Brain-computer interfaces

Purpose: To develop a prediction model for postoperative axial length (AL) in Asian children with congenital cataracts undergoing primary/secondary intraocular lens (IOL) implantation.Design: Retrospective observational study.Methods: Data were collected from children who underwent cataract surgery for congenital cataracts at the Eye Hospital of Wenzhou Medical University between 2006 and 2020. All participants completed preoperative and at least 1‐year of postoperative follow‐up. SPSS 26.0 software was used to analyze the variable factors affecting AL growth and the interactions among these factors. A generalized estimating equation (GEE) was employed to assess the correlation between the AL and related univariates over time. The univariate model was applied to build a multivariate model to predict the postoperative AL. Two validation sets were used to verify the accuracy of the formula.Results: The study involved 86 children, accounting for 148 eyes. The median age at the time of surgery was 3.00 years, with a median age of 9.50 years at the final follow‐up visit. The median duration of follow‐up was 5.00 years. The preoperative and final follow‐up mean ALs were 21.79 ± 1.77 and 23.36 ± 1.90 mm, respectively. Taking the predicted AL (Y) as the dependent variable and the age at surgery (X1), age at review (X2), and preoperative AL (X3) as the independent variables, the prediction model was established as Y = 0.20 − 0.473 × X1 + 0.446 × X2 + 0.993 × X3 − 0.014 × (X2 − X1)∗X2.Conclusions: This model predicts AL growth in children following congenital cataract surgery and IOL implantation, helping ophthalmologists select appropriate IOL power.

Purpose: To analyze the refractive accuracy of a novel swept‐source optical coherence biometer (SS‐OCT), that uses individual refractive indices to measure axial length, in short and long eyes implanted with monofocal intraocular lenses (IOLs).Methods: This retrospective comparative study considered eyes with short axial length (AL) (< 22.5 mm) or long AL (> 26 mm) bilaterally implanted with the Acrysof IQ monofocal IOL. All eyes were preoperatively analyzed with the Argos biometer and IOL calculations were made using the Barrett Universal II (BUII). One month after the surgery, refractive and visual outcomes and refractive prediction errors were calculated. Furthermore, a back calculation of the prediction errors based on the Barrett True Axial Length (BTAL) formula was also performed and the results of both formulas were compared.Results: Sixty eyes of 60 patients (30 with AL < 22.5 mm (short) and 30 with AL > 26 mm (long)) were included. After surgery, monocular UDVA was 0.03 ± 0.10 and 0.10 ± 0.15 logMAR for short‐eye and long‐eye groups, respectively. For short eyes, mean prediction error (MPE) with BUII and BTAL were 0.19 ± 0.34 D and 0.00 ± 0.35 D, respectively (p  <  0.001). Mean absolute error (MAE) was 0.32 ± 0.22 D with the BUII and 0.29 ± 0.20 D with the BTAL formula (p = 0.21). For long eyes, MPE with BUII was −0.15 ± 0.35 D and −0.13 ± 0.36 D with BTAL (p = 0.08), while MAE was 0.31 ± 0.21 D and 0.32 ± 0.20 D with BUII and BTAL, respectively (p = 0.33). The percentage of eyes with a prediction error within ±0.5 D predicted postop spherical equivalent was > 75% for both groups and both formulas (p > 0.05 for all situations).Conclusions: The novel SS‐OCT biometer using individual refractive indices to measure AL showed an overall good refractive accuracy using the BUII. The results were similar or better with the optimized BTAL formula, suggesting that formulas purposely designed for biometric measurements with this novel technology are a promising tool for eyes with extreme AL.

Purpose: Dry eye disease (DED) is a multifactorial disorder affecting millions worldwide. Inflammation plays a central role in DED. The aim of this review is to critically evaluate the literature concerning the efficacy and safety of lifitegrast, a small molecule immunomodulator that blocks the action of lymphocyte function‐associated antigen‐1.Methods: Studies were identified using PubMed and ClinicalTrials.gov. Fourteen studies met the inclusion criteria, six of which were randomized controlled trials. The articles were assessed regarding the effect of lifitegrast on symptoms and signs of DED, its usefulness compared to other treatments, and potential adverse events.Results: The analysis demonstrated positive effects of lifitegrast on subjective and objective parameters of DED in the selected studies. However, despite promising results, the included studies did not provide enough evidence to conclude that lifitegrast could outperform other treatments of DED. No major side effects were reported.Conclusions: Based on the current literature, we conclude that lifitegrast could improve various parameters of DED. Still, larger controlled trials are required to establish additional benefits of this medication beyond those of other DED treatments.

