RESUMEN
PURPOSE: To compare the clinical and aberrometric outcomes obtained with a new diffractive pentafocal intraocular lens (IOL) and a diffractive trifocal IOL. METHODS: Patients bilaterally implanted with the pentafocal Intensity SeeLens IOL (Hanita Lenses) (n = 30) and the trifocal FineVision POD F IOL (PhysIOL) (n = 30) during cataract surgery were studied after 1 month for refraction, visual acuity, defocus curve, contrast sensitivity, Hartmann-Shack aberration, and double-pass aberration. The Quality of Vision (QoV) questionnaire was used to evaluate visual comfort. RESULTS: Distance and near visual acuities were similar with the two IOLs, but distance-corrected intermediate visual acuity was better with the Intensity IOLs (0.03 ± 0.04 vs 0.11 ± 0.04 logMAR in the FineVision eyes, P < .01). The difference between objective and subjective refraction was more myopic for the Intensity IOL (-1.15 vs -0.29 diopters [D]). The defocus curve was flatter with the Intensity IOL. Contrast sensitivity was similar in both IOLs. Hartmann-Shack aberration and double-pass aberration were similar, but the modulation transfer function cut-off value was worse with the Intensity IOL: 11.6 ± 2.7 vs 15.3 ± 4.9 (P < .01). QoV scores were better with the Intensity IOL, in particular for glare, halos, and starburst. CONCLUSIONS: In this comparative series, the pentafocal Intensity IOL provided better intermediate vision and better defocus curve than the FineVision IOL, with comparable distance and near vision. The optical disturbances as reported by the patients were higher with the FineVision IOL. Additional studies will better define the aberration profile obtained with the pentafocal IOL. [J Refract Surg. 2024;40(9):e604-e613.].
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Sensibilidad de Contraste , Implantación de Lentes Intraoculares , Lentes Intraoculares Multifocales , Facoemulsificación , Diseño de Prótesis , Seudofaquia , Refracción Ocular , Agudeza Visual , Humanos , Agudeza Visual/fisiología , Refracción Ocular/fisiología , Sensibilidad de Contraste/fisiología , Femenino , Masculino , Seudofaquia/fisiopatología , Anciano , Persona de Mediana Edad , Encuestas y Cuestionarios , Estudios Prospectivos , Satisfacción del Paciente , Aberrometría , Lentes Intraoculares , Aberración de Frente de Onda Corneal/fisiopatologíaRESUMEN
PURPOSE: To investigate the impact of back-to-front corneal radius ratio (B/F ratio) and posterior keratometry (PK) on the accuracy of intraocular lens power calculation formulas in eyes after myopic laser in situ keratomileusis (LASIK)/photorefractive keratectomy (PRK) surgery. METHODS: A retrospective, consecutive case series study included 101 patients (132 eyes) with cataract after myopic LASIK/PRK. Mean prediction error (PE), mean absolute PE (MAE), median absolute error (MedAE), and the percentage of eyes within ±0.25, ±0.50, and ±1.00 diopters (D) of PE were determined. RESULTS: The Barrett True K-TK formula exhibited the lowest MAE (0.59 D) and MedAE (0.48 D) and the highest percentage of eyes within ±0.50 D of PE (54.55%) in total. In eyes with a B/F ratio of 0.70 or less and PK of -5.70 D or greater, the Potvin-Hill formula displayed the lowest MAE (0.46 to 0.67 D). CONCLUSIONS: The Barrett True-TK exhibited the highest prediction accuracy in eyes after myopic LASIK/PRK overall. However, for eyes with a low B/F ratio and flat PK, the Potvin-Hill performed best. [J Refract Surg. 2024;40(9):e635-e644.].
