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Incidence of posterior capsular opacification requiring Nd:YAG capsulotomy after cataract surgery and implantation of enVista? MX60 IOL
摘要： Purpose. — To evaluate incidence of posterior capsule opacification requiring Nd:YAG capsulotomy over 3 years in a large series of eyes implanted with the enVista? MX60 Intraocular Lens (IOL). Methods. — A university-based, single-center, observational study of patients’ medical records was conducted. Uneventful cataract surgery patients with in-the-bag implantations of the enVista? MX60 IOL with a minimum of 24 months follow-up were included in the study. Exclusion criteria were insufficient follow-up (< 24 months), intraoperative complications and combined surgery. The primary outcome measure was rate of YAG laser capsulotomy, while secondary outcome measures were time to YAG laser capsulotomy and rate of glistenings. Results. — A total of 245 eyes of 143 patients received the MX60 IOL and were followed in the same center. Of these, 226 eyes were included in the study. Mean age was 80.7 ± 8.3 years and M/F ratio was 42/101 (29.4/70.6%). The mean preoperative distance (logMAR) visual acuity was 0.67 ± 0.5, while postoperatively it was 0.31 ± 0.5 at the last visit. The Mean follow-up time (min-max) was 35.2 ± 7.2, (24—48.4) months. The incidence of Nd:YAG capsulotomy over 3 years was 5/226 (2.2%). Average time between surgery and Nd:YAG capsulotomy was 32.17 months. Univariate analysis of age, gender, presence of comorbidity and baseline visual acuity found no predictive factors for capsulotomy. No glistenings were reported at any postoperative visit. Conclusion. — The three-year cumulative incidence of PCO requiring Nd:YAG laser capsulotomy was 2.2% for the enVista? MX-60 IOL, with no glistenings observed during follow-up. This low rate confirms the excellent safety profile of this IOL.
关键词： Cataract surgery,Intraocular lens,Posterior capsule opacification,MX60,Glistening
更新于2025-09-23 15:23:52
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[Lecture Notes in Computational Vision and Biomechanics] Computer Aided Intervention and Diagnostics in Clinical and Medical Images Volume 31 || Deep Neural Architecture for Localization and Tracking of Surgical Tools in Cataract Surgery
摘要： Over the last couple of decades, the quality of surgical interventions has improved owing to the use of computer vision and robotic assistance. One such application of computer vision, namely, detection of surgical tools in videos is gaining attention of the medical image processing community. The main motivation for detection, localization, and annotation of surgical tools is to develop applications for surgical workflow analysis. Such an analysis can aid in report generation, real-time decision support, etc. Cataract surgery is one of the common surgical procedure where surgeons do have direct visual access to the surgical site. Extremely small tools are used for this procedure and the surgeons observe the surgical site through a surgical microscope. In such cases, detecting the presence of tools can act an additional aid to the surgeon as well as other surgical staffs. We propose a framework consisting of a Convolutional Neural Network (CNN) which learns to distinguish and detect the presence of various surgical tools by learning robust features from the frames of a surgical video. Various deep neural architectures are hence evaluated for the task of detecting tools. The baseline models used for the purpose are pretrained on Imagenet dataset and they render upto 50% prediction accuracy. All the experiments have been validated on the dataset released as part of the Cataracts Grand Challenge. A framework for localization and detection of tools has also been proposed, which is capable of extracting visual features from glimpses of an image, by adaptively selecting and processing only the selected regions at high resolution.