Purpose: The effect of the Rho‐kinase inhibitor ripasudil on the retinal optic nerve fiber layer (RNFL) remains unclear. We aimed to determine this effect in patients with primary open‐angle glaucoma (POAG) using optical coherence tomography (OCT) measurements and linear mixed analysis.Methods: This study prospectively included outpatients from a single center with POAG without a history of vitreoretinal or glaucoma surgery from December 2014 to June 2020, in whom the circumpapillary RNFL thickness (cpRNFLT) was measured more than three times before and after ripasudil initiation, without additional medication or surgery during the period. Measurements were performed using OCT in the follow‐up mode. The cpRNFLT change rates were compared before and after treatment using linear mixed models with adjustments for intraocular pressure (IOP) changes.Results: Thirty eyes of 20 patients (12 males and eight females) were included. Upon ripasudil prescription, the average cpRNFLT was 60.2 ± 2.1 μm. The average IOP was 15.1 ± 0.5 and 13.5 ± 0.5 mmHg, respectively, before and after treatment initiation, with a difference of −1.6 ± 0.3 mmHg. Analysis of 343 cpRNFLT measurements using linear mixed models revealed that the cpRNFLT change rate was −0.91 ± 0.15 and −0.40 ± 0.14 μm/year, respectively, before and after treatment onset, with an increase of 0.51 ± 0.21 μm/year. After adjusting for IOP changes, the improvement in cpRNFLT change rate was 0.33 ± 0.23 μm/year, albeit not statistically significant.Conclusion: The cpRNFLT change rate significantly increased after ripasudil administration, whereas the contribution of the IOP decline was not significant.

Severe dry eye disease (DED) is an inflammatory condition characterized by a lack of sufficient moisture or lubrication on the surface of the eye, significantly impacting the quality of life and visual function. Since detrimental immune response is crucially responsible for the development and aggravation of DED, therapeutic agents which modulate phenotype and function of eye‐infiltrated inflammatory immune cells could be used for the treatment of severe DED. Due to their potent immunomodulatory properties, mesenchymal stem cells (MSCs) represent potentially new remedies for the treatment of inflammatory eye diseases. The majority of MSC‐sourced bioactive factors are contained within MSC‐derived exosomes (MSC‐Exos), nano‐sized extracellular vesicles which, due to their nanosize dimension and lipid envelope, easily by pass all biological barriers in the body and deliver their cargo directly into the target immune cells. MSC‐Exos contain a variety of bioactive proteins (growth factors, immunoregulatory molecules, cytokines, and chemokines) lipids, and microRNAs (miRNAs) which affect viability, proliferation, phenotype, and function of eye‐infiltrated immune cells. Accordingly, MSC‐Exos may modulate the progression of inflammatory eye diseases, including DED. Therefore, in this review article, we summarized the current knowledge regarding molecular and cellular mechanisms which were responsible for trophic, anti‐inflammatory, immunoregulatory, and regenerative properties of MSC‐Exos in the treatment of severe DED. For this purpose, an extensive literature review was carried out in February 2024 across several databases (Medline, Embase, and Google Scholar), from 2000 to the present. Eligible studies delineated molecular and cellular mechanisms responsible for the MSC‐Exos–based modulation of immune cell–driven eye inflammation in DED, and their findings were analyzed in this review. Results obtained in these studies demonstrated beneficial effects of MSC‐Exos in the treatment of severe DED, paving the way for their future clinical use in ophthalmology.Trial Registration: ClinicalTrials.gov identifier: NCT04213248, NCT06475027, NCT06543667, NCT05738629