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Biometría , Córnea , Queratomileusis por Láser In Situ , Láseres de Excímeros , Implantación de Lentes Intraoculares , Lentes Intraoculares , Miopía , Queratectomía Fotorrefractiva , Refracción Ocular , Agudeza Visual , Humanos , Miopía/cirugía , Miopía/fisiopatología , Queratomileusis por Láser In Situ/métodos , Estudios Retrospectivos , Queratectomía Fotorrefractiva/métodos , Femenino , Masculino , Córnea/patología , Córnea/cirugía , Refracción Ocular/fisiología , Adulto , Persona de Mediana Edad , Láseres de Excímeros/uso terapéutico , Agudeza Visual/fisiología , Biometría/métodos , Óptica y Fotónica , Topografía de la Córnea , Reproducibilidad de los Resultados , Adulto Joven , FacoemulsificaciónRESUMEN
PURPOSE: To evaluate the influence of a capsular tension ring (CTR) on the intraocular lens (IOL)-capsule complex after cataract surgery in patients with long axial length. METHODS: This was a prospective study. Patients underwent phacoemulsification and IOL implantation, with or without CTR implantation. Swept-source optical coherence tomography was performed at 1 day, 1 week, 1 month, and 3 months postoperatively to determine the postoperative aqueous depth (PAD), capsular bend index (CBI), and IOL tilt and decentration. Spherical equivalent values were obtained through subjective refraction and autorefraction. Root mean square was adopted to evaluate the indices listed above. RESULTS: Forty-three patients (56 eyes) were included in the study. Generalized estimating equation analysis of PAD showed a statistical difference between groups (P = .031). The RMS of the change in PAD was smaller in the CTR group than in the non-CTR group during the 3 months after surgery (P = .015). CBI in the CTR group increased more from 1 to 3 months after surgery than that in the non-CTR group (P = .025). The RMS of the change in vertical decentration was smaller in the CTR group than in the non-CTR group during the 3-month follow-up (P = .009). CONCLUSIONS: CTR implantation can stabilize the axial position of the IOL within the capsular bag after cataract surgery in patients with long axial length without affecting the refractive stability. The formation of capsular bend may be slightly delayed in the early stage after CTR implantation, but it accelerates from 1 to 3 months after surgery. [J Refract Surg. 2024;40(9):e654-e661.].
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Longitud Axial del Ojo , Cápsula del Cristalino , Implantación de Lentes Intraoculares , Lentes Intraoculares , Facoemulsificación , Refracción Ocular , Tomografía de Coherencia Óptica , Agudeza Visual , Humanos , Estudios Prospectivos , Masculino , Femenino , Anciano , Longitud Axial del Ojo/patología , Agudeza Visual/fisiología , Persona de Mediana Edad , Cápsula del Cristalino/patología , Cápsula del Cristalino/cirugía , Cápsula del Cristalino/diagnóstico por imagen , Refracción Ocular/fisiología , Prótesis e Implantes , Seudofaquia/fisiopatologíaRESUMEN
PURPOSE: To investigate the feasibility and safety of a new small-aperture device, which is implanted on top of the intraocular lens. METHODS: Regular cataract surgery was performed in both eyes in 7 patients. In the non-dominant eye, a small-aperture device (VisionXtender; Morcher) was additionally implanted into the capsular bag at the end of the surgery. The mask had an inner diameter of 1.4 mm. Feasibility and safety were investigated 3 months and 2 years after surgery. RESULTS: In all cases, the device was successfully positioned in the capsular bag without any intraoperative complications. No inflammation was observed at the 3-month follow-up visit. All patients achieved binocular uncorrected distance visual acuity of 0 logarithm of the minimum angle of resolution (log-MAR) or better. Additionally, distance-corrected intermediate visual acuity of 0.1 logMAR or better was measured in the non-dominant eye. Two years postoperatively, Nd:YAG capsulotomy was performed in three patients in both eyes. CONCLUSIONS: This clinical feasibility trial demonstrates that the use of the new small-aperture device is both easy and safe. No intraoperative or postoperative complications were reported. All patients attained satisfactory distance, intermediate, and near visual acuity. The device shows significant potential when used in combination with different intraocular lenses (eg, toric). In the future, different opening shapes seem to be possible. [J Refract Surg. 2024;40(9):e662-e666.].
