Haike Guo

Background: Selecting intraocular lenses (IOLs) for cataract patients with long axial length remains challenging. Two diffractive toric IOLs with distinct design combinations—differing in material (hydrophobic vs. hydrophilic acrylic), optical design (trifocal vs. bifocal), haptic configuration (C-loop vs. plate-haptic), and IOL color (yellow-tinted vs. clear)—represent commonly used options. This study compared their long-term visual outcomes and rotational stability. Notably, this study was not designed to isolate individual contributions of material or IOL color, as these factors covary; posterior capsule opacification (PCO) and Nd:YAG capsulotomy rates were not systematically evaluated. Methods: This retrospective case series enrolled 57 patients (57 eyes) undergoing cataract surgery with toric multifocal IOL implantation (January–December 2023), including 29 eyes receiving the hydrophobic trifocal IOL and 28 eyes receiving the hydrophilic bifocal IOL. Sample size was based on IOL rotation as the primary endpoint (≥25 eyes per group to detect a 3° difference, 80% power, α =0.05). Inclusion criteria required axial length ≥25.0 mm and corneal astigmatism >0.75 D. Patients were followed at 1 week, 1 month, and 3 months postoperatively. Primary endpoint was IOL rotation at 3 months; secondary endpoints included uncorrected visual acuity, corneal astigmatism, defocus curve, objective visual quality, and satisfaction scores. Results: At 3 months, mean rotation was (2.83 ± 2.56)° in the hydrophobic trifocal group and (3.25 ± 2.29)° in the hydrophilic bifocal group ( P > 0.05). At 1 month, uncorrected intermediate visual acuity (LogMAR) was significantly better in the hydrophobic trifocal group (0.01 ± 0.07 vs. 0.16 ± 0.09, P < 0.001). Cumulative uncorrected distance visual acuity of 0.1 LogMAR or better was achieved in 96.6% and 92.9% of eyes, respectively. No significant differences were found in uncorrected distance and near visual acuity, total higher-order aberrations, Strehl ratio, or questionnaire scores. Both IOLs achieved comparable visual quality and rotational stability despite design differences. Conclusions: Both diffractive toric multifocal IOLs demonstrate comparable long-term visual outcomes and rotational stability in cataract patients with long axial length. Differences in material, haptic configuration, and IOL color did not result in significant visual quality disparities. The trifocal design demonstrates advantages in intermediate visual acuity.

Background: Surgical decision-making for highly myopic cataracts requires a high level of expertise. We, therefore, aimed to develop a preliminary artificial intelligence (AI) model for surgical decision-making in highly myopic cataracts, based on previous deep learning models.Materials and methods: We first established a highly myopic cataract decision-making AI model by integrating cataract grading and postoperative visual acuity prediction models of highly myopic eyes, which we had developed previously, with surgical decision logic. The outcomes of surgical decision-making were classified into four categories: surgery not advised, cataract surgery recommended, retinal surgery recommended, and combined cataract–retinal surgery recommended. The gold standard for surgical decision is defined as the decision jointly made by two professional ophthalmologists together (X.Z. and Y.W.). If the decision-makings regarding highly myopic cataract surgery were not fully consistent, a final judgment was made by a third expert (Y.L.). Subsequently, we evaluated the accuracy of AI model’s surgical decision-making against the gold standard and doctors at different levels, using both internal (107 highly myopic eyes from Eye and ENT Hospital, Fudan University) and external (55 highly myopic eyes from Wuhan Aier Eye Hospital) test datasets.Results: In the internal and external datasets, according to the Lens Opacities Classification System (LOCS) III international standards for cataract grading, 99.07% and 87.27% of automatic nuclear grading, along with 88.79% and 61.82% of automatic cortical grading, respectively, had an absolute prediction error of ≤1.0 compared with the gold standard. The mean postoperative visual acuity prediction error was 0.1560 and 0.3057 logMAR in the internal and external datasets, respectively. Finally, the consistency of the AI model’s surgical decisions with the gold standard for highly myopic cataract patients in the internal and external datasets was 96.26% and 81.82%, respectively. AI demonstrated substantial agreement with the gold standard (Kappa value = 0.811 and 0.556 in the internal and external datasets, respectively).Conclusion: The AI decision-making model for highly myopic cataracts, based on two deep learning models, demonstrated good performance and may assist doctors in complex surgical decision-making for highly myopic cataracts.

