Purpose: To present a case of post-traumatic dislocation of the WIOL-CF® accommodating intraocular lens (IOL), composed of hydrogel material and featuring a full-optic body design, in a vitrectomized eye, highlighting considerations for surgical correction.Case summary: A 54-year-old man with a history of left-eye WIOL-CF® implantation and vitrectomy experienced sudden onset of vision deterioration in the left eye following trauma. The IOL was dislocated due to posterior capsule rupture, with the anterior capsulorhexis margin intact. The support-less circular design and material properties made it challenging to grasp the dislocated IOL in one attempt, and there was a risk of tearing when using intraocular forceps and an extrusion needle. Conclusions The case of WIOL-CF® dislocation without the capsular bag emphasizes the importance of considering the structural vulnerability and propensity for fragmentation of the IOL during removal. Adequate corneal incision size, active utilization of perfluorocarbon liquid to approximate the IOL to the anterior chamber, and gentle removal in one attempt without applying excessive force are crucial steps in the removal of a dislocated IOL.

Purpose: To present a case of post-traumatic dislocation of the WIOL-CF® accommodating intraocular lens (IOL), composed of hydrogel material and featuring a full-optic body design, in a vitrectomized eye, highlighting considerations for surgical correction.Case summary: A 54-year-old man with a history of left-eye WIOL-CF® implantation and vitrectomy experienced sudden onset of vision deterioration in the left eye following trauma. The IOL was dislocated due to posterior capsule rupture, with the anterior capsulorhexis margin intact. The support-less circular design and material properties made it challenging to grasp the dislocated IOL in one attempt, and there was a risk of tearing when using intraocular forceps and an extrusion needle. Conclusions The case of WIOL-CF® dislocation without the capsular bag emphasizes the importance of considering the structural vulnerability and propensity for fragmentation of the IOL during removal. Adequate corneal incision size, active utilization of perfluorocarbon liquid to approximate the IOL to the anterior chamber, and gentle removal in one attempt without applying excessive force are crucial steps in the removal of a dislocated IOL.

Purpose: To present a case of post-traumatic dislocation of the WIOL-CF® accommodating intraocular lens (IOL), composed of hydrogel material and featuring a full-optic body design, in a vitrectomized eye, highlighting considerations for surgical correction.Case summary: A 54-year-old man with a history of left-eye WIOL-CF® implantation and vitrectomy experienced sudden onset of vision deterioration in the left eye following trauma. The IOL was dislocated due to posterior capsule rupture, with the anterior capsulorhexis margin intact. The support-less circular design and material properties made it challenging to grasp the dislocated IOL in one attempt, and there was a risk of tearing when using intraocular forceps and an extrusion needle. Conclusions The case of WIOL-CF® dislocation without the capsular bag emphasizes the importance of considering the structural vulnerability and propensity for fragmentation of the IOL during removal. Adequate corneal incision size, active utilization of perfluorocarbon liquid to approximate the IOL to the anterior chamber, and gentle removal in one attempt without applying excessive force are crucial steps in the removal of a dislocated IOL.

Purpose: Various vitrectomy probes are currently being used commercially, and there are ongoing efforts toward developing probes with higher cutting rates and smaller gauges. This study aimed to compare the efficiency and safety of various commercially available small gauge ultrahigh-speed dual pneumatic vitrectomy probes. Methods: We retrospectively analyzed the medical records of patients and recorded intraoperative videos while they underwent microincision three-port vitrectomy surgery for idiopathic epiretinal membrane at Soonchunhyang University Seoul Hospital. The patients were categorized into four groups based on the vitrectomy probe used during surgery: 23-7500 (UltraVit 23-gauge 7,500 cuts per minute [CPM]), 23-7500 (UltraVit 25-gauge 7,500 CPM), 25-10K (Advanced UltraVit 25-gauge 10,000 CPM), and 27-10K (Advanced UltraVit 27-gauge 10,000 CPM). Results: In total, 82 eyes from 82 patients were included in this work, with 16, 11, 26, and 29 eyes in groups 23-7500, 25-7500, 25-10K, and 27-10K, respectively. The corresponding vitrectomy times were 295.56 ± 53.55, 293.09 ± 50.28, 299.92 ± 59.42, and 349.38 ± 67.23 seconds, respectively. There was a significant difference in the vitrectomy time between the groups (p = 0.004). The mean number of sutures was 3, 3, 2.96, and 0.83, respectively. In the 23-7500 group, there was one case of iatrogenic retinal break, while in the 27-10K group, there was one case of postoperative hypotony. Conclusions Although advancements have been made in the 27-gauge vitrectomy probe, it still takes more vitrectomy time than it does when using the 23- and 25-gauge probes. However, the delay was within an average of 1 minute, and considering the significantly reduced need for sutures, there is a substantial benefit in terms of postoperative discomfort. Therefore, when choosing a probe for epiretinal membrane surgery among the four options, it is reasonable to select the 27-gauge probe according to the surgeon’s preference.

Purpose: To compare and analyze the performance of dual pneumatic ultra-high-speed vitreous cutters based on their cut rates, vacuum levels, and diameters in terms of flow rate and cutting time. Methods: The Constellation Vision System was used to remove egg white for 30 seconds, after which we calculated the flow rate by measuring the change in weight. We then measured the time required to remove 4 mL of egg white. We tested the UltraVit (UV) 7,500 cuts per minute (cpm) probe and the Advanced UltraVit (AUV) 10,000 cpm probe in biased open duty cycle mode, using 23-, 25-, and 27-gauge probes, respectively. Results: In biased open duty cycle, the flow rate tended to decrease as the cut rates increased for all three gauges. At the same cut rates, the flow rate increased as the vacuum level increased (p < 0.05), and as the diameter increased (p < 0.05). Among cutters with the same diameter, the AUV cutter showed higher flow rates than the UV cutter, with increases of 0.267 mL/min (18.5%) at 27 gauge, 0.627 mL/min (20.8%) at 25 gauge, and 1.000 mL/min (20.7%) at 23 gauge (all p < 0.05). The times required to remove 4 mL of egg white took longer with the UV cutter than the AUV cutter for all three gauges (all p < 0.05). Conclusions The use of a smaller gauge vitreous cutter may reduce the flow rate and increase the time required for vitrectomy, but this can be partially compensated for by increasing the vacuum level as well as using a vitreous cutter with a higher maximum cut rate, improved port size, and improved duty cycle.

