To systematically identify plasma proteins associated with cataract development and explore their potential causal relationships. Design: Prospective population-based cohort study with integrated Mendelian randomization (MR) and colocalization analyses. Participants: Forty-nine thousand, five hundred and eighty-one UK Biobank participants free of cataract at baseline. Cox proportional hazards models were used to assess associations between 2920 plasma proteins and cataract risk, followed by MR to evaluate causal relationships. Colocalization analysis was conducted to examine whether identified protein-cataract associations shared causal genetic variants. Main Outcome Measures: Incident cataract. Of the 2920 plasma proteins analyzed, 58 demonstrated significant associations with cataract risk (P < 1.71×10-5, Bonferroni-corrected threshold). Beta-crystallin B2 (CRYBB2) showed the most robust association (hazard ratio: 1.60; 95% confidence interval: 1.55-1.66, P = 5.28×10-164). Mendelian randomization analysis provided evidence supporting causal relationships for 4 proteins (CRYBB2, V-set and immunoglobulin domain-containing protein 4, mevalonate kinase, and metalloproteinase inhibitor 1) with cataract, with genetically predicted CRYBB2 levels showing a significant association with cataract risk, which is strongly supported by colocalization evidence. Functional enrichment analyses revealed involvement of biological pathways related to immune activation, cell fate decision, and structural remodeling in cataract development. This study identified distinct plasma proteomic signatures associated with incident cataract, offering novel insights into cataract pathogenesis and highlighting potential targets for early detection and therapeutic development. The author has no/the authors have no proprietary or commercial interest in any materials discussed in this article.
To evaluate the time-adjusted economics of retinal and cataract surgery in order to clarify how the dynamics of ambulatory surgery centers influence access to urgent care. A time-driven activity-based costing model integrating Centers for Medicare & Medicaid Services ambulatory surgery center reimbursement, intraservice times, and cost data from a provider was applied to 18 421 retinal and 880 448 cataract procedures (2021-2024). Reimbursement, cost, and profit were converted to per-minute values, and a financial efficiency coefficient was used to quantify time-adjusted profitability. Variation in time and overhead allocation was assessed with sensitivity analyses. Retinal procedures required 76.1 minutes vs 20.8 minutes for cataract surgery (ratio, 3.65). Time-normalized metrics favored cataract surgery, with reimbursement, cost, and profits per minute of $52.63, $29.28, and $23.35, compared with retinal procedures' $24.61, $16.22, and $8.40. The profit per minute for retinal procedures was 36% of the cataract profit. The financial efficiency coefficient was 0.098, indicating retinal surgery was less than 10% efficient after adjusting for operative duration. Parity would require reducing operative time to 7.5 minutes or increasing reimbursement by $61.05 per minute (~71%). No retinal Current Procedural Terminology code achieved a financial efficiency coefficient ≥1. Block modeling showed adding 2 retinal cases to a cataract block converted a margin to a loss, with retinal blocks generating losses approaching $5,908. Although ambulatory surgery center reimbursement was higher for retinal than cataract surgery and the cost per minute was lower for retinal surgery, cataract surgery was more profitable per minute. These findings underscore the need for reform of time-based reimbursement that reflects the complexity of retinal surgery.
