3-piece Intraocular Lens Research Articles

Toric and mulitifocal lens utilization independent of patient cost and physician remuneration at a single institution

PurposeTo determine if the rates of toric and multifocal intraocular lenses (IOLs) are affected by patient cost or physician reimbursement. MethodsAt Naval Medical Center San Diego (NMCSD) there is no increased patient cost or physician reimbursement for toric or multifocal IOLs. The medical records of all patients who underwent cataract surgery with IOL implantation at NMCSD between 2013 and September 2016 were reviewed. The type of IOL implanted was identified. The rates of toric and multifocal IOL usage were compared to the rates reported in the 2016 American Society of Cataract and Refractive Surgery (ASCRS) Clinical Survey. ResultsThe inclusion criterion was met for 2585 cataract surgeries. The percentage of toric IOLs at NMCSD in 2016 was 10%. If the patients that received 3 piece or anterior chamber IOLs were excluded, the percentage of single piece IOLs that were toric was 12%. The percentage of multifocal IOLs at NMCSD ranged from 0.8% in 2013 to 0.3% in 2016. The rates of toric and multifocal IOLs reported in the ASCRS clinical survey were 10% and 9%, respectively. Conclusions and ImportanceThe rate of toric IOLs usage was not significantly affected by patient cost or physician reimbursement. The rate of multifocal IOLs usage was significantly lower at NMCSD.

Five-Year Cumulative Incidence and Risk Factors of Nd:YAG Capsulotomy in 10 044 Hydrophobic Acrylic 1-Piece and 3-Piece Intraocular Lenses

To evaluate the 5-year cumulative incidence and risk factors of Nd:YAG capsulotomy between hydrophobic acrylic intraocular lenses (IOLs). A retrospective cohort study. A review of the registry of operations between the years 2007 and 2016 was carried out at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland. A total of 10 044 eyes having cataract surgery and in-the-bag implantation of ZCB00 (Abbott Medical Optics Johnson & Johnson Vision, Inc, Abbott Park, Illinois, USA), SN60WF (Alcon Laboratories, Inc, Fort Worth, Texas, USA), or ZA9003 (Abbott Medical Optics Johnson & Johnson Vision, Inc) IOLs were included in the study. The cumulative incidence of Nd:YAG capsulotomy was estimated with competing risks methodology. Competing risks regression modeling was used to evaluate potential risk factors, including the patient's age, sex, type of IOL, dioptric power of IOL, and operating surgeon's seniority. The 5-year cumulative incidence of Nd:YAG capsulotomy after cataract surgery was 13.2% (95% confidence interval [CI] 12.5%-14.0%) for all eyes and 18.1% (16.5%-20.0%), 11.5% (10.5%-12.6%), and 9.6% (8.2%-11.4%) for ZCB00, SN60WF, and ZA9003 IOLs, respectively. Implantation of SN60WF and ZA9003 IOLs was associated with a 38% and 47% subhazard reduction (SHR), respectively, compared to ZCB00, after accounting for other predictors (SHR= 0.62; 95% CI 0.54-0.71; P < .001 and SHR= 0.53; 95% CI 0.43-0.64; P < .001). Increased risk of Nd:YAG capsulotomy was associated with eyes of patients aged younger than 60 years, female sex, and eyes implanted with an IOL of <22.5 diopters power. Real-world evidence suggests that the cumulative incidence of Nd:YAG capsulotomy is significantly lower in eyes receiving SN60WF orZA9003 IOLs compared to ZCB00.

Haptic tuck for reverse optic capture of a single-piece acrylic toric or other single-piece acrylic intraocular lenses

We describe a new technique for capsule fixation of 1-piece acrylic toric intraocular lens (IOL) or other 1-piece acrylic IOLs in the presence of a large posterior capsule tear resulting in an open capsule. To keep the thick haptics out of the sulcus, reverse optic capture is necessary, with the haptics below the capsule and the optic edges above the capsule. This is done by placing the IOL in the sulcus and if it is a toric IOL, with the toric marks on the optic aligned with the corneal marks. Then, each haptic is separately tucked through the anterior continuous curvilinear capsulorhexis (CCC) opening, leaving the optic edges above the capsule. This technique achieves reverse optic capsulorhexis capture without the challenge of injecting the IOL through the CCC with an open posterior capsule. We propose the term haptic tuck for reverse optic capture for this technique.