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Estudios de Factibilidad , Implantación de Lentes Intraoculares , Lentes Intraoculares , Facoemulsificación , Diseño de Prótesis , Agudeza Visual , Humanos , Agudeza Visual/fisiología , Masculino , Femenino , Anciano , Persona de Mediana Edad , Refracción Ocular/fisiología , Visión Binocular/fisiología , Estudios Prospectivos , Seudofaquia/fisiopatologíaRESUMEN
Accurate measurement of astigmatism parameters is the basis for prescribing modern means of optical correction. In recent years, another direction for correcting astigmatism has emerged - implantation of toric intraocular lenses (TIOL). PURPOSE: This study evaluates the diagnostic accuracy of various methods for measuring the parameters of regular astigmatism. MATERIAL AND METHODS: The study included 83 patients (122 eyes) with regular astigmatism exceeding 1.0 D. Three groups were formed depending on the type of astigmatism. Spherical and cylindrical (power and axis) components of refraction were determined using automatic refractometry. The results were refined with subjective tests: power and axis tests with a cross-cylinder. The criterion for diagnostic accuracy was the level of corrected visual acuity. To assess the impact of cylinder position on visual acuity, discrete deviations of the axis of trial astigmatic lenses from the correct position (determined based on subjective tests) were modeled at 5, 10, and 15 degrees in both clockwise and counterclockwise directions. RESULTS: In the overall sample of observations, coincidence of results was found only in one-third of cases, with a tendency for discrepancies in data between the two methods in nearly 70% of cases. Statistical processing revealed significant differences only in the magnitude of the cylinder in the group with against-the-rule astigmatism (p<0.0005). An increase in maximum visual acuity corrected based on subjective test data was noted. With a deviation of the cylinder axis from the correct position by 10-15 degrees, regardless of the type of astigmatism, a significant tendency for a decrease in visual acuity was identified. At the same time, with a deviation of the cylinder axis within 5 degrees, a significant decrease in visual acuity was noted only in with-the-rule astigmatism and counterclockwise deviation. CONCLUSION: To achieve maximum visual acuity in the correction of regular astigmatism, objective method data must be refined with subjective tests. The results of modeling the deviation of the axis of the corrective lens from the proper position can be considered when evaluating the functional outcomes of TIOL implantation.
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Astigmatismo , Refracción Ocular , Agudeza Visual , Astigmatismo/diagnóstico , Astigmatismo/fisiopatología , Humanos , Refracción Ocular/fisiología , Masculino , Reproducibilidad de los Resultados , Femenino , Persona de Mediana Edad , Lentes Intraoculares , Adulto , Refractometría/métodos , Pruebas de Visión/métodosRESUMEN
BACKGROUND: To explore intraocular lens (IOL) preferences of United Kingdom-based (UK) refractive surgeons in cataract and refractive lens exchange (RLE) surgery. METHODS: An online survey on IOL preferences (and reasons for their choice) in cataract and RLE surgery was distributed. It also enquired about implementing mini-monovision with extended depth of field (EDoF) IOLs, about utilising IOL mix-and-match (different IOL types in each eye), and at what level of corneal astigmatism they prefer toric lenses. RESULTS: Following an 81.6% response rate, thirty responses were analysed; median years of refractive surgery experience was 12.5. The most popular IOL choices for cataract surgery were EDoF lenses (30%), monofocals (20%), and trifocals (20%). The most cited reason for each was better overall visual outcomes (88.9%), fewer unwanted symptoms (66.7%) and best spectacle independence (66.7%), respectively. For RLE, EDoF remained most popular (36.7%), followed by trifocals (30%), and multifocals (16.7%) with the same reasons for choice cited above. Mini-monovision with EDoF lenses was well-regarded (83% recommend for most/select patients), unlike utilising IOL mix-and-match (60% did not recommend). 40% prefer toric IOLs for astigmatism of 1 dioptre (D) or higher, whilst 30% opt for them at < 1D. CONCLUSIONS: Experienced UK refractive surgeons prefer newer IOLs with enhanced optics; ≥50% of respondents favoured either EDoF or trifocals for a 'typical' cataract or RLE patient. Notably, respondents have a low corneal astigmatism threshold for toric lenses. Mini-monovision with EDoF IOLs was well-regarded, whilst mix-and-match of different IOL types was less recommended.
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Lentes Intraoculares , Humanos , Reino Unido , Encuestas y Cuestionarios , Implantación de Lentes Intraoculares , Extracción de Catarata , Agudeza Visual/fisiología , Femenino , Masculino , Persona de Mediana EdadRESUMEN
We report the successful reconstruction of suture exposure with the oral mucosal graft in a patient with suture exposure after transscleral-sutured posterior chamber intraocular lens implantation. The 70-year-old patient had a history of vitreoretinal surgery and transscleral-sutured posterior chamber intraocular lens implantation after complicated cataract surgery. He was referred to our department because of suture exposure. The best-corrected visual acuity was 20/2000 OD and 20/50 OS. We observed exposed PC9 sutures from both the nasal and temporal conjunctiva in the right eye. The patient showed appearance of scleromalacia in the same regions, so scleral flap surgery was not considered. Despite both tenoplasty and amniotic membrane transplant procedures, exposure could not be controlled. Instead, the patient received oral (buccal) mucosal graft transplant to the resistant exposure areas. A single layer of protective amniotic membrane was transplanted over the buccal mucosal graft. This method resulted in effective control of the exposed area. In conclusion, an oral mucosal graft can be used in many ocular pathologies that require conjunctival reconstruction because of the simplicity of tissue excision from the mucosa, allowing adequate tissue excision, durability of the obtained tissue, and ease of use. Our case report highlights that resistant transscleral-sutured posterior chamber intraocular lens suture exposure can be successfully managed with oral mucosal grafting.