Background/Objectives: Schlemm canal-based minimally invasive glaucoma surgery (MIGS) can be combined with cataract surgery, but topical glaucoma therapy alone is not a sufficient indication for adding MIGS. This review addresses when cataract surgery alone may be sufficient, when combined cataract surgery and MIGS may be appropriate, and when filtration surgery should be considered. Methods: This narrative review used a targeted PubMed/MEDLINE search of English-language literature published from January 2000 to May 2026 to support source identification and reference selection. The review focused on cataract surgery combined with Schlemm canal- or trabecular meshwork-targeted MIGS, including stent-based Schlemm canal procedures and trabeculotomy/goniotomy-based procedures, medication burden, ocular surface disease, refractive and visual outcomes, corneal endothelial safety, complications, angle visibility, guideline-based decision-making, and patient selection. Final references were selected according to clinical relevance to cataract-surgeon decision-making and evidence priority, with emphasis on guidelines, systematic reviews or meta-analyses, randomized or prospective comparative studies, pivotal or long-term studies, large real-world or post-market studies, and clinically informative safety, refractive, endothelial, imaging, or complication-related studies. Results: Stent-based Schlemm canal procedures and trabeculotomy/goniotomy-based procedures can provide additional IOP and medication reduction compared with cataract surgery alone in selected eyes with mild-to-moderate open-angle glaucoma. Stent-based procedures generally have a lower hyphema risk, whereas trabeculotomy/goniotomy-based procedures may provide comparable or greater IOP reduction in selected eyes but are associated with more frequent hyphema. In normal-tension glaucoma or low-baseline-IOP eyes, the expected benefit is often medication reduction or modest IOP lowering rather than reliable achievement of very low target IOP. Available refractive evidence remains limited and procedure-specific, but suggests that major refractive instability is uncommon in appropriately selected eyes. Conclusions: The decision to combine Schlemm canal-based MIGS with cataract surgery should be goal-directed rather than based solely on the presence of topical therapy. Practical selection should integrate glaucoma subtype, disease stage, baseline and target IOP, expected phacoemulsification-only IOP reduction, medication burden, ocular surface status, adherence, angle visibility, endothelial reserve, refractive objectives, and future filtration surgery options.
To assess the association of cataract progression and intraocular pressure (IOP) elevation with stable-dosing of topical corticosteroid for chronic anterior uveitis (CAU). All patients with CAU from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort treated with topical prednisolone 1% or equipotent equivalent for at least six months were analyzed. Main outcomes were incident cataract formation and IOP elevation above predefined thresholds (≥21 mmHg and ≥30 mmHg). Additional variables with potential to influence the frequency of the main outcomes were also collected. For the incident cataract outcome, 346 patients met the eligibility criteria. Based on differing eligibility criteria, fewer patients were enrolled for the IOP events (n = 260 and 282 for ≥21 and ≥30 mmHg, respectively). In general, the incidence of cataract formation increased with increasing daily drops of stable-dosing of topical corticosteroid; however, there was no excess risk (relative to zero drops) for eyes exposed to ≤1 drop daily of prednisolone 1% or equivalent [aHR, 0.91 (95% CI, 0.29, 2.84)]. Similarly, higher daily topical corticosteroid exposure conferred greater risk of both IOP outcomes, though plateau effects were observed. For eyes receiving ≤1 drop daily of prednisolone 1% or equivalent, there was no excess risk of either IOP outcome [aHR for ≥21 mmHg, 0.77 (95% CI, 0.19, 3.05) and aHR for ≥30 mmHg, 0.92 (95% CI, 0.11, 7.76)]. Stable-dosing of topical prednisolone 1% or equivalent more than once daily was associated with increased cataract formation and IOP elevation over medium-term follow-up, whereas ≤1 drop/day was not.
In cataract surgery for eyes with corneal opacity, reduced intraoperative visibility remains a major surgical challenge. To enhance intraoperative visualization, OQrimo, a robotic medical device approved in Japan, was used to hold a light guide. Outcomes of 3 eyes from 2 cases are reported. Case 1: A 48-year-old man developed bilateral corneal opacity from graft-versus-host disease following umbilical cord blood transplantation for acute myeloid leukemia. At age 45, he underwent penetrating keratoplasty in the right eye but declined surgery in the left eye. Bilateral cataract surgery under general anesthesia was performed. Due to poor visibility under the surgical microscope in both eyes, a 25-gauge light pipe was inserted into the vitreous cavity and stabilized using OQrimo, thereby improving intraoperative visibility and enabling successful cataract surgery in both eyes. Case 2: A 74-year-old man had previously undergone pterygium excision with conjunctival autograft transplantation for a lesion involving the pupillary area of the left eye. Residual central corneal opacity remained, and cataract surgery was performed 6 months later. Due to poor microscopic visibility, a 25-gauge light pipe was inserted into the vitreous cavity and held using OQrimo. While visualization improved, the weight of the OQrimo arm caused ocular deviation, preventing stable positioning and necessitating its discontinuation. OQrimo effectively enhanced intraoperative visibility in cataract surgery for eyes with corneal opacity, although stable positioning was occasionally challenging.