A clinical assessment of visual performance of combining the TECNIS® Symfony Extended Range of Vision IOL (ZXR00) with the +3.25 D TECNIS Multifocal 1-piece IOL (ZLB00) in subjects undergoing bilateral cataract extraction.

PurposeTo combine the increased depth of focus of the TECNIS® Symfony intraocular lens (IOL) with a TECNIS Multifocal (MF) low-add IOL (+3.25) to enable a patient to be less dependent on corrective lenses.SettingClinic in Canada.DesignSingle-center, prospective, open-label.Materials and methodsFifty patients were enrolled for bilateral surgery. Patients were implanted with TECNIS Symfony Extended Range of Focus lens in the dominant eye, and TECNIS low-add +3.25 MF IOL in the non-dominant eye. Patients were ≥18 years of age and had best-corrected visual acuity >20/30 in both eyes, pupil size >3.5 mm, and <1.5 D of corneal astigmatism. Patients were evaluated preoperatively, operatively, and postoperatively on Day 1, Day 7, Month 1, and Month 3. Postoperative evaluations at Month 3 were completed by 32 of 50 patients enrolled, and included distance, intermediate and near visual acuity (VA), and subjective outcomes.ResultsThree months postoperatively, binocular results without correction revealed 97% (29/30) of patients had distance VA of 20/20 or better, 97% (29/30) had intermediate VA of 20/25 or better, and 94% (28/30) had near VA of 20/25 or better. At Month 3, the majority of patients reported “none” for visual symptoms of glare (30/30, 100%), halo (29/30, 96.6%), starbursts (29/30), or other – blur (30/30, 100%).ConclusionThree months postoperatively, the combination of the increased depth of focus of the TECNIS Symfony IOL with a TECNIS MF low-add (+3.25) IOL may provide excellent uncorrected VA at near, intermediate, and far distances with minimal ocular symptoms.

Serial intraocular lens opacifications of different designs from the same manufacturer: Clinical and light microscopic results of 71 explant cases

To report clinical findings and light microscopic results of 71 opacified hydrophilic acrylic intraocular lenses (IOLs). Vivantes Klinikum Neukoelln, Ophthalmology Department, Berlin, Germany. Retrospective case series. Sixty-three patients (71 eyes) were referred to the clinic because of vision-impairing IOL opacification between December 2012 and September 2016 after routine cataract surgery elsewhere. The explanted IOLs were analyzed with light microscopy at the John A. Moran Eye Center (University of Utah, Salt Lake City, Utah, USA). Medical records were reviewed for visual acuity, comorbidities, and complications. Clinical follow up was 6months. Seventy-one opacified 1-piece or 3-piece hydrophilic acrylic IOLs (Lentis) of different designs from 2009 to 2012 (LS-502-1, LS-402-1Y, LS 312-1Y, LS-313-1Y, L-402, L-312) were found. Morphological findings were surface, subsurface, or deep calcifications of the IOL material. Explantation was performed 4years±1.2 (SD) after initial phacoemulsification. The mean patient age was 78.6±8.2years. Ocular and systemic comorbidities were found without statistical correlation: the most frequent were diabetes, uveitis, and glaucoma. The preoperative mean corrected distance visual acuity changed from 0.63±0.47 logarithm of the minimum angle of resolution (logMAR) to 0.20±0.28 logMAR postoperatively (P<.001). Different designs of IOLs by the same manufacturer, implanted between 2009 and 2012, developed late calcification with significant visual loss after routine cataract surgery. No medical, surgical, or ophthalmologic trigger could be determined. A manufacture issue might be the reason for the opacification.

