Effect of intraocular lens material and haptic design on anterior capsule contraction after cataract surgery: A systematic review and meta-analysis

PURPOSE

To compare anterior capsule contraction (ACC) after cataract surgery with implantation of intraocular lens (IOLs) of different materials and designs.

METHODS

We searched three electronic databases for relevant studies published up to January 1, 2023. Five randomized controlled trails (RCTs) and three cohort studies involving 1,221 eyes were included in quantitative synthesis. We extracted data, assessed their quality independently, and calculated standard mean difference (SMD) using a random-effects model. Six RCTs and one retrospective cohort were included in information summary.

RESULTS

The contraction of the anterior capsule opening area in the hydrophilic group was larger than that of the hydrophobic group from one month to one year postoperatively (P < 0.001 and P < 0.001, respectively). Specifically, the hydrophilic group showed greater contraction of the anterior capsule opening area at one month postoperatively (Standardized mean difference [SMD] = -0.73, 95% confidence interval [CI] = -0.93 to -0.52), three months (SMD = -1.04, 95% CI = -1.32 to -0.75), six months (SMD = -0.99, 95% CI = -1.24 to -0.74) and one year (SMD = -1.33, 95% CI = -2.50 to -0.16). As of one year postoperatively, the anterior capsular opening area showed a trend of decreasing over time in both groups (P = 0.046 and P = 0.050, respectively). In information summary, three studies indicated no relationship between haptic design and ACC, while the other four studies reported that the number and shape of haptic would affect ACC.

CONCLUSION

This meta-analysis suggested that the postoperative ACC after the implantation of hydrophobic IOLs was less than that induced by hydrophilic IOLs. Haptic design may also affect the degree of ACC.

Factors affecting anophthalmic socket reconstruction outcomes using autologous oral mucosal graft

BACKGROUND

Limited studies have reported surgical outcomes that are defined by strict criteria following grade 2 or 3 socket reconstruction using an oral mucosal graft (OMG). We aimed to determine factors influencing surgical outcomes of anophthalmic socket reconstruction using OMG in patients with grade 2 or 3 socket contractures.

METHODS

Thirty-seven patients who underwent socket reconstruction with autologous OMG between January 2007 and December 2017 were retrospectively analyzed. The successful outcome was defined as an eye prosthesis wearing without experiencing displacement and the absence of any re-operations or additional surgeries following socket reconstruction. Factors affecting surgical outcomes were identified using multivariate analysis.

RESULTS

A total of 15 male and 22 female patients (mean age: 40.2 ± 17.2 years) were included. The median duration of socket contracture was 21.5 years. Grade 2 and 3 socket contractures, based on Tawfik's classification, were reported in 20 and 17 patients, respectively. Twenty-eight and eight patients underwent socket reconstruction using OMG alone and OMG combined with a hard palate graft, respectively. The success rates of grades 2 and 3 socket contracture reconstruction were 80.0% and 52.9%, respectively. Multivariate analysis demonstrated that only grade 3 contractures were predictive of worse outcomes. At the final visit (mean follow-up: 6.3 years), 34 patients (91.9%) could wear their eye prostheses.

CONCLUSIONS

Socket reconstruction using autologous OMG can provide acceptable results in grade 2 and 3 contractures; however, satisfactory results were more significantly reported in grade 2 than in grade 3 contractures.

Polydopamine based photothermal/photodynamic synchronous coating modified intraocular lens for efficient and safer posterior capsule opacification prevention

Posterior capsule opacification (PCO), as one of the most common late complications after intraocular lens (IOL) implantation in cataract surgery, seriously affects patients' postoperative vision and surgical satisfaction, and can only be treated by laser incision of the posterior capsule. Although drug eluting coating modification have been proved to inhibit PCO effectively, the complicated coating methods and the potential toxicity of the antiproliferative drugs hinders its actual application. In this study, an indocyanine green (ICG) loaded polydopamine (PDA) coating modified IOL (IP-IOL) was designed to prevented PCO. In vitro and in vivo studies have shown that IP-IOL can effectively eliminate lens epithelial cells and significantly reduce the degree of PCO. At the same time, it still has good imaging quality and optical properties. Furthermore, both the near-infrared irradiation and ICG loaded PDA coating modified IOLs have proved to possess high biological safety to eyes. Thus, with easy preparation and safer near-infrared irradiated photothermal/photodynamic synchronous properties, such ICG loaded PDA coating provides an effective yet easier and safer PCO prevention after IOL implantation.

Repeatability of Pentacam-derived intraocular lens decentration measurements and the level of agreement with OPD-Scan III: A prospective observational case series

PURPOSE

This study aimed to assess the repeatability of intraocular lens (IOL) decentration measurements obtained through Pentacam, based on corneal topographic axis (CTA) and pupillary axis (PA), and to evaluate the level of agreement between Pentacam and OPD-Scan III devices in measuring IOL decentration.

METHODS

In this prospective observational case series, three measurements were performed with Pentacam to evaluate the repeatability of the measurements. The analysis included the calculation of the mean and standard deviations (SD), conducting a repeated measures analysis of variance (rANOVA), and determining an intraclass correlation coefficient (ICC) to assess the repeatability of the measurements. Moreover, Bland-Altman analysis was employed to assess the agreement between Pentacam and OPD-Scan III devices in measuring IOL decentration. IOL decentration measurements were obtained with respect to both CTA and PA.

RESULTS

A total of 40 eyes from 40 patients were analyzed. The rANOVA revealed no significant difference among three consecutive measurements of IOL decentration obtained with Pentacam. The mean SD of all parameters ranged from 0.04 mm to 0.07 mm. With CTA as the reference axis, the ICC values for Pentacam measurements of IOL decentration were 0.82 mm for the X-axis, 0.76 mm for the Y-axis, and 0.82 mm for spatial distance. When using PA as the reference axis, the corresponding ICC values were 0.87, 0.89, and 0.77, respectively. The 95% limits of agreement for all IOL decentration measurements were wide when comparing Pentacam and OPD-Scan III.

CONCLUSIONS

Pentacam demonstrated high repeatability in measuring IOL decentration with respect to both CTA and PA. However, due to poor agreement between Pentacam and OPD-Scan III measurements, caution should be exercised when using data interchangeably between the two devices.

The effect of corneal power on the accuracy of 14 IOL power formulas

BACKGROUND

This study evaluates the impact of corneal power on the accuracy of 14 newer intraocular lens (IOL) calculation formulas in cataract surgery. The aim is to assess how these formulas perform across different corneal curvature ranges, thereby guiding more precise IOL selection.

METHODS

In this retrospective case series, 336 eyes from 336 patients who underwent cataract surgery were studied. The cohort was divided into three groups according to preoperative corneal power. Key metrics analyzed included mean prediction error (PE), standard deviation of PE (SD), mean absolute prediction error (MAE), median absolute error (MedAE), and the percentage of eyes with PE within ± 0.25 D, 0.50 D, ± 0.75 D, ± 1.00 D and ± 2.00 D.

RESULTS

In the flat K group (Km < 43 D), VRF-G, Emmetropia Verifying Optical Version 2.0 (EVO2.0), Kane, and Hoffer QST demonstrated lower SDs (± 0.373D, ± 0.379D, ± 0.380D, ± 0.418D, respectively) compared to the VRF formula (all P < 0.05). EVO2.0 and K6 showed significantly different SDs compared to Barrett Universal II (BUII) (all P < 0.02). In the medium K group (43 D ≤ Km < 46 D), VRF-G, BUII, Karmona, K6, EVO2.0, Kane, and Pearl-DGS recorded lower MAEs (0.307D to 0.320D) than Olsen (OLCR) and Castrop (all P < 0.03), with RBF3.0 having the second lowest MAE (0.309D), significantly lower than VRF and Olsen (OLCR) (all P < 0.05). In the steep K group (Km ≥ 46D), RBF3.0, K6, and Kane achieved significantly lower MAEs (0.279D, 0.290D, 0.291D, respectively) than Castrop (all P < 0.001).