Purpose: To investigate the correlation between corneal biomechanical characteristics and refractive status in adolescents aged 5–13 years.Methods: A cross‐sectional study involved 339 children aged 5–13 with a spherical equivalent (SE) range from −6.00 to +2.00 diopters. Axial length (AL) was measured by IOL Master, corneal biomechanical parameters by Corvis ST, and anterior segment parameters by Pentacam. According to SE of right eye, the subjects were divided into moderate myopia, mild myopia, and emmetropia group. The correlation between AL and SE and corneal biomechanical parameters was analyzed. The corneal biomechanical parameters of the three groups were also compared.Results: The A2V value in the moderate myopia group was significantly lower than that in both the mild group and emmetropia group (p < 0.001). PD in the moderate group was higher than that in the mild group (p < 0.05), while PD in mild myopia was higher than that in emmetropia (p < 0.05). The SSI in the emmetropia group was significantly higher than that in the other two groups (all p < 0.001), and the SSI in the mild group was higher than that in the moderate group (p < 0.01). The A2V value in the 11–13 years old group was lower than that in the 5–7 years old group (p < 0.001) and 8–10 years old group (p < 0.01). PD in the 11–13 years old group was significantly higher than that in the 8–10 years old group (p < 0.001), and PD in the 8–10 years old group was significantly higher than that in the 5–7 years old group (p < 0.01). The SSI in the 5–7 years old group was significantly higher than that in the 8–10 years old group (p < 0.001), and the SSI in the 8–10 years old group was significantly higher than that in the 11–13 years old group (p < 0.05). AL was positively correlated with PD and negatively correlated with SSI and A2V. SE was positively correlated with A2V and SSI and negatively correlated with PD.Conclusions: Corneal stiffness seems to decrease with the increase of SE. The changes of SSI, PD, and A2V were statistically significant and can be predictors of myopia progression in adolescents aged 5–13 years.

Purpose: We sought to compare the effect of cyclosporine 0.1% after various pretreatments in patients with dry eye disease.Methods: Two hundred seventy‐four eyes of 137 patients diagnosed with dry eye disease were retrospectively enrolled. Thirty patients (Group 1, 60 eyes) were not pretreated, while 68 patients (Group 2, 136 eyes) were pretreated with fluorometholone 0.1%, and 39 patients (Group 3, 78 eyes) were pretreated with cyclosporine 0.05% before treatment with cyclosporine 0.1%. The Ocular Surface Disease Index Questionnaire (OSDI) score, Schirmer I test result, noninvasive tear film break‐up time (NItBUT), corneal staining score, matrix metalloproteinase‐9 (MMP‐9) grade, meibography result, meibum quality and expressibility scores, and tear meniscus height were examined before treatment and at 1, 2, and 3 months after treatment.Results: All dry eye signs and symptoms of all Groups at 1, 2, and 3 months were significantly improved compared to those before treatment with cyclosporine 0.1% (p < 0.05). Notably, the OSDI score, Schirmer I test result, NItBUT, corneal and conjunctival fluorescein score, and MMP‐9 grade in Group 3 were significantly improved compared to those in Groups 1 and 2 at 1, 2, and 3 months after treatment with cyclosporine 0.1% (p < 0.05). The percentages of cases with treatment discontinuation in Groups 1, 2, and 3 were 20.0%, 7.4%, and 10.0%, respectively.Conclusion: Pretreatment with cyclosporine 0.05% can augment the anti‐inflammatory effect of cyclosporine 0.1%. Pretreatment with a steroid or a lower concentration of cyclosporine can increase compliance in patients using a cyclosporine 0.1% eye drop.

Purpose: To analyze patients’ quality of life (QOL) after laser vision correction (LVC) from a worldwide literature review.Methods: Studies of prospective or cross‐sectional design which evaluated QOL in patients after LVC and compared that to preoperative values or a matched group of emmetropes were included. The Web of Science, PubMed, Scopus, and ProQuest were searched for relevant articles published until February 2024. The fixed‐ or random‐effects models were used to estimate the weighted mean difference (WMD) for postoperative QOL changes. Meta‐regression was conducted for adjusting the effects of potential confounders.Results: A total of 11 peer‐reviewed articles (1753 patients) were included in the study. LVC improved QOL of patients at one (SMD = 0.38, 95% CI: 0.15, 0.60), three (SMD = 1.03, 95% CI: 0.55, 1.50), and six months after surgery (SMD = 0.71, 95% CI: 0.30, 1.11). In meta‐regression analysis, QOL improvement was lower in older patients compared to younger ones (β = −0.06, 95% CI: −0.11, −0.01). Also, no statistically significant difference was noted while comparing QOL in post–laser refractive surgery patients and emmetropes (SMD = −0.44, 95% CI: −0.95, 0.07).Conclusion: Patients undergoing LVC experience significant improvements in QOL, particularly in younger subjects, and achieve comparable QOL to individuals with emmetropia.

