To critically evaluate new evidence regarding big language models (LLMs) in cataract and refractive surgery and suggest a clinically responsible validation system. Conceptual synthesis of the recent literature of high impact and comment on a recent JCRS study on the performance of LLM compared to ophthalmology residents. Despite the high benchmark performance of LLMs, there are still severe deficits in clinical reliability, reproducibility, citation traceability, and safety in anterior-segment procedures. It proposes a three-layer validation pipeline, which includes domain-specific benchmarking, multi-dimensional performance reporting, and use-case-based deployment thresholds. It is necessary to shift the accuracy of examination to responsible clinical integration. An equity-sensitive validation framework applicable globally can make the application of AI in cataract and refractive surgery safe, transparent, and effective.
To compare the postoperative rotational stability of three toric intraocular lens (IOL) platforms and identify platform-specific biometric factors associated with rotation. Three eye centers in China. Prospective multicenter randomized controlled trial. A total of 256 eyes of 172 cataract patients with regular corneal astigmatism that completed 3 months of follow-up after phacoemulsification with implantation of TECNIS Toric II, Clareon Toric, or AT TORBI 709M were included. Participants were randomly assigned to 1 of the 3 toric IOL platforms. Baseline rotational alignment was defined at the end of surgery and compared with retroillumination images obtained at 1 day, 3 days, 1 week, 2 weeks, 1 month, and 3 months postoperatively. Absolute rotation changed most prominently within the first week and then progressively stabilized. Rotational stability was reached earlier in the ZCU and CNW0T groups, which plateaued at 1 week, whereas the 709 approached stability between 2 weeks and 1 month. Throughout follow-up, the 709 showed greater rotation than the CNW0T, whereas the ZCU demonstrated the least rotation. Significant rotation of ≥10° occurred in 1.2%, 2.4%, and 12.2% of eyes, respectively. White-to-white distance was associated with greater rotation in the CNW0T and 709 groups, lens thickness was additionally associated with greater rotation in the 709 group, and no biometric factor reached significance in the ZCU group. Hydrophobic C-loop toric IOLs showed better early rotational stability than the hydrophilic plate-haptic toric IOL. Biometric correlates of rotation differed across platforms, supporting individualized toric IOL selection and postoperative monitoring.
To provide the first reliability analysis of swept-source optical coherence tomography (SS-OCT) biometry-derived corneal optical quality metrics that may impact intraocular lens design selection in refractive cataract surgery. This was a retrospective instrument evaluation study at the Department of Ophthalmology, Hanusch Hospital, Vienna, Austria. Three consecutive preoperative single-operator scans of patients with cataract were analyzed using the updated wavefront analysis software of a SSOCT biometer (ANTERION; Heidelberg Engineering). Corneal higher order aberrations (HOAs) were quantified as paired polar Zernike magnitudes, dioptric vector components, individual signed Zernike coefficients, and root mean square (RMS) values. For each metric, pooled within-subject standard deviation (Sw), coefficient of variation, and intraclass correlation coefficient (ICC) were calculated. Primary analysis was done at a 4-mm optical zone, with additional 3- and 5-mm assessments to evaluate zone-dependent consistency. Fifty-six eyes of 56 patients with cataract were included. All anterior, posterior, and total HOAs revealed repeatability limits (R = 2.77 × Sw) below 0.10 µm with ICCs of 0.76 to 0.97 and coefficients of variation less than 25% at 4 mm. For the total cornea, RMS HOA and spherical aberration showed repeatability limits of 0.07 µm (ICC: 0.89) and 0.03 µm (ICC: 0.84), respectively. Test-retest variance scaled with zone size (photopic to scotopic) and interindividual variation. Corneal optical quality can be reliably characterized from a SS-OCT biometer at optical zones relevant to refractive cataract surgery. Because measurement uncertainty can impair clinical decision-making, repeatability limits should be considered if wavefront metrics are employed to inform intraocular lens design selection or outcome-based research.
