OBJECTIVE: This study evaluates the accuracy of modern intraocular lens (IOL) calculation formulas using axial length (AL) data obtained by ultrasound biometry (UBM) compared to the third-generation SRK/T calculator.
METHODS: The study included 230 patients (267 eyes) with severe lens opacities that prevented optical biometry, who underwent phacoemulsification (PE) with IOL implantation. IOL power calculation according to the SRK/T formula was based on AL and anterior chamber depth obtained by UBM (Tomey Biometer Al-100) and keratometry on the Topcon KR 8800 autorefractometer. To adapt AL for new generation calculators - Barrett Universal II (BUII), Hill RBF ver. 3.0 (RBF), Kane and Ladas Super Formula (LSF) - the retinal thickness (0.20 mm) was added to the axial length determined by UBM, and then the optical power of the artificial lens was calculated. The mean error and its modulus value were used as criteria for the accuracy of IOL calculation.
RESULTS: A significant difference (p=0.008) in the mean IOL calculation error was found between the formulas. Pairwise analysis revealed differences between SRK/T (-0.32±0.58 D) and other formulas - BUII (-0.16±0.52 D; p=0.014), RBF (-0.17±0.51 D; p=0.024), Kane (-0.17±0.52 D; p=0.029), but not with the LSF calculator (-0.19±0.53 D; p=0.071). No significant differences between the formulas were found in terms of mean error modulus (p=0.238). New generation calculators showed a more frequent success in hitting target refraction (within ±1.00 D in more than 95% of cases) than the SRK/T formula (86%).
CONCLUSIONS: The proposed method of adding 0.20 mm to the AL determined by UBM allows using this parameter in modern IOL calculation formulas and improving the refractive results of PE, especially in eyes with non-standard anterior segment structure.
UNASSIGNED: Оценка точности современных формул расчета интраокулярных линз (ИОЛ) с использованием данных о длине переднезадней оси (ПЗО), полученных при ультразвуковой биометрии (УЗБ), по сравнению с калькулятором третьего поколения SRK/T.
UNASSIGNED: В исследование включено 230 пациентов (267 глаз) с выраженными помутнениями хрусталика, препятствовавшими выполнению оптической биометрии, которым была проведена факоэмульсификация (ФЭ) с имплантацией ИОЛ. Калькуляция оптической силы ИОЛ по формуле SRK/T основывалась на длине ПЗО и глубине передней камеры, полученных с помощью контактной УЗБ (Tomey Biometer Al-100) и кератометрии на авторефрактокератометре Topcon KR 8800. В целях адаптации ПЗО для калькуляторов нового поколения — Barrett Universal II (BUII), Hill RBF ver. 3.0 (RBF), Kane и Ladas Super Formula (LSF) — к определяемой с помощью УЗБ аксиальной длине добавлялась толщина сетчатки (0,20 мм), а затем вычислялась оптическая сила искусственного хрусталика. В качестве критериев точности расчета ИОЛ использовались средняя ошибка и модуль ее значения.
UNASSIGNED: Обнаружена значимая разница (p=0,008) в средней ошибке расчета ИОЛ между формулами. Попарный анализ выявил различия между SRK/T (–0,32±0,58 дптр) и другими формулами — BUII (–0,16±0,52 дптр; p=0,014), RBF (–0,17±0,51 дптр; p=0,024), Kane (–0,17±0,52 дптр; p=0,029), но не с калькулятором LSF (–0,19±0,53 дптр; p=0,071). Значимых различий между формулами по параметру модуля средней ошибки найдено не было (p=0,238). Калькуляторы новых поколений показали более частое попадание в рефракцию цели (в пределах ±1,00 дптр более чем в 95% случаев), чем формула SRK/T (86%).
UNASSIGNED: Предложенный метод добавления 0,20 мм к определяемой с помощью УЗБ длине ПЗО позволяет использовать данный параметр в современных формулах расчета ИОЛ и улучшать рефракционные результаты ФЭ, особенно в глазах с нестандартным строением переднего отрезка.