Purpose: To investigate a series of peripheral lattice degeneration cases using an ultra-widefield (UWF) swept-source optical coherence tomography (SS-OCT) system. Methods: From August 1, 2022 to July 31, 2023, 19 eyes from 16 patients with peripheral lattice degeneration were included. They all underwent a UWF SS-OCT examination. Anatomy of retina, vitreous, and associated pathologic changes were assessed. Results: UWF SS-OCT showed various anatomical changes of retina and vitreous in patients with lattice degeneration. Of 15 eyes from 12 patients whose UWF SS-OCT images were clearly obtained, eight eyes showed regional retinal thinning, seven eyes showed vitreous traction, two eyes showed detached vitreous, and three eyes showed retinal break. Conclusions UWF SS-OCT can be a useful tool to understand anatomical changes and pathophysiology of peripheral lattice degeneration.

Purpose: To compare short-term efficacy and safety of intravitreal brolucizumab injection with aflibercept in treatment-naive neovascular age-related macular degeneration (nAMD) patients. Methods: A total of 59 eyes from 59 treatment-naive nAMD patients in three hospitals were retrospectively reviewed. Of which, 27 patients underwent intravitreal brolucizumab injections and 32 received aflibercept. After monthly consecutive three injections, best-corrected visual acuity (BCVA; in logarithm of minimal angle of resolution [logMAR]), central macular thickness (CMT), dry macula achievement rate, and intraocular inflammation (IOI) incidence were compared. Results: After loading-phase treatment, BCVA was significantly increased from 0.48 ± 0.30 logMAR at baseline to 0.33 ± 0.21 logMAR at 3 months in the brolucizumab group (p = 0.002) and 0.40 ± 0.39 logMAR at baseline to 0.33 ± 0.36 logMAR at 3 months in the aflibercept group (p = 0.007). But there was no significant difference in BCVA improvement at 3 months between the two groups. CMT significantly decreased from 429.67 ± 250.59 μm at baseline to 210.67 ± 93.53 μm at 3 months in the brolucizumab group and from 346.69 ± 159.09 μm to 234.52 ± 83.42 μm in the aflibercept group (both p < 0.001). The amount of CMT reduction was significantly greater in the brolucizumab group after 3 months (p = 0.036). In typical AMD eyes, brolucizumab showed similar BCVA improvement but better CMT reduction at 3 months (p = 0.018). Dry macula achievement rate was not significantly different between the two groups. One IOI was observed in the brolucizumab group. Conclusions Intravitreal injections of brolucizumab and aflibercept showed similar anatomical and functional outcomes. But CMT reduction was greater in the brolucizumab group. One IOI was identified, which was tolerable for topical agents. These results suggest that brolucizumab could be a novel first line treatment option for treating naive nAMD patients.

Purpose: Binocular diplopia is a primary complication that may arise after scleral buckling surgery in patients with rhegmatogenous retinal detachment. This study examined the incidence of and risk factors for binocular diplopia after scleral buckling surgery; it also evaluated the rate of strabismus surgery success in patients with diplopia. Methods: Medical records of 417 patients who underwent scleral buckling surgery for rhegmatogenous retinal detachment at a single institution from January 2017 to June 2022 were retrospectively reviewed. Patients who experienced binocular diplopia for > 6 months were included in the diplopia group. Results: After surgery, 22 patients (5.3%) developed binocular diplopia. There were no significant correlations of diplopia onset with buckle position (i.e., the affected muscle), cryophotocoagulation, subretinal fluid drainage, and the use of gas or oil injections. Prism therapy restored binocular single vision in three patients. Ten patients chose to undergo strabismus surgery, and one patient underwent encircling band removal. All strabismus surgery patients displayed adhesion between the buckle and extraocular muscle. After surgery, 60% of these patients regained binocular single vision. Conclusions Clear risk factors leading to ocular movement disorders and diplopia after scleral buckling remain undefined. If diplopia persists despite prism-based conservative treatment, strabismus surgery may offer relief.

Purpose: To compare electroretinogram (ERG) waveforms acquired using a portable flash/flicker ERG with skin electrodes (RETevalTM; LKC Technologies, Gaithersburg, MD, USA), a portable flash/flicker ERG with ERG-jet contact lens electrodes (Fabrinal SA, La Chaux-De-Fonds, Swiss), and a conventional full-field (Ganzfeld) ERG. Methods: The left eyes of 30 volunteers with no general or ocular history were measured with a portable RETeval ERG, a portable ERG-jet system, and a conventional full-field ERG. Amplitudes and implicit times were compared among the measurements obtained using the three systems. Results: The RETeval ERG generally showed a lower amplitude than that obtained using a conventional full-field ERG (all, p < 0.001). Amplitude readings from the ERG-jet showed no differences with those acquired using the conventional full-field ERG (all p > 0.1). Conclusions Given the differences in the readings from those obtained using a conventional full-field ERG, data from the portable ERG-RETeval type should be analyzed with caution. Notably, the portable ERG-jet showed no differences in its readings compared to those obtained using a conventional full-field ERG.