To evaluate the visual, refractive and safety outcomes of the light adjustable lens (LAL) in eyes with pre-existing macular pathology undergoing cataract surgery. Private practice, multiple locations. Retrospective, consecutive case series. Patients with macular pathology undergoing cataract surgery with LAL implantation were included. Diagnoses comprised epiretinal membrane (ERM), dry age-related macular degeneration (AMD)/drusen, and other macular conditions. Primary outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and the percentage of eyes within ±0.25 D (diopter), ±0.50 D and ±1.00 D of the refractive target. Safety endpoints included intraoperative and postoperative complications and changes in CDVA pre- and post-adjustments. 171 eyes from 106 patients were included. The most common diagnoses were ERM and dry AMD. Among eyes targeted for distance (n=95), 96% achieved UDVA of 20/25 or better and 85% achieved 20/20 or better. For refractive accuracy, 87% of eyes were within ±0.50 D and 68% were within ±0.25 D of the target. The percentage of eyes within ±0.50 D of target rose from 66% to 87% following the adjustment process and the percentage of eyes achieving 20/20 or better climbed from 26% to 85%. In eyes with macular pathology, the LAL provides excellent uncorrected visual acuity and highly accurate refractive outcomes with a favorable safety profile. These findings position the LAL as a viable advanced IOL option in patients traditionally considered suboptimal candidates due to underlying macular disease.
To compare tolerance to induced astigmatism (TIA) across four intraocular lenses (IOLs). Medical University of South Carolina, Charleston, South Carolina, USA. Prospective observational study. Patients underwent cataract surgery with a standard monofocal (ZCB00), enhanced monofocal (DIB00), diffractive violet light filter (VLF) extended depth of field (DOFi) (ZXR00V), or VLF full DOFi (DRN00V) IOL. At 1-3 months postoperatively, astigmatic defocus (0.5-2.0 D) was simulated in WTR, oblique, and ATR orientations. 100 patients were included. DCIVA was statistically significantly better with VLF extended DOFi compared with the monofocal (P≤0.001) and enhanced monofocal IOLs (P=0.002). DCNVA was significantly better with VLF Full-DOFi IOL than with all other groups (P<0.001). No statistically significant differences were observed among the four IOL groups with induction of WTR astigmatism ≤1.0 D. At 0.5D oblique, the enhanced monofocal group outperformed the extended DOFi group (P=0.014), and at 2.0 D induced oblique astigmatism, it surpassed all other IOL groups. The enhanced monofocal IOL group showed the greatest tolerance to induced ATR astigmatism across all magnitudes. The VLF Full-DOFi IOL group maintained astigmatic tolerance like standard monofocal, enhanced monofocal, and extended DOFi IOLs up to 2.0 D in WTR and ATR, and 1.5 D in oblique orientations. TIA was not statistically significantly different among the standard monofocal, enhanced monofocal, VLF extended DOFi, and VLF Full-DOFi IOL groups with low to moderate induced WTR astigmatism. The enhanced monofocal IOL provided the greatest tolerance to induced astigmatism, especially under oblique and ATR astigmatic defocus.
To report the outcomes of the Light Adjustable Lens (LAL) collected from a clinical registry. Multiple private practices in the United States. Multi-center prospective observational study. Patients who underwent bilateral LAL implantation and who had best-corrected distance visual acuity (CDVA) ≥ 20/20-2 before lens adjustment were enrolled. Assessment was performed at one visit 1-3 months after final lock-in treatment. A total of 1101 participants (2202 eyes) were included. Of these, 586 eyes had prior corneal refractive surgery (CRS) and 1616 had no prior CRS (No CRS). 12.3% of participants were targeted for bilateral emmetropia, 9.3% for bilateral near and 78.4% for blended vision. Of eyes targeted for emmetropia, 81.2% achieved a UDVA of >20/20 (82.2% of No CRS and 78.4% of CRS). A total of 94.3% of eyes targeted for emmetropia had a MSE of <0.5D (94.7% of No CRS, 92.8% of CRS). The mean prediction error in MSE was -0.048 ± 0.366D in No CRS and -0.016 ± 0.441D in CRS. A total of 89% of patients with blended vision and 93% of patients with bilateral emmetropic target had binocular UCVA of >20/20. In the CRS, group 87% with blended vision and 87% with binocular emmetropia achieved binocular UCVA of >20/20. Binocular UNVA of >J1 was achieved with blended vision in 85% of patients in the No CRS group and 82% of patients in the CRS group. In this multi-center study, patients achieved a high degree of precision with the LAL regardless of prior corneal refractive surgery.