关键词： Multiple tool detection,Cataract surgery,CNN,Glimpse network,Deep neural architectures,Class imbalance
更新于2025-09-23 15:23:52
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Simulateur de chirurgie de cataracte EyeSi?: validité de construction des modules capsulorhexis, phacoémulsification et aspiration des masses cristalliniennes
摘要： Introduction. — Le but de notre étude est de tester la capacité du simulateur EyeSi à discriminer les chirurgiens novices des chirurgiens expérimentés lors de la réalisation des exercices de 3 modules de formation à la chirurgie de cataracte, afin de confirmer sa validité de construction pour ceux-ci. Matériels et méthode. — Nous avons inclus 18 chirurgiens répartis en 3 groupes : les ? novices ? (6 internes n’ayant jamais opéré de cataracte), les ? intermédiaires ? (6 internes ayant opéré entre 1 et 10 cataractes) et les ? experts ? (6 chirurgiens ayant opéré plus de 500 cataractes). Nous avons sélectionné 3 modules d’entra?nement du simulateur, le capsulorhexis, la phacoémulsification-cracking et l’aspiration des masses cristalliniennes résiduelles. Douze exercices de difficulté croissante ont été réalisés 2 fois de suite par chaque participant. Nous avons comparé les résultats du 2ème essai en stratifiant sur l’expérience du chirurgien. Résultats. — Pour le module capsulorhexis, dans l’exercice 1, les experts obtiennent des scores plus élevés que les 2 autres groupes (p = 0,0102). Pour le module phacoémulsification-cracking, les experts ont des scores significativement supérieurs dans l’exercice 8 (p = 0,0495) et il existe une tendance à la significativité dans les exercices 3 (p = 0,0934) et 5 (p = 0,0938). Le temps de réalisation de l’exercice décro?t également en fonction du niveau d’expérience dans les exercices 1 (p = 0,0444), 4 (p = 0,06) et 5 (p = 0,0189). Conclusion. — Nos résultats mettent en évidence de meilleurs résultats du groupe experts pour 4 exercices des modules capsulorhexis et phacoémulsification-cracking. Ceci confirme la validité de construction du simulateur EyeSi pour la chirurgie de cataracte déjà mise en évidence par d’autres travaux. Notre étude permettra de contribuer à la réalisation de programmes de formation pertinents sur simulateur pour les internes en ophtalmologie.
关键词： Irrigation and aspiration,Capsulorhexis,Cataract surgery,EyeSi cataract surgery simulator,Construct validity,Phacoemulsification,Systematic training program
更新于2025-09-23 15:22:29
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Comparison of Clinical Outcomes between Torsional and Longitudinal Phacoemulsification
摘要： Purpose: To compare the clinical outcomes during phacoemulsification when using recently improved longitudinal (Stellaris?, Bausch & Lomb, Rochester, NY, USA) and torsional (Infiniti Ozil?, Alcon, Fort Worth, TX, USA) ultrasound. Methods: The present study included 74 eyes of 59 patients undergoing cataract surgery. Operated eyes with mild cataract (nuclear sclerosis grade 1 and 2), moderate cataract (nuclear sclerosis grade 3) and hard cataract (nuclear sclerosis grade 4 and 5) were compared in terms of the total phacoemulsification (phaco) time, average phaco power, total phaco energy and amount of fluid used during cataract surgery between the 2 modalities. Endothelial cell density, corneal edema, central corneal thickness (CCT), surgically induced astigmatism (SIA) and best-corrected visual acuity (BCVA) were also evaluated preoperatively and up to 3 month postoperatively. Results: In mild cataracts, the operative parameters and corneal changes were similar between the 2 modalities. In moderate cataracts, the total phaco time was significantly higher in the torsional group than the longitudinal group, but the average phaco power, total phaco energy, and amount of fluid were not significantly different. In patients with hard cataract, the torsional group showed higher total phaco time (27.50 ± 17.77 sec vs. 97.08 ± 12.67 sec), average phaco power, total phaco energy, persistent corneal edema at 1 week postoperatively and more endothelial cell loss at 3 month postoperatively (16.33 ± 15.50% vs. 38.71 ± 26.49%). Postoperative CCT, SIA and BCVA were not significantly different in hard cataracts between the 2 modalities. Conclusions: In mild and moderate cataracts, the efficiency of phaco and corneal changes were similar between the 2 modalities. However, recently improved longitudinal phaco showed superior efficiency for hard cataracts and induced less endothelial cell loss than torsional phaco.
关键词： Longitudinal,Cataract surgery,Phacoemulsification,Nuclear density,Torsional
更新于2025-09-23 15:22:29
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Neue Intraokularlinsendesigns f??r die Femtosekundenlaser-assistierte Kataraktoperation; New intraocular lens designs for femtosecond laser-assisted cataract operations;
摘要： The perfection and high reproducibility of capsulotomy in femtosecond laser-assisted cataract surgery (FLACS) lead to the possibility of new intraocular lens (IOL) designs for capsulotomy fixed implantation. Currently four different types of femtolenses for capsulotomy fixation are described in the literature or are commercially available. The first described was the lens in the bag or Tassignon IOL, which was developed for secondary cataract prevention, the second was the Masket IOL for reduction of negative dysphotopsia and third the 90F designed by Dick. All three types are or will be produced by Morcher. The fourth lens is the Femtis from Oculentis. All lenses are characterized by a high level of safety during implantation, The Tassignon lens leads to reduction of secondary cataract, especially in juvenile cataract because of the additional posterior capsulotomy. In studies the Masket IOL could show a decrease of negative dysphotopsia. In comparison to standard lenses, the 90F and Femtis in particular showed better results with respect to tilt, rotation and decentration. The new IOL designs for capsulotomy fixation show a safe implantation procedure and indications for a very stable position in the capsular sac. Further studies must be carried out to confirm the possible advantages in comparison to standard IOL with respect to postoperative results for refraction, tilt, rotation and decentration and possible induction of aberrations.
