Lens Exchange Research Articles

Comparison between Refractive Outcome of Primary Piggyback Intraocular Lens versus Secondary Lens Iris Claw Lens in Posterior Microphthalmos.

Purpose To compare the refractive outcome of 2 different methods of intraocular lens implantation in cases of posterior microphthalmos, primary piggyback IOLs versus secondary iris claw lenses. Methods This study was a retrospective interventional comparative study that included 60 eyes of 30 patients. The included patients had bilateral microphthalmos with high axial hyperopia and had undergone a lens-based surgical procedure for hyperopia correction. The included patients were equally divided into two groups. The first group had undergone refractive lens exchange (RLE) with primary piggyback IOL implantation. The second group undergone RLE with maximum available IOL power implanted followed by a secondary implantation of Artisan iris-fixated IOL (Ophtec B.V., Groningen, the Netherlands). Results The 2 groups were highly comparable to each other regarding the mean age, axial length (AL), manifest refraction (MR), and K readings. Postoperatively, there was a statistically significant difference between the 2 groups regarding the manifest refraction spherical equivalent (MRSE), mean absolute error (MAE), and uncorrected distance visual acuity (UDVA). There was no significant difference between the 2 groups regarding the CDVA. At 36 months, 20% and 73% of the eyes were within ±0.5 D of intended refraction at 36 months in 1ry piggyback and 2ry Artisan groups, respectively. Fifty-three percent and 93% of the eyes were within ±1.0 D of intended refraction at 36 months in 1ry piggyback and 2ry Artisan groups, respectively (p=0.001). Conclusion Secondary procedure with implantation of iris-fixated intraocular lens yielded very good results for treatment of axial hyperopia in cases of posterior microphthalmos. The primary piggyback IOL showed less satisfactory results with cases of under correction and the possible complication of interlenticular opacification. Both groups showed good safety parameters.

Repositioning a posteriorly dislocated silicone plate-haptic toric intraocular lens

We describe a technique for repositioning an encapsulated, posteriorly dislocated silicone plate-haptic toric intraocular lens (IOL) while preventing further dislocation into the vitreous cavity. Sutures of 10-0 polypropylene were used to ensure safe retrieval of the dislocated IOL. An anterior vitrectomy was then performed to remove the contracted capsular bag around the IOL. The IOL fixation hole was temporarily externalized to allow quick and secure IOL fixation, eliminating the risk for losing the slippery silicone IOL into the vitreous cavity. Using this technique, the IOL was successfully placed in the proper position and resulted in good vision for the patient while avoiding the trauma of lens exchange.

Image-guided lens extraction surgery: a systematic review.

A systematic review of the recent literature regarding the current image-guided systems used for cataract surgery or refractive lens exchange was performed based on the PubMed and Google Scholar databases in March 2018. Literature review returned 21 eligible studies. These studies compared image-guided systems with other keratometric devices regarding their accuracy, repeatability and reproducibility in measurement of keratometric values, astigmatism magnitude and axis, as well as in IOL power calculation. Additionally, the image-guided systems were compared with conventional manual ink-marking techniques for the alignment of toric IOLs. In conclusion, image-guided systems seem to be an accurate and reliable technology with measurements of high repeatability and reproducibility regarding the keratometry and IOL power calculation, but not yet interchangeable with the current established and validated keratometric devices. However, they are superior over the conventional manual ink-marking techniques for toric IOL alignment.

The Effect of Anterior Corneal Astigmatism Orientation on Toric Intraocular Lens Outcomes

Background: It is unclear whether post-operative errors after toric intraocular lens implantation would be more amenable to pre-operative correction with a fixed adjustment or a correction ratio that scales with the magnitude of pre-operative astigmatism. Purpose: To investigate the effect of pre-operative anterior corneal astigmatism orientation on outcomes of toric intraocular lens implantation in a large population. Methods: A retrospective cohort study of 625 patients undergoing refractive lens exchange through a superior clear corneal incision with Oculentis M-Plus toric intraocular lens implantation at an Optical Express, Inc. located in the United Kingdom and Ireland. Patients were stratified by axis of astigmatism on automated keratometry as with-the-rule, against-the-rule, or oblique. Analysis of visual acuity and refractive outcomes was performed using American National Standards Institute (ANSI) guidelines on astigmatic corrections with non-vector as well as vector analyses. Analysis was limited to one eye per patient. Results: Patients who had with-the-rule (WTR) astigmatism, compared with oblique and against-the-rule (ATR), had higher vector magnitudes of surgically induced refractive correction (2.89D, 2.55D, 2.42D; p < 0.001), and larger correction ratios (1.18, 1.02, 1.07; p < 0.001). This created a change of astigmatic axis in the with-the-rule cohort from WTR pre-operative astigmatism to an average ATR post-operative astigmatism. The overcorrection in the WTR cohort averaged 0.30D. We found that the absolute dioptric overcorrection among WTR patients did not differ significantly with magnitude of corneal astigmatism, but the correction ratio was lower among those with higher baseline cylindrical errors (p = 0.93 and 0.0002, respectively). Conclusions: Refractive lens exchange surgery using toric intraocular lenses overcorrected patients who had with-the-rule astigmatism. Degree of overcorrection did not vary with severity of pre-operative astigmatism. Incorporation of axis of astigmatism in lens selection and reduction of astigmatic correction among with-the-rule patients by an absolute value of 0.25D - 0.35D, rather than proportional adjustments, may reduce cylindrical over-correction.

Refrakcyjna wymiana soczewki z wszczepieniem soczