Catharina Latz

This feasibility study developed and validated an AI algorithm for automatic classification of human lens opacification (cataracts) using anterior segment optical coherence tomography (OCT). The dataset comprised 1,802 unprocessed OCT images from 901 eyes, with cataract severity graded by slit-lamp examination using the Lens Opacities Classification System (LOCS) III. Nuclear opalescence (NO) was stratified as mild (≤3.0), moderate (3.5–4.0), or severe (≥4.5), while posterior subcapsular cataract (PSC) was classified as mild (<4) or severe (≥4). Nuclear color (NC) and cortical cataract (C) were not evaluated. After balancing, images were randomly divided into three sets: 70% for training, 20% for testing and 10% for validation. A convolutional neural network was trained five times. Patients had a mean age of 72 ± 8.8 years, with mean LOCS III grades of 3.81 ± 0.79 (NO) and 1.74 ± 1.55 (PSC). The AI achieved 60.3% accuracy for NO classification; among misclassifications, 34.9% were within one category, 4.8% were grossly inaccurate. PSC classification performed with 86.4% accuracy, yielding a true positive rate of 81.8% and a true negative rate of 90.9%. These results demonstrate the potential of deep learning for automated cataract grading.

Background: Partial range of field (PROF) intraocular lenses (IOLs) provide good distance visual acuity with enhanced intermediate visual acuity. Neuroadaptation to new intraocular lenses can take several months. This study investigates visual and patient-reported outcomes (PROMs) in patients implanted with the PROF IOL ICB00 (Johnson & Johnson Vision) 18 months post-surgery. A particular focus was put on spectacle independence while performing activities of daily life. Methods: This ambispective, single-center study included 41 patients (aged 48–84). Visual acuities (distance, intermediate), refraction, and PROMs were assessed ≥18 months post-surgery. Spectacle independence was evaluated using the PRSIQ questionnaire. Patients also self-reported on visual quality, task performance, and photic phenomena. Results: Binocular visual acuity of 0.20 logMAR or better was achieved by 100.0% of patients for uncorrected or corrected distance, by 73.2% for uncorrected intermediate, and by 79.5% for distance-corrected intermediate vision. Photic phenomena were reported by <10%. Mean visual quality scores were 1.68 ± 0.72 for distance and 2.05 ± 0.92 for intermediate vision, where 1 equaled very good and 6 equaled very poor. Complete spectacle independence was reported by 87.8% for distance and 53.7% for intermediate vision. Satisfaction rates were 90.2% (distance), 87.8% (intermediate), and 51.2% (near). Conclusions: The ICB00 IOL provides excellent long-term distance and satisfactory intermediate vision, with high spectacle independence and even higher patient satisfaction, although most patients require spectacles for near vision. Trial registration: This study was approved by the medical ethics committee of the Medical Chamber of North-Rhine, Germany (CE # 2124770CE01).

Purpose This study aimed to evaluate the occurrence of pseudophakic cystoid macular edema (PCME) post low-energy femtosecond laser-assisted cataract surgery (FLACS) in a high-volume surgical setting. Methods The medical records of 242 FLACS patients were retrospectively reviewed. The central subfield macular thickness (CSMT) was measured via optical coherence tomography (OCT) before and 4–6 weeks after surgery, and the results were compared for PCME detection. Macular edema was defined as a 10% increase in CSMT, a new onset of intraretinal fluid, or a decrease in visual acuity (VA). VA development in PCME patients was reviewed at 2–3 months and 6 months. Results The median patient age was 72 years (49–92 years). Among 242 eyes, seven eyes (2.89%) developed PCME. The median preoperative CSMT in these eyes was 255 μm (minimum 231 μm, maximum 326 μm), whereas the median CSMT at 4–6 weeks after surgery was 317 μm (minimum 255 μm, maximum 463 μm). 4- to 6-week postoperative visual acuity decreased in comparison with 1-week postoperative values in three eyes of two patients, remained stable in two patients, and improved in one patient, whereas one patient did not return for his 1-week appointment but improved from 0.4 to 0.2 logMAR 2.5 months postoperatively. By 3–6 months, all eyes with PCME had gained visual acuity in comparison with their preoperative values. None of the PCME patients had diabetes or used prostaglandin analogues. Three patients were receiving anticoagulation medication. Conclusion A 2.89% incidence of PCME after low-energy FLACS matched published standard phacoemulsification rates. In our series of uncomplicated cases, PCME caused only a transient postoperative decrease in visual acuity. Key messages What is known Increased prostaglandin levels have been detected in the aqueous humour of cataract patients after femtosecond laser application. Prostaglandins are mediators of inflammation. Femtosecond lasers come in low energy and high energy variants. There is contrasting evidence of increased incidence of PCME after femtosecond laser assisted cataract surgery (FLACS) What is new The incidence of PCME after low-energy FLACS in our high volume surgical setting is 2.89% Low-energy FLACS does not seem to have a causative effect on PCME.