关键词： Femtolens,Femtosecond laser-assisted cataract surgery,Capsulotomy,Decentration,Tilt
更新于2025-09-23 15:21:01
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Change in Axial Length Pre and Post Cataract Surgery Measured with IOL Master
摘要： Objective: Cataract surgery with intraocular lens (IOL) implantation tries to get a refractive result nearby to the optic emmetropia. So an accurate IOL power calculation is mandatory, and axial length (AL) measurement is one of the most influential parameter in this calculation. IOL Master is one of the most popular devices to measure AL, which uses the same group refractive index of the lens for all patients, independently of the cataract grade. But lens refractive index is higher as cataract grade increases. Nowadays cataract tends to be operated earlier, so moderate cataracts are the most extracted in clinical practice. Therefore, it is important to study the influence of moderate lens opacity in AL measurements. The objective of this study was to compare the AL value measures with IOL Master, before and after uncomplicated cataract surgery in patients with moderate cataracts. Material and methods: This study included 153 eyes of 105 patients (67.51 ± 13.56 years old) undergoing uncomplicated cataract surgery. Lens opacity was determined with the LOCSIII scale and AL was measured using optical biometry (IOL Master; Carl Zeiss Meditec) before and one month after intervention. Intraoperative measurements (ultrasound time and fluid volume) were also registered. Results: Mean preoperative AL of 25.10 ± 3.19 mm (range 20.54 to 36.06; IC95% 24.59 to 25.60 mm) and postoperative of 24.88 ± 3.16 mm (IC 95% 24.37 to 25.39; range 20.43 to 35.79 mm). The mean AL difference before and after surgery was 0.19 ± 0.05 mm (p=0.549 ANOVA) with agreement limits from 0.09 to 0.29 mm. It was observed more difference in eyes with larger AL (r2=0.14 p<0.01). The average cataract grade in each category was: nuclear opacity 2.25 ± 1.00 (range 1 to 5) (p=0.564 ANCOVA), cortical opacity 2.04 ± 0.73 (range 0 to 4) (p=0.543 ANCOVA), posterior subcapsular opacity 0.44 ± 0.90 (range 0 to 4) (p=0.563 ANCOVA), and nuclear color 2.40 ± 1.05 (range 0 to 5) (p=0.558 ANCOVA), without statistical significant effect in the AL difference pre and after cataract surgery. The ultrasound time used during the surgery was 43 ± 29 seconds (p=0.525 ANCOVA) and the fluid volume was 4.73 ± 1.31 (p=0.560 ANCOVA) cubic centimeters without statistically significant relationship between these parameters and the difference in the AL measurement. Conclusions: The difference in AL measurement with IOL Master before and after cataract surgery in eyes with low grade of cataract should be related with IOL Master reproducibility especially in extreme-long eyes. Moderate cataract showed non-statistically effect on AL measurement with IOL Master biometry.
关键词： IOL master biometry,Cataract surgery
更新于2025-09-23 15:21:01
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Application of Femtosecond Laser in Anterior Segment Surgery
摘要： Femtosecond laser (FSL) is a near-infrared laser that can create reliable and reproducible tissue cutting with minimal damage to adjacent tissue. As the laser can also create incisions with various orientations, depths, and shapes, it is expected to be a useful tool for anterior segment surgery, such as cornea, refractive, and cataract surgery. In this review, the authors will introduce the application of FSL in various anterior segment surgeries and discuss the results of studies regarding the efficacy and safety of FSL in cornea, refractive, and cataract surgery. Experimental studies regarding the potential use of FSL will also be introduced. The studies discussed in this review suggest that FSL may be a useful tool for improving the prognosis and safety of surgeries of the anterior segment.
