Based on the Real-Life Data of Türkiye; Comparison of Anatomical and Functional Outcomes of Phakic and Pseudophakic Patients in Wet Type Age-Related Macular Degeneration

Objectives

The aim of the study was comparison of wet-type age-related macular degeneration in phakic and pseudophakic patients in terms of anatomical and functional success based on the real-life data of Türkiye.

Methods

The multicenter retrospective real-life study data of the. retinal study group were used in this study. Among 867 eyes of 867 patients were included in the study. Patients were divided into two groups according to the status of the lens; phakic group and pseudophakic group. The follow-up period of the two groups, the number of injections at the 1st, 2nd, and 3rd years, and changes in the central macular thickness (CMT, μ) and visual acuity (VA, logMAR) of the patients at the beginning, 6th, 12th, 24th, and 36th months were examined.

Results

In our study, the number of injections in the 1st, 2nd, and 3rd years, respectively, was 4.2±2.0, 1.8±1.9, and 1.0±1.7 in the phakic group, and 3.9±2.0, 1.7±1.9, and 0.8±1.4 in the pseudophakic group. When the two groups were compared in terms of the number of injections, there was a statistically significant difference in the 1st year, but there was no significant difference in the 2nd and 3rd years (p=0.001, p=0.350, and p=0.288, respectively). There was no statistically significant difference between the groups in terms of CMT in the baseline, 6th, 12th, 24th, and 36th months (p=0.991, p=0.327, p=0.652, p=0.599, and p=0.873, respectively). Although there was no difference in VA between groups at the beginning (p=0.052), the phakic group showed statistically better VA in controls at 3rd, 6th, 12th, 24th, and 36th months (p=0.001, p=0.001, p=0.000, p=0.000, and p=0.003, respectively).

Conclusion

Differences in the number of injections and visual results between phakic and pseudophakic patients in wet type AMD may necessitate the creation of different treatment and follow-up protocols.

Calculation of ocular magnification in phakic and pseudophakic eyes based on anterior segment OCT data

PURPOSE

The purpose of this study is to develop a straightforward mathematical concept for determination of object to image magnification in both phakic and pseudophakic eyes, based on biometric measures, refractometry and data from an anterior segment optical coherence tomography (OCT).

METHODS

We have developed a strategy for calculating ocular magnification based on axial length measurement, phakic anterior chamber and lens thickness, keratometry and crystalline lens front and back surface curvatures for the phakic eye, and axial length measurement, anterior chamber and lens thickness, keratometry and intraocular lens power, refractive index and shape factor for the pseudophakic eye. Comparing the magnification of both eyes of one individual yields aniseikonia, while comparing the preoperative and postoperative situation of one eye provides the gain or loss in ocular magnification. The applicability of this strategy is shown using a clinical example and a small case series in 78 eyes of 39 patients before and after cataract surgery.

RESULTS

For the phakic eye, the refractive index of the crystalline lens was adjusted to balance the optical system. The pseudophakic eye is fully determined and we proposed three strategies for considering a potential mismatch of the data: (A) with spherical equivalent refraction, (B) with intraocular lens power and (C) with the shape factor of the lens. Magnification in the phakic eye was -0.00319 ± 0.00014 and with (A) was -0.00327 ± 0.00013, with (B) was -0.00323 ± 0.00014 and with (C) was -0.00326 ± 0.00013. With A/B/C, the magnification of the pseudophakic eye was on average 2.52 ± 2.83%/1.31 ± 2.84%/2.14 ± 2.80% larger compared with the phakic eye. Magnification changes were within a range of ±10%.

CONCLUSIONS

On average, ocular magnification does not change greatly after cataract surgery with implantation of an artificial lens, but in some cases, the change could be up to ±10%. If the changes are not consistent between the left and right eyes, then this could lead to post-cataract aniseikonia.

Evaluation of Visual Quality in Pseudophakic Eyes with Different Ocular Spherical Aberrations

Purpose: To evaluate the effects of different residual total ocular spherical aberration (SA) on objective and subjective visual quality in pseudophakic eyes. Methods: This prospective consecutive study comprised 171 patients with age-related cataract and undergone unilateral uneventful phacoemulsification. All participants were divided into four groups based on residual ocular SA at 6 mm pupil: negative SA (≤-0.10 μm, group A), neutral SA (0.00 ± 0.05 μm, group B), slightly positive SA (0.10 ± 0.05 μm, group C), and more positive SA (0.20 μm, group D), respectively. Subjective visual acuity and contrast sensitivity, and objective optical quality and ocular aberrations were analyzed 3 months postoperatively. Results: There was no significant difference in baseline measurements across all groups. Postoperatively, no statistically significant differences were found in visual acuity between groups (P > .05), while differences reached statistical significance in mesopic contrast sensitivity at 12 and 18 cpd (P < .01). There were significant differences in ocular SA and higher-order aberrations at 6 mm pupil, as well as in optical quality parameters (P < .05). Group C showed a minimum value of objective scatter index (1.17 ± 0.55) but maximum values of modulation transfer function cutoff (31.94 ± 9.18) and optical quality value OV 100% (1.07 ± 0.31), indicating lower intraocular scattering and superior optical quality. Conclusions: This comprehensive evaluation is conducive to deepening the understanding of visual and optical performance of pseudophakic eye. A modest amount of positive ocular SA seemed to be a more preferable option for enhancing visual quality after aspheric ntraocular lense (IOL) implantation.