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Implantación de Lentes Intraoculares , Mucosa Bucal , Técnicas de Sutura , Agudeza Visual , Humanos , Masculino , Implantación de Lentes Intraoculares/efectos adversos , Anciano , Mucosa Bucal/trasplante , Resultado del Tratamiento , Esclerótica/cirugía , Esclerótica/trasplante , Amnios/trasplante , Lentes Intraoculares , Extracción de CatarataRESUMEN
BACKGROUND: In pediatric ophthalmology, calculating intra-ocular lens (IOL) power can be challenging. It is important to predict if the post-surgery refractive error (RE) will meet the intended refractive goal. In this study, we aimed to investigate the factors and predictors influencing RE outcomes in children undergoing IOL implantation. METHODS: This was a retrospective cross-sectional cohort study that involved 47 eyes with congenital cataracts underwent IOL implantation. Each patient underwent follow-up visits at two months and two years' post-surgery. The IOL power calculations were conducted using the Holladay 1 formula, and both the prediction error (PE) and absolute prediction error (APE) were calculated. RESULTS: The mean age was 6.52 ± 4.61 years, with an age range of 1-15 years. The mean IOL power was 20.31 ± 6.57 D, and the mean post-operative refraction was 1.31 ± 2.65 D. The mean of PE and APE were 0.67 ± 1.77 and 1.55 ± 1.06 D, respectively. Whereas PE was correlated to axial length with an R-value of - 0.29 (P = 0.04). The calculation method had a significant negative relationship with APE and PE, with coefficients of - 1.05 (P = 0.009) and - 1.81 (P = 0.009), respectively. CONCLUSION: High astigmatism was associated with greater errors in the refractive outcome. The calculation methods had the most considerable impact on the post-operative RE. The customization of surgical approaches to accommodate individual characteristics is crucial. Further research with diverse subgroups is needed to comprehensively understand the influence of each factor.
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Implantación de Lentes Intraoculares , Lentes Intraoculares , Refracción Ocular , Errores de Refracción , Agudeza Visual , Humanos , Estudios Retrospectivos , Niño , Masculino , Femenino , Refracción Ocular/fisiología , Adolescente , Estudios Transversales , Preescolar , Lactante , Agudeza Visual/fisiología , Errores de Refracción/fisiopatología , Errores de Refracción/etiología , Errores de Refracción/diagnóstico , Implantación de Lentes Intraoculares/métodos , Catarata/congénito , Catarata/fisiopatología , Estudios de Seguimiento , Extracción de Catarata/métodos , Extracción de Catarata/efectos adversos , Periodo PosoperatorioRESUMEN
PURPOSE: To compare the two most used digital alignment systems regarding precision, repeatability and loss of track. METHODS: 15 eyes of 15 patients older than 21 years with cataracts were included in this prospective study. The two systems were intraoperatively superimposed and recorded, and the alignment of the two displayed alignment axes was analysed regarding precision, repeatability and loss of track. RESULTS: There was a significant difference in precision and repeatability between the two digital alignment systems regarding the projected alignment axis. The deviation from the actual target axis was significantly different, with a mean of 0.34°±0.75° for the Zeiss system and 1.60°±1.08° for the Alcon system (p=0.03, n=14). The within-subject SD was significantly lower with 0.21° for the Zeiss system and 0.34° for the Alcon system (p=0.03, n=14). CONCLUSIONS: The Zeiss Callisto system showed a significantly lower deviation from the target axis, higher stability with eye movements and less need for microscope illumination than the Alcon system. Both systems showed high precision when compared with manual marking methods. TRIAL REGISTRATION NUMBER: NCT05220683.