关键词： anterior segment surgery,Femtosecond laser,cataract surgery,refractive surgery,cornea surgery
更新于2025-09-23 15:19:57
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Zukunftsperspektiven des Femtosekundenlasers in der Vorderabschnittschirurgie; Future perspectives of the femtosecond laser in anterior segment surgery;
摘要： Around 12 years after its introduction laser cataract surgery (LCS) has enabled remarkable progress, such as extremely precise capsulotomy and lens fragmentation with reduced or no ultrasound energy at all (zero phako); however, another innovation push is necessary to bring this technology to its full potential. Among the many benefits that have not yet been fully explored are primary posterior laser capsulotomy (PPLC) and the use of the femtosecond laser in pediatric cataract patients. In the present collective of patients in whom a PPLC was carried out at the end of the operation, a clearly reduced prevalence of secondary cataract could be observed, whereas the short additional intervention was not associated with notable complications. The LCS in infants is best carried out as an off-label procedure, which has been rendered more precise by the Bochum formula. In the near future, postoperative laser fine tuning will enable the target refraction to be achieved in most patients. Laser-induced refractive index change (LIRIC) will enable very exact refraction alterations on an already implanted intraocular lens (IOL), on a contact lens and on a treatment native cornea. A new version of the Scheimpflug camera will be used just prior to surgery to analyze the morphology and kernel density of the lens opacity and to carry out a real-time grading of lens hardness. Based on this categorization, where the system classifies the results into five different density grades, the surgeon is automatically provided with an individualized fragmentation pattern defined preoperatively by the operator. A further innovation of the same system involves microcorneal incisions for fine tuning of residual refractive deficits.
关键词： Femtosecond laser-assisted cataract surgery,Bochum formula,Postoperative refractive enhancement/fine tuning,Primary posterior laser capsulotomy,Laser-induced refractive index change
更新于2025-09-23 15:19:57
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Comparison of astigmatism correction between anterior penetrating and intrastromal arcuate incisions in eyes undergoing femtosecond lasera??assisted cataract surgery
摘要： To compare the safety, efficacy, and predictability of femtosecond laser–enabled anterior penetrating and intrastromal arcuate incisions for the correction of preoperative astigmatism at the time of cataract surgery.
关键词： anterior penetrating incisions,femtosecond laser,cataract surgery,astigmatism correction,intrastromal incisions
更新于2025-09-23 15:19:57
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The Role of Subthreshold Micropulse Yellow Laser as an Alternative Option for the Treatment of Refractory Postoperative Cystoid Macular Edema
摘要： Background: To evaluate the efficacy and the safety of subthreshold micropulse yellow laser (SMYL) in the treatment of chronic postoperative cystoid macular edema (PCME), which is refractory to standard therapies. Methods: A retrospective chart review of ten eyes of ten patients affected by refractory PCME who underwent SMYL was performed. Five PCME cases were subsequent to uncomplicated cataract surgery (CS), two cases to complicated CS (CCS) with posterior capsule rupture and three cases occurred after retinal detachment surgery (RD). All conditions were refractory to conventional treatments prior to SMYL interventions for at least 4 months, including nonsteroidal anti-inflammatory eyedrops, topical steroids, oral indomethacin, sub-Tenon’s triamcinolone injections and Dexamethasone intravitreal implants. All patients underwent one or more treatments with 577 nm SMYL photo-stimulation, with 7 × 7 grids with confluent spots and a 5% duty cycle covering the whole edematous retina, including the foveal center. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were obtained using OCT, and evaluated before and after the treatment at 1, 2, 3 and 6-month follow-ups. Results: A complete subfoveal macular edema resolution was observed in all of the eyes, with statistically significant improvements in terms of BCVA and CMT in all of the follow-up timelines (at 6 months, p = 0.002 and p = 0.005, respectively). The mean number of laser treatments was 1.3. At the final follow-up, a complete subfoveal edema reabsorption was observed in all patients with visual acuity improvement. No complications were observed in any case. Conclusions: SMYL seems to be a safe and effective treatment for the long-term resolution of refractory PCME and may be a useful alternative to expensive and invasive therapeutic options.
关键词： micropulse yellow laser,cataract surgery,refractory macular edema,post-surgical cystoid macular edema
更新于2025-09-23 15:19:57