Since cataract surgery is commonly performed under topical anesthesia, patients remain conscious during the procedure, which may lead to heightened levels of anxiety and pain. This study aimed to examine the effects of a music intervention and stress ball application on patients' levels of anxiety and pain during cataract surgery. This study was designed as a randomized, controlled, single-blind trial. The sample consisted of 240 patients scheduled for cataract surgery at the day surgery unit of a public hospital. Patients were randomly assigned to one of three groups: a music intervention group, a stress ball group, or a control group. State anxiety was assessed preoperatively, immediately after surgery while the patient remained on the operating table, and approximately 10 minutes after transfer to the ward. Pain was assessed immediately after surgery and approximately 10 minutes after transfer to the ward.Patients in the music group listened to music for 15minutes during the surgery, while those in the stress ball group used a stress ball for 15minutes. Baseline (trait) anxiety was measured once preoperatively using the STAI-II. There were no statistically significant differences in sociodemographic or baseline characteristics among the groups (p>0.05). The music group demonstrated significantly lower postoperative pain scores than the control group (p<0.001). Similarly, postoperative anxiety levels were significantly lower in the music group compared to both the stress ball and control groups (p<0.001). Both interventions were effective in reducing anxiety and pain; however, the music intervention demonstrated greater effectiveness compared to the stress ball application. These low-cost, easy-to-implement, and side-effect-free interventions can be recommended for use by surgical nurses to enhance patient comfort, alleviate pain, and improve the overall quality of perioperative care. The findings of this study provide evidence for the clinical effectiveness of nurse-led non-pharmacological interventions in managing pain and anxiety during cataract surgery. Music intervention, in particular, may be prioritized as a primary nursing intervention for reducing pain and anxiety in the immediate and early postoperative period.Stress ball use can serve as a practical alternative in situations where music intervention is not feasible, or as a complementary strategy. Integrating such interventions into perioperative care protocols may enhance patient comfort and improve the overall perioperative care experience.In this context, it is recommended that surgical nurses take an active role in managing patients’ pain and anxiety during cataract surgery and incorporate personalized, patient-preference-based non-pharmacological interventions into routine care practices.
To compare visual performance and patient satisfaction of various intraocular lenses (IOLs) in individuals who underwent bilateral cataract extraction with plano outcomes. Patients underwent staged, bilateral cataract surgery with implantation of AcrySof PanOptix Trifocal, AcrySof SA60 Monofocal, or TECNIS Eyhance monofocal IOLs. All surgeries were performed by a single surgeon using femtosecond laser-assisted cataract surgery. Patients were followed postoperatively at day one, one month, and three months. A validated patient-reported outcome questionnaire, Refractive Cataract Surgery Survey (RCSS), was performed at one month. Exclusion criteria included postoperative spherical equivalent > 0.5 diopters and/or cylinder > 0.75 diopters in either eye. Outcomes were analyzed per patient; thus, both eyes were excluded if the above criteria was not met. The study included 242 eyes of 121 patients, consisting of 62 (51.2%) females and 59 (48.8%) males with a mean age of 66.8 ± 8.2 years (range 31-83 years). A total of 66 eyes (27.2%) received the SA60 IOL, 124 eyes (51.3%) received the PanOptix Trifocal IOL, and 52 eyes (21.5%) received the Eyhance IOL. Toric IOL selection occurred in 65% for SA60, 50% for Eyhance, and 49% for PanOptix. The SA60 showed better uncorrected distance visual acuity compared to other lenses (p < 0.05). The PanOptix showed significantly better binocular uncorrected near visual acuity compared to other lenses (p < 0.001). RCSS lens satisfaction scores were highest with the PanOptix despite having the highest level of dysphotopsia. Overall lens satisfaction was highest with the PanOptix IOL despite having the highest prevalence and severity of dysphotopsias. Some patients may prioritize functional spectacle independence at all distances, explaining high satisfaction rates despite optical trade-offs such as diffractive dysphotopsias.