To investigate the spatial and morphologic features of lenses with different axial length (ALs) in cataract patients using swept-source optical coherence tomography (SS-OCT). Totally 105 eyes of 105 patients scheduled to have cataract surgery were included. Eyes were divided into the control (AL < 24.5 mm), moderate myopia (MM, 24.5 ≤ AL < 26 mm) and high myopia (HM, AL ≥ 26 mm) groups. Spatial features including lens vault (LV) and iris-to-lens distance (ILD), and morphologic features including radii of curvature of anterior and posterior surface (Ra, Rp), lens diameter (LD) and lens thickness (LT) were measured in eight directions by SS-OCT. Spatially, the HM group had larger LV and ILD than the control group (both P < .05). LV and ILD were negatively correlated with AL, respectively (LV: r = -.484, P < .0001; ILD: r = -.656, P < .0001). Morphologically, both MM and HM groups had greater Ra and Rp than the control group. Ra was positively correlated with AL (r = .622, P < .0001), while the relationship between Rp and AL was non-linear. Moreover, the MM and HM groups had larger LD than the control group (both P < .001). Anterior LT was thinner in the HM than in the MM group (P = .026), while posterior LT between these two groups was similar. When compared in eight directions, similar trends were seen in Ra, Rp and LD, and the HM group showed a greater difference in Ra between horizontal and vertical directions. This SS-OCT-based study showed that longer axial length is associated with a flatter lens, which was mainly attributed to the increase of Ra and LD. Longitudinal studies would be necessary to establish a causal relationship and temporal progression.

This prospective, non-randomized, comparative study aimed to compare the visual outcomes and patient satisfaction after implantations of three presbyopia-correcting intraocular lenses (IOLs) after myopic refractive surgery. It was conducted from January 2020 to December 2021 in Shanghai Heping Eye Hospital. Patients were divided into three groups based on the type of IOL implanted. The visual acuity, refractive stability, high-order aberrations, objective visual quality, spectacle independence, and visual function index 14 questionnaire scores of the three groups were compared. This study included 78 eyes of 39 patients: 26 eyes with 839MP, 26 eyes with MF30, and 26 eyes with ZXR00. Uncorrected distance visual acuity improved significantly for all three groups. For a pupil diameter of 4.0 mm, the spherical aberrations of the three groups were 0.33 ± 0.16μ, 0.50 ± 0.08μ, and 0.39 ± 0.10μ, respectively. The spectacle independence for distance vision was over 90% in each group; for near vision, it was only 25% for the ZXR00 group. All three types of presbyopia-correcting IOLs improved visual quality in post-LASIK or PRK patients. However, the high incidence of photic phenomena after presbyopia-correcting IOL implantation in patients who have undergone myopic LASIK should not be neglected.

Introduction: Astigmatism reduces the postoperative visual performance after non-toric intraocular lenses (IOLs) implantation, and limits the use of refractive IOLs in cataract surgery. The purpose of this study was to compare the efficacy in astigmatism correction and the postoperative visual outcomes between the implantation of a trifocal IOL with femtosecond laser-assisted arcuate keratotomy (FSAK) in one eye and a bifocal toric IOL (TIOL) in the other, in patients with cataract and moderate astigmatism.Methods: This prospective observational paired-eye study enrolled patients with cataract and corneal astigmatism (CA) between 0.75 and 2.25 D in both eyes. The patients underwent a mix-and-match treatment comprising trifocal IOL implantation with FSAK and bifocal TIOL implantation. We compared the visual acuity (VA) at all distances, defocus curve, postoperative refractive astigmatism (RfA), CA, high-order aberrations, modulation transfer function (MTF) curve, and Strehl ratio between the two eye groups.Results: In total, 41 patients (82 eyes) were enrolled and completed a 6-month follow-up. The 1- and 3-month uncorrected distance VA and 3-month uncorrected near VA were greater in eyes with bifocal TIOLs than with trifocal IOLs and FSAK (p = 0.036, 0.010, and 0.030, respectively), whereas the latter had greater uncorrected intermediate VA at every visit and greater VA in the intermediate range of defocus curve (at −1.50 and − 2.00 D) than the eyes with bifocal TIOLs. The postoperative RA of the eyes with trifocal IOL and FSAK was significantly higher than that of the bifocal TIOL-implanted eyes at the 3- and 6-month follow-ups.Discussion: Both FSAK and TIOL implantation effectively reduce pre-existing moderate astigmatism in patients with cataract. The eyes with bifocal TIOLs had more stable long-term astigmatism correction, whereas those with trifocal IOLs and FSAK had better intermediate VA. Therefore, a mix-and-match implantation of trifocal IOL with FSAK and contralateral bifocal TIOL could achieve effective astigmatism correction and provide an overall optimal VA.

Purpose: The aim of this study was to evaluate the effect of residual astigmatism on postoperative visual outcomes after trifocal intraocular lens implantation.Methods: In this prospective observational study, we divided 156 eyes into two groups according to postoperative astigmatism measured by subjective optometry and followed them up for 3 months. Visual acuity, modulation transfer function (MTF) curves, Strehl ratio (SR), Visual Function Index-14 scores, and photic phenomena were compared.Results: Linear regression analysis revealed a weak correlation between residual astigmatism and uncorrected distance visual acuity (UDVA) (r = 0.190, P = 0.016) at 3 months and a significant between-group difference at 1- and 3-month postoperative UDVA (P = 0.038, P = 0.018, respectively). MTF curve values and SR (MTF-10 total, MTF-10 cornea, MTF-30 total, MTF-30 cornea, SR Total, and SR cornea) were significantly worse (P < 0.001), and the Visual Function Index-14 scores were lower in the 0.5 < astigmatism ≤ 1.25 D group (P < 0.05) than in the astigmatism ≤ 0.5 D group. No significant differences were found in the frequency, severity, and bothersomeness of photic phenomena (P > 0.05).Conclusion: Postoperative residual astigmatism affects the UDVA of the trifocal intraocular lens-implanted eyes. Although we found no significant differences in uncorrected intermediate and near visual acuity, both objective and subjective visual quality were affected, suggesting the need for surgical planning when the anticipated postoperative astigmatism is >0.5 D.

Purpose. To investigate the benefits of multifocal lens in patients with high myopic cataract and compare the clinical effects between AT LISA tri 839MP and MPlus LS-313 MF30 intraocular lenses (IOLs) in high myopic eyes. Methods. This retrospective cohort study analyzed 60 eyes with axial length >26 mm in 40 patients. Thirty eyes were implanted with MF30, and the remaining 30 eyes were implanted with 839MP. Postoperative uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (BCDVA), uncorrected intermediate visual acuity (UIVA) and uncorrected near visual acuity (UNVA), defocus curve, modulation transfer function (MTF) curve, Strehl ratio (SR), and complications were compared between the two groups. Results. All vision outcomes were significantly improved in both groups ( ). There was no significant between-group difference in UDVA at 1 and 3 months postoperatively ( ). However, UIVA and UNVA were significantly better in the 839MP group ( ). The VF-14 score, especially for near vision quality, was significantly higher in the MF30 group (2.2 ± 0.9 vs. 0.8 ± 0.7; ). The SR of both groups significantly increased postoperatively ( ). All the 3-month MTF curve values (MTF 10 total, MTF 10 internal, MTF 30 total, and MTF 30 internal) were significantly better in the 839MP group ( ). Meanwhile, all the high-order aberration values (coma, spherical aberration, and trefoil) were significantly greater in the MF30 group ( ). Conclusion. Multifocal IOL implantation achieves good quality of distance, intermediate, and near vision in patients with high myopia, improving their quality of life. Both 839MP and MF30 IOLs can provide good distance vision, but 839MP performs better in near and intermediate vision. However, for some patients with an extra-long optic axis, MF30 may be a good choice because of its wider range of degrees.

To report a case of femtosecond laser-assisted removal of an intracorneal chestnut. A chestnut was obliquely protruding to the stroma of cornea and it was localized at the paracentral region on the left eye of a 32-year-old man. The best-corrected visual acuity (BCVA, in decimal values) was 0.6 in the injured eye. The white ulcers with feathery edges or satellite infiltrates were not observed in the lesion, and the anterior chamber was deep and quiet. Anterior segment optical coherence tomography (AS-OCT) demonstrated that the original entry path of the foreign body had been sealed, spanning a thickness of approximate 152 μm. In view of location of the intraocular chestnut at the paracentral region, femtosecond laser was applied according to the procedures of IntraLase Enabled Keratoplasty (IEK) to create an anterior lamellar flap rapidly and precisely. The lamellar flap was easily separated with a flap lifter, and the chestnut was removed entirely using a pair of forceps. In 3 days after surgery, the patient complained of mild pain and blurred vision. These symptoms were relieved after treatment with the eyedrops. At three-month follow-up, the corneal wound was healed well, and the BCVA was greatly improved to 1.2 in the left eye. A dot-like haze was observed corresponding to the scar at the site of foreign body removal. No surgical induction of corneal astigmatism was found in the corneal topography. Without induction of a visually significant scar and corneal astigmatism, the IEK procedure of femtosecond laser is of particular interest as it provides a unique method for removal of intracorneal foreign bodies impinging on the visual axis.

To appraise the effect of treatment for diabetic macular edema (DME) in proliferative stage with sufficient panrentinal photocoagulation (PRP) therapy and intravitreal injections (IV) Conbercept and posterior subtenon's triamcinolone acetonide (STTA) sequential therapy. This prospective clinical randomized controlled trial of cross-over design was conducted in three phases. The participants included cases of DME in proliferative stage. They were divided into two groups and treated with PRP before enrollment. Group A were treated with IV-Conbercept 0.5 mg for one month in the 1st phase. Group B were treated with STTA 40 mg (twice per two weeks). The interventions were exchanged in the second phase (2mo) between the two groups. In the third phase (3-6mo) no other treatment was given. Best corrected visual acuity (BCVA), central macular thickness (CMT) measured by OCT and complications were compared. After phase I: in Group A, BCVA improved from 0.201±0.17 to 0.37±0.24 (F=5.88, P=0.004). CMT changed from 449±155.10 to 304.1±84.70 µm (F=14.9, P0.05). After phase III: in Group A, BCVA maintained 0.42±0.25 (F=0.22, P=0.001), CMT maintained 267.8±58.34 µm, (F=-0.27, P<0.01); in Group B, BCVA was 0.47±0.25 (F=-0.27, P<0.01), CMT was 272.71±49.16 µm (F=-191.1, P<0.01). No serious complications happened in all phases. PRP+Conbercept is better than PRP+STTA in DME with proliferative stage but PRP+Conbercept+STTA sequential therapy may be a wiser choice for persistent effectiveness on anatomical as well as functional status.