STRUCTURAL ANALYSIS AND COMPREHENSIVE SURGICAL OUTCOMES OF THE SUTURELESS INTRASCLERAL FIXATION OF SECONDARY INTRAOCULAR LENSES IN HUMAN EYES.

To describe surgical outcomes and structural characteristics of intraocular lenses (IOLs) implanted with transconjunctival sutureless intrascleral (SIS) fixation in human eyes. Retrospective interventional surgical case series involving live and cadaveric human eyes. In this study, we investigated the surgical outcomes and structural anatomy of secondary IOLs implanted with the SIS technique in human eyes. All cases involving SIS IOL fixation performed at a single academic center from January 1, 2012, through July 30, 2016, were reviewed to describe the surgical technique, common indications, clinical outcomes, and the rate of common operative complications. To investigate the structure of SIS-fixated IOLs in vivo, slit-lamp biomicroscopy, ultrasound biomicroscopy, and intraoperative endoscopy were analyzed to describe anatomical outcomes. The primary anatomical outcomes were the optic pupillary centration and location of haptic externalization. Results were correlated with cadaveric human eyes that underwent the SIS-IOL technique. Cadaveric eyes were imaged and analyzed using high-resolution photography for centration, stress measurements at the haptic-optic junction, and qualitative descriptors of IOL optic and haptic position. A total of 122 consecutive patients who underwent IOL placement using SIS technique were included in the study with mean follow-up of 1.52 years (range, 0.4-4.5 years). The majority (75%) of patients received a new 3-piece IOL for primary aphakia or after IOL exchange. The other patients (25%) had a dislocated 3-piece IOL that was rescued using the SIS technique. Preoperative mean Snellen visual acuity was 20/633 (logarithm of the minimum angle of resolution = 1.501). At the final visit, the mean best-corrected visual acuity was 20/83 (logarithm of the minimum angle of resolution = 0.6243) and final mean spherical equivalent was -0.57 diopters. The most common complications were vitreous hemorrhage (22% of eyes), which resolved spontaneously in most cases, and cystoid macular edema. The rates of IOL dislocation, IOL decentration, haptic erosion, IOL tilting, iris capture, and endophthalmitis were low. Intraoperative endoscopy and ultrasound biomicroscopy demonstrated a securely fixated IOL and well-centered optic without iris or ciliary body touch. Structural study of cadaveric eyes confirmed IOL optic and haptic anatomy observed during live human surgery. The ab interno haptic insertion was the anterior pars plana, away from the iris, ciliary processes and ora serrata. The degree of haptic externalization was correlated with the degree of strain on the haptic-optic junction. The angle of the haptic-optic junction in SIS-fixated IOLs (33.97°) was not significantly different compared with overlaid native nonfixated IOL (32.93°) but increased slightly with degree of haptic tip externalization (36.26 and 39.16 for 2 and 3 mm haptic externalizations, respectively). In this comprehensive study, we demonstrate the surgical outcomes achieved with SIS fixation of IOLs. Surgical and postoperative complications do occur, albeit at a low rate, and can effectively be managed with excellent anatomical and visual outcomes. The structural and anatomical data in this study may help guide SIS placement and optimize long-term surgical results.

An imprint of intra ocular lens on an iris

The Uveitis Glaucoma Hyphema (UGH) syndrome is a triad that in the new era of phacoemulsification cataract surgeries is considered uncommon. One of the risk factor for this complication is implant a one piece intra ocular lens in the anterior chamber.We present a case of one piece intraocular lens that was implanted in the anterior chamber and caused to UGH. The lens chafing the iris and created an unusual appearance of iris transillumination defects in the shape of intra ocular lens.

SCLERAL SUTURE FIXATION TECHNIQUE FOR ONE-PIECE ACRYLIC INTRAOCULAR LENS.