Cataract surgery is associated with a four times increased risk of nonarteritic anterior ischemic optic neuropathy (NAION). This paper presents the first report of patients from Indian ethnicity with post-cataract surgery NAION (psNAION) and aims to evaluate perioperative risk factors for prediction of psNAION. A retrospective evaluation of patients who developed psNAION was done and clinical characteristics noted. An emulated target trial to evaluate the role of perioperative blood pressure and blood sugar, and postoperative intraocular pressure was conducted with controls matched for age, sex, systemic and ocular comorbidities with known risk of NAION, grade of cataract, type of surgery, type of anesthesia, and intraoperative complications. Nineteen patients (8 males, 11 females) aged 66.6 ± 7.7 years developed psNAION 80.8 ± 50.6 days after cataract surgery. Five (21.1%) patients had no known systemic risk factors for NAION. Three patients presented <7 days and 16 presented >6 weeks from surgery. None of the evaluated variables (perioperative blood pressure and blood sugar, and postoperative intraocular pressure) correlated significantly with increased risk of psNAION. Onset of psNAION is much later in Indian patients. All patients had classical features of NAION, and clinical evaluation was sufficient to establish diagnosis. One-fifth of patients had no known coexisting risk factors. Perioperative control of blood pressure or blood sugar, and postoperative intraocular pressure were not associated with increased risk.
To describe preoperative triage and compare early postoperative complications after manual small-incision cataract surgery (MSICS) and extracapsular cataract extraction (ECCE) performed during a humanitarian mission in Benin, where no phacoemulsification device was available. Medical records and operative reports from 1,280 individuals examined during a humanitarian cataract mission in Porto-Novo, Benin, between November 25 and December 6, 2024, were retrospectively reviewed. Patients were triaged according to cataract-related best-corrected visual acuity, systemic risk factors, and ocular findings. After exclusion of patients with capillary glucose > 300 mg/dL, blood pressure > 200/120 mmHg, or preoperative retinal detachment, 287 patients were considered suitable for surgery and 125 underwent surgery. Patients were classified by technique as MSICS (n = 79) or ECCE (n = 46). Postoperative complications documented on postoperative day 1 or during the mission were compared using two-sided Fisher exact tests. Among the 125 operated patients, 79 underwent MSICS and 46 underwent ECCE. Aphakia occurred in 6 patients (4.8%), IOL dislocation in 3 (2.4%), marked endothelial edema in 11 (8.8%), postoperative IOP elevation in 12 (9.6%), and corneal suture dehiscence in 1 (0.8%). Marked endothelial edema was more frequent after ECCE than MSICS (8/46 [17.4%] vs. 3/79 [3.8%]; p = 0.018). No significant between-group differences were observed for aphakia (p = 0.192), IOL dislocation (p = 0.554), IOP elevation (p = 0.533), or corneal suture dehiscence (p = 0.368). No cases of IOL drop into the vitreous cavity, nuclear drop, intravitreal hemorrhage, toxic anterior segment syndrome, or endophthalmitis were observed in either group. In settings without a phacoemulsification device, MSICS and ECCE can be performed during humanitarian missions when experienced surgeons, careful preoperative triage, and appropriate postoperative assessment are available. MSICS may offer practical advantages where follow-up is limited because it generally avoids routine corneal suture removal. Because technique and surgeon were not independently separable in this nonrandomized study, the observed differences should not be interpreted as purely technique-related.