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Implantación de Lentes Intraoculares , Humanos , Estudios Prospectivos , Femenino , Masculino , Implantación de Lentes Intraoculares/métodos , Implantación de Lentes Intraoculares/instrumentación , Persona de Mediana Edad , Anciano , Lentes Intraoculares , Reproducibilidad de los Resultados , Astigmatismo/cirugía , Adulto , Facoemulsificación/métodos , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/instrumentación , Agudeza Visual/fisiología , CatarataRESUMEN
Lens drop and intraocular lens (IOL) drop can occur after cataract or phacoemulsification surgery, where the IOL is dislocated from the capsular bag into the vitreous cavity. The aim of this study was to investigate the short-term outcomes of implanting a retropupillary iris-claw in patients with IOL drop and lens drop after phacoemulsification. A cross-sectional study was conducted at Santosa Hospital, Bandung, West Java, Indonesia, from January 2020 to December 2023. Patients were divided into two groups: IOL drop and lens drop groups. Total sampling was used, involving 51 patients in the present study, with 27 patients in the IOL drop group and 24 patients in the lens drop group. Data collected included age, sex, eye laterality, the onset of IOL drop or lens drop, intraocular pressure (IOP), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), record of astigmatism change preoperative and postoperative, and postoperative pars plana vitrectomy (PPV) complications. Our data indicated that the UDVA significantly improved in both IOL drop and lens drop groups after PPV surgery (p<0.001). However, there were no significant changes in IOP or astigmatism following the surgery in either group. Over one month, both groups showed improved UDVA, decreased IOP, and changes in astigmatism, with no significant differences between groups. Similarly, there was no significant difference in CDVA between IOL drop and lens drop groups. Only four complications were recorded in the present study. Comparing IOL drop and lens drop groups, only an increase in IOP showed a significant difference (p=0.018). Corneal edema, IOL decentration, and pupil ovalization were not significantly different. In conclusion, retropupillary iris-claw IOL implantation is safe and effective for aphakic patients with complications from phacoemulsification, regardless of whether it is lens drop or IOL drop.
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Implantación de Lentes Intraoculares , Lentes Intraoculares , Facoemulsificación , Agudeza Visual , Humanos , Femenino , Masculino , Estudios Transversales , Implantación de Lentes Intraoculares/métodos , Implantación de Lentes Intraoculares/efectos adversos , Persona de Mediana Edad , Agudeza Visual/fisiología , Facoemulsificación/métodos , Anciano , Iris/cirugía , Indonesia , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Resultado del Tratamiento , Astigmatismo/cirugíaRESUMEN
The extended depth-of-focus AcrySof IQ Vivity intraocular lens technology offers promising features for presbyopia management, evaluated in this research in a 6 months real-world setting. Prospective interventional mono-centric study including 40 patients who underwent elective bilateral phacoemulsification. We performed one pre-operative visit (V0) and one evaluation six months post-operatively (V1), evaluating uncorrected and corrected visual acuity for near (UNVA/CNVA), intermediate (UIVA/CIVA) and far (UDVA/UCVA), slit-lamp evaluation, tomography with static pupillometry, endothelial cell count and contrast sensitivity chart. In order to assess post-operative Quality of Life, we administered the patients McAlinden's Quality of Vision test and Morlock's Patient-Reported Spectacle Independence Questionnaire. We divided eyes in with Toric-IOL and with non-Toric IOL. A total of 36 eyes received non-tonic IOL implantation, whereas 44 eyes received toric IOL implantation. There were no statistically significant disparities observed in visual outcome measures and contrast sensitivity between the toric group and the non-toric group. Furthermore, we assessed the predictive preoperative refractive astigmatism (PPRA) and residual refractive astigmatism (RRA) in both cohorts, and no statistical significance was found between the two cohorts (p = 0.08). Twenty-one (53%) patients reported total independence from their glasses at all distances. The mean difference between the predicted and measured refractive error, as calculated by spherical equivalent, was 0.09 D. AcrySof IQ Vivity is a well-tolerated and effective IOL with optimal refractive target for both distant and intermediate vision, needing slight spherical addition for the best near vision. Great questionnaire-based satisfaction was reported by the patients.
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Implantación de Lentes Intraoculares , Lentes Intraoculares , Calidad de Vida , Agudeza Visual , Humanos , Femenino , Masculino , Implantación de Lentes Intraoculares/métodos , Anciano , Persona de Mediana Edad , Estudios Prospectivos , Facoemulsificación , Resultado del Tratamiento , Sensibilidad de Contraste/fisiología , Presbiopía/cirugía , Presbiopía/fisiopatología , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To assess the efficacy and safety of using the adjustable flanged technique for secondary implantation of four-point scleralfixated posterior chamber intraocular lenses with two parallel 6-0 polyglactin sutures. METHODS: Two parallel 6-0 polyglactin sutures were passed separately through the two haptics on the horizontal line of the 4-haptic IOL. The four externalized sutures were then trimmed and cauterized to form flanges. The best corrected visual acuity, intraocular pressure, and complications in all patients were observed and recorded. RESULTS: The flanged technique using two parallel 6-0 polyglactin sutures was applied to 14 aphakic eyes. The average preoperative best corrected visual acuity was 1.00 ± 0.88 LogMAR (Snellen 20/200), which improved to 0.42 ± 0.38 LogMAR (Snellen 20/48) at the final follow-up (P = 0.004). None of the patients experienced vitreous hemorrhage, low intraocular pressure, or issues with exposed or broken sutures. CONCLUSION: The simplicity of the technique, along with its ability to accommodate adjustments post-implantation, allows for optimal positioning and reduces risks like IOL tilt or dislocation. Overall, this is a promising approach to secondary IOL implantation, with potential benefits for both patient outcomes and surgical efficiency.