BACKGROUND: This study aims to assess the effectiveness of the preoperative flash visual evoked potential (VEP) test in predicting postoperative visual acuity for monocular mature cataract cases when compared to the contralateral normal eye.
METHODS: The study included 60 patients, each with a monocular mature cataract diagnosis, who underwent preoperative flash VEP testing showing no pattern VEP response. Subsequently, phacoemulsification was performed. The relationship between the flash VEP test latency values (P1, N2, P2) and amplitude value (N2-P2), and the degree of visual acuity recovery 3 months post-cataract surgery, was evaluated using the LogMAR scale. Furthermore, a linear regression analysis was conducted to explore the connection between preoperative flash VEP components and postoperative visual acuity.
RESULTS: The average age of the patients was 65.4 ± 13.6 years, with a range of 43 to 87 years. The study included 36 males and 24 females. A significant disparity in visual acuity was observed between the preoperative and 3-month postoperative stages (p < 0.001). The preoperative flash VEP test for mature cataracts revealed significant delays in P1, N2, and P2 latency, as well as a reduction in N2-P2 amplitude potential when compared to the contralateral normal eye (p < 0.001). Notably, delayed P2 latency and reduced N2-P2 amplitude potential were particularly indicative of poor visual acuity prognosis after cataract surgery in the multiple regression analysis (p < 0.05). The N2-P2 amplitude potential was the important value that exhibited statistically significant results, with an area under the curve (AUC) of 80% sensitivity and 88% specificity, using a cutoff value of 6.07 μV.
CONCLUSIONS: In cases of monocular mature cataract, a reduction in N2-P2 amplitude potential compared to the contralateral normal eye emerged as the most reliable predictor of postoperative visual prognosis following cataract surgery.

Introduction To compare the prediction accuracy of lens power calculation formulas in patients undergoing mature cataract surgery. Methods A total of 90 operations involving the Alcon SA60AT IOL implant (Alcon, Geneva, Switzerland) were analyzed in terms of mean refractive prediction error (PE) and mean absolute prediction error (MAE) using backward calculation in a retrospective design. Results A negative PE was observed in SRK/T, Holladay 1, Holladay 2, Hoffer Q, Haigis, and Emmetropia Verifying Optical (EVO) formulas. In contrast, positive PEs were observed in Barrett Universal II (BAUII), Kane, and Radial Basis Function (RBF) formulas. Negative PE was observed with all formulas, except BAUII, in patients with a shallow anterior chamber depth (ACD). While the SRK/T, Holladay 1, BAU, Kane, and RBF formulas demonstrated positive PE, the Holladay 2, Hoffer Q, Haigis, and EVO formulas indicated negative PE. In patients with deep ACD, positive PE was observed in all formulas, barring Holladay 2 and EVO. No significant differences were identified between the formulas concerning MAE and percentages of 0.25 diopter (D), 0.50 D, 0.75 D, and 1.0 D across all study groups. Conclusion Although the new generation formulas provide very good results, achieving the best with a single formula is still impossible.

To identify the risk factors predisposing posterior capsule rupture (PCR) during mature cataract surgery.
A total of 1302 consecutive mature cataract cases were included in this retrospective study. A detailed examination was performed for each patient and risk factors including age, gender, systemic diseases, ocular comorbidities, surgeon, and surgery method were recorded. Cases with PCR during surgery were classified as complicated. Multivariate logistic regression analysis with a generalized estimating equations method was applied for statistical analysis.
The overall rate of PCR was 7.30% (n=95 eyes). After adjusting for confounders, factors that remained significant on multivariate analysis were strabismus (odds ratio [OR]: 5.70, 95% confidence interval [CI]: 2.17-14.97; P < 0.001), phacodonesis (OR: 4.62, 95% CI: 2.59-8.22; P < 0.001), history of trauma (OR: 4.46, 95% CI: 1.64-12.12; P = 0.003), surgery method (extracapsular cataract extraction/phacoemulsification) (OR: 2.61, 95% CI: 1.60-4.26; P < 0.001), and pseudoexfoliation (OR: 1.94, 95% CI: 1.20-3.16; P = 0. 007).
Strabismus, phacodonesis, history of trauma, extracapsular cataract extraction method, and pseudoexfoliation were found to be important risk factors for developing PCR. Appropriate preoperative and perioperative precautions for these higher-risk cases can reduce complications.