Purpose. To assess the nozzle tip damage and the parameters of three different hydrophilic intraocular lens (IOL) injector models. Methods. After routine cataract surgeries at the University Eye Hospital Heidelberg, all the used IOL injectors were collected from the operating room and sent to our laboratory. Nozzle tip damage was assessed under a microscope and graded as follows: no damage (grade 0), slight scratches (1), deep scratches (2), extensions (3), cracks (4), and bursts (5). Each damage grade was assigned a score from 0 to 5, and the total damage score for each injector system was calculated and compared. Nozzle tip parameters (diameters and areas), plunger tip parameters, and tip angles were also measured in each model. Results. The damage scores were (median, Q3-Q1): 1 (1-1) for Accuject, 1 (1-1) for Bluemixs, and 1 (1-1) for RayOne. There was no statistically significant difference in the damage scores between the study groups (P>0.05). The outer cross-sectional vertical and horizontal diameters were 1.69 and 1.69 mm for Accuject, 1.69 and 1.69 mm for Bluemixs, and 1.70 and 1.71 mm for RayOne. Plunger tip areas were 0.78 mm2 for Accjuect, 0.74 mm2 for Bluemixs, and 0.43 mm2 for RayOne. Plunger tip area/inner cross-sectional area of the nozzle tip (%) was 31.2% for RayOne, 66.7% for Accuject, and 63.8% for Bluemixs. The tip angles for three injector models were 56° (Accuject), 56° (Bluemixs), and 44° (RayOne). Conclusions. All the injector models showed mild to moderate damage to the nozzle tip after IOL implantation, even with smaller diameter tips. RayOne resulted in the lowest ratio between plunger tip area and inner cross-sectional area of the nozzle tip and a better distribution of damage categories than the other two groups. All three injector models had relatively small tip parameters. If smaller incisions are required in certain patients, smaller tip parameters should be considered.

Purpose. To investigate the relationship between corneal volume (CV) at different zones and corneal biomechanics in keratoconus (KC) along with the significance of CV in diagnosing and staging KC. Methods. This prospective clinical study included 456 keratoconic eyes (Group B) and 198 normal eyes (Group A). Using the topographic KC classification method, Group B was divided into subgroups based on severity (mild, moderate, and severe). The CVs of the 3 mm, 5 mm, and 7 mm zones and biomechanical parameters were obtained by Pentacam and Corvis ST. The diagnostic utility of multirange CVs at different disease stages and severity was determined using a receiver operating characteristic (ROC) curve analysis. Results. The CV of the 7-mm zone had the strongest correlation with A1V, A2T, PD, DA ratio max (2 mm), DA ratio max (1 mm), ARTh, integrated radius, SPA1, and CBI p<0.01. The CVs of the Group B subgroups were significantly lower than those of Group A for each diameter range p<0.05. There were significant differences between the severe, mild, and moderate subgroups for the 3 mm zone (p<0.05, all). The 3 mm zone CV exhibited better diagnostic ability in each group for distinguishing KC from the normal cornea (Groups A vs. B: area under the ROC curve (AUC) = 0.926, Groups A vs. B1: AUC = 0.894, Groups A vs. B2: AUC = 0.925, Groups A vs. B3: AUC = 0.953). Conclusion. The CV significantly decreased in keratoconic eyes. Progressive thinning in the 3 mm zone may be a valuable measurement for detecting and staging KC. Combining the CV examination with corneal biomechanical information may effectively enhance the ability to detect KC.