Transient receptor potential vanilloid 4 (TRPV4) channels are mechanosensitive ion channels implicated in Ca2+ signalling across various tissues, yet their functional role in human lens epithelial cells remains poorly understood. We aimed to investigate the contribution of TRPV4 to mechanically induced Ca2+ signalling in human anterior lens epithelium. Human anterior lens epithelial preparations were obtained from postoperative lens capsules, including both cataractous and non-cataractous samples. Using multicellular Ca2+ imaging, we analysed the spatiotemporal properties of intercellular Ca2+ waves following localised mechanical stimulation under control conditions and after pharmacological inhibition of TRPV4 with HC-067047. Mechanical stimulation triggered radially propagating Ca2+ waves characterised by distance-dependent attenuation of amplitude and kinetics. TRPV4 inhibition significantly reduced wave propagation velocity and enhanced spatial signal decay, indicating a key role in maintaining efficient intercellular Ca2+ signal propagation. These effects were most pronounced in non-cataractous epithelium, while in cataractous lenses, they exhibited stage-dependent differences, suggesting remodelling of Ca2+ signalling pathways during disease progression. The observed intercellular Ca2+ wave propagation is consistent with gap junctional and paracrine signalling, while TRPV4 activity modulates its efficiency by shaping the initiating Ca2+ response. TRPV4 channels contribute to both the efficiency and spatial extent of Ca2+ signalling in the lens epithelium. These findings identify TRPV4 as an important regulator of mechanically induced intercellular communication and a potential target for modulating lens function in health and disease.
Age-related cataract is a leading cause of visual impairment among older adults, significantly affecting quality of life and independence. Accurate severity grading is essential for determining optimal surgical timing and improving clinical outcomes; however, conventional slit-lamp examination relies heavily on subjective assessment, resulting in considerable inter-observer variability. In this study, we propose a progressive ordinal attention network (POA-Net) for automated four-level cataract classification. The proposed method is built on a convolutional neural network backbone and introduces a progressive ordinal cumulative attention mechanism to explicitly capture the continuous progression of disease severity. A spatial gating module is further incorporated to suppress background interference and enhance feature representation of the lens region. In addition, an ordinal prototype projection head with a topology-constrained learning strategy is designed to enforce structured feature distributions consistent with clinical knowledge. Experimental results demonstrate that POA-Net achieves an accuracy of 89.20% and a weighted kappa coefficient of 93.82%, outperforming several state-of-the-art convolutional and Transformer-based methods. The model shows improved capability in distinguishing adjacent severity levels and exhibits strong agreement with clinical annotations. These findings indicate that the proposed approach provides an accurate, consistent, and interpretable solution for automated cataract grading, with potential applications in large-scale screening and long-term monitoring, particularly in resource-limited settings.
To compare the changes of pupil parameters and visual quality after cataract surgery and explore their potential correlations. This retrospective cohort study analyzed clinical data of Han Chinese patients who received cataract surgery from June 2016 to October 2016. Visual acuity, pupil size, pupil shift, wavefront aberrations, point spread function (PSF), and modulation transfer function (MTF) were detected preoperatively, 1d and 1mo postoperatively. Pupil parameters and visual outcomes were compared across the three time points. A total of 110 eyes from 110 patients (42 males and 68 females) were enrolled, with a mean age of 66.8±7.9y (range: 53-88y). Under both photopic and mesopic conditions, pupil diameter and pupil shift at 1d and 1mo after surgery were significantly lower than baseline levels. Corneal aberrations decreased postoperatively. Photopic and mesopic modulation transfer function derived from higher-order (HO) aberrations increased significantly from postoperative day 1 to postoperative month 1. Pupil size was positively correlated with wavefront aberrations, and negatively correlated with total PSF and HO-PSF. Significant correlations were identified between preoperative pupil diameter and 1-month postoperative visual quality indicators (including aberrations, PSF and modulation transfer function). A preoperative mesopic pupil diameter over 5.60 mm effectively predicted poor 1-month postoperative visual quality (HO aberrations >0.5 µm), with an area under the curve (AUC) of 0.71. Pupil parameters and visual quality alter significantly after cataract surgery, and moderate correlations exist between pupil diameter and visual quality at each time point. Preoperative pupil diameter is correlated with 1-month postoperative visual quality.