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Implantación de Lentes Intraoculares , Lentes Intraoculares , Esclerótica , Técnicas de Sutura , Suturas , Agudeza Visual , Humanos , Implantación de Lentes Intraoculares/métodos , Femenino , Agudeza Visual/fisiología , Masculino , Esclerótica/cirugía , Persona de Mediana Edad , Anciano , Adulto , Presión Intraocular/fisiología , Poliglactina 910 , Afaquia Poscatarata/cirugía , Afaquia Poscatarata/fisiopatologíaRESUMEN
BACKGROUND: To compare the visual efficacy and patient satisfaction between 2 toric IOLs (TIOL), enhanced for intermediate vision or monofocal. METHODS: A retrospective chart review was performed of 100 eyes from 68 astigmatic patients who underwent cataract surgery with implantation of a Tecnis Eyhance Toric II IOL (Johnson & Johnson Vision, Irvine, CA, USA) (Group 1, 50 eyes) or Tecnis TIOL (Group 2, 50 eyes). The uncorrected distant (UDVA), intermediate (UIVA), and near (UNVA) visual acuities; residual refractive astigmatism; defocus curve; and IOL axis rotation were evaluated at 1 week, 1 month, 2 months, and 3 months postoperatively. RESULTS: The postoperative UDVA and UNVA refractive astigmatism values of the two groups were better than the preoperative measurements (P < 0.05), but there was no statistical difference between the two groups (P > 0.05). The postoperative UIVA of group 1 (0.18 ± 0.15 logMAR) was significantly better than that of group 2 (0.30 ± 0.25) (P < 0.05). The mean postoperative IOL rotation of group 1 (2.51 ± 0.79°) was lower than that of group 2 (3.02 ± 0.84°) (P < 0.05). Overall satisfaction of group 1 (1.27 ± 0.47) was better than that of group 2 (2.02 ± 0.53) (P < 0.05). CONCLUSIONS: The Tecnis Eyhance Toric II IOL demonstrated less postoperative IOL rotation and excellent uncorrected intermediate vision compared with the Tecnis TIOL. Near visual acuity and overall satisfaction with the Tecnis Eyhance Toric II IOL were also higher than those with the Tecnis TIOL.
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Astigmatismo , Implantación de Lentes Intraoculares , Lentes Intraoculares , Satisfacción del Paciente , Diseño de Prótesis , Agudeza Visual , Humanos , Agudeza Visual/fisiología , Estudios Retrospectivos , Femenino , Masculino , Anciano , Persona de Mediana Edad , Implantación de Lentes Intraoculares/métodos , Astigmatismo/cirugía , Astigmatismo/fisiopatología , Facoemulsificación , Refracción Ocular/fisiología , Seudofaquia/fisiopatología , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Posterior chamber intraocular lens (IOL) dislocation is a common complication of cataract surgery. Dislocated IOLs often require surgical intervention due to the potentially severe risks of leaving this condition untreated. If a patient with extremely low corneal endothelial cell density (ECD) presents with IOL dislocation, the surgeon faces a crucial dilemma of choosing the most optimal surgical treatment option. We sought to investigate the efficacy and safety of retropupillary iris claw intraocular lens (R-IOL) implantation in patients with IOL dislocation and extremely low (< 1000 cells/mm2) ECD. METHODS: We retrospectively reviewed the medical records of nine patients (all men) whose pre-operative ECD was < 1000 cells/mm2 and who underwent R-IOL implantation due to intraocular subluxation or total dislocation into the vitreous cavity between 2014 and 2020. We evaluated corneal endothelial function and visual outcomes after surgery. RESULTS: Nine patients were included in this study. The mean age at diagnosis was 64.89 ± 7.15 years (range 57-76 years), and the follow-up duration was 37.93 ± 23.72 months (range 18.07-89.07 months). No patients developed bullous keratopathy during follow-up. Compared to the initial ECD, corneal thickness (CT), coefficient variation of cell area (CV) and percentage of hexagonal cells (HEX), there was no statistically significant decrease in the ECD, CV, and HEX at last follow-up (P = 0.944, 0.778, 0.445, 0.443). There was significant improvement in the mean uncorrected distance visual acuity (UDVA) at the last follow-up (average 0.13 logMAR, 20/27 Snellen) compared to the pre-operative mean UDVA (average 1.09 logMAR, 20/250 Snellen) (P < 0.01). CONCLUSIONS: R-IOL implantation did not result in a statistically significant decline in corneal endothelial function in patients with preoperatively low ECD, and it significantly improved the mean UDVA postoperatively. R-IOL implantation appears to be a safe and effective treatment modality for intraocular lens dislocation in patients with low ECD (< 1000 cells/mm²); however, long-term follow-up studies are warranted to corroborate these findings.