CONCLUSIONS

The study highlights the varying accuracy of newer IOL formulas based on corneal power. VRF-G, EVO2.0, Kane, K6, and Hoffer QST are highly accurate for flat corneas, while VRF-G, RBF3.0, BUII, Karmona, K6, EVO2.0, Kane, and Pearl-DGS are recommended for medium K corneas. In steep corneas, RBF3.0, K6, and Kane show superior performance.

Comparison of visual performance between diffractive bifocal and diffractive trifocal intraocular lenses

To evaluate the visual performance of a diffractive bifocal intraocular lens (IOL) with + 4.0 D near addition (ZMB00) and a diffractive trifocal IOL with + 2.17 D and + 3.25 D near addition (AcrySof IQ PanOptix TFNT00), we investigated the 10-week postoperative parameters after cataract surgery in which ZMB00 or TFNT00 lenses were implanted bilaterally from 2011 to 2020 (with a 3-month interval between implantation of the right and left lenses). The study included 1448 eyes of 724 patients. The diffractive bifocal group comprised 1326 eyes of 663 patients (aged 67.0 ± 7.8 years; females/males, 518/145), and the diffractive trifocal group comprised 122 eyes of 61 patients (aged 66.6 ± 7.3 years; females/males, 35/26). A linear mixed-effects model using data for both eyes, with strict adjustments for sex, age, subjective refraction spherical equivalent, subjective refraction cylinder, corneal astigmatism, axial length, corneal higher-order aberrations, and pupil diameter, ensured statistical validity. Uncorrected near visual acuity and higher-order aberrations (ocular/internal, scaled to a pupil size of 4 mm) (Wavefront_4mm_postoperative_Ocular/Internal_Spherical) were significantly better in the bifocal group (p < 0.00068, Wald test). Uncorrected intermediate visual acuity, contrast sensitivity (6.3/4.0/2.5/1.6/1.0/0.7 degrees), and contrast sensitivity with glare (4.0/1.6/1.0/0.7 degrees) were significantly better in the trifocal group (p < 0.00068, Wald test).

A technique for iris disk positioning on a custom ocular prosthesis

Various techniques have been described for the rehabilitation of ocular defects with ocular prostheses to restore lost anatomical structures and correct cosmetic defects. This article describes a technique for optimizing the position of an iris disk over a custom-made ocular prosthesis, by using eyeglasses with customized graph paper pattern lenses. It presents a simplified method that will be useful for people with ocular defects in remote and distant service areas with limited resources.

[Intraoperative opacification of a scleral-fixated Carlevale (Soleko®) intraocular lens]

Thermal shock can cause intraoperative opacification of a Carlevale (Soleko®) implant. This is a rare phenomenon which resolves spontaneously. It is crucial to recognise this phenomenon in order to avoid unnecessary and potentially harmful explantation decisions for the patient.

Prediction of IOL decentration, tilt and axial position using anterior segment OCT data

BACKGROUND

Intraocular lenses (IOLs) require proper positioning in the eye to provide good imaging performance. This is especially important for premium IOLs. The purpose of this study was to develop prediction models for estimating IOL decentration, tilt and the axial IOL equator position (IOLEQ) based on preoperative biometric and tomographic measures.

METHODS

Based on a dataset (N = 250) containing preoperative IOLMaster 700 and pre-/postoperative Casia2 measurements from a cataractous population, we implemented shallow feedforward neural networks and multilinear regression models to predict the IOL decentration, tilt and IOLEQ from the preoperative biometric and tomography measures. After identifying the relevant predictors using a stepwise linear regression approach and training of the models (150 training and 50 validation data points), the performance was evaluated using an N = 50 subset of test data.

RESULTS

In general, all models performed well. Prediction of IOL decentration shows the lowest performance, whereas prediction of IOL tilt and especially IOLEQ showed superior performance. According to the 95% confidence intervals, decentration/tilt/IOLEQ could be predicted within 0.3 mm/1.5°/0.3 mm. The neural network performed slightly better compared to the regression, but without significance for decentration and tilt.

CONCLUSION

Neural network or linear regression-based prediction models for IOL decentration, tilt and axial lens position could be used for modern IOL power calculation schemes dealing with 'real' IOL positions and for indications for premium lenses, for which misplacement is known to induce photic effects and image distortion.

Automatic data-driven design and 3D printing of custom ocular prostheses

Millions of people require custom ocular prostheses due to eye loss or congenital defects. The current fully manual manufacturing processes used by highly skilled ocularists are time-consuming with varying quality. Additive manufacturing technology has the potential to simplify the manufacture of ocular prosthetics, but existing approaches just replace to various degrees craftsmanship by manual digital design and still require substantial expertise and time. Here we present an automatic digital end-to-end process for producing custom ocular prostheses that uses image data from an anterior segment optical coherence tomography device and considers both shape and appearance. Our approach uses a statistical shape model to predict, based on incomplete surface information of the eye socket, a best fitting prosthesis shape. We use a colour characterized image of the healthy fellow eye to determine and procedurally generate the prosthesis's appearance that matches the fellow eye. The prosthesis is manufactured using a multi-material full-colour 3D printer and postprocessed to satisfy regulatory compliance. We demonstrate the effectiveness of our approach by presenting results for 10 clinic patients who received a 3D printed prosthesis. Compared to a current manual process, our approach requires five times less labour of the ocularist and produces reproducible output.

Visual outcomes and patient satisfaction after bilateral implantation of an enhanced monofocal intraocular lens: a single-masked prospective randomized study

PURPOSE

To evaluate and compare the visual outcomes of an enhanced monofocal intraocular lens (IOL) with two different monofocal IOLs.

SETTING

Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.

DESIGN

Prospective, single-center, single-masked, randomized controlled clinical study.

METHODS

The study included patients undergoing phacoemulsification and IOL implantation. Patients were consecutively randomized by block randomization and assigned in a 1:1:1 allocation ratio to three study arms to bilaterally receive Tecnis Eyhance™ (model ICB00) or Tecnis® monofocal 1-piece (model PCB00) or Clareon® monofocal (model CNA0T0), respectively. Monocular and binocular (both corrected and uncorrected) visual acuities for far, intermediate and near were registered and compared among groups at 3 months. To track changes in patient quality of life, the Catquest-9SF questionnaire was administered to each patient before and after cataract extraction.

RESULTS

Ninety patients (30 for each group) were enrolled. At 3 months follow-up, statistically significant differences for intermediate visual acuities were found between the three groups. Nonstatistically significant differences were observed for distance visual acuities and the changes in Catquest-9SF scores.

CONCLUSION

Tecnis Eyhance™ provided better results in intermediate visual outcomes without adverse effects on patients' quality of life.

Accuracy of intraocular lens formulas in combined phacovitrectomy

PURPOSE

To assess the refractive accuracy of eight intraocular lens (IOL) formulas in eyes that underwent combined phacovitrectomy.

METHODS

A retrospective chart review of 59 eyes that underwent uncomplicated phacovitrectomy between 2017 and 2020 at the Johns Hopkins Wilmer Eye Institute. Inclusion criteria were postoperative best corrected visual acuity of 20/40 or better within 6 months of surgery and IOL implantation in the capsular bag. The Barrett Universal II (BUII), Emmetropia Verifying Optical (EVOv2.0), Hill-Radial Basis Function (Hill-RBFv3.0), Hoffer Q, Holladay I, Kane, Ladas Super Formula (LSF), and SRK/T formulas were compared for accuracy in predicting postoperative spherical equivalents (SE) using Wilcoxon rank sum tests. Pearson's correlation coefficients were used to assess correlations between biometric parameters and errors for all formulas.