To evaluate whether the corneal endothelium experiences increased temperatures and thermal damage during femtosecond laser-assisted cataract surgery (FLACS), we performed comparative in vivo studies. These studies compared FLACS with conventional phacoemulsification cataract surgery (CPS) systems. In this study, 410 eyes with grade II or III nuclear sclerotic cataracts undergoing either CPS (n = 213) or FLACS (n = 197) were examined. All eyes received balanced salt solution at 21°C or 29°C during phacoemulsification. In FLACS, a SoftFit patient interface (PI) was used at 21°C or 29°C. The surface temperature and intraocular temperature were recorded using a thermometer. Postoperative therapies were identical across all groups. Endothelial cell loss (ECL) was measured with a specular microscope before and 1 week post-surgery. The average temperature in the anterior chamber was similar after FLACS and CPS. FLACS used less cumulative dissipated energy (CDE) and resulted in lower ECL than CPS. However, no significant difference was found in mean CDE or ECL between subcohorts with different PI temperatures. The same applied to subcohorts with different balanced salt solution temperatures. At a PI temperature of 21°C, both anterior chamber temperature and ECL were lower in the first 10 minutes after femtosecond laser (FL) treatment than afterward. FL does not cause temperature increases in the anterior chamber. In contrast, FLACS reduces CDE and ECL compared with CPS. Additionally, lowering PI temperature and performing FL before phacoemulsification - especially during the first 10 minutes - may help protect the corneal endothelium.
This systematic review and meta-analysis evaluates refractive error (RE), visual acuity (VA), intraocular pressure (IOP), and anterior chamber depth (ACD) outcomes following surgical procedures in adults (≥ 18 years) with nanophthalmos, microphthalmos, and high hyperopia. Nanophthalmos, microphthalmos, and high hyperopia are a spectrum of anatomic variants characterized by short axial length and crowded anterior segment. These features create significant risks for angle-closure glaucoma and complex cataract surgery. As existing literature is fragmented and limited to small case series, this study provides a comprehensive evaluation of surgical safety and efficacy in these high-risk populations. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a search was conducted across five databases (Cochrane, PubMed, Scopus, Ovid MEDLINE, and Embase via Ovid) for studies published between January 2010 and December 2024. Eligible studies reported original clinical data on surgical interventions for adult (≥ 18 years) patients with nanophthalmos, microphthalmos, or high hyperopia with concomitant cataract or glaucoma. Meta-analysis, subgroup analysis, and meta-regression were performed to assess changes in RE, VA, IOP, and ACD. Meta-analysis of 21 articles involving 957 patients (1,110 eyes) suggests that surgical intervention is associated with improvement in clinical parameters across a spectrum of short eyes. Standalone phacoemulsification significantly reduced RE in nanophthalmic eyes (mean difference (MD) = -13.20 diopters (D); 95% confidence interval (CI): -15.19, -11.22; Q = 3.51, p = 0.48, I2 = 0.0%) at medium-term follow-up and in high hyperopic eyes (MD = -9.23 D; 95% CI: -15.02, -3.45; Q = 322.19, p < 0.001, I2 = 97.8%) at medium-term follow-up with high heterogeneity in the effects. Standalone phacoemulsification significantly improved VA in nanophthalmic eyes at both short-term (MD = -0.66 logarithm of the minimum angle of resolution (logMAR); 95% CI: -1.30, -0.02; Q = 98.45, p < 0.001, I2 = 97.0%) and medium-term (MD = -0.70 logMAR; 95% CI: -1.30, -0.09; Q = 97.14, p < 0.001, I2 = 93.8%) follow-up with high heterogeneity in the effects. In contrast, phacoemulsification + filtering surgery resulted in a significant worsening in VA at short-term follow-up for nanophthalmic eyes (MD = 0.28 logMAR; 95% CI: 0.21, 0.35; Q = 1.24, p = 0.27, I2 = 19.4%). Significant IOP reduction was achieved primarily through combined procedures in both nanophthalmic and microphthalmic