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Endotelio Corneal , Implantación de Lentes Intraoculares , Lentes Intraoculares , Agudeza Visual , Humanos , Masculino , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Endotelio Corneal/patología , Agudeza Visual/fisiología , Recuento de Células , Implantación de Lentes Intraoculares/métodos , Iris/cirugía , Pérdida de Celulas Endoteliales de la Córnea/diagnóstico , Migracion de Implante de Lente Artificial/cirugía , Migracion de Implante de Lente Artificial/fisiopatología , Estudios de Seguimiento , Femenino , Resultado del TratamientoRESUMEN
PURPOSE: To compare the outcomes of anterior chamber intraocular lens (AC-IOL) implantation versus the four-flanged scleral fixation technique in eyes with loss of capsular support during routine cataract surgery. METHODS: This was a retrospective cohort study of all patients in whom an IOL was implanted either during or after short-term aphakia due to loss of capsular and sulcus support in a routine cataract surgery with at least 6 months of follow-up time between 2015 and 2023 in a tertiary medical center in Israel. Two different IOL implantation techniques were compared: the implantation of an angle-supported ACIOL and four-flanged scleral fixation. Main outcome measures included postoperative complications such as pseudophakic bullous keratopathy, loss of intraocular pressure control and glaucoma, IOL subluxation, and retinal detachment. RESULTS: Sixty-five eyes of 65 patients were included in the study, 33 eyes in the AC-IOL group and 32 eyes in the flange group. Follow-up time was 29.92 ± 20.02 months in the AC-IOL group and 20.17 ± 15.56 months in the flange group (P = .087). Pseudophakic bullous keratopathy was observed in 10 (30.3%) patients in the AC-IOL group and in 1 (3.1%) patient in the flange group (P = .04). This association remained significant using survival analysis (P = .006). In 4 (12.1%) patients in the AC-IOL group, a glaucoma filtering procedure was performed to control the intraocular pressure compared with none in the flange group (P = .042). CONCLUSIONS: In the setting of loss of capsular support during routine cataract surgery, four-flanged scleral fixation showed an overall lower rate of complications and significantly reduced rate of subsequent surgical interventions. [J Refract Surg. 2024;40(8):e520-e526.].
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Cámara Anterior , Implantación de Lentes Intraoculares , Esclerótica , Agudeza Visual , Humanos , Implantación de Lentes Intraoculares/métodos , Estudios Retrospectivos , Esclerótica/cirugía , Femenino , Masculino , Anciano , Agudeza Visual/fisiología , Persona de Mediana Edad , Cámara Anterior/cirugía , Complicaciones Posoperatorias , Técnicas de Sutura , Estudios de Seguimiento , Presión Intraocular/fisiología , Lentes Intraoculares , Extracción de Catarata/métodos , Facoemulsificación/métodos , Anciano de 80 o más Años , Cápsula del Cristalino/cirugía , Seudofaquia/fisiopatologíaRESUMEN
PURPOSE: To assess the refractive predictability of the Carlevale sutureless scleral fixation intraocular lens (IOL) (Sole-ko IOL Division) power calculation. METHODS: This retrospective, non-comparative, interventional case series included patients without a capsular support having undergone sutureless scleral fixation IOL implantation in two French hospitals between October 2019 and April 2022. IOL calculation was performed with the Barrett Universal II, Hoffer Q, Holladay 1, and SRK/T formulas with constant optimization to achieve a mean arithmetic prediction error equal to zero. The main outcomes were prediction error (PE) and its standard deviation (SD-PE), the median absolute error (MedAE), the mean absolute error (MAE), and the percentage of eyes with PE within ±0.50, ±1.00 and ±2.00 diopters (D) 6 months after surgery. RESULTS: Thirty eyes of 30 patients were included in the study. The mean age was 66.6 years, the mean axial length was 24.31 mm, and the mean keratometry was 43.07 D. SDPE ranged from 0.73 to 0.87 D depending on the formula. MedAE ranged from 0.38 to 0.61 D, and MAE from 0.52 to 0.68 D. Between 46.7% and 56.7% of eyes were within ±0.50 D, 76.7% and 90.0% were within ±1.00 D, and 96.7% were within ±2.00 D of target equivalent. No statistically significant difference was observed between the four formulas for any outcomes. CONCLUSIONS: This study confirmed that the design of the Carlevale sutureless scleral fixation IOL provides satisfactory refractive results. [J Refract Surg. 2024;40(8):e527-e532.].
