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Purpose: To determine whether any of three keratometry devices is superior to the others in predicting the ideal toric intraocular lens (IOL) alignment meridian., Methods: A retrospective review was performed to identify patients who underwent cataract phacoemulsification with toric IOL implantation from November 2014 to November 2016 at a single academic institution. For each patient, corneal measurements were performed with an optical low-coherence reflectometer/autokeratometer (OLCR), a dual Scheimpflug/Placido analyzer, and a color light-emitting diode (LED) topographer. Postoperatively, the ideal toric IOL alignment meridian that would have resulted in the least amount of residual astigmatism was determined using the online Berdhal & Hardten Toric Results Analyzer (BHTRA). To determine the prediction error, this ideal alignment meridian was compared to the corneal meridian with the highest refractive power, as provided by the three devices., Results: Fifty-six eyes of 56 patients were included in the study. The mean absolute errors in the toric IOL alignment meridians of the color LED topographer, dual Scheimpflug/Placido analyzer, and OLCR were 5.2° ± 5.2°, 7.6° ± 5.7°, and 5.4° ± 5.1°, respectively. There was no significant difference in the ability of each device to predict the ideal alignment meridian as determined by the BHTRA., Conclusions: The color LED topographer, dual Scheimpflug/Placido analyzer, and OLCR may all be used to preoperatively determine the best alignment meridian for toric IOL placement. Surgeons should use their best judgment in determining which device to use in preoperative planning for individual patients. [J Refract Surg. 2018;34(8):515-520.]., (Copyright 2018, SLACK Incorporated.)

Purpose: To determine the effect of anterior chamber depth (ACD) on the accuracy of 8 intraocular lens calculation formulas in patients with normal axial lengths (ALs)., Setting: Baylor College of Medicine, Alkek Eye center, Houston, Texas, USA., Design: Retrospective case series., Methods: Patients having cataract surgery with ALs between 22.0 mm and 25.0 mm were divided into 3 groups based on their preoperative ACD measurement. The mean prediction errors, mean absolute errors (MAEs), and median absolute errors for each group were calculated., Results: For the ACD of 3.0 mm or less group and the ACD of 3.5 mm or more group, the Barrett Universal II, Holladay 2, Haigis, and Olsen ray-tracing formulas had mean prediction error values that were not significantly different from zero. For the ACD of 3.01 to 3.49 mm group, all formulas had mean prediction error values that were not significantly different from zero. For the ACD of 3.0 mm or less group, the Barrett Universal II formula had a smaller median absolute error than the Haigis, Hoffer Q, and Olsen optical low-coherence reflectometry (OLCR) (Lenstar) formulas and a smaller MAE than the Hoffer Q, Hill-RBF, and Olsen OLCR (P < .05). In the ACD of 3.5 mm or more group, the Barrett MAE was smaller than the Hoffer Q (P < .05); however, there were no significant differences between median absolute errors., Conclusion: In eyes with normal ALs, taking preoperative ACD values into consideration might improve refractive outcomes., (Copyright © 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To identify the preoperative risk factors, intraoperative events, and postoperative complications increasing the risk for poor visual outcomes in resident-performed cataract surgeries at a tertiary-care county hospital., Setting: Ben Taub General Hospital, Houston, Texas, USA., Design: Retrospective case series., Methods: Resident-performed cataract surgeries were analyzed for risk factors, comorbidities, and intraoperative and postoperative complications. The main outcome measures were preoperative and postoperative uncorrected distance visual acuity and corrected distance visual acuity (CDVA), which were correlated with preoperative demographics, intraoperative and postoperative events, and resident training level. The data were subdivided into cases without events and cases with events to determine which complications led to poor visual outcomes., Results: The study analyzed 1290 resident-performed cataract surgeries. The mean visual acuity improved significantly after surgery in all patients (P < .001), with 80.5% of patients without complications and 70.7% with complications attaining a CDVA of 20/40 or better (P < .002). Poor visual outcomes were associated with α-antagonist use (P = .043) and pseudoexfoliation syndrome (P = .001). The most common intraoperative complications were vitreous loss (6.7%) and posterior capsule tear (7.0%). The mean postoperative visual acuity did not vary by trainee year, and the rate of dropped nucleus during surgery declined as residents progressed in training (P < .05). All other complication rates were similar between levels of training., Conclusion: Despite more complicated cataracts and advanced comorbidities, primary resident-performed cataract surgery in a tertiary-care county hospital system achieved visual outcomes and complication rates similar to those found in other training hospitals., (Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare complication rates, visual acuity, and refractive outcomes of secondary intraocular lens (IOLs) implantation., Setting: Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA., Design: Retrospective case series., Methods: All secondary IOLs placed by the anterior segment service were reviewed. Preoperative data, operative reports, and data from each subsequent postoperative visit were evaluated. Patients were divided into 5 groups based on the final IOL position: (1) sulcus with optic capture, (2) sulcus without optic capture, (3) anterior chamber (AC), (4) iris-fixated, and (5) transscleral-sutured. Complication rates, visual acuity, and refractive outcomes were compared for each group., Results: The sulcus with and without optic capture groups had the lowest complication rates and best visual acuity outcomes. There was no difference in final corrected distance visual acuity (CDVA) between the transscleral-sutured IOL, iris-fixated IOL, and AC IOL groups, although the AC IOL group had the lowest rates of early postoperative complications and a significant improvement in vision. The transscleral-sutured IOL group had the highest complication rates, and 25% of patients in the iris-fixated IOL group lost 2 or more lines of CDVA., Conclusions: When a secondary IOL cannot be placed within the capsular bag, sulcus with optic capture is the best alternative, followed by sulcus without optic capture. There was no difference in visual acuity outcomes between transscleral-sutured IOLs, iris-fixated IOLs, and AC IOLs. Anterior chamber IOLs resulted in fewer early complications., (Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the accuracy of toric intraocular lens (IOL) alignment in femtosecond laser-assisted cataract surgery using the Truevision 3-dimensional (3-D) computer-guided visualization system compared with a manual marking method., Setting: Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA., Design: Retrospective comparative case series., Methods: Preoperatively, all patients had corneal topography measurements with a color light-emitting diode topographer. The 3-D system used the anterior keratometry values to create an optimized plan for the toric IOL alignment. Intrastromal marks were created by the femtosecond laser at the intended toric meridian, guided by manual ink marks placed at the 3 o'clock and 9 o'clock limbus with the patient sitting upright. Intraoperatively, the 3-D system was used to align the IOL and measure the angular position of the femtosecond marks relative to the IOL meridian. Three weeks postoperatively, the manifest refraction, corrected distance visual acuity, and toric IOL alignment were recorded., Results: The mean 3-D imaging error was -0.58 degrees ± 3.90 (SD) (range -9 to 5 degrees), and the mean manual ink error was -0.27 ± 3.65 degrees (range -8 to 5 degrees); neither was statistically significantly different from zero (P = .28 and P = .76, respectively). The mean absolute errors were 2.96 ± 2.54 degrees and 2.88 ± 2.18 degrees, respectively., Conclusion: The 3-D computer-guided system and manual marking combined with femtosecond laser marks were similar in accuracy for toric alignment., Financial Disclosures: Dr. Wang received research support from Ziemer USA, Inc. Dr. Weikert is a consultant to Ziemer USA, Inc. Dr. Koch is a consultant to Alcon Laboratories, Inc., and Abbott Medical Optics, Inc., and received research support from Ziemer USA, Inc., i-Optics Corp, and Truevision Systems. None of the other authors has a financial or proprietary interest in any material or method mentioned., (Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)