This is a review of the available literature on blepharoptosis following modern phacoemulsification cataract surgery with intraocular lens (IOL) implantation. Blepharoptosis is a frequently underestimated complication of ocular surgery. This review followed PRISMA guidelines and was prospectively registered in PROSPERO (CRD420261348501). A literature search was conducted in PubMed/MEDLINE and the Cochrane Central Register of Controlled Trials, from database inception to February 2026. Studies evaluating postoperative ptosis after modern phacoemulsification with IOL implantation were included. Extracted data focused on the incidence of ptosis and associated risk factors. Eight studies, including a total of 863 eyes, met the inclusion criteria. Five studies reported the exact incidence of ptosis, whereas the remaining studies only compared preoperative and postoperative marginal reflex distance 1 (MRD1). Among studies reporting incidence, rates ranged from 0%-10.7%, with four of the five studies (674/702 eyes, 96%) reporting incidences ≤4.1%. None of the studies comparing preoperative and postoperative MRD1 measurements found a statistically significant difference. Lower preoperative levator palpebrae superioris function and higher preoperative MRD1 were identified as potential risk factors. Conversely, surgical duration and lid speculum type were not consistently associated with ptosis. Studies using exclusively topical anaesthesia reported either no ptosis or no significant change in MRD1. Postoperative ptosis following modern cataract surgery has a low but not negligible incidence. Preoperative eyelid characteristics and the type of anaesthesia may influence its occurrence. Postoperative ptosis should be routinely discussed during preoperative counselling.
To compare biomechanical and microstructural effects of keratan sulfate (KS) glycosaminoglycans (GAGs) in human and porcine cornea. Computational Biomechanical Laboratory, University of Illinois Chicago. Experimental in vitro laboratory study. Human and porcine corneal samples were divided into control (untreated), enzyme-treated (enzyme) groups. For enzyme-treated samples, keratanase enzyme II was used to deplete KS GAGs. Uniaxial tensile experiments along with histochemical and transmission electron microscopy (TEM) studies were used to characterize biomechanical and microstructural properties. Human corneas were mechanically stronger (P<0.05), with maximum modulus of 14.31±2.87 MPa and stress of 0.55±0.10 MPa; compared to 6.71±1.35 MPa and 0.27±0.04 MPa, respectively for porcine corneas. Following KS GAG removal, samples became significantly softer and weaker (P<0.05), with maximum moduli of 7.49±1.55 MPa and 2.80±0.30 MPa and maximum stresses of 0.33±0.06 MPa and 0.13±0.01 MPa for human and porcine corneas, respectively. Histochemical staining for GAGs showed markedly reduced blue color intensity following the treatment, indicating a substantial decrease in GAG content. TEM images showed significant differences in collagen fibril diameter and interfibrillar spacing between control porcine and human cornea (P<0.05). GAG depletion had an insignificant effect on collagen fibril diameter but caused a significant increase in the interfibrillar spacing in both human and porcine corneas (P<0.05). Although human and porcine corneas exhibit distinct tensile properties, alterations in KS GAG content substantially affect their microstructure and structural integrity. A thorough understanding of roles of GAGs could facilitate improved management of visions diseases rooted in GAG defects.