Purpose: To evaluate long-term clinical and patient-reported outcomes (PROMs) following the implantation of an enhanced monofocal intraocular lens (IOL). Methods: This ambispective non-comparative single-centre study involved 41 patients (ages 48-84) who underwent bilateral cataract surgery with the Tecnis Eyhance IOL (model ICB00, Johnson & Johnson Vision). Distance and intermediate visual acuities, refraction, and PROMs were assessed 18 months or more after surgery. Spectacle independence was evaluated using the PRSIQ questionnaire, with patients self-reporting on visual quality, difficulties in performing specific tasks and perception of photic phenomena at distance and intermediate vision. Results: At 18 months or later, 100.0%, 73.2%, 100% and 79.5% of patients achieved a binocular uncorrected distance, uncorrected intermediate, corrected distance, and distance-corrected intermediate visual acuity of 0.20 logMAR or better, respectively. Less than 10% of patients reported photic phenomena. Mean visual quality scores were 1.68±0.72 for distance and 2.05±0.92 for intermediate vision (1=very good to 6=very poor). The dashboard was clearly visible while driving for 95.1% of patients, while 45.0% could perform screen work without glasses; an additional 40.0% could do so with enlarged fonts. Complete spectacle independence was reported by 87.8% for distance vision, and 53.7% for intermediate vision. At least moderately satisfied were 90.2% with distance vision, 87.8% with intermediate vision, and 51.2% with near vision. Conclusions: The enhanced monofocal IOL ICB00 provides good long-term distance and intermediate visual quality, leading to considerable spectacle independence and patient satisfaction. Most patients required near vision correction.

Purpose: To investigate if the cytokine profile in the aqueous humor (AH) of cataract patients varies according to cataract type and severity. Methods: This prospective study included 397 eyes of 397 patients (median age, 76 years; range, 30–94 years) who underwent standard small-incision phacoemulsification surgery. Cataracts were graded using the LOCS III system: mild (≤3), moderate (3.5–5), and severe (≥5). Biometric measurements from the IOL master 700 (Zeiss, Oberkochen, Germany) were used to differentiate between thick (>4.5 mm) and thin lenses. Information about age, gender, and self-reported diseases was obtained from patient records. Eleven different proteins were measured in AH using a multiplex cytokine assay (AYOXXA Biosystems, Cologne, Germany), including IL- 6, IL-8, angiopoietin 2, C-reactive protein (CRP), vascular endothelial growth factor A (VEGF-A), platelet-derived growth factor BB, placental growth factor, CXCL12, CXCL13, and CXCL10. Statistical analysis was performed using R and included nonparametrical testing, linear regression, and k-means clustering. Results: Higher nuclear LOCS grades correlated with increased levels of CCL2 (360 vs. 387 vs. 517 pg/mL, P < 0.001), VEGF-A (270 vs. 292 vs. 390 pg/mL, P = 0.012), IL-8 (3.1 vs. 4.2 vs. 5.7 pg/mL, P = 0.018), and CXCL10 (52 vs. 61 vs. 90 pg/mL, P = 0.003). No associations were observed for cortical and subcapsular cataracts. Thicker lenses were associated with significantly increased levels of CRP, CXCL10, CXCL12, IL-6, IL-8, and VEGF-A. Conclusions: The cytokine profile of AH varies based on cataract grading and lens thickness. In highly dense nuclear cataracts, CCL2, VEGF-A, IL-8, and CXCL10 were elevated.