To apply a previously published scleral fixation technique to secure one-piece acrylic intraocular lenses (IOLs) to the sclera. Retrospective, consecutive, noncomparative case series. All patients (16 eyes of 15 patients) who underwent scleral fixation of 1-piece acrylic IOLs using the loop method from 2014 to 2016 were included. The mean follow-up was 8.1 months. Repositioning of dislocated 1-piece acrylic IOLs was performed in 8 eyes, a primary implantation in 5 eyes, and IOL exchange in 3 eyes. All IOLs remained well-centered postoperatively. The vision improved from an initial best-corrected visual acuity of 0.97 ± 0.74 logMAR (Snellen equivalent ≈20/190) to 0.47 ± 0.49 logMAR (≈20/60, P = 0.031) at the last follow-up. The postoperative complications were self-limited. The previously reported scleral suture fixation technique can be readily applied to one-piece acrylic IOLs.

Postoperative outcomes of intraocular lens implantation in the bag versus posterior optic capture in pediatric cataract surgery

To compare complications in children up to 4years old having cataract surgery with intraocular lens (IOL) implantation using2 techniques: in-the-bag IOL with anterior vitrectomy or optic capture of IOL with no anterior vitrectomy. Iladevi Cataract & IOL Research Centre, Ahmedabad, India. Prospective randomized control clinical trial. The study included children having cataract surgery with IOL implantation. Patients were randomized to Group 1 (in-the-bag 3-piece hydrophobic acrylic IOL [Acrysof MA60AC] with anterior vitrectomy) or Group 2 (optic capture of the same IOL without anterior vitrectomy). Intraoperative complications were documented. Postoperative visual axis obscuration (VAO), glaucoma, cell deposits on the IOL, and posterior synechiae were compared at 1, 3, 6, and 12months. The study comprised 61 children (61 eyes). The mean ages were 14.8months±11.47 (SD) in Group 1 (n=30) and 18.2±11.47months in Group 2 (n=31). Overall, only 1 eye in Group 1 developed a VAO requiring membranectomy 4months postoperatively,and 2 eyes in Group 1 developed glaucoma over 12months (P=.49). Intraocular lens cell deposits and posterior synechiaewere comparable between groups. The IOL could not becaptured in 5 eyes (16.1%); no complications occurred in these eyes. Optic capture of 3-piece hydrophobic acrylic IOLs could be achieved in most eyes. The VAO, glaucoma, and inflammation were comparable 12months postoperatively. Thus, optic capture of an IOL is an alternative surgical technique that can be used to avoid vitrectomy, even in children younger than 4years.

Prediction of the true IOL position

PurposeTo develop algorithms for preoperative estimation of the true postoperative intraocular lens (IOL) position to be used for IOL power calculation.SettingMoorfields Eye Hospital NHS Foundation Trust, London, UK.MethodsFifty patients were...

Modified technique for intrascleral fixation of posterior chamber intraocular lens without scleral flaps

We present a modified technique for intrascleral fixation of a posterior chamber intraocular lens (IOL) without scleral flaps and assess its long-term safety and efficacy. The haptics of the IOL are externalized with a 23-gauge forceps and fixated in a scleral tunnel. Two clockwise scleral incisions are made using a 23-gauge needle at an angle 30 degrees above the sclera. A 3-piece IOL is inserted into the anterior chamber with an injector through the cornea incision, and the trailing haptic is kept outside to prevent the IOL from falling into the vitreous cavity. The leading haptic is held wit a forceps and extracted from the eye through the scleral incisions. The trailing haptic is held with a forceps and both haptics externalized onto the sclera. The conjunctival incisions are closed with 8-0 absorbable sutures tied to fixate 1 haptic (2 o'clock) after 1 more bite on the scleral bed.