To evaluate the efficacy and safety of a selective laser device (CAPSULaser, EXCEL- LENS, CA, USA) to create centred and circular anterior capsulotomies in eyes with white intumescent cataracts. International, multicentre, study across five clinical sites in the United Kingdom, Bulgaria, India and Saudi Arabia. Prospective, multicentre interventional cohort study. A total of 93 eyes of 91 subjects with white intumescent cataracts were recruited after anterior segment OCT (AS-OCT) established the presence of intralenticular fluid pockets indicative of raised intralenticular pressure. In all cases, prior to phacoemulsification, selective laser capsulotomy (SLC) was performed by staining the anterior capsule with a customised 0.4 % trypan blue solution. Capsulotomies were created with a diameter of 5.5 mm. Subjects were followed up at one day, one week, one and three months postoperatively. In all cases, the capsulotomy was successfully created. No intraoperative complications were observed. At 3 months postoperatively the mean capsulotomy diameter measured 5.3 mm (range: 5.2 to 5.5 mm). No cases of capsular phimosis were observed during the three months follow-up. In all cases, visual acuity improved from preoperative light perception to mean postoperative uncorrected distance visual acuity (UDVA) of 0.28 LogMAR (range: 0.0 to 1.0). The use of SLC in this series of eyes with intumescent cataracts achieved consistently sized and well-centred capsular openings. There were no complications. These results highlight the precision and safety of using selective laser capsulotomy for creating anterior capsulotomies in white intumescent cataracts.
To compare postoperative outcomes of absorbable versus non-absorbable sutures and sutureless versus sutured incisions in pediatric cataract surgery (0-18 years). Pediatric cataract surgery requires precise wound closure to ensure postoperative stability. Identifying the most effective closure method is essential to minimize complications and the need for reintervention under general anesthesia. The review protocol was registered in the International Prospective Register of Systematic Reviews (CRD420251174549). We searched PubMed, Embase, Cochrane, and Web of Science (inception to October 2025). The primary outcome was the overall rate of postoperative complications. Meta analysis utilized Mantel-Haenszel fixed-effects model (Review Manager 5.4); certainty of evidence was assessed via Grading of Recommendations Assessment, Development and Evaluation (GRADE). Eight studies (four per comparison) evaluated suture material (321 absorbable; 430 non-absorbable) and closure technique (1,127 sutureless; 187 sutured closure). Absorbable sutures were associated with significantly lower odds of overall complications than non-absorbable sutures (OR 2.35; 95% CI 1.38 to 3.99; P=0.002; very low-certainty evidence). Specifically, 10-0 polyglactin 910 outperformed 10-0 nylon (OR 2.18; P=0.005; very low-certainty evidence), though loosening was more frequent (P=0.05). Sutureless closure was associated with significantly lower complication odds than sutured techniques (OR 0.34; 95% CI 0.23 to 0.49; P<0.00001; very low-certainty evidence). No significant differences were found for wound leakage (P=0.60) or endophthalmitis (P=0.10). Absorbable sutures and sutureless techniques are associated with a lower risk of overall complications. However, results are limited by very low-certainty and potential selection bias, as sutures are often reserved for leaking wounds. While non-absorbable sutures provide early wound security, they appear to increase long term ocular surface morbidity. Large scale RCTs are required to establish definitive surgical guidelines.
A valuable meta-analysis was performed by the authors to investigate the prophylactic efficacy of several antibiotics to prevent postoperative endophthalmitis (PE) in case of a posterior capsule rupture (PCR) during cataract surgery. It is of interest that the authors found a superior effect of moxifloxacin in the reduction of the incidence of endophthalmitis in the event of a PCR. This in addition to the better safety profile could make a call for preference of this antibiotic for use as antibiotic intra-ocular prophylaxis during cataract surgery. The authors also argue that there are arguments to use intra-ocular antibiotic prophylaxis only in case of a PCR, which is in line with data we published on this subject.