Purpose. Our study aimed to evaluate the indications and outcomes of intraocular lens (IOL) explantation surgeries in a tertiary eyecare center in Hungary. Materials and Methods. This retrospective study included all IOL explantation surgeries performed between 2006 and 2020 at the Department of Ophthalmology of Semmelweis University, Budapest, Hungary. There were no exclusion criteria for this study. For each patient, the demographics, clinical history, preoperative status, indications for IOL explantation, and operative and postoperative details were reviewed. Primary outcomes included explantation indications and the type of secondary implanted IOL. Results. A total of 161 eyes from 153 patients were included (96 males; 62.7%); age at the time of the IOL explantation was 65.0 ± 17.4 years. The mean time between primary cataract surgery and IOL explantation was 8.5 ± 7.7 years. In total, 139 (86.3%) PCIOLs and 22 (13.7%) ACIOLs were explanted. The main indications for IOL explantation were dislocation (n = 133; 95.7%) and refractive cause (n = 2; 1.4%) in the PCIOL group. Among ACIOL explantations, the main reasons were pseudophakic bullous keratopathy (n = 14; 63.6%), dislocation (n = 4; 18.2%), and refractive cause (n = 2; 9.1%). In the PCIOL group, 115 (82.7%) primary IOLs were implanted in the capsular bag, 16 (11.5%) were sulcus fixated, and 8 (5.8%) were scleral fixated. The most frequent ocular comorbidities were previous vitrectomy (n = 50, 31.1%), previous ocular trauma (n = 45, 28.0%), glaucoma (n = 16, 9.9%), pseudoexfoliation syndrome (n = 15, 9.3%), and high axial myopia (n = 14, 8.7%). The most commonly used secondary IOL implant was the prepupillary iris-claw IOL (n = 115, 73.7%), followed by the retropupillary iris-claw IOL (n = 32, 20.5%). Uncorrected visual acuity (UCVA) was significantly better following IOL exchange in the entire sample (1.57 ± 0.61 (range: 2.40–0.05) vs. 0.77 ± 0.56 (range: 2.40–0.00); p<0.001). Best-corrected visual acuity (BCVA) was maintained or improved in 80.7% of cases after IOL explantation. Conclusions. The most common indication for IOL explantation at a tertiary eyecare center in Hungary is IOL dislocation, followed by pseudophakic bullous keratopathy. Prepupillary and retropupillary iris-claw IOL are the most frequently used secondary implants and their use resulted in a significant UCVA improvement following IOL exchange.

Purpose. The reference range for the preoperative anterior chamber angle width for ICL surgery is unclear. Our objective was to assess the clinical effect and the range of anterior chamber angle width of posterior-chamber implantable collamer lens V4c (ICL V4c) implantation in patients with anterior chamber depth (ACD) < 2.8 mm. Methods. Patients who underwent ICL V4c implantation with shallow ACD were included in this retrospective study. The patients’ uncorrected and corrected distance visual acuity, angle of trabecular-iris (TIA), angle-opening distance (AOD500), trabecular-iris space area (TISA500), corneal endothelial cell density, vault, retinal nerve fiber layer thickness, intraocular pressure, visual field, and complications were analyzed. Results. Forty-one patients (68 eyes) completed at least 12 months of follow-up (median follow-up, 30 months). The effectiveness and safety indices were 1.09 ± 0.13 and 1.04 ± 0.21, respectively. The preoperative TIA values on the nasal and temporal sides were 39.78 ± 7.68 degree (range, 25.8-65.1 degree) and 41.54 ± 8.03 degree (range, 28.5-63.00 degree). Forty-seven eyes had uncorrected distance visual acuity ≥1.0, and 55 had corrected distance visual acuity ≥1.0 at the last follow-up visit. The TIA, AOD500, and TISA500 on the nasal and temporal sides were significantly reduced compared to those before surgery (all P<0.01); no eye had an angle closure or elevated intraocular pressure. The ICL V4c vault was 290.88 ± 153.36 μm (range, 60.0-880.0 μm). No severe complications occurred in any patient. Conclusions. In patients with myopia with shallow ACD (2.55-2.79 mm), a preoperative TIA >25.8° is safe and effective for a relatively long time after surgery; however, an extended long-term close follow-up is needed.