RESULTS

Prediction errors of SE ranged from - 1.69 to 1.43 diopters (D), mean absolute errors (MAE) ranged from 0.39 to 0.47 D, and median absolute errors (MedAE) ranged from 0.23 to 0.37 D among all formulas. The BUII had the lowest mean error (- 0.043), MAE (0.39) and MedAE (0.23). The BUII also had the highest percentage of eyes with predicted error within ± 0.25 D (51%) and ± 0.50 D (83%). Based on MedAE however, no pairwise comparisons resulted in statistically significant differences. Axial length (AL) was positively correlated with the error from the Hoffer Q and Holladay I formulas (correlation coefficients = 0.34, 0.30, p values < 0.01, 0.02 respectively).

CONCLUSION

While all eight IOL formulas had comparable accuracy in predicting refractive outcomes in eyes undergoing combined phacovitrectomy, the BUII and Kane formulas had a tendency to greater accuracy.

Improving the accuracy of the SRK/T formula in Chinese with implanting less than 10 D IOL calculated by the SRK/T formula: the SRK/T-Li formula

PURPOSE

To explore the accuracy of the improved SRK/T-Li formula in eyes following implantation of intraocular lens (IOL) of less than 10 D as calculated by using the SRK/T formula in Chinese.

METHODS

A total of 489 eyes from 489 patients with cataracts were included in this study. These patients were divided into a training set (271 patients) and a testing set (218 patients). The IOL power calculated by using SRK/T was less than 10 D. We evaluated the accuracy of the modified SRK/T-Li formula (P = PSRK/T × 0.8 + 2 (P = implanted IOL power; PSRK/T = IOL power calculated by SRK/T)). We evaluated the mean absolute error (MAE), percentage of prediction error (PE) within ± 0.25, ± 0.50, and ± 1.00 D, and the percentage of postoperative hyperopia.

RESULTS

The MAE values in order of lowest to highest were as follows: 0.412 D (SRK/T-Li), 0.414 D (Barrett Universal II, (BUII)), 0.814 D (SRK/T), and 1.039 D (Holladay 1). The percentage of PE within ± 0.25 D, ± 0.50 D, and ± 1.00 D was 38.99%, 69.27% and 92.66% (BUII), 40.83%, 69.27% and 94.04% (SRK/T-Li), 20.64%, 41.28% and 71.56% (SRK/T), and 7.34%, 16.51% and 53.21% (Holladay 1), respectively. SRK/T-Li had the smallest postoperative hyperopic shift.

CONCLUSIONS

For Chinese patients with an IOL power of less than 10 D as calculated by using the SRK/T, the SRK/T-Li has good accuracy and is the best choice to reduce postoperative hyperopic shift.

Factors predicting the visual outcome of intracorneal ring segment for keratoconus

OBJECTIVES

To identify predictive factors and to construct predictive models using epidemiological and clinical preoperative factors for the visual acuity change after intracorneal ring segment (ICRS) implantation in patients with keratoconus.

METHODS

The medical records of 287 keratoconic eyes of 230 patients implanted with ICRS at Chula Refractive Surgery Center of a tertiary university hospital (Bangkok, Thailand) between January 2012 and March 2022 were retrospectively reviewed for epidemiological and clinical preoperative variables, including those derived from Scheimpflug tomography. After randomly excluding one eye for each bilateral case, the remaining 230 eyes were randomized into two groups: a training group (184 eyes) and a validation group (46 eyes). In the training group, the correlation between the interesting variables and postoperative uncorrected and corrected distance visual acuity change (ΔUDVA and ΔCDVA; logMAR scale) at 6 months was explored, and then the multiple linear regression analysis was used to develop the predictive models. The obtained models were tested using the validation group.

RESULTS

There were 5 and 14 preoperative variables that statistically correlated with ΔUDVA and ΔCDVA respectively. Only the preoperative corrected distance visual acuity (CDVAp) strongly correlated with ΔCDVA (Beta = -0.746). Using multiple regression, the preoperative uncorrected distance visual acuity (UDVAp) and front mean keratometry were selected in the proposed model for ΔUDVA (adjusted R2 = 38.8%), while the CDVAp and index of surface variance (ISV) were selected in the model [Formula: see text] (adjusted R2 = 48.9%). The ΔUDVA and ΔCDVA models were correct in 47.83% and 63.4% of the validation group within 0.20 logMAR, respectively.

CONCLUSIONS

Potential predictive factors and models for ICRS-induced changes in visual acuity are proposed as adjunctive tools for clinicians. Such tools could be used for case selection and during counselling before ICRS implantation to maximize surgical outcomes.

CONTRIBUTION FACTORS OF EFFECTIVE LENS POSITION, TILT, AND DECENTRATION DURING FLANGED SCLERAL FIXATION OF INTRAOCULAR LENS: A Model Eye Study

PURPOSE

The authors aimed to elucidate the factors related to effective lens position, tilt, and decentration of scleral fixed intraocular lenses (IOLs) with a flanged haptic technique in an artificial eye model using anterior segment optical coherence tomography.

METHODS

Two bent 27-gauge needles were passed through a 1.0- or 2.0-mm scleral tunnel, 2.0 mm posterior to the limbus and 180° apart. Both haptics of a three-piece IOL were docked with guide needles and externalized. Factors related to the IOL position were analyzed using anterior segment optical coherence tomography and a stereomicroscope.

RESULTS

The 1.0-mm scleral tunnel induced a significantly longer effective lens position than the 2.0-mm tunnel and suture fixation ( P < 0.05 and P < 0.01, respectively). Discrepancy in scleral tunnel length induced higher decentration of the optic to the opposite side of the haptic-embedded shorter tunnel and tilt perpendicular to the fixed axis than that in the scleral tunnel of the same length ( P < 0.001 and P < 0.05, respectively). If the scleral fixation points of both haptics are not exactly 180° apart, the IOL may become decentered and tilted ( P < 0.01 and P < 0.05, respectively).

CONCLUSION

In the flanged haptic technique, the length, balance, and position of both scleral tunnels determine IOL effective lens position, tilt, and decentration.

A mini-invasive surgical technique for Carlevale IOL implantation: case series study and description of concomitant surgery

PURPOSE

To examine the feasibility and outcomes of a modified technique for the implantation of scleral fixated Carlevale intraocular lens (IOL) (I71 FIL SSF. Soleko IOL Division, Pontecorvo, Italy), and to analyze the occurrence of adverse events.

METHODS

This is a retrospective observational study conducted revising patients charts from 2018 to 2023. Thirty-five eyes of 33 patients were included. Patients requiring IOL explantation had either IOL dislocation or opacification. The implantation of the Carlevale IOL was performed with the subconjunctival positioning of the anchors without any scleral flap. All maneuvers were performed transconjunctivally. The anatomical outcomes considered were IOL positioning, and the absence of postoperative complications. The functional outcomes analyzed were best correctedvisual acuity (BCVA) and refraction.

RESULTS

In all the cases, the IOL was well positioned and centered postoperatively. No cases of conjunctival erosion were recorded. The best corrected visual acuity (BCVA) was 0.9±0.6 logMar (mean±standard deviation) preoperatively and 0.5±0.5 logMar (mean±standard deviation) postoperatively. The mean preoperative spherical equivalent was +6.8±7.7 dioptres, while postoperatively it was -1.1±1.6 dioptres. The most frequent procedure associated to secondary IOL implantation was posterior vitrectomy (25 eyes, 71.4%), which was performed with 25-gauge transconjunctival cannulas in the ciliary sulcus. The follow-up period was 24.5±16.9 months (mean±standard deviation).

CONCLUSION

The described mini-invasive technique for Carlevale IOL implantation is safe and effective. It can be recommended either as a stand-alone operation or associated to concurrent surgical procedures.

Rehabilitation of pediatric retinoblastoma patients with ocular prostheses and their subsequent modifications: A 15-year retrospective study

PURPOSE

Enucleation is a common treatment modality performed for pediatric retinoblastoma patients, and the resultant defects are reconstructed using an ocular prosthesis. The prostheses are modified or replaced periodically, as the child develops due to orbital growth and patient-error. The purpose of this report is to evaluate the replacement frequency of prostheses in the pediatric oncologic population.

