23/2022] Open
Abstract
Capsular tension ring (CTR) realizes safe cataract surgery. However, residual cortex removal becomes difficult with CTR. Originally, the flushing technique was developed for intracameral antibiotic administration. Using this technique with larger amounts of solution enables surgeons to 1) deliver antibiotics to the anterior chamber and area behind the intraocular lens, resulting in stable, scheduled antibiotic concentration and 2) entirely irrigate and displace the area, leading to the effective cleansing of residual substances and bacterial pollution. When performing the flushing technique, the residual cortex and debris that were not eliminated by ordinary irrigation and aspiration can be pushed out to the anterior chamber. Applying flushing technique to CTR cases, the residual cortex and debris trapped between the CTR loop and capsular equator is lifted into the anterior chamber and easily removed. If the capsular bag is polluted by bacteria, it may also be lifted to the anterior chamber.
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Affiliation(s)
- Kazuki Matsuura
- Nojima Hospital, Kurayoshi-city, Tottori Pref, 6820863, Japan
| | - Teruyuki Miyoshi
- Miyoshi Eye Center, Fukuyama-city, Hiroshima Pref, 7200053, Japan
- Correspondence: Teruyuki Miyoshi, Miyoshi Eye Center, 2-39 Daikoku-cho, Fukuyama-city, Hiroshima Pref, 7200053, Japan, Tel +81-84-927-2222, Fax +81-84-927-2223, Email
| | - Hironori Yoshida
- Miyoshi Eye Center, Fukuyama-city, Hiroshima Pref, 7200053, Japan
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22
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Belov D, Nikolaenko V, Potemkin V. Effect of capsular tension ring implantation during phacoemulsification on postoperative refraction. Eur J Ophthalmol 2021; 32:2189-2193. [PMID: 34693771 DOI: 10.1177/11206721211051920] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess refractive outcomes of phacoemulsification (PE) with additional capsular tension ring (CTR) implantation. MATERIAL AND METHODS In total, 37 eyes of 37 patient who underwent PE with intraocular lens (IOL) implantation were divided into 2 groups: study group (n = 18) with CTR co-implantation (inclusion criteria was preoperative irido-phacodonesis) and control group (n = 19) without CTR. Optical biometry (IOL-Master 500) was performed for each patient before PE. Barrett Universal II Formula was used for IOL calculation. IOL power calculation error was assessed by comparing target refraction and final refraction measured by Topcon-8800 autorefractometer 1 month after surgery. RESULTS Despite almost identical preoperative values in both groups refractive result was different. Patients with CTR co-implantation had more hyperopic IOL power calculation error of 0.41 ± 0.52 D versus 0.04 ± 0.59 D in the control group (p = 0.043). Postoperative spherical equivalent in study group was more hyperopic (-0.40 ± 1.47 D) than in control group (-0.77 ± 1.24), nevertheless, this difference was insignificant (p = 0.166). CONCLUSION CTR co-implantation in patients with weak zonules and preoperative irido-phacodonesis leads to more hyperopic IOL power calculation error compared with control group.
