The accuracy of intraocular lens (IOL) calculations is suboptimal for long or short eyes, which results in a low visual quality after multifocal IOL implantation. The purpose of the present study is to evaluate the accuracy of IOL formulas (Barrett Universal II, SRK/T, Holladay 1, Hoffer Q, and Haigis) for the Acrysof IQ Panoptix TFNT IOL (Alcon Laboratories, Inc, Fort Worth, Texas, United States) implantation based on the axial length (AXL) from a large cohort of 2018 cases and identify the factors that are associated with a high mean absolute error (MAE). The Barrett Universal II showed the lowest MAE in the normal AXL group (0.30 ± 0.23), whereas the Holladay 1 and Hoffer Q showed the lowest MAE in the short AXL group (0.32 ± 0.22 D and 0.32 ± 0.21 D, respectively). The Haigis showed the lowest MAE in the long AXL group (0.24 ± 0.19 D). The Barrett Universal II did not perform well in short AXL eyes with higher astigmatism (P = 0.013), wider white-to-white (WTW; P < 0.001), and shorter AXL (P = 0.016). Study results suggest that the Barrett Universal II performed best for the TFNT IOL in the overall study population, except for the eyes with short AXL, particularly when the eyes had higher astigmatism, wider WTW, and shorter AXL.

PURPOSE: To evaluate the accuracy of total corneal power calculation from a swept-source optical coherence tomography–based biometer and a rotating Scheimpflug tomographer for the Acrysof IQ Panoptix toric TFNT intraocular lens (IOL) (Alcon Labroatories, Inc). METHODS: A retrospective study was undertaken on 145 eyes implanted with the TFNT IOL. The accuracy of total corneal power calculation from a SS-OCT–based biometer (IOLMaster 700; Carl Zeiss Meditec AG; total keratometry [TK]) and a rotating Scheimpflug tomographer (Oculus Optikgeräte GmbH; total corneal refractive power at 3 mm [TCRP3] and at 4 mm [TCRP4]) were compared. The surgically induced astigmatism vector, difference vector, angle of vector, correction index, index of success, coefficient of adjustment, and flattening index were analyzed using the VectrAK analysis program (ASSORT). RESULTS: The index of success showed a significant difference between the three methods ( P = .035, analysis of variance test). The mean ± standard deviation of the index of success was the best in TK (0.43 ± 0.20), followed by TCRP4 (0.47 ± 0.24, P = .400, Bonferroni HSD test) and TCRP3 (0.50 ± 0.22, P = .030, Bonferroni HSD test). The preoperative refractive astigmatism prediction error was within ±0.50 diopters (D) in 62 eyes (42.8%) when using TCRP4 and in 66 eyes (45.5%) when using TK. CONCLUSIONS: These study results suggest that the refractive accuracy of TFNT implantation using total corneal power from TCRP4 and TK was favorable. [ J Refract Surg . 2021;37(10):686–692.]

The prevalence of epiretinal membrane (ERM) and associated factors in the phakic eyes have not been fully elucidated yet. This cross-sectional study included 2,354 phakic eyes without retinal diseases or surgical history. Ocular parameters, such as uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), intraocular pressure (IOP), white-to-white corneal diameter (WTW), mean keratometric value (Km) of total corneal refractive power at 4-mm diameter (TCRP4), astigmatism of TCRP4, total corneal irregular astigmatism (TCIA), pupil diameter, axial length (AXL), anterior chamber depth (ACD), lens thickness (LT), and posterior vitreous detachment (PVD) were compared between ERM group and control group. Additionally, an age-matched control group was selected by individual matching and compared with the ERM group to eliminate the confounders. Multiple logistic regression analysis was performed to evaluate the factors associated with the presence of ERM. Among 2,354 eyes, 429 eyes (18.2%) had ERM based on spectral-domain optical coherence tomography. The ERM group showed higher prevalence of PVD, worse CDVA, higher astigmatism of TCRP4, higher TCIA, smaller pupil size, longer AXL, and thicker LT than control group (P < 0.001, P < 0.001, P = 0.011, P < 0.001, P = 0.023, P < 0.001, and P < 0.001, respectively). Only PVD, CDVA, SE, astigmatism of TCRP4, TCIA, and AXL maintained the significance when compared with the age-matched control group (P < 0.001, P = 0.026, P < 0.001, P = 0.001, P = 0.003, and P < 0.001, respectively). Multivariate logistic regression analysis showed that age, PVD, CDVA, and TCIA were independently associated with the presence of ERM (P < 0.001, P < 0.001, P = 0.011, and P = 0.002). The prevalence of ERM detected using SD-OCT was 18.2% in the middle aged phakic population. Eyes with TCIA, in addition to older age and PVD, were more likely to have ERM.