METHODS

A retrospective review was completed by the two senior research investigators, of patients that had ocular prostheses fabricated following enucleation of their retinoblastoma from 2005 to 2019 (n = 90). Data collected from the medical records of the patient included the pathology, date of surgery, date of prosthesis delivery, and the replacement schedule of the ocular prosthesis.

RESULTS

During the 15-year study period, 78 enucleated observations (ocular prosthesis fabricated) were included for analysis. The median age of the patients at the time of delivery of their first ocular prosthesis was calculated to be 2.6 years (range 0.3-18 years). The median time to the first modification of the prosthesis was calculated to be 6 months. The time to modification of the ocular prosthesis was further stratified by age.

CONCLUSION

Pediatric patients require modification of their ocular prostheses throughout their growth and development period. Ocular prostheses are reliable prostheses with predictable outcomes. This data is helpful to set an expectation among the patient, parent, and provider.

S-FIX: A sutured way of doing sutureless SFIOL surgeries beyond X-NIT!

BACKGROUND

The video describes a technique in scleral fixation intraocular lens (SFIOL) surgery that is very simple and easily reproducible by any novice surgeon.

PURPOSE

This technique may serve as a simple option for tucking the haptic of a multipiece IOL into the sclera without the need for the scleral flap, scleral pocket, forceps, glue, or flange.

SYNOPSIS

The two most crucial steps in scleral fixation intraocular lens (SFIOL) surgery are 1) the exteriorization of the haptic, and 2) the fixation of the exteriorized haptic. The first half of the video describes the steps of our previously published technique of extraocular needle-guided haptic insertion technique (X-NIT), which simplifies the exteriorization step by shifting the intraocular hand-shake maneuver to an extraocular site. The second half describes a novel suture-guided haptic fixation (S-FIX) device, which simplifies the fixation step. S-FIX has three components: 1) a 380-micron spatulated needle, 2) a 5-o nylon suture thread, and 3) a polyimide tube. There are four steps involved in S-FIX: 1) docking of the exteriorized haptic into the polyimide tube, 2) pushing the docked polyimide tube into the eye, 3) suture bite starting from the point of sclerotomy, and 4) pulling the suture thread. As the suture thread is being pulled, the haptic along with the polyimide tube comes out and the haptic gets fixed into the narrow suture track.

HIGHLIGHTS

The technique enhances the overall safety in SFIOL surgeries by avoiding haptic slips during exteriorization and fixation steps. Most anterior segment and novice surgeons do not perform SFIOL surgeries due to fear of fall of IOL.

VIDEO LINK

https://youtu.be/ZoJBiw2SNaU.

Application of the suture needle retrograde threading method in scleral fixation of intraocular lenses

BACKGROUND

Here we described a new threading technique for the universal fixation of any posterior chamber intraocular lens (IOL).

METHODS

Twenty-seven eyes of 27 patients whose surgery done by Surgeon A with the needle-guided method or the suture needle retrograde threading (SNRT) method for intrascleral IOL fixation were enrolled in the first group. Thirty-four eyes of 34 patients whose surgery done by Surgeon A, Surgeon B or Surgeon C with the SNRT method for intrascleral IOL fixation were grouped into three sub-groups by surgeon. Information regarding age, sex, best-available visual acuity (BCVA), intraocular pressure (IOP), past ophthalmological history, threading time (from puncturing to externalizing suture) and complications during and after the surgery were gathered.

RESULTS

The analysis showed that the threading time was less in the SNRT group than needle-guided group by Surgeon A. There was one eye with suture needle slipping from the guide needle when guiding out of the eye. The threading procedure was completed one time without suture ruptures or loop slippage in the SNRT group operated by Surgeon A. And using the SNRT method, Surgeon A, Surgeon B, and Surgeon C did not show any significant difference in threading time. No complications (e.g., vitreous hemorrhage, hyphemia, retinal detachment, suprachoroidal hemorrhage, or hypotony) were observed during surgery or postoperatively in all cases. No leakage occurred at the site of the puncture after the operation.

CONCLUSIONS

The described technique appears to be a safe, simple, easy-to-learn, and universal surgical method, which is suitable for various types of IOLs.

Microbiological evaluation of conjunctival anopthalmic flora after using digital 3D-printed ocular prosthesis compared to conventional one: a randomized clinical trial

BACKGROUND

This study aims to assess the influence of using 3D-printed acrylic resin versus conventional Poly-methyl methacrylate (PMMA) for fabricating ocular prostheses on the biofilm and microbial flora of anophthalmic socket.

METHODS

A randomized controlled trial was designed as a parallel group study. Participants were allocated randomly into two groups: the control group, which received conventionally fabricated ocular prostheses (CG, n = 11), and the test group, which received digitally 3D-printed ocular prostheses (DG, n = 11). Microbiological analysis was conducted before prosthesis insertion and three months after using the ocular prosthesis. Swab samples were inoculated on blood agar, MacConkey's agar, and Sabouraud's dextrose agar (SDA) for isolating Gram-positive, Gram-negative, and fungal organisms, respectively. Subsequently, the plates were incubated at 37 degrees Celsius for 48 h. Additionally, a validated questionnaire was used for subjective clinical evaluation, including parameters such as comfort level, socket discharge, lacrimation, and frequency of lubrication for each ocular prosthesis patient in both groups.

RESULTS

Test group (DG, n = 11) exhibited a positive, though statistically insignificant, difference (p > 0.001) in microbial growth when compared to the control group (CG, n = 11). A statistically significant difference was observed in comfort levels between the two groups, with more comfort level within group II (test group) patients. While parameters such as discharge amount, discharge location, lacrimation and lubrication frequency displayed statistically insignificant differences between the two groups, all parameters showed improved results after three months of prosthesis use.

CONCLUSIONS

The choice of ocular prosthesis fabrication technique did not yield a statistically significant difference in anophthalmic flora. However, the 3D-printed acrylic resin, as an artificial eye material, displayed potential advantages in reducing the colonization of opportunistic pathogens. All subjective clinical evaluation parameters exhibited enhanced outcomes after three months of prosthesis use, emphasizing the need for an adaptation period during which patients complains are alleviated. In comparison with PMMA, 3D-printed acrylic resin showcased a certain degree of anti-colonization ability against pathogenic bacteria, along with a significant level of patient comfort, suggesting its potential as a promising material for ocular prostheses.

TRIAL REGISTRATION

This parallel double-blinded RCT has been registered at ClinicalTrials.gov with identification number: NCT05584865, 18/10/2022.

Efficacy and safety of intracorneal allogenic ring segment implantation in keratoconus: 1-year results

BACKGROUND

To evaluate the safety and efficacy of corneal allogenic intrastromal ring segments in the management of keratoconus patients.

METHODS

The retrospective, nonrandomized, interventional case series consisted of 65 keratoconic eyes of 49 consecutive patients who had ring segment-shaped corneal allografts (KeraNatural®) implanted in intrastromal tunnels created using a femtosecond laser. The main outcome measures were uncorrected visual acuity (UCVA), corrected distant visual acuity (CDVA), refraction, keratometry, and pachymetry. Computed tomography scans of the corneal surfaces were also performed preoperatively as well as 3, 6 and 12 months postoperatively.

RESULTS

Mean age was 29.5 ± 7.3 years (median 29, range: 20-52 years). The mean UCVA improved from 0.91 ± 0.50 logMAR preoperatively to 0.40 ± 0.24 logMAR postoperatively at 6 month follow-up (p < 0.01) and the mean CDVA improved from 0.87 ± 0.20 logMAR preoperatively to 0.27 ± 0.06 logMAR postoperatively (p < 0.01). The mean spherical equivalent improved from -8.82 ± 4.57 to -3.45 ± 4.81D (p < 0.01). Average Keratometry decreased from 49.23 ± 5.22 preoperatively to 45.63 ± 4.89 D postoperatively (p < 0.01). Mean anterior and posterior maximum elevation were also decreased significantly (p < 0.01). In one patient, dislocation of the graft towards the tunnel incision site and dehiscense at the tunnel entrance were observed in the first week of the operation. Yellow-white deposits were observed in the segment tunnels in five cases after 6 months.