Background and Objectives: The aim of our study was to identify risk factors associated with phacomorphic glaucoma (PG) by comparing the biometric parameters of contralateral eyes of patients with PG with the eyes of patients with a mature cataract. Methods: This retrospective case−control study included 71 eyes affected with PG, 311 eyes of control participants, and 71 contralateral eyes of patients with PG. All participants were ethnically Kazakh. Axial lengths (AL), anterior chamber depths (ACD), and lens thicknesses (LT) were measured using A-scan ultrasound biometry. To determine the threshold value of the A-scan parameters associated with PG, we performed ROC analysis. Results: The eyes with PG had smaller AL and ACD values and larger LT values, followed by the fellow eyes with PG and the control eyes. There were no differences in age and sex between patients with PG and mature cataracts. After adjustment for age and other A-scan parameters, continuous measures of ACD and LT were associated with PG (OR 0.57, 95% CI 0.38−0.73, p < 0.001; OR 3.36, 95% CI 1.64−6.912, p = 0.001). When A-scan parameters were dichotomized according to the identified threshold, an ACD of less than 2.5 mm (OR 3.113, 95% CI 1.562−6.204, p = 0.001) and an LT thicker than 4.75 mm (OR 26.368, 95% CI 9.130−76.158, p < 0.001) were found to be related to PG. Conclusions: We found that a thicker lens and, possibly, a shallow ACD are risk factors for PG.

OBJECTIVE: To report the outcomes of cataract surgery in patients with Human Immunodeficiency Virus (HIV) infection. Setting Tertiary care ophthalmic hospital DESIGN: Retrospective study METHODS: This study included all eyes of patients with known HIV infection undergoing cataract surgery with a minimum follow-up of 6 months between January 2017 and December 2020. Patients who underwent combined surgeries and pediatric patients were excluded from analysis. Data were retrieved from electronic medical records and we documented demographics, history, detailed anterior and posterior segment examination, pre-operative grade and type of cataract, type of surgery done, its complication and post-operative course. All these parameters were recorded at the baseline visit and at 1 month and 6 months postoperatively.
RESULTS: One hundred and twenty nine eyes of 107 HIV infected patients that underwent cataract surgery were evaluated. Mature cataract was seen in 31% of the eyes. Features of HIV related uveitis/retinitis were seen in 21 (16.2%) eyes. Phacoemulsification was performed in 44 (34.1%) eyes while manual small incision cataract surgery (MSICS) was done in 85 (65.9%) eyes. Intra-operative complications were encountered in 4 (3.1%) eyes. At the final follow-up, there was a significant improvement in median corrected distance visual acuity (CDVA) from LogMAR 1.08 (5/60) at baseline to LogMAR 0 (6/6) at 6 months follow-up.
CONCLUSIONS: Patients with HIV infection usually present early and with advanced cataracts. Visual outcomes after cataract surgery are generally good but affected by presence of prior HIV related uveitis or retinitis.