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Affiliation(s)
- Dmitrii Belov
- Saint-Petersburg Multifield Hospital 2, Saint-Petersburg, Russia
| | - Vadim Nikolaenko
- Saint-Petersburg Multifield Hospital 2, Saint-Petersburg, Russia.,48544Saint Petersburg State University, Saint-Petersburg, Russia
| | - Vitaly Potemkin
- Saint-Petersburg Multifield Hospital 2, Saint-Petersburg, Russia.,Academican I.P. 104721Pavlov First St Petersburg State Medical University, Saint-Petersburg, Russia
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23
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Salimi A, Fanous A, Watt H, Abu-Nada M, Wang A, Harasymowycz P. Prevalence of zonulopathy in primary angle closure disease. Clin Exp Ophthalmol 2021; 49:1018-1026. [PMID: 34382734 PMCID: PMC9293109 DOI: 10.1111/ceo.13983] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/22/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
Background To determine the prevalence of zonulopathy in a large cohort of eyes with primary angle closure disease (PACD) that underwent cataract surgery. Methods Retrospective consecutive case series of PACD eyes (including primary angle closure suspect, primary angle closure, and primary angle closure glaucoma) that underwent phacoemulsification cataract surgery or clear lens extraction between 2009 and 2020 at a single ophthalmology centre. Those with risk factors for zonulopathy such as history of trauma, pseudoexfoliation syndrome, intraocular surgery, retinitis pigmentosa or connective tissue disorders were excluded. The primary outcomes included the prevalence of zonulopathy assessed intraoperatively and secondary pigment dispersion syndrome. Results In our cohort of 806 consecutive PACD eyes, the prevalence of zonulopathy was 7.3% (59 of 806 eyes) – significantly greater than the 0.46%–2.6% range reported for the general population (p < 0.001). Intraoperative signs of zonular weakness included floppy capsular bag (29 eyes, 3.6%), zonular laxity (25 eyes, 3.1%) and zonular dehiscence (11 eyes, 1.4%). Among these eyes, capsular tension ring was used in 23 eyes (39.0%), six eyes (10.2%) experienced vitreous prolapse intraoperatively and underwent anterior vitrectomy, and two eyes (3.4%) experienced posterior capsular rupture, one of which required a scleral‐fixated intraocular lens. Secondary pigment dispersion syndrome was observed in 141 eyes (17.5%). Conclusions This study evidenced a high prevalence of zonulopathy among a large cohort of PACD eyes and suggests zonulopathy as a possible under‐recognised cause of angle closure. Until more sophisticated imaging modalities become available, awareness about the prevalence of zonulopathy in angle closure disease coupled with careful preoperative examinations can help minimise or prevent the complications of zonulopathy.
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Affiliation(s)
- Ali Salimi
- Department of Ophthalmology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Montreal Glaucoma Institute and Bellevue Ophthalmology Clinics, Montreal, Quebec, Canada
| | - Anthony Fanous
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Harrison Watt
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Mohamed Abu-Nada
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Anna Wang
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Paul Harasymowycz
- Montreal Glaucoma Institute and Bellevue Ophthalmology Clinics, Montreal, Quebec, Canada.,Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
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Ucar F, Ozcimen M. Can toric IOL rotation be minimized? Toric IOL-Capsular Tension Ring suturing technique and its clinical outcomes. Semin Ophthalmol 2021; 37:158-163. [PMID: 34096458 DOI: 10.1080/08820538.2021.1933545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: In this study, we aimed to evaluate the outcomes of the toric intraocular lens (IOL) and capsular tension ring (CTR) suturing technique in patients with cataract and astigmatism. Methods: Group 1 comprised 37 eyes of 36 patients to whom the CTR-toric IOL complex was co-implanted after the CTR was sutured to the toric IOL haptic. Group 2 comprised 35 eyes of 33 patients in whom the toric IOL and CTR were implanted without suturing. Both groups were compared in terms of preoperative and postoperative astigmatism, best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), and IOL rotation. Results: The mean rotation degree was 0.54° ± 2.29° in group 1 and 4.28° ± 8.84° in group 2 (p = .01). While there was no significant difference between the postoperative residual astigmatism and the estimated residual astigmatism in group 1, the postoperative residual astigmatism was statistically higher than the estimated residual astigmatism in group 2 (p = .47 and 0.000, respectively). The mean postoperative UCVA was 0.02 ± 0.04 (logMAR) in group 1 and 0.08 ± 0.13 (logMAR) in group 2 (p = .01). Conclusion: The toric IOL and CTR suturing technique provides excellent rotational stability and astigmatism correction.
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Affiliation(s)
- Fikret Ucar
- Ophthalmology Department, Konyagoz Eye Hospital, Konya, Turkey
| | - Muammer Ozcimen
- Ophthalmology Department, Saglik Bilimleri University Konya Training and Research Hospital, Konya, Turkey
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