Die Kataraktchirurgie ist in der entwickelten Welt ein sehr häufig und erfolgreich durchgeführtes Verfahren. Die Indikation für die Operation hat sich einerseits zu gesünderen Patienten, die eine Brillenfreiheit wünschen, andererseits zu komplexeren Fällen verschoben. Wie sind die Patienten aufzuklären? Welche Komplikationen können intraoperativ auftreten und welche Optionen zur Behandlung dieser Komplikationen gibt es? Cataract surgery is frequently and successfully performed in the developed world. The indications for the operation have shifted on one hand towards healthier patients seeking freedom from glasses and on the other hand towards more complex cases. How should the patient be informed? What complications can occur intraoperatively, and what treatment options are available for these complications? This article offers a focus on conditions such as zonulopathy and pseudoexfoliation that can pose challenges to cataract surgery. It discusses the use of specialized tools such as capsular tension rings and capsular hooks and precise maneuvers to minimize stress on weakened zonules in order to ensure in-the-bag fixation of the IOL. Furthermore, the article addresses appropriate actions towards intraoperative complications such as anterior or posterior capsule ruptures and loss of nuclear fragments into the vitreous cavity. Exploring innovative advancements, this article presents the latest alternatives for intracapsular lens fixation, such as sutureless scleral fixation and emerging lens designs in cases where there is insufficient capsular support. Ultimately, the primary objective remains delivering optimal outcomes even for complex cases, and minimizing post-surgical issues. Numerous tools and techniques are available. Article published online: 27 February 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Die Kataraktchirurgie ist in der entwickelten Welt ein sehr haufig und erfolgreich durchgefuhrtes Verfahren. Die Indikation fur die Operation hat sich einerseits zu gesunderen Patienten, die eine Brillenfreiheit wunschen, andererseits zu komplexeren Fallen verschoben. Wie sind die Patienten aufzuklaren? Welche Komplikationen konnen intraoperativ auftreten und welche Optionen zur Behandlung dieser Komplikationen gibt es? Abstract Cataract surgery is frequently and successfully performed in the developed world. The indications for the operation have shifted on one hand towards healthier patients seeking freedom from glasses and on the other hand towards more complex cases. How should the patient be informed? What complications can occur intraoperatively, and what treatment options are available for these complications? This article offers a focus on conditions such as zonulopathy and pseudoexfoliation that can pose challenges to cataract surgery. It discusses the use of specialized tools such as capsular tension rings and capsular hooks and precise maneuvers to minimize stress on weakened zonules in order to ensure in-the-bag fixation of the IOL. Furthermore, the article addresses appropriate actions towards intraoperative complications such as anterior or posterior capsule ruptures and loss of nuclear fragments into the vitreous cavity. Exploring innovative advancements, this article presents the latest alternatives for intracapsular lens fixation, such as sutureless scleral fixation and emerging lens designs in cases where there is insufficient capsular support. Ultimately, the primary objective remains delivering optimal outcomes even for complex cases, and minimizing post-surgical issues. Numerous tools and techniques are available.

The presence of neutralizing antibodies against SARS-CoV-2 correlates with protection against infection and severe COVID-19 disease courses. Understanding the dynamics of antibody development against the SARS-CoV-2 virus is important for recommendations on vaccination strategies and on control of the COVID-19 pandemic. This study investigates the dynamics and extent of α-Spike-Ab development by different vaccines manufactured by Johnson & Johnson, AstraZeneca, Pfizer-BioNTech and Moderna. On day 1 after vaccination, we observed a temporal low-grade inflammatory response. α-Spike-Ab titers were reduced after six months of vaccination with mRNA vaccines and increased 14 days after booster vaccinations to a maximum that exceeded titers from mild and critical COVID-19 and Long-COVID patients. Within the group of critical COVID-19 patients, we observed a trend for lower α-Spike-Ab titers in the group of patients who survived COVID-19. This trend accompanied higher numbers of pro-B cells, fewer mature B cells and a higher frequency of T follicular helper cells. Finally, we present data demonstrating that past infection with mild COVID-19 does not lead to long-term increased Ab titers and that even the group of previously infected SARS-CoV-2 patients benefit from a vaccination six months after the infection.

Purpose: To assess potential changes in pupil size during femtosecond laser-assisted cataract surgery (FLACS) using a low-energy laser system. Methods: The pupil sizes of eyes undergoing FLACS were measured using the Ziemer LDV Z8 by extracting images from the laser software after each of the following steps: application of suction, lens fragmentation, and capsulotomy. Furthermore, the pupil diameters were measured based on preoperative surgical microscope images and after releasing the suction. Paired t-test and the two one-sided tests (TOST) procedure were used for statistical analyses. The horizontal and vertical pupil diameters were compared in each of the steps with preoperative values. Results: Data were available for 52 eyes (52 patients, mean age 73.4 years, range 51–87 years). The equivalence between mean preoperative pupil size and status immediately after femtosecond laser treatment was confirmed (ppp values <0.001). Conclusions: No progressive pupil narrowing was observed using low-energy FLACS. Although a suction-induced, slight increase in pupil area became apparent, this effect was completely reversible after removing the laser interface.

This article provides an overview of both established and innovative applications of femtosecond (fs)-laser-assisted surgical techniques in ophthalmology. Fs-laser technology is unique because it allows cutting tissue at very high precision inside the eye. Fs lasers are mainly used for surgery of the human cornea and lens. New areas of application in ophthalmology are on the horizon. The latest improvement is the high pulse frequency, low-energy concept; by enlarging the numerical aperture of the focusing optics, the pulse energy threshold for optical breakdown decreases, and cutting with practically no side effects is enabled.