eyes. Presence of concomitant glaucoma was associated with a greater reduction in IOP across all axial lengths. Significant ACD deepening was achieved across all axial lengths (MD = 1.30 millimeters (mm), 95% CI: 0.86, 1.74; Q = 244.55, p < 0.001, I2 = 99.3%) with high heterogeneity in the effects. Meta-regression identified a significant study-level association between mean age and post-operative RE (multiple adjusted coefficient: 10.72, p = 0.001). No effect of race was detectable in this study-level meta-regression, although power was limited. Surgical interventions in adults with nanophthalmos, microphthalmos, and high hyperopia were associated with meaningful improvements in RE, VA, IOP, and ACD, although outcomes varied by underlying diagnosis and procedure type. Standalone phacoemulsification consistently improved refractive and anatomical outcomes, particularly in nanophthalmos and high hyperopia, while combined procedures incorporating vitrectomy or filtering surgery achieved greater IOP reduction in eyes with concomitant glaucoma. Subgroup analyses suggested that shorter axial length and the presence of glaucoma influenced treatment response. However, substantial heterogeneity across studies and frequent post-operative complications highlight the need for standardized surgical protocols and higher-quality prospective studies to better define optimal management strategies for these anatomically complex eyes. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251033701, identifier CRD420251033701.
Presbyopia and corneal astigmatism frequently coexist in cataract patients, reducing visual quality and increasing spectacle dependence. Toric trifocal intraocular lenses (IOLs) aim to address both conditions simultaneously. This prospective study evaluated the visual performance, quality, patient satisfaction, and safety profile of the Liberty 677MTY toric IOL, and classified its functional profile based on distance-corrected monocular defocus curve analysis. This prospective, single-center, non-comparative clinical investigation included 28 eligible cataract patients with corneal astigmatism (1.00-6.00 D) who underwent bilateral implantation of the Liberty 677MTY trifocal toric IOL. Uncorrected and distance-corrected visual acuities at all distances, subjective refraction, IOL rotational stability, defocus curves, contrast sensitivity, patient-reported visual function, and safety were reported during a 12-month follow-up period. The Liberty 677MTY IOL demonstrated significant improvements (p < 0.05) in uncorrected and distance-corrected visual acuities and subjective refractive cylinder, with stability over time. IOL alignment was stable through follow-up, with mean signed and absolute rotations of < 2° and < 5°, respectively. Binocular visual acuity defocus curves showed visual acuities better than 0.2 logMAR across the range of + 1.00 to ‑3.50 D. Monocular visual acuity defocus analysis confirmed full range of field smooth (FRoF-Sm) classification of the IOL. Contrast sensitivity defocus curve met acceptance criteria. Based on patient-reported outcomes 89% rated satisfaction as high, and 83% reported mild or no difficulty with visual disturbances. At 12 months, spectacle independence was achieved in 96.3% of patients for far, 81.5% for intermediate, and 92.6% for near vision. Safety analysis revealed one Nd: YAG-treated PCO case (1.61%) and no other IOL-related adverse events. This study provides a detailed evaluation of the Liberty 677MTY trifocal toric IOL, integrating real-life binocular visual experience with comprehensive monocular assessments. The lens demonstrated predictable refractive outcomes, excellent rotational stability, and consistently high-quality vision across all distances, with strong patient satisfaction. Classified as FRoF-Sm by monocular defocus curve analysis, the lens offers continuous functional vision. By integrating monocular and binocular perspectives, these findings offer a clearer understanding of the lens's performance, supporting its use as a safe and effective solution for achieving spectacle independence and enhancing postoperative quality of life.