CONCLUSION

This study demonstrated that implantation of corneal allograft ring segments is a viable alternative treatment for keratoconus with safety and good visual results.

Evaluation of continuous curvilinear capsulorhexis based on a neural-network

PURPOSE

Continuous curvilinear capsulorhexis (CCC), as a prerequisite for successful cataract surgery, is one of the most important and difficult steps in phacoemulsification. In clinical practice, the size and circularity of the capsular tear and eccentricity with the lens are often employed as indicators to evaluate the effect of CCC.

METHODS

We present a neural network-based model to improve the efficiency and accuracy of evaluation for capsulorhexis results. The capsulorhexis results evaluation model consists of the detection network based on U-Net and the nonlinear fitter built from fully connected layers. The detection network is responsible for detecting the positions of the round capsular tear and lens margin, and the nonlinear fitter is utilized to fit the outputs of the detection network and to compute the capsulorhexis results evaluation indicators. We evaluate the proposed model on an artificial eye phantom and compare its performance with the medical evaluation method.

RESULTS

The experimental results show that the average detection error of the proposed evaluation model is within 0.04 mm. Compared with the medical method (the average detection error is 0.28 mm), the detection accuracy of the proposed evaluation model is more accurate and stable.

CONCLUSION

We propose a neural network-based capsulorhexis results evaluation model to improve the accuracy of evaluation for capsulorhexis results. The results of the evaluation experiments show that the proposed results evaluation model evaluates of the effect of capsulorhexis better than the medical evaluation method.

Two-way adjustable double-knots intrascleral fixation and single sclerotomy looping technique: a novel minimal invasive adjustable intraocular lens fixation technique

BACKGROUND

IOL fixation without capsular support presents challenges for surgeons. Although innovative techniques were developed to address subluxated IOLs, adjustable IOL fixation methods are seldom reported. We introduce a novel two-way adjustable double-knots intrascleral fixation combined with single sclerotomy looping technique for fixing intraocular lenses (IOL) or IOL-capsular bags.

METHODS

A bent 30-gauge needle threaded with 8 - 0 polypropylene was introduced into the eye. A gripping forceps assisted the haptic looping. Two overhand knots were made with 8 - 0 polypropylene thread. The knots were incarcerated into a scleral tunnel made by a 30-gauge needle, with two ends of the thread left at each side of the tunnel. The IOL was adjusted to the premium position with adequate tension by pulling either end of the threads. The study included 19 eyes with aphakia, subluxated IOL-capsular bags, or subluxated crystalline lenses. The mean followed up period was 18.9 ± 7.1 months with evaluations of uncorrected visual acuity (UCVA), intraocular pressure, slit-lamp examination, and swept-source optical coherence tomography of the anterior segment.

RESULTS

UCVA increased from 1.28 ± 0.74 at baseline to 0.44 ± 0.51 (logMAR) at final visit (P < 0.001). All IOLs were fixed well-centered. The mean IOL tilt was 3.5°±1.1°. Postoperative complications included transient IOP elevation (15.8%), hypotony (10.5%), and cystoid edema (5.3%) which resolved within 4 weeks.

CONCLUSIONS

We presented a novel adjustable technique for IOL fixation, which stabilize IOLs by using an intrascleral double-knots structure. This technique minimized surgical manipulations by using a single sclerotomy looping technique without large conjunctival dissection and scleral flap creation. The technique offers a reliable and optimal IOL positioning and improved visual outcomes in patients undergoing scleral fixed IOL implantation.

Custom-made ocular prosthesis: solitary method to improve facial aesthetics (a case report)

Loss of facial structures has a physical, social and psychological impact on affected individuals. Ocular trauma caused by assaults, falls, road traffic accidents, and household or work-related accidents may necessitate eye enucleation. Enucleation is also performed to treat severe infections of the eye, intraocular tumours and painful blind eyes. This procedure can result in post-enucleation socket syndrome with facial disfigurement and severely compromising facial aesthetics. Our patient complained of facial disfigurement because of a defect associated with the right eye. History and clinical features were suggestive of post-enucleation socket syndrome. The defect was rehabilitated with an ocular prosthesis. The rehabilitation procedure provided satisfactory results and a happy patient with good aesthetics. Maxillofacial prosthesis can restore and rehabilitate lost facial structures with artificial substitutes and helps in regaining patient´s natural appearance, the health of adjoining structures and subsequently, provide physical, social and psychological well-being.

Late-onset distal-apical intracorneal ring-segments keratopathy: an analysis of a large sample in a multicenter study

PURPOSE

To review the prevalence and describe the characteristics, of cases with late-onset intracorneal ring segments (ICRS) keratopathy in a multicenter study.

METHODS

A retrospective multicentric case-series study was performed in a specialized keratoconus service, from Buenos Aires, Argentina. An electronic clinical chart from patients with ICRS keratopathy between January 1999 and January 2019 was reviewed. We included cases with late-onset distal-apical ICRS keratopathy, which was defined as a persistent corneal lesion developed 12 months or later after implantation, located over, around, or closer to the ICRS. All the surgeries were performed by a manual corneal tunnel creation technique. Samples were taken to rule out infectious etiology.

RESULTS

From 5217 eyes that underwent ICRS implantation, 13 cases (0.24%) were detected. The keratopathy onset was 72 ± 42.98 months (29-133) after ICRS implantation. Cultures were negative in all cases. An ICRS exchange was made for five cases in stage I and four in stage II. Four cases presented with partial ICRS extrusion in stage III. ICRS exchange was possible in two of them and a penetration keratoplasty was necessary for the rest. All cases remained stable 1 year after surgical procedures.

CONCLUSIONS

A late-onset distal-apical ICRS keratopathy was detected with low prevalence (0.24%) in a large sample. It was classified into three stages according to its severity. Different treatments were selected for each stage, obtaining stable results 1 year after treatment.

Management of external ocular prosthesis by ocularists: results of an online survey conducted in Brazil and Spain

PURPOSE

To analyse the ocularist's perspective on the management of the anophthalmic socket and external ocular prosthesis (EOP).

METHODS

Ocularists from two countries were invited to participate in an online questionnaire. Data were collected on demographics, anophthalmic socket and EOP management (manufacturing, use, cleaning), complications, follow-up visits and multidisciplinary care. The frequency and proportions of the responses were statistically analysed.

RESULTS

The questionnaire was addressed to 20 Brazilian and 17 Spanish ocularists, obtaining a response rate of 65% and 64.7%, respectively. 62.5% of respondents were men. The most common cause of anophthalmia in Brazil (69.2%) and Spain (36.4%) is an eye disease (chi square: p = 0.188). Polymethylmethacrylate (PMMA) is the most commonly used material in EOP manufacture (chi square: p = 0.448), and 70.8% reported using customized EOPs (chi square: p = 0.069). Deposits are frequently observed in both countries (chi square: p = 0.157). Changing the prosthesis is recommended after 5 to 10 years by Brazilian ocularists, and after less than 5 years of use by Spanish ocularists (81.8%) (chi square: p = 0.041). Annual follow-up is recommended by Spanish ocularists (45.5%), while semestral (38.5%) and case-dependent (38.5%) follow-up is recommended by Brazilian ocularists (chi square: p = 0.267). Daily cleaning is advocated by 61.5% of Brazilian ocularists and once a month by 45.5% of Spanish ocularists (chi square: p = 0.098), with 75% of ocularists from both countries not recommending EOP removal at night (Fisher´s exact test: p = 0.166). Good communication between ocularists and ophthalmologists was reported by 87.5% of our responders (chi square: p = 0.642).