Background and Objectives: The purpose of this study is to present the clinical results over a 12-month follow-up period in patients after simultaneous bilateral crystalline lens removal with implantation of a Tecnis Eyhance DIB00 monofocal plus lens. Materials and Methods: This is a single-center, 12-month, retrospective study involving 214 eyes of 107 patients operated on between 2021 and 2023. Measurements included uncorrected and best-corrected visual acuity at 30 cm, 70 cm, and distance vision under fixed lighting conditions, instead of focusing on patient-dependent factors, such as pupil size, which varies individually based on sympathetic and parasympathetic nervous systems balance, simulating visual performance in real-world conditions. Contrast sensitivity was also assessed at 6 and 12 months postoperatively. Patients filled out a questionnaire on quality of life after surgery. Results: Uncorrected and best-corrected visual acuity were, respectively, for a 30 cm distance UCVA 0.76/BCVA 0.18 LogMAR; for a 70 cm distance UCVA 0.03/BCVA -0.036 LogMAR; and for distance vision UCVA 0.05/BCVA 0.02. None of the patients reported adverse phenomena such as halo, glare, contrast decrease, or other phenomena after surgery. The average rating of patient satisfaction assessed in a special questionnaire was 8.54 out of 10 points. Conclusions: The Tecnis Eyhance DIB00 lens implanted during bilateral cataract surgery produced good results in terms of uncorrected visual acuity under various lighting conditions, which in our population was better than predicted by the lens manufacturer. Through the 12-month observation period, postoperative refractive values remained stable, with no deterioration of vision.
The purpose of this study was to determine the detection rate and associated factors of latent macular lesions using preoperative Spectral-domain optical coherence tomography (SD-OCT) in Japanese patients scheduled for cataract surgery with no clinically confirmed macular abnormalities. Teine Keijinkai Hospital, Sapporo, Japan. Retrospective observational study. We included 316 eyes of 316 Japanese cataract patients scheduled for surgery between January 2023 and December 2024 who had no suspected macular pathology on slit-lamp biomicroscopy. All patients underwent comprehensive ophthalmic examinations and SD-OCT, and the detection rate of latent macular lesions and their associated factors were investigated. Latent macular lesions were detected in 30 eyes (9.5%) of 316 patients with a mean age of 76.8 ± 8.8 years. The most frequent lesions were epiretinal membrane (15 eyes, 4.7%), followed by irregular elevation of the retinal pigment epithelium (10 eyes, 3.2%). Clinically significant lesions requiring immediate surgical modification or additional treatment were identified in 3 eyes (1.0%), including a full-thickness macular hole (1 eye) and neovascular age-related macular degeneration (2 eyes). Age was independently associated with latent macular lesions (odds ratio 1.10, 95% Confidence Interval 1.04-1.16, P<0.01). Preoperative OCT screening may contribute to the evaluation of latent macular lesions, particulary in elderly cohort, and lead to optimized surgical planning.
To compare the safety and efficacy of low-THC oral cannabidiol (CBD) with oral codeine-acetaminophen for postoperative pain control following photorefractive keratectomy. Academic outpatient clinical practice. Prospective, randomized, crossover, self-controlled clinical trial. Thirty-five adults underwent bilateral sequential PRK, receiving oral CBD (50 mg twice daily) for one eye and oral T3 (codeine-acetaminophen 30mg-300mg every 4 hours) for the contralateral eye in a randomized sequence. Primary outcomes included pain and uncorrected visual acuity at month 3. Secondary outcomes included diary-reported symptoms, and patient-reported quality-of-life scores: Patient Reported Outcomes with LASIK (PROWL), Quality of Life Impact of Refractive Correction (QIRC), and Ocular Surface Disease Index (OSDI). Pain scores peaked on postoperative day 2 across both interventions with no significant difference in mean or maximum pain ratings (p = 0.538). Visual acuity improved significantly by POM3 (p < 0.001), with no treatment-related differences (p = 0.928). Sensorium was significantly higher when taking CBD for the first eye, and not the second eye, indicating first exposure effect (p = 0.035). Other symptoms and outcomes were equivalent between treatments. Low-THC oral CBD provides non-inferior pain control to codeine-acetaminophen following PRK with similar recovery outcomes and minimal side effects. Mild sensorium changes may occur in surgically naïve patients taking CBD. CBD may represent a viable opioid-sparing alternative in refractive surgery or acute pain management.