Refractive predictability of a 3-piece intraocular lens platform versus its 1-piece counterpart

ObjectiveTo compare the refractive outcomes of a 3-piece acrylic intraocular lens (IOL) with its 1-piece counterpart after phacoemulsification with in-the-bag implantation. DesignRetrospective chart review. ParticipantsOne-hundred twenty-six eyes of 95 patients were analyzed in the study, including 60 eyes of 43 patients receiving a 3-piece IOL and 66 eyes of 52 patients receiving a 1-piece IOL. MethodsRandomized chart review of all patients who underwent uncomplicated phacoemulsification with in-the-bag IOL implantation with either a 3-piece hydrophobic acrylic IOL (Tecnis ZA9003) or a 1-piece hydrophobic acrylic IOL (Tecnis ZCB00) between 2006 and 2014 in a tertiary ophthalmology care centre in Mississauga, Ontario. Preoperative visual acuity and refraction, anterior chamber depth, axial length, IOL design and power, predicted refraction, postoperative visual acuity, and refraction were recorded. ResultsMean absolute error was 0.40 ± 0.27 in the ZA9003 group and 0.39 ± 0.35 in the ZCB00 group, with no statistically significant difference between the 2 IOLs (p = 0.86). Mean arithmetic error was 0.11 ± 0.47 D in the ZA9003 group and 0.01 ± 0.47 D in the ZCB00 group (p = 0.019). In the ZA9003 group, 23 (38%), 42 (70%), and 52 (87%) of 60 eyes were within 0.25, 0.50, and 0.75 D, respectively, of predicted postoperative refraction. In the ZCB00 group, 32 (48%), 46 (70%), and 56 (85%) of 66 eyes were within 0.25, 0.50, and 0.75 D, respectively, of predicted postoperative refraction (p = 0.2836, p = 1.00, p = 0.8044). ConclusionsThe ZA9003 and the ZCB00 have similar mean absolute error and thus appear to have similar refractive predictability.

Management of sulcus-fixated single-piece intraocular lens-induced pigmentary glaucoma with 3-piece IOL exchange.

To describe our experience with exchanging sulcus-fixated single-piece intraocular lens (IOL) with 3-piece IOLs for management of pigmentary glaucoma. In this retrospective study, records of patients who underwent sulcus-fixated single-piece IOL exchanged with 3-piece IOLs were retrieved, and demographic and baseline data of patients, type of IOL, pre- and post-IOL exchange BCVA, IOP, number of anti-glaucoma medications, and optic nerve head examination were documented. Baseline and final examinations were analyzed and compared. Mean age of the patients was 59±10years, and 5 (41.6%) were female. Mean interval between primary cataract extraction operation and IOL exchange was 17±5months. Nine patients received in sulcus implantation of Alcon SA60AT, and three patients had SN60WF model at the end of primary surgery. BCVA changed insignificantly from 0.06±0.06 logMAR to 0.06±0.06 after IOL exchange. (P=0.22) IOP was controlled in 8 cases (66.6%), but four cases (33.3%) needed glaucoma surgery to further control glaucoma condition. IOP decreased significantly from preoperative 17±3 to 14±1mmHg postoperatively. Patients with advanced age and higher baseline IOP were more likely to undergo glaucoma surgery after IOL exchange. (P=0.07 and 0.00, respectively). single-piece IOL exchange with 3-piece IOL dramatically decreases pigment release and reduces IOP. Those with advanced age and higher IOP are less likely to respond to IOL exchange and may need glaucoma surgery to control high intraocular pressure.

A simple technique of intraocular lenses explantation for single-piece foldable lenses.

Foldable intraocular lenses (IOLs) are most commonly used in modern-day cataract surgery. Explantation of these IOLs is not frequently encountered, but sometimes extreme situations may demand the same. Commonly explantation is achieved by bisecting the IOL inside the anterior chamber with a cutter and delivering the pieces out one by one. This may require corneal wound extension with associated damage and endothelial loss leading to visual deterioration. We devised a simple, innovative IOL explantation technique utilizing a modified Alcon A cartridge and snare. This can successfully refold the IOL to be explanted inside the eye and deliver it out through the same wound. The device has limitations with very thick optic lenses, multipiece, and silicon IOLs. In conclusion, we describe a simple, innovative, and reproducible technique to explant almost any single piece IOL without compromising the original surgery and yielding very satisfactory outcomes.