CONCLUSION

Although there are no unified protocols on the management of EOPs, Brazilian and Spanish ocularists follow similar guidelines. Differences between countries were the patients´ referral and the prosthesis´ useful life.

Stainability of Acrylic Intraocular Lens With Brilliant Blue G: An In Vitro Study

PURPOSE

To evaluate the stainability of several acrylic intraocular lens (IOLs) with Brilliant Blue G (BBG) in vitro.

DESIGN

Clinically relevant, laboratory, experimental study.

METHODS

LS313MF15 as a hydrophilic acrylic IOL and X-70, W60R, CP2.2R, YP2.2R, XC1, and XY1 as hydrophobic acrylic IOLs were included in this study. Prepared acrylic IOLs were evaluated for staining via immersion for different periods in BBG solution with adjusted concentrations. In cases where IOLs were stained blue, the sustained release of BBG and IOL cross-sectional images were evaluated, as well as changes in the optical properties of the IOLs via spectrophotometry.

RESULTS

All acrylic IOLs were stained with BBG in a BBG concentration- and staining time-dependent manner, with almost no sustained release of BBG observed. Lenses with a higher water content exhibited more pronounced staining, and BBG penetrated into the IOLs. A decrease in light transmittance with a peak wavelength of 610 to 620 nm was observed in blue-stained IOLs. LS313MF15 was markedly blue stained even with a short period of staining.

CONCLUSIONS

Any acrylic IOL can be stained with BBG, but hydrophilic IOLs are particularly susceptible to blue staining. Precautions should be taken in surgeries requiring the use of BBG staining, and efforts should be made to ensure that BBG components are sufficiently washed out intraoperatively.

Dead bag syndrome-in the capsular bag subluxated intraocular lens centration and refixation: A new technique

We describe a technique of scleral IOL fixation and optic centration of in the capsular bag subluxated IOL in a patient of "dead bag syndrome." A 29-year-old male diagnosed case of thalassemia presented with painless progressive diminution of vision in the left eye following uncomplicated sequential phacoemulsification in both eyes 15 years back. The right eye revealed completely centered IOL with significant amount of anterior capsular opacification (ACO), while the left eye revealed inferior subluxation of the IOL within capsular bag. The capsular bag was dilated, diaphanous with clear anterior and posterior capsule without any evidence of capsular fibrosis or opacification. Thus, a diagnosis of "dead bag syndrome" was made. The haptics were sutured to sclera (Hoffman's pockets) using two loops of 9-0 polypropylene, passed anterior and posterior to IOL haptics within the capsular bag. Postoperatively, the patient had a vision of 20/40 with a centered intraocular lens.

EyeCee One preloaded intraocular lens: are patients with glaucoma more at risk?

OBJECTIVE

The Medicine and Healthcare products Regulatory Agency reported links of raised intraocular pressure (IOP) with recently implanted EyeCee One intraocular lens (IOL). This work investigates if glaucomatous eyes were more susceptible to these postoperative IOP rises and if they required more intensive management.

METHODS

Retrospective observational study of all phacoemulsification surgery with implanted EyeCee One IOL, performed between 1 October 2022 and 26 January 2023 inclusive.

ANALYSIS

A significant IOP elevation was defined as an IOP rise of 10 mm Hg or more from preoperative to maximal postoperative IOP reading. The management of all patients who had a significant IOP elevation was reviewed. Glaucoma/ocular hypertension cases were identified and analysed against non-glaucomatous eyes and statistical analysis performed.

RESULTS

112 glaucoma and 671 non-glaucoma cases identified; 19.6% of the glaucoma cohort had a significant postoperative IOP rise compared with 8.9% of patients without glaucoma (OR 2.49 (95% CI 1.45 to 4.20) p=0.0014). In the glaucoma cohort, 12.5% had an increase in the number of topical IOP-lowering agents (mean increase 1.65±1.58), 6.3% required systemic treatment and 2.7% surgical intervention. In the non-glaucoma group, 3.3% required topical treatment (mean number of agents 0.88±1.34), 0.8% required systemic treatment and 0.2% surgical intervention.

CONCLUSION

This study shows that during the time frame in question, patients with glaucoma or ocular hypertension who had an EyeCee One IOL were almost two and a half times more likely to have a postoperative rise of 10 mm Hg or more in IOP following routine cataract surgery, requiring more aggressive management.

The Ganesh-Grewal cystitome maker - A step in standardizing cataract surgery

A well-centered, adequately sized continuous curvilinear capsulorhexis (CCC) is a prerequisite for successful cataract surgery. A perfect capsulorhexis ensures safe and effective performance of various steps of surgery as well as a correctly positioned intraocular lens (IOL) with optimal rotational stability. Ganesh and Grewal (GG) cystitome maker is a step toward standardizing the creation of a cystitome to reduce variations and complications associated with the crucial step of CCC in cataract surgery. We conducted a study to measure the repeatability and precision of cystitomes made by the GG cystitome maker versus those made manually with a needle holder. The results showed that the cystitomes made with GG cystitome maker had a lesser degree of variation. This indicates a more repeatable cystitome, which will inadvertently help in reducing the error caused by the instrument in making a good CCC during cataract surgery.

The design of functional proteins using tensorized energy calculations

In protein design, the energy associated with a huge number of sequence-conformer perturbations has to be routinely estimated. Hence, enhancing the throughput and accuracy of these energy calculations can profoundly improve design success rates and enable tackling more complex design problems. In this work, we explore the possibility of tensorizing the energy calculations and apply them in a protein design framework. We use this framework to design enhanced proteins with anti-cancer and radio-tracing functions. Particularly, we designed multispecific binders against ligands of the epidermal growth factor receptor (EGFR), where the tested design could inhibit EGFR activity in vitro and in vivo. We also used this method to design high-affinity Cu2+ binders that were stable in serum and could be readily loaded with copper-64 radionuclide. The resulting molecules show superior functional properties for their respective applications and demonstrate the generalizable potential of the described protein design approach.

Long-term follow-up in a pediatric patient with Ligneous Conjunctivitis due to PLG gene mutation in topical plasminogen treatment after successful use of ocular prosthesis for aesthetic rehabilitation: a case report

BACKGROUND

Ligneous Conjunctivitis (LC) is the most common clinical manifestation of Type I Plasminogen deficiency (T1PD; OMIM# 217090), and it is characterized by the formation of pseudomembranes (due to deposition of fibrin) on the conjunctivae leading to progressive vision loss. In past times, patients with LC were treated with surgery, topical anti-inflammatory, cytostatic agents, and systemic immunosuppressive drugs with limited results (Blood 108:3021-3026, 2006, Ophthalmology 129:955-957, 2022, Surv Ophthalmol 48:369-388, 2003, Blood 131:1301-1310, 2018). The surgery can also trigger the development of membranes, as observed in patients needing ocular prosthesis (Surv Ophthalmol 48:369-388, 2003). Treatment with topical purified plasminogen is used to prevent pseudomembranes formation (Blood 108:3021-3026, 2006, Ophthalmology 129:955-957, 2022).

CASE PRESENTATION

We present the case of a sixteen-year-old girl with LC with severe left eye involvement. We reported the clinical conditions of the patient before and after the use of topical plasminogen eye drops and described the treatment schedule allowing the surgical procedure for the pseudomembranes debulking and the subsequent use of ocular prosthesis for aesthetic rehabilitation.

CONCLUSIONS

The patient showed a progressive response to the topical plasminogen, with a complete absence of pseudomembrane formation at a twelve-year follow-up, despite using an ocular prosthesis.

Explantation of a sutureless scleral fixated Carlevale intraocular lens due to calcification: a clinical and laboratory report

BACKGROUND

Hydrophilic intraocular lens opacification is a rare complication due to calcification. With current new surgical techniques, including lamellar endothelial keratoplasty and vitrectomies, this irreversible complication is becoming more common. In this case study, we present clinical and laboratory features of a case of Carlevale hydrophilic acrylic IOL calcification.