To compare the refractive prediction accuracy of contemporary intraocular lens (IOL) calculation formulas based on swept-source optical coherence tomography (OCT) biometry in cataract surgery with capsular tension ring (CTR) implantation, and to assess for systematic postoperative refractive tendencies. This retrospective study included 98 eyes of 92 patients who underwent phacoemulsification with in-the-bag IOL and CTR implantation. Preoperative biometry utilized swept-source OCT (ARGOS, Alcon). Refractive prediction accuracy was evaluated for the Barrett Universal II, Haigis, SRK/T, and Holladay II formulas. Main outcomes included mean prediction error, mean absolute error (MAE), median absolute error (MedAE), and percentages of eyes within ±0.25, ±0.50, and ±1.00 diopter (D). The mean age was 73.0±8.1 years, and the mean axial length was 23.03±1.04 mm. Barrett Universal II yielded the lowest MAE and MedAE (0.36±0.34 D and 0.24 D, respectively), followed by Holladay II (0.40±0.32 D and 0.30 D). Higher MAE was observed with SRK/T (0.45±0.37 D) and Haigis (0.54±0.45 D). MAE differed significantly among the formulas (p<0.001), with pairwise comparisons showing that Barrett Universal II and Holladay II performed similarly (p>0.05) and better than both Haigis and SRK/T (all p≤0.003). The highest percentage of eyes within ±0.25 D was observed with Barrett Universal II (52.04%), whereas Holladay II showed the highest percentage within ±0.50 D (69.39%), and the two formulas tied within the ±1.00 D range (both 92.86%). Prediction errors were positive for all formulas, indicating a mild hyperopic shift. In eyes undergoing cataract surgery with CTR implantation, Barrett Universal II and Holladay II showed more favorable refractive prediction accuracy than Haigis and SRK/T. A mild hyperopic shift was observed across all formulas. This finding may be clinically relevant when selecting the target refraction or IOL power in these eyes. Kapsül germe halkası (KGH) implantasyonu ile katarakt cerrahisi uygulanan gözlerde, swept-source optik koherens tomografi (OKT) biyometrisine dayalı güncel göz içi lens (GİL) hesaplama formüllerinin refraktif tahmin doğruluğunu karşılaştırmak ve sistematik postoperatif refraktif eğilimleri değerlendirmek. Bu retrospektif çalışmaya, fakoemülsifikasyon, kapsül içine GİL ve KGH implantasyonu uygulanan 92 hastanın 98 gözü dahil edildi. Preoperatif biyometri, swept-source OKT temelli bir cihaz ile yapıldı (ARGOS, Alcon). Barrett Universal II, Haigis, SRK/T ve Holladay II formülleri için refraktif sonuçlar değerlendirildi. Ortalama tahmin hatası (OTH), ortalama mutlak hata (OMH), medyan mutlak hata (MMH) ve ±0,25 diyoptri (D), ±0,50 D ve ±1,00 D içinde kalan göz oranları hesaplandı. Ortalama yaş 73,0±8,1 yıl, ortalama aksiyel uzunluk 23,03±1,04 mm’ydi. En düşük OMH ve MMH değerlerini Barrett Universal II (sırasıyla 0,36±0,34 D ve 0,24 D) sağlarken, onu Holladay II (0,40±0,32 D ve 0,30 D) izledi. SRK/T ve Haigis formüllerinde OMH daha yüksekti (sırasıyla 0,45±0,37 D ve 0,54±0,45 D). OMH, formüller arasında anlamlı farklılık gösterdi (p<0,001). Post-hoc analizde Barrett Universal II ve Holladay II’nin benzer performans sergilediği (p>0,05) ve hem Haigis hem de SRK/T’ye göre OMH’nin daha düşük olduğu saptandı (p≤0,003). ±0,25 D içinde kalan göz oranı Barrett Universal II’de en yüksek (%52,04), ±0,50 D aralığında Holladay II’de en yüksek (%69,39) olup, ±1,00 D aralığında her iki formülde aynı oran (%92,86) gözlenmiştir. Tüm formüllerde OTH pozitifti ve bu durum hafif hipermetropik eğilime işaret ediyordu. KGH implante edilen gözlerde Barrett Universal II ve Holladay II, Haigis ve SRK/T’ye göre daha olumlu refraktif tahmin doğruluğu gösterdi. Tüm formüllerde hafif hipermetropik eğilim izlendi. Bu durum, hedef refraksiyon ve GİL gücü seçiminde klinik açıdan önem taşıyabilir.