A Case with Excessive Deformed End of Haptics of Single Piece Intraocular Lens

A Case with Excessive Deformed End of Haptics of Single Piece Intraocular Lens

New preventative approach for negative dysphotopsia

To evaluate whether positioning the intraocular lens (IOL) to decrease the entry of inferotemporal light would decrease the incidence of negative dysphotopsia. Private practices, Boston and Chelmsford, Massachusetts, USA. Prospective randomized case study. Patients had cataract surgery with implantation of either a silicone IOL inferotemporally or vertically (randomly assigned) or a 1-piece acrylic IOL with the optic-haptic junction inferotemporally or vertically (randomly assigned). Other patients received acrylic IOLs bilaterally and inferotemporally without randomization. Patients were asked about negative dysphotopsia symptoms postoperatively. Data were analyzed using the z test and a chi-square test for comparing the incidence of negative dysphotopsia between the 3 groups. The study comprised 305 patients (418 eyes). A silicone IOL was implanted inferotemporally in 39 eyes and vertically in 60 eyes. An acrylic IOL was implanted with the optic-haptic junction inferotemporally in 163 eyes and with the junction vertical in 114 eyes. Forty-two eyes had bilateral inferotemporal implantation of an acrylic IOL. For the acrylic IOL on the first postoperative day, the incidence of negative dysphotopsia was smaller for the inferotemporal IOL orientation (6%) than in the control group (14%) (P=.026). The rate of persistent negative dysphotopsia decreased in both groups over time, and the difference 1month after surgery was no longer statistically significant. The negative dysphotopsia rate for the silicone IOL was 0%. Positioning the optic-haptic junction of an acrylic IOL inferotemporally resulted in a 2.3-fold decrease in the incidence of negative dysphotopsia after cataract surgery. When implanted in the vertical position, Acrylic IOLs seemed to lead to a higher incidence of negative dysphotopsia than silicone IOLs. Dr. Henderson is a consultant to Abbott Medical Optics, Inc., Alcon Laboratories, Inc., and Bausch & Lomb, Inc. None of the other authors has a financial or proprietary interest in any material or method mentioned.

Management of dislocated intraocular lenses with iris suture.

Subluxated or malpositioned intraocular lenses (IOLs) and inadequate capsular support is a challenge for every ophthalmic surgeon. Iris suture of an IOL seems to be an easy technique for the management of dislocated 3-piece IOL, allowing the IOL to be placed behind the iris, far from the trabecular meshwork and corneal endothelium. The purpose of this study is to assess the results of pars plana vitrectomy (PPV) and iris suture of dislocated 3-piece acrylic IOLs. In this retrospective, nonrandomized, interventional case consecutive study, of a total of 103 dislocated IOLs, 36 eyes were considered for analysis. All 36 eyes had subluxated or totally luxated 3-piece IOL and underwent iris suture at the Ophthalmology Department of Santa Maria Hospital-North Lisbon Hospital Center, Portugal, from January 2011 until November 2015. All patients underwent 3-port 23-G PPV. The optic zone of the dislocated IOL was placed anterior to the iris with the haptics behind, in the posterior chamber. Haptics were sutured to iris followed by placement of the optics behind iris plane. Postoperative measures included best-corrected visual acuity (BCVA), IOL position, intraocular pressure, pigment dispersion, clinical signs of endothelial cell loss, and development of macular edema. A total of 36 eyes of 36 patients were included. All underwent successful iris fixation of dislocated 3-piece IOL. Mean overall follow-up was 15.9 months (range 3-58 months). At presentation, 16 eyes (44.4%) had a luxated IOL and 20 eyes (55.6%) a subluxated IOL. As underlying cause, 17 eyes (47.2%) had a history of complicated cataract surgery, 5 eyes (13.9%) had a traumatic dislocation of the IOL, and 6 eyes (16.7%) had a previous vitreoretinal surgery. A total of 8 eyes (22.2%) had late spontaneous IOL dislocation after uneventful cataract surgery. The mean preoperative BCVA was 1.09 ± 0.70 logarithm of the minimal angle of resolution (logMAR) units and mean postoperative BCVA was 0.48 ± 0.58 of logMAR units. The mean visual acuity improvement was 4.08 ± 5.33 lines on the logMAR scale. In this study, every IOL was stable at the last follow-up. As late complications, macular edema occurred in 1 patient and retinal detachment occurred in 2 patients. There were no cases of endophthalmitis. Iris suture fixation of subluxated IOL is a good treatment option for eyes with dislocated IOLs, leading to long-term stability of the IOL. The advantage of this procedure is using the same IOL in a closed eye surgery. No astigmatic difference is expected as no large corneal incision is needed.