CASE PRESENTATION

Observational case report of a single incident case. An 83-year-old man was referred to our ophthalmic department complaining of right eye vision blurring for six months. Slit-lamp biomicroscopy revealed IOL opacification. Deposits of calcium phosphate were found both on the IOL's surface and inside it, according to thorough investigation using optical, scanning electron microscopy (SEM), and energy-dispersive X-ray (EDX) spectrometry.

CONCLUSIONS

To the best of our knowledge, this is the first case to describe the laboratory evidence of Carlevale hydrophilic IOL calcification, suggesting possible explanation mechanisms based on underlying pathology and surgical technique. It reminds us that these findings suggest that physicians should be aware of possible hydrophilic IOL calcification.

Autologous fat transfer for orbital volume augmentation in sockets with small nonseeing eyes

OBJECTIVE

End-stage ocular diseases usually end up with atrophic bulbi or phthisis bulbi leading to orbital volume loss which needs to be addressed. We studied the use of autologous fat for volume augmentation of the orbit because it is minimally invasive and allows early rehabilitation with the use of an artificial eye.

DESIGN

It was a prospective, interventional study.

METHODS

A total of 14 eyes of 14 patients with atrophic bulbi with shrinkage or phthisis bulbi with no perception of light (PL) and aged older than 18 years were included for the study purpose. Painful or inflamed eyes or suspected intraocular tumors were excluded. An autologous fat graft was obtained from the lower abdomen or buttocks and injected into the retrobulbar space using a 20-gauge cannula after adequate peribulbar anesthesia. Outcomes measures were patient satisfaction, change in Hertel's exophthalmometry, vertical and horizontal palpebral aperture, and socket volume.

RESULTS

Hertel exophthalmometry showed a significant improvement both with and without an artificial eye from 14.92 ± 2.3 mm to 16.71 ± 1.94 mm (p-value 0.003 without an artificial eye). The vertical palpebral aperture also showed a significant improvement from 5 ± 1.70 mm to 6.71 ± 1.58 mm (p-value < 0.001). There was a significant reduction in the socket volume from 1.22 ml to 0.39 ml (p-value < 0.001). No local or donor site complications were seen.

CONCLUSIONS

Autologous fat transfer is a minimally invasive, safe, and effective procedure for orbital volume augmentation in small, nonseeing eyes. The short-term outcome of our study was good in most patients and can be considered for such patients.

The art of managing various ocular defects in different clinical scenarios: A case series

The absence of eye and irradiation post-enucleation may result in problems like dryness of the eye sockets, itching and crusting. This may lead to poor prosthesis adaptation and a lack of patient acceptance of the prosthesis. To combat the most common problem of dryness, patients are advised artificial tears to use as teardrops or ocular prostheses along with a tear reservoir. This case series describes methods of fabricating ocular prosthesis indicated in different scenarios: the modified stock ocular and a custom-made ocular prosthesis when tearing secretion is enough in the eye socket and an ocular prosthesis with a tear reservoir in cases showing reduced tear secretion. A novel technique of fabricating hollow lightweight ocular prostheses having the sustained prolonged release of artificial tears has been described.

AiKPro: deep learning model for kinome-wide bioactivity profiling using structure-based sequence alignments and molecular 3D conformer ensemble descriptors

The discovery of selective and potent kinase inhibitors is crucial for the treatment of various diseases, but the process is challenging due to the high structural similarity among kinases. Efficient kinome-wide bioactivity profiling is essential for understanding kinase function and identifying selective inhibitors. In this study, we propose AiKPro, a deep learning model that combines structure-validated multiple sequence alignments and molecular 3D conformer ensemble descriptors to predict kinase-ligand binding affinities. Our deep learning model uses an attention-based mechanism to capture complex patterns in the interactions between the kinase and the ligand. To assess the performance of AiKPro, we evaluated the impact of descriptors, the predictability for untrained kinases and compounds, and kinase activity profiling based on odd ratios. Our model, AiKPro, shows good Pearson's correlation coefficients of 0.88 and 0.87 for the test set and for the untrained sets of compounds, respectively, which also shows the robustness of the model. AiKPro shows good kinase-activity profiles across the kinome, potentially facilitating the discovery of novel interactions and selective inhibitors. Our approach holds potential implications for the discovery of novel, selective kinase inhibitors and guiding rational drug design.

Analysis of microbial communities of ocular prostheses and anophthalmic sockets using 16S rRNA gene sequencing

Ocular prostheses are liable to host microbial adhesion, which can favor conjunctival inflammation. Knowing the microbiota of the ocular prosthesis and anophthalmic socket is important for predicting infection-related pathogens. This study evaluated the microbiota of the prostheses and anophthalmic sockets of six individuals by 16S rRNA sequencing. The microbial abundance and diversity were analyzed using the Operational Taxonomic Units at the genus level. Forty-seven phyla, capturing 1,258 named genera, were recorded in the sample set. In both sites, the most frequent genera were Fusobacterium, Staphylococcus, Prevotella, and Streptococcus. The microbial abundance was higher for the anophthalmic socket than for the prosthesis. Alpha diversity showed no significant differences in bacterial richness or diversity between sites. Although the microbial abundance in the anophthalmic socket was higher, both sites had similar microbiota with high diversity and low dominance among the genera.

[Ocular prosthetics in children-Possibilities and challenges]

One of the greatest challenges for ocularists is prosthetic fitting in children, especially in children with congenital anomalies such as clinical anophthalmia or functionless (blind) microphthalmia. The most frequent reason for prosthetic fitting in children is a condition following enucleation for retinoblastoma, followed by trauma and congenital pathologies. The standard treatment after enucleation or evisceration begins intraoperatively with the selection of an suitable implant and the use of a conformer at the end of the operation to shape the prosthetic cavity. An initial prosthesis can be fitted 4 weeks postoperatively, with a final fitting taking place 3 months later. If iatrogenic scarring or scarring due to an infection of the prosthetic cavity occurs, the approach of the ocularist must be appropriately adapted with the use of modified prosthesis shapes and shorter treatment intervals. Surgical options include scar excision and oral mucosa or amniotic membrane transplantation. Congenital anomalies require the shortest treatment intervals and even more so for anophthalmia than for microphthalmia. The strategy is characterized by simultaneous stimulation of the soft tissue of the ocular adnexa as well as the bony orbit. As self-inflating hydrogel expanders are no longer available, conservative prosthetic treatment is the only option. Close cooperation between child/parent, ocularist and ophthalmic plastic surgeon is the best prerequisite for a good long-term treatment outcome.

An adaptive spatiotemporal correlation filtering visual tracking method

Discriminative correlation filter (DCF) tracking algorithms are commonly used for visual tracking. However, we observed that different spatio-temporal targets exhibit varied visual appearances, and most DCF-based trackers neglect to exploit this spatio-temporal information during the tracking process. To address the above-mentioned issues, we propose a three-way adaptive spatio-temporal correlation filtering tracker, named ASCF, that makes fuller use of the spatio-temporal information during tracking. To be specific, we extract rich local and global visual features based on the Conformer network, establish three correlation filters at different spatio-temporal locations during the tracking process, and the three correlation filters independently track the target. Then, to adaptively select the correlation filter to achieve target tracking, we employ the average peak-to-correlation energy (APCE) and the peak-to-sidelobe ratio (PSR) to measure the reliability of the tracking results. In addition, we propose an adaptive model update strategy that adjusts the update frequency of the three correlation filters in different ways to avoid model drift due to the introduction of similar objects or background noise. Extensive experimental results on five benchmarks demonstrate that our algorithm achieves excellent performance compared to state-of-the-art trackers.