To evaluate the effects of extracorporeal ultra-high-fluence corneal cross-linking (ECO-CAIRS) on the dehydration and rehydration behavior of porcine corneal stromal ring segments in an experimental model simulating the preparation of corneal allogenic intrastromal ring segments. ELZA Institute, Zurich, Switzerland. Corneal ring segments (two per cornea) were prepared from freshly enucleated porcine corneas (n=48) and randomly divided into three groups: controls (no CXL, Jerky technique), extracorporeal ultra-high-fluence CXL at 30 J/cm2, and 60 J/cm2 (n=32 each). After epithelial removal and ring preparation, segments in the control group were soaked in balanced salt solution (BSS), while those in the experimental groups were soaked in riboflavin solution (Ribo-Ker, EMAGine AG, Zug, Switzerland) for 10 minutes. Each group subsequently underwent a total dehydration period of 45 minutes, which included both UV-A irradiation and waiting phases for the CXL-treated groups, followed by a 10-minute rehydration phase using BSS. Segment thickness was measured by calibrated imaging at baseline, after dehydration, and after rehydration. Baseline structural thickness values did not differ significantly between groups. Both CXL-treated groups demonstrated significantly greater dehydration (p<0.01) and reduced rehydration (p<0.01) when compared to controls. No significant differences were found between the two CXL-treated groups. Ultra-high-fluence cross-linking enhanced segment dehydration and slowed rehydration. ECO-CAIRS effectively modulates the dehydration and rehydration of corneal ring segments, which may improve handling and implantation characteristics during surgery. These findings support the potential clinical benefit of CXL in CAIRS procedures. Further in vivo studies are required to confirm long-term behavior and biomechanical impact.
To evaluate the long-term safety, stability, and visual outcomes of diagonal haptic capture (DHC) of a 4-haptic hydrophilic acrylic intraocular lens (Akreos adapt, Bausch&Lomb) in eyes with posterior capsule deficiency and an intact anterior capsulorhexis. Single tertiary referral center. Retrospective interventional case series. Medical records were reviewed for patients who underwent cataract surgery complicated by posterior capsule rupture and in whom DHC was used for IOL fixation between 2015 and 2023. Twenty eyes of 20 patients were identified. Fellow eyes with uneventful in-the-bag implantation of the same IOL model served as controls. Median follow-up was 2 years (mean 2.6±2.1 years; range 0-6 years) based on data from referring ophthalmologists, and 8 years (mean 6.0±2.8 years; range 2-9 years) for patients examined at the study center. Mean postoperative corrected distance visual acuity did not differ significantly between DHC eyes and fellow eyes (p>0.4). Refractive predictability and intraocular pressure were comparable between groups. All IOLs remained well centered with normal tilt throughout follow-up. No cases of pigment dispersion glaucoma, uveitis-glaucoma-hyphema syndrome, pseudophacodonesis, or late IOL dislocation were observed. In a subset of eyes, anterior segment optical coherence tomography demonstrated adequate clearance between the IOL and posterior iris without evidence of iris chafing. Diagonal haptic capture of a 4-haptic hydrophilic acrylic IOL provided stable long-term fixation, satisfactory visual and refractive outcomes, and a low incidence of complications. However, these results may be IOL-specific.