OBJECTIVE: To develop an alternative method of intraocular lens (IOL) power calculation in eyes with mature cataract and axial length (AL) of less than 22.0 mm using modern formulas Barrett Universal II and Hill RBF.
METHODS: The study enrolled 41 patients (41 eyes) who underwent phacoemulsification (PE). Ultrasound biometry (Tomey Biometer Al-100) and keratometry (Topcon-8800) were used for IOL power calculation by SRK/T and Haigis formulas. To calculate IOL power by Barrett Universal II and Hill RBF formulas, 0.2 mm were added to AL measured with ultrasonography (retinal thickness). One month after PE, spherical equivalent of refraction was compared with target refraction (calculated by the formulas listed above), and based on that a conclusion was made on the accuracy of calculations.
RESULTS: Haigis formula was found to be the least accurate (IOL calculation error -0.39±0.79 D). The calculation error in SRK/T (0.04±0.79 D), Barrett Universal II (0.02±0.79 D) and Hill RBF (-0.05±0.73 D) formulas was much lower. However, among them Hill RBF had the lowest spread of the mean absolute IOL calculation error. Pairwise comparison revealed significant difference of mean IOL calculation error by Haigis formula versus the others. There was no significant difference in the following pairs: SRK/T - Barrett Universal II (p=0.855), and SRK/T - Hill RBF (p=0.167), but there was a significant difference (p=0.043) in the Barrett Universal II - Hill RBF pairdue to the tendency for slight hypermetropic calculation error in the former and the inherent slight myopic shift in the latter..
CONCLUSIONS: The proposed alternative method of IOL power calculation in eyes with mature cataract and short AL using modern formulas (Barrett Universal II and Hill RBF) shows higher accuracy compared to the formulas embedded in ultrasound biometer (SRK/T and Haigis), and can be recommended for use in everyday practice.
UNASSIGNED: Разработка алгоритма расчета оптической силы интраокулярных линз (ИОЛ) в глазах со зрелой катарактой и длиной переднезадней оси (ПЗО) <22,0 мм с использованием калькуляторов Barrett Universal II и Hill RBF.
UNASSIGNED: Исследуемую группу составили пациенты (n=41; 41 глаз), которым выполнялась факоэмульсификация (ФЭ). Расчет ИОЛ (по формулам SRK/T и Haigis) производился на основании данных, полученных при кератометрии и аппланационной ультразвуковой биометрии. Для расчета по формулам Barrett Universal II и Hill RBF к измеренной ультразвуковым методом длине ПЗО добавляли 0,2 мм (толщина сетчатки). Спустя 1 мес после ФЭ показатель сфероэквивалента клинической рефракции сравнивался с расчетной (согласно вышеперечисленным формулам) рефракцией, на основании чего делался вывод о точности попадания в рефракцию цели.
UNASSIGNED: Наибольшей ошибкой расчета ИОЛ сопровождалось применение формулы Haigis (–0,39±0,79 дптр). Величина отклонения от целевой рефракции при использовании SRK/T (0,04±0,79 дптр), Barrett Universal II (0,02±0,79 дптр) и Hill RBF (–0,05±0,73 дптр) оказалась намного меньшей. Минимальный разброс абсолютной ошибки расчета ИОЛ характерен для уравнения Hill RBF. При попарном сравнении средних значений ошибки расчета формула Haigis существенно отличалась от всех остальных. В парах SRK/T и Barrett Universal II (p=0,855), SRK/T и Hill RBF (p=0,167) значимых различий не отмечалось, однако при сравнении Barrett Universal II (с ее тенденцией к легкой гиперметропической ошибке расчета) и Hill RBF (которой присущ незначительный миопический сдвиг) была найдена значимая разница (p=0,043).
UNASSIGNED: Предложенный нами альтернативный метод расчета ИОЛ, использующий современные калькуляторы (Barrett Universal II, Hill RBF), показал более высокую точность по сравнению со встроенными в ультразвуковой биометр формулами (SRK/T, Haigis) и может быть использован в повседневной клинической практике для расчета ИОЛ.