A narrative review on techniques of iris replication in an ocular prosthesis

The disfigurement associated due to the loss of an eye can cause a significant physical and psychological disturbance. Psychological distress among such unfortunate patients can be reduced by providing an artificial eye. Rehabilitating such patients with an ocular defects is the most challenging task for a prosthodontist. The custom-made ocular prostheses are preferred over the prefabricated stock eye shells as it provides intimate contact with the tissue bed, enabling an ideal fit. For an esthetic ocular prosthesis, the precise positioning of an iris is a primary requirement to avoid the squint eye appearance. Various case reports are documented in the literature for centralizing the iris in the prosthetic eye. This review article explores the established methods and techniques for positioning the iris in a custom-made ocular prosthesis.

Antibiofilm effect of cleaning agents for ocular prostheses

Introduction

This study aimed to evaluate the antibiofilm effect of different agents (neutral soap, 4% chlorhexidine, Efferdent effervescent tablets, 1% triclosan, and citronella essential oil) used for ocular prosthesis cleaning.

Material and Methods

Biofilms of S. aureus and S. epidermidis were formed on 60 ocular prosthesis acrylic resin specimens. The specimens were cleaned with the studied agents with different techniques. Microorganism counting was performed. Data were submitted to ANOVA and HSD Tukey-Kramer (p<.01).

Results

When compared to the control group, all cleaning protocols promoted a reduction in growth of microorganisms. The 4% chlorhexidine, effervescent tablets, and 1% triclosan cleaning agents eliminated biofilm in all groups.

Conclusion

Therefore, immersion in 4% chlorhexidine, effervescent tablets, and 1% triclosan could be the best protocols indicated for ocular prosthesis cleaning due to their ability to eliminate biofilm.

[Endocapsular fixation of intraocular lens in patients with ectopia lentis and Marfan syndrome (case study)]

Modern trends in advancement of phaco surgery techniques in patients with ectopia lentis (including patients with Marfan syndrome) are characterized by the transition from complete removal of the lens (lensectomy) to aspiration of the lens substance and attempts to preserve and reposition the capsular bag. This case study analyzes the results of surgical treatment of bilateral ectopia lentis in a 6-year-old patient with Marfan syndrome. The specifics of microinvasive phaco surgery consisted in capsular bag preservation and endocapsular fixation of the intraocular lens. The article presents the results of ophthalmological observation over a seven-year period.

Comparison of the Barrett Universal II, Kane and VRF-G formulas with existing intraocular lens calculation formulas in eyes with short axial lengths

BACKGROUND

To compare the accuracy of recently developed modern intraocular lens (IOL) power formulas (Barrett Universal II, Kane and VRF-G) with existing IOL power formulas in eyes with an axial length (AL) ≤ 22 mm.

METHODS

This analysis comprised 172 eyes of 172 patients operated on by one surgeon (LT) with one IQ SN60WF (Alcon Labs, Fort Worth, TX, USA) hydrophobic lens. Ten IOL formulas were evaluated: Barrett Universal II (BUII), Haigis, Hoffer Q, Holladay 1, Holladay 2, Kane, SRK/T, T2, VRF and VRF-G. The median absolute error (MedAE), mean absolute error (MAE), standard deviation (SD) and all descriptive statistics were evaluated. Percentages of eyes with a prediction error within ±0.25 D, ±0.50 D, ±0.75 D and ±1.00 D were calculated using standard optimised constants for the entire range of axial lengths.

RESULTS

The VRF-G, Haigis and Kane produced the smallest MedAE among all formulas (0.242 D, 0.247 D and 0.263 D, respectively) and had the highest percentage of eyes with a PE within ±0.50 D (75.67%, 73.84% and 75.16%, respectively). The Barrett was less accurate (0.298 D and 68.02%, respectively). Statistically significant differences were found predominantly between the VRF-G (P < 0.05), Kane (P < 0.05) and Haigis (P < 0.05) and all other formulas. The percentage of eyes with a PE within ±0.50 D ranged from 66.28% to 75.67%.

CONCLUSIONS

In eyes with AL ≤ 22.0 mm, the VRF-G, Haigis and Kane were the most accurate predictors of postoperative refraction, and the Barrett formula was less predictable.

Rehabilitation of orbital exenteration postsquamous cell carcinoma of orbit using magnet retained two-part silicone and acrylic prosthesis: A case report

ABSTRACT

Orbital exenteration performed to treat various neoplasms or nonmalignant diseases results in functional, aesthetic, and psychological issues for the patients. If reconstructive surgery is not possible or not desired by the patient, an orbital prosthesis is an excellent choice for cosmetic and psychological rehabilitation. An orbital prosthesis is aesthetic, durable, long lasting, cost-effective, and most importantly retentive. The present case report describes the rehabilitation of an orbital exenteration postsquamous cell carcinoma using a two-part prosthesis, in which retention is achieved by a combination of relining of anatomic undercuts and magnets.

Evaluation of macular visibility through a high-order aspheric intraocular lens using a simulated model eye

We evaluated the macular visibility of a newly designed extended depth of focus (EDOF) intraocular lenses (IOL) using a wide viewing system for macular manipulation (Risight;60D, Carl Zeiss Meditec AG) in a model eye and compared it with various other types of IOLs. We used a model eye that was constructed based on the Glustrand model to compare a newly designed EDOF IOL (DIB00V; Johnson & Johnson Surgical Vision), an EDOF IOL with a diffraction grating (ZXR00V; Johnson & Johnson surgical Vision), and a monofocal aspheric (DCB00V; Johnson & Johnson Vision, XY-1; HOYA Surgical Optics, Tokyo, Japan) or spherical IOL (NX70s; Santen Pharmaceutical Co., Ltd). In the model eye, a 1951 United States Air Force (USAF) test was placed at the location of the macula. The contrasts in a range of spatial frequencies were quantified using the images obtained from the 1951 USAF test target. The contrast at each spatial frequency was plotted and integrated to calculate the area under the curve contrast (AUC-contrast). Qualitative evaluations showed that good-quality images were obtained for all IOLs. At a spatial frequency of 16 LP/mm, the average contrast was the highest for the DIB00V and NX70s (0.216 each). The highest average contrast at 32 LP/mm was obtained using the NX70s (0.128), and at 64 LP/mm using the DIB00V (0.123). The horizontal AUC-contrast was the highest for the NX70s (8.754), and the vertical AUC-contrast was the highest for the DIB00V (8.334). On average, the DIB00V had the highest AUC-contrast value (8.227). The high-order aspheric IOL, DIB00V, was found to exhibit good macular visibility despite being an EDOF IOL.

Effect of intracorneal ring segments on posterior corneal topography in eyes with keratoconus

PURPOSE

To analyze the changes in the anterior and posterior corneal surfaces measured with a Scheimpflug imaging device in keratoconus patients implanted with intracorneal ring segments (ICRS) and to correlate those changes with the visual outcomes.

METHODS

This prospective interventional case series study included 92 eyes of 60 patients with keratoconus who underwent Kerarings (Mediphacos, Belo Horizonte, Brazil) ICRS implantation. Keratometric (K) readings, corneal asphericity (Q value) and elevations of both anterior and posterior corneal surfaces were evaluated using a Scheimpflug imaging device preoperatively and at 1, 3, 6 and 12 months after surgery.

RESULTS

The mean best corrected visual acuity (BCVA) improved from 0.61 to 0.19 logMAR at 12 months after surgery. Both anterior and posterior corneal surfaces showed significant flattening with statistically significant reduction of the mean anterior K reading by 3.39 D and the mean posterior K reading by 0.39 D (p<0.001) at 12 months. Statistically significant change of the anterior Q to a less negative value (from -1.05 to -0.36) was observed (p<0.001) with no significant change of the posterior Q value. Improvement of the anterior Q was significantly correlated to better postoperative BCVA (p=0.03). Better postoperative BCVA significantly correlated to better preoperative BCVA, flatter preoperative anterior and posterior K, less prolate anterior Q value and lower anterior elevations.

CONCLUSIONS

ICRS implantation has a significant flattening effect on both anterior and posterior corneal surfaces. Improvement of corneal asphericity is correlated to better visual outcome. Certain preoperative parameters were predictive factors of the postoperative visual improvement.