Comparison of Clinical Long-Term Outcomes with Two Types of One-Piece Aspheric Intraocular Lenses after Cataract Surgery

Purpose: To compare the clinical outcomes of glistening-free intraocular lens (IOL) and conventional 1-piece aspheric IOL in implanted in-the-bag. Methods: After phacoemulsification performed by a single surgeon, 2 different IOLs were implanted: enVista MX60 (glisteningfree 1-piece aspheric IOL) in 38 eyes (group A) and AcrySof IQ (conventional 1-piece aspheric IOL) in 46 eyes (group B). Glare symptom score (0-5) obtained by questionnaires, best corrected visual acuity (BCVA), Functional Acuity Contrast Test (FACT), posterior capsular opacity (PCO), glistening formation and spherical equivalent error were compared and analyzed preoperatively and 6 months and 12 months postoperatively. Results: A statistically significant improvement of BCVA and contrast sensitivity postoperatively was observed in all groups. There was statistically significant increase of glistening in group B compared with group A. However, there was no significant difference of FACT scores of spatial frequency in A, B, C, D and E columns and glare symptom score (0-10) obtained by questionnaires 12 months after surgery. Spherical equivalent errors were -0.38 ± 0.27 D and -0.36 ± 0.28 D for groups A and B, respectively. PCO occurred in 2 eyes in group A and 4 eyes in group B. Conclusions: EnVista MX60 IOL showed less glistening formation than AcrySof IQ IOL, however, there was no significant difference in terms of vision quality such as BCVA, FACT and glare symptom score at 12 months postoperatively. J Korean Ophthalmol Soc 2016;57(2):221-227

Long-term changes in intraocular lens position and corneal curvature after cataract surgery and their effect on refraction

To evaluate the role of intraocular lens (IOL) position shift and changes in corneal curvature on long-term refractive shift after cataract surgery. Rotterdam Ophthalmic Institute, Rotterdam, the Netherlands. Prospective cohort study. Patients who had routine cataract surgery with implantation of a hydrophobic acrylic 1-piece IOL (Acrysof SA60AT) in the capsular bag were enrolled. Measurements were performed preoperatively and 1 month, 3 months, and 1 year postoperatively. Refraction was measured with the ARK-530A autorefractor. The IOL position and corneal curvature were measured with the Lenstar LS-900 biometer. The refractive effect of changes in IOL position and corneal curvature was calculated with a Gaussian optics-based thin-lens formula and correlated with the measured refractive shift. The study group comprised 59 eyes of 59 patients. The median measured absolute refractive change was 0.25 diopter (D). The IOL position showed a statistically significant mean posterior shift of 0.033 mm ± 0.060 (SD) between 1 month and 1 year postoperatively (P < .01), of which the median calculated absolute refractive effect was 0.05 D. This did not correlate with the measured refractive shift (Pearson r = 0.10, P = .46). Natural fluctuations in corneal curvature caused a median calculated absolute refractive effect of 0.17 D, which correlated well with the measured refractive shift (Pearson r = .55, P < .001). Long-term changes in refraction after cataract surgery resulted from natural fluctuations in corneal curvature rather than from IOL position shift. These fluctuations limit the accuracy with which the refractive outcome can be planned. No author has a financial or proprietary interest in any material or method mentioned.

Spontaneous disinsertion of an iris-fixated 3-piece intraocular lens haptic from the optic in a patient with pathologic myopia

Spontaneous disinsertion of an iris-fixated 3-piece intraocular lens haptic from the optic in a patient with pathologic myopia