Ophthalmic viscoelastic devices (OVDs) are currently used in cataract surgery and have significantly improved the safety and effectiveness of this surgical procedure. OVDs are classified according to the zero-shear viscosity and the cohesion-dispersion index in cohesive, dispersive, and viscoadaptives. OVDs create and maintain anterior chamber depth and visibility, protecting the corneal endothelium and other intraocular tissues during surgery. The selection of the most adequate OVD is especially relevant when performing cataract surgery in challenging cases, such as in hard, mature cataracts, flat anterior chamber, pseudoexfoliation syndrome, intraoperative floppy iris syndrome, or glaucoma surgery. In such cases, OVD is crucial for facilitating the surgical procedure and the associated minimal complication rate. The use of a combination of OVDs (soft-shell technique and modifications), the use of blue-colored OVDs, and the combination of sodium hyaluronate with lidocaine have also been described as useful tools in some of these challenging cases.

UNASSIGNED: To study the morphological changes within mature senile cataracts on modified posterior segment optical coherence tomography (OCT).
UNASSIGNED: A cross-sectional observational study recruiting patients of mature cataracts admitted for elective cataract surgery in tertiary eye care. A modified OCT imaging of the lens was done and lenticular findings were noted by a single observer. Corresponding slit-lamp biomicroscopic findings and intraoperative experiences were also noted by a second observer and respective surgeons.
UNASSIGNED: Forty-four eyes of 44 patients were included. The mean age of patients was 65 ± 5.7 years. The intralenticular findings were uniform in groups of eyes, and they were characterized into three stages. First was a stage of early lamellar separation where small intralenticular clefts were noted superficially. Second was the stage of established lamellar separation where crescentic fluid clefts appeared interspersed between the lens fibers, and the depth increased as a function of severity. Both these stages did not show any distinct slit-lamp or intraoperative findings. A third stage of liquefaction identified as extensive lamellar separation with subcapsular fluid pockets. This was also reflected in slit-lamp biomicroscopy, showing the hydrated cortex with intraoperative challenges. Two cases showed peculiar changes, one of a hyperreflective subcapsular sheath and another of superficial nuclear lamellar separation.
UNASSIGNED: Mature cataracts may also show graded progression, which could be delineated on lenticular OCT. This could be of immense help in pre-operative planning and optimal management of these high-risk cases.

UNASSIGNED: The aims of this study were to compare the biometric parameters and axial lengths of eyes with phacomorphic glaucoma and mature cataract and to identify differences that might predispose to development of phacomorphic glaucoma.
UNASSIGNED: Three hundred forty-two patients were enrolled in this retrospective study. The eyes were divided into four groups-Group (G)1: phacomorphic glaucoma (n = 29), G2: mature cataract (n = 313), G3: contralateral phacomorphic glaucoma (n = 29), and G4: contralateral mature cataract (n = 313). Central corneal thickness and anterior chamber depth were assessed by optical low-coherence reflectometry (Lenstar LS 900®; Haag-Streit AG, Switzerland), while axial length was determined by A-scan ultrasound biometry.
UNASSIGNED: The mean central corneal thickness of G1 was significantly higher than in other groups (p < 0.001) and the mean anterior chamber depth of G1 was the lowest among the groups (p < 0.001). Also, G2 had lower mean anterior chamber depth than G4 (p < 0.001) and G3 had lower mean anterior chamber depth than G4 (p = 0.007). Anterior chamber depth less than 3.27 mm had the higher odds ratio for distinguishing G3 versus G4 (odds ratio = 10.79, p < 0.001). Furthermore, patients aged ⩾68.9 years had the higher odds ratio for distinguishing G1 versus G2 (odds ratio = 2.82, p = 0.019). There was no significant difference in the presence of pseudoexfoliation material between G1 and G2 (p = 0.057). There were no significant differences in axial length values among the four groups (p = 0.097).
UNASSIGNED: Advanced age and shallow anterior chamber depth were found to be risk factors for developing phacomorphic glaucoma, but the presence of pseudoexfoliation material was not found to play a role as a risk factor in phacomorphic glaucoma development.