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A newly developed extended-depth-of-focus AcrySof® Vivity™ intraocular lens (IOL), which has a wavefront-shaped anterior surface, has shown a promising outcome in minimizing dysphotopsia, the biggest issue after diffractive type IOL implantation. On the contrary, relatively low uncorrected near visual acuity (UNVA) has been raised as a demerit of this IOL. However, there is only limited information about the UNVA after Vivity implantation. In the present study, we compared the uncorrected distant and intermediate visual acuity (UDVA and UIVA) and UNVA according to the range of refractive error (RE) from 91 eyes from 91 patients implanted with Vivity IOL. Then we assessed the biometric factors for their association with UNVA from 66 eyes with a RE within ± 0.25 D. The UDVA was worst in eyes with RE < -0.50 D (0.17 ± 0.21), which was significantly worse than in any other group (P < 0.001 for every analysis). The UIVA was worst in eyes with RE of 0.25 to 0.50 D (0.35 ± 0.07 D), which was significantly worse than in eyes with RE of -0.50 to -0.26 D (P = 0.020) and in eyes with RE of -0.25 to -0.01 D (P = 0.028). The UNVA was worst in eyes with RE of 0.25 to 0.50 D (0.40 ± 0.14 D), which was significantly worse than in eyes with RE of -0.50 to -0.26 D (P = 0.022), which suggests that the extent of monovision should be limited up to -0.50 diopter. On univariate analysis for UNVA in eyes with a RE within ± 0.25 D, the anterior chamber depth (R = 0.257; P = 0.037) and pupil size (R = 0.451; P < 0.001) had a statistically significant relation to UNVA, while multivariate analysis showed the pupil size (β = 0.451; P < 0.001) as the sole indicator, suggesting eyes with a small pupil size might receive a UNVA benefit.

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PURPOSE: To evaluate the effect of a capsular tension ring (CTR) on refractive outcomes in eyes undergoing implantation of the quadrifocal Acrysof PanOptix TFNT00 intraocular lens (IOL) (Alcon Laboratories, Inc). METHODS: A retrospective case–control study was undertaken of 91 eyes implanted with the TFNT00 IOL. Of these 91 eyes, a CTR was implanted in 33 and these eyes were compared to the 58 eyes in which a CTR was not implanted. The main outcome measure was the mean absolute error (MAE) of the refractive prediction error. To evaluate the consistency of refractive outcomes, variance of MAE was measured. Using a swept-source optical coherence tomography device, postoperative aqueous depth (AQD) was measured to estimate the position of the IOL. RESULTS: Eyes with a CTR showed a significantly smaller MAE when compared with eyes without a CTR ( P = .038 at 1 m, P = .003 at 2 m, and P = .001 at 6 m). There was a lower variance of MAE in the eyes implanted with a CTR, with higher precision of refraction ( P = .058 at 1 m, P = .007 at 2 m, and P = .001 at 6 m). There was a significant difference in the percentage of the eyes showing more than 0.50 D from the estimated target of the Barrett Universal II formula ( P = .007 at 1 m, P = .064 at 2 m, and P = .004 at 6 m, respectively). AQD was significantly shallower in eyes with a CTR than in eyes without a CTR ( P = .006). CONCLUSIONS: Use of the CTR enhanced the accuracy of postoperative refractive outcomes after TFNT00 IOL implantation by preventing the posterior bowing of the optic–haptic junction. [ J Refract Surg . 2021;37(3):174–179.]

Our perfusion apparatus is highly stable, sensitive, and capable of measuring subtle changes in outflow facility in vivo and in vitro.