Asunto(s)
Implantación de Lentes Intraoculares , Refracción Ocular , Esclerótica , Agudeza Visual , Humanos , Estudios Retrospectivos , Anciano , Esclerótica/cirugía , Refracción Ocular/fisiología , Implantación de Lentes Intraoculares/métodos , Masculino , Femenino , Agudeza Visual/fisiología , Persona de Mediana Edad , Lentes Intraoculares , Seudofaquia/fisiopatología , Anciano de 80 o más Años , Procedimientos Quirúrgicos sin Sutura/métodos , Facoemulsificación , Diseño de Prótesis , Óptica y FotónicaRESUMEN
INTRODUCTION: Modern intraocular lens (IOL) designs for cataract treatment can be broadly classified into three focal range categories; monofocal, extended depth-of-focus (EDOF) and multifocal IOLs.Monofocal IOLs allow spectacle independence for one focus, typically distance. In contrast, EDOF IOLs provide a greater range of vision, extending spectacle independence to intermediate distance, while multifocal IOLs enable spectacle independence at all distances with the drawback of positive dysphotopsias and reduced contrast perception.EDOF lenses are an attractive compromise with fewer dysphotopic side effects than multifocals. The purpose of this study is to assess whether implanting an EDOF IOL in the second eye of a patient who received a monofocal IOL in the first eye can improve spectacle independence while maintaining the same optical quality as bilateral monofocal IOL implantation. METHODS AND ANALYSIS: This study compares combined monofocal and EDOF IOL implantation versus bilateral monofocal IOL implantation in terms of clinical and patient-reported outcomes in a monocentric, randomised, patient-masked and assessor-masked, parallel group trial in 88 bilateral cataract patients. The primary outcome measure is binocular photopic distance corrected intermediate visual acuity. The secondary outcome measures include (un)corrected distance and near visual acuity, reading speed at intermediate distance, quality of visual function assessments, patient-reported spectacle independence, contrast sensitivity, aberrometry, stereopsis and straylight measurement at the 3-month follow-up. ETHICS AND DISSEMINATION: The protocol was approved by the ethical committee of the University Hospital of Brussels (BUN 23219_EDOF). TRIAL REGISTRATION NUMBER: NCT06002399.
Asunto(s)
Percepción de Profundidad , Implantación de Lentes Intraoculares , Lentes Intraoculares , Diseño de Prótesis , Agudeza Visual , Humanos , Agudeza Visual/fisiología , Implantación de Lentes Intraoculares/métodos , Percepción de Profundidad/fisiología , Femenino , Masculino , Facoemulsificación/métodos , Refracción Ocular/fisiología , Seudofaquia/fisiopatología , Lentes Intraoculares Multifocales , Anciano , Persona de Mediana Edad , Extracción de Catarata/métodos , Sensibilidad de Contraste/fisiología , Satisfacción del PacienteRESUMEN
Purpose: To evaluate the differences between two extended depth-of-focus intraocular lenses, the Alcon IQ Vivity and the Bausch & Lomb LuxSmart and to compare them with a simple monofocal lens, the Alcon IQ, using a simulation-based approach. Methods: A mathematical lens model was created for each lens type based on a measured surface geometry. The lens model was then used in a raytracer to calculate a refractive power map of the lens and a ray propagation image for the focal zone. Results: The simulations confirm the enhanced depth of focus of these two lenses. There are apparent differences between the models. For the Vivity, more light is directed into the far focus in low light conditions, whereas the LuxSmart behaves more pupil independent and prioritizes intermediate vision. Conclusions: The simulation-based approach was effective in evaluating and comparing the design aspects of these lenses. It can be positioned as a valuable third tool for lens characterization, complementing in vivo studies and in vitro measurements. Translational Relevance: With this approach not only focusing on the resulting optical performance, but the underlying functional mechanisms, it paves the way forward for a better adaptation to the individual needs and preferences of patients.