Epithelial downgrowth (ED) is a rare but dreaded complication of intraocular surgery or trauma and is characterized by the intraocular migration or seeding of epithelial cells from the ocular surface, sometimes with concurrent intraocular proliferation of fibrovascular tissue. Due to its insidious development, it may present diagnostic difficulties to the ophthalmologist; moreover, its relentless progression poses a tough therapeutic challenge with a generally poor visual prognosis. In this paper, we describe the case of a 68-year-old man who developed mixed ED and fibrous ingrowth (FI) after complicated cataract surgery. His clinical picture was initially misdiagnosed and treated as malignant glaucoma with only a brief period of improvement. Surgical removal of a specimen of the pathologic intraocular tissue, followed by its cytological analysis, confirmed the diagnosis. Due to intractably high intraocular pressure (IOP) and persistent corneal edema, we proceeded to glaucoma shunt implantation and subsequently to full-thickness corneal transplantation. Eighteen months after the keratoplasty, the patient fares well with a reasonably good vision of 20/30, a clear corneal graft, and no signs of downgrowth recurrence. This case illustrates the diagnostic and therapeutic challenges posed by ED but also the importance of its multidisciplinary management in order to achieve the best possible visual outcome for the patient.
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Whether prior pars plana vitrectomy (PPV) independently increases the risk of cystoid macular edema (CME) following cataract surgery remains unknown. To evaluate associations between prior PPV and incidence of CME after cataract surgery. This retrospective cohort study was conducted using the TriNetX US Network, a multicenter federated electronic health record network from December 2005 to December 2025 including academic and community hospitals in the US. Adults aged 18 years or older who underwent cataract surgery were categorized into those with vs those without a history of PPV (≥6 months prior to cataract surgery), excluding those with preexisting CME or risk factors for CME. Data were analyzed from December 2025 through January 2026. History of PPV performed more than 6 months prior to cataract surgery. The primary outcome was the incidence of CME within 30 to 90 days postoperatively, identified by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnostic codes. Risk ratios (RR) were used to compare outcomes. Propensity score matching was performed for demographic and clinical covariates (age, sex, race, hypertension, hyperlipidemia, diabetes, myopia, retinal detachment [RD] history). After propensity score matching with 615 983 patients undergoing cataract surgery, 7422 patients had a prior PPV. After propensity score matching, among patients with prior PPV, mean (SD) age was 62.0 (11.6) years, and 3623 patients (49.5%) were female; among the non-PPV group, mean (SD) age was 61.9 (12.2) years, and 3625 patients (49.5%) were female. Among 14 636 patients representing 7318 propensity score-matched pairs, CME occurred in 336 of 7318 patients with prior PPV (4.59%) compared with 90 of 7318 non-PPV controls (1.23%) (difference, 3.36%; 95% CI, 2.82%-3.90%; RR, 3.73; 95% CI, 2.97-4.70; P < .001). Elevated CME risk persisted in subgroup analyses evaluating prior PPV for RD (5.65% vs 1.22%; absolute difference, 4.43%; 95% CI, 3.48%-5.38%; RR, 4.62; 95% CI, 3.20-6.67; P < .001), as well as those for non-RD indications (3.99% vs 1.23%; absolute difference, 2.76%; 95% CI, 2.06%-3.48%; RR, 3.26; 95% CI, 2.36-4.50; P < .001). Furthermore, after excluding patients with intraoperative and postoperative complications of cataract surgery, the prior PPV group was still found to have a higher risk of CME (4.59% vs 1.26%; absolute difference, 3.32%; 95% CI, 2.77%-3.88%; RR, 3.63; 95% CI, 2.88-4.58; P < .001). Results of this cohort study suggest that eyes with vs without prior PPV have higher incidences of postoperative CME. However, numerous limitations, including dependence on coding-based diagnoses and lack of visual acuity outcomes, preclude determining the role of prophylaxis or monitoring for CME in vitrectomized eyes undergoing cataract extraction.