To compare the efficacy and safety of Implantable Phakic Contact Lens (IPCL) versus Implantable Collamer Lens (ICL) implantation for myopia correction. ICL is an established treatment for moderate-to-high myopia. However, comparative evidence evaluating outcomes between ICL and IPCL remains limited. Following PRISMA 2020 guidelines (PROSPERO CRD420251207282), PubMed, Embase, and the Cochrane were searched through November 7, 2025 for studies comparing IPCL and EVO ICL implantation in myopic eyes. Primary outcomes were uncorrected (UDVA) and corrected distance visual acuity (CDVA), and spherical equivalent (SE). Secondary outcomes included refractive accuracy, vault, adverse events, and efficacy and safety indices. Random-effects models were used. Nine studies (3 randomized, 6 observational) including 1,187 eyes (559 IPCL; 628 ICL), were analyzed. UDVA and CDVA were similar between groups. A small statistical difference in SE favored IPCL (MD -0.06 D; 95% CI -0.11 to -0.00; p = 0.03), although this was not robust to sensitivity analysis. Refractive accuracy was similar (83% vs 88% within ±0.50D; RR 0.96; p = 0.21). Secondary outcomes were comparable, including out-of-range vault, cataract formation (0.7% vs 0.8%), endothelial cell loss (2.2% in both groups), and explantation. Acute glaucoma was rare (0.17%), occurring only with IPCL V1.0. Toric ICL demonstrated greater rotational stability (7.1% vs 1.8%; RR 3.49; p = 0.03). Efficacy and safety indices were comparable (IPCL: 1.05/1.19 vs ICL: 1.06/1.18). IPCL and ICL provide comparable visual and safety outcomes for myopia correction. Toric ICL showed greater rotational stability. Further long-term studies are warranted.
To evaluate the dynamic in vivo capsular apposition to the intraocular lens (IOL) in highly myopic eyes following capsular tension ring (CTR) implantation using swept-source optical coherence tomography (SS-OCT), and to investigate its correlation with in-the-bag IOL behavior. Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China. Prospective randomized clinical trial. Highly myopic patients undergoing cataract surgery were randomized to receive CTR implantation or not. SS-OCT was performed at 1 day, 1 week, 1 month, 3 months, and 6 months to assess capsular apposition. Postoperative aqueous depth (PAD), IOL rotation, and anterior and posterior capsular opacification (ACO/PCO) were evaluated at each follow-up visit. A total of 29 eyes with CTR implantation and 30 eyes without CTR were included. The CTR group exhibited accelerated anterior capsular apposition, demonstrated by a smaller lens-anterior capsule distance (LCD) at 1 day and a higher proportion of anterior capsular apposition at 1 week. From 1 month onward, posterior capsular apposition occurred more frequently in the CTR group. At 1 day, the average LCD positively correlated with both PAD and IOL rotation. During subsequent follow-up period, the mean capsular bend index exhibited negative correlations with the absolute changes in PAD and IOL rotational speed. The CTR group developed less severe ACO, Eyes with incomplete posterior capsular apposition had a higher risk of PCO. CTR implantation facilitates accelerated anterior and more complete posterior capsular apposition to the IOL in highly myopic eyes, which may contribute to improved postoperative IOL stability and a reduced incidence of capsular opacification.
Reports on posterior capsular rupture (PCR) incidence in the US from the past decade are limited, and impact of trainee presence versus responsibility is unclear. We retrospectively analyzed a database of surgical complications within all cataract surgeries from 2022 to 2024 at the Moran Eye Center. PCR rates were stratified by case complexity and presence and direct responsibility of trainees. Among 14,240 cataract surgeries, the PCR rate was 0.67% (95% CI: 0.54-0.81%). PCR occurred more frequently in complex (1.4%) versus routine (0.5%) cases (p<0.001). In cases with PCR, 68% had vitreous loss and 34% reported anterior vitrector use. With assisting trainees present, PCR rate was elevated at 0.94% versus 0.23% without (p<0.001). When residents assisted, they caused PCR twice as often as attending physicians: 0.80% > 0.40% (p=0.03). Overall, up-to-date PCR incidence from a large academic center is provided. Case complexity and both trainee presence and responsibility significantly increased risk.