Introduction. Social media has increasingly become a prominent source of health information. Platforms like TikTok that allow for videos to reach millions of viewers have become among the most common platforms to share and receive health information. Laser in situ keratomileusis (LASIK) videos and patients’ experiences are commonly discussed on social media. The quality of these videos remains to be assessed. The aim of this study is to evaluate the content, quality, and reach of the top 100 videos related to LASIK eye surgery on TikTok. Methods. Video quality was assessed using the DISCERN, JAMA, and GQS instruments which have all been proven to be both reliable and valid. Results. 100 videos were included in the study. Results showed that the videos have an immense reach with a total view count of 245 million views and 21.9 million likes. Two thirds of the videos were posted by personal accounts as compared ophthalmologists that only constituted 26% of the content. Healthcare professionals produced higher quality videos compared to nonhealthcare professionals (p<0.0001) although there was no significant difference in video duration (p=0.18). Increased duration, view count, comments, shares, saves, and views/day were all associated with increased DISCERN score and quality of the videos. Educational videos were of higher quality compared to entertainment videos, and videos outlining the procedure details had the highest quality score. Conclusions. LASIK videos on TikTok have established a wide reach, whereby viewers are highly interacting and viewing these videos. It appeared that viewers interacted more with the higher quality videos. Ophthalmologists approximately only contributed to a quarter of the videos analyzed in this study. This highlights the need for ophthalmologists to establish a presence on TikTok and produce high quality videos.

Introduction. To evaluate the changes of lens antidilatation, antiedema, and antienzymolysis ability after different concentrations of 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide and N-hydroxysuccinimide (EDC-NHS)-induced collagen cross-linking. Methods. Corneal stromal lenticules (n = 100) obtained from small incision lenticule extraction (SMILE) procedures were divided into 5 groups: no treatment (control); EDC/NHS (5%/2.5%); EDC/NHS(5%/5%); EDC/NHS (10%/5%); riboflavin and ultraviolet-A light (UVA). Collagen crosslinking was induced using EDC-NHS and UVA. Biomechanical assessments including inflation test, enzymatic degradation resistance, and light transmittance were evaluated posttreatment. Results. (1) Lenticule apex displacement ranked: control Group > UVA Group > Group (5%/5%) > Group (5%/2.5%) > Group (10%/5%) (Friedman test, p<0.0001). (2) Light transmittance was significantly higher in the crosslinked groups versus control, with EDC/NHS superior to UVA riboflavin. After 15 minutes in PBS, light transmittance decreased due to swelling; however, crosslinked groups maintained significantly higher transmittance versus control. (3) Following crosslinking, enzymatic resistance improved significantly, with the EDC-NHS crosslinking group was significantly better than the UVA cross-linking group. Conclusions. EDC/NHS crosslinking enhanced lenticule stiffness, antiedema, and enzymatic resistance and without compromising the transparency of the lens. Moreover, EDC/NHS crosslinking efficacy exceeded UVA riboflavin crosslinking in improving lenticule biomechanical properties.

Purpose. To compare the refractive errors measured by the Spot photoscreener (with or without cycloplegia) to cycloplegic retinoscopy in 6- to 10-week-old infants. Materials and Methods. 101 right eyes from 101 healthy infants aged 6 to 10 weeks were recruited for this cross-sectional observational study. Refractive errors were measured using Spot photoscreener before and after cycloplegia, as well as cycloplegic retinoscopy. Comparisons between the refractive measurements were performed using one-way ANOVA with the post hoc Tukey HSD test or Kruskal–Wallis test with the Steel–Dwass test according to the data normality. Pearson’s correlation test and 95% confidence intervals were calculated. The agreement was evaluated using a Bland–Altman plot with 95% limits of agreement of the differences. Results. Spot photoscreener was found to underestimate the spherical equivalent by 2.33 Diopters (D) in these infants. Following the induction of cycloplegia, the spherical equivalent measured by Spot photoscreener was in excellent agreement with cycloplegic retinoscopy with the mean difference of 0.01 D. Spot photoscreener overestimated cylindrical parameter by 0.2 D with poor agreement with cycloplegic retinoscopy no matter whether cycloplegia was induced. It had good agreement with cycloplegic retinoscopy in the J0 vector than the J45 vector measurement. Conclusions. With the induction of cycloplegia, Spot photoscreener can accurately evaluate spherical equivalent in hyperopic infants with mild-to-moderate astigmatism. While it may provide valuable measurements of astigmatism, discrepancies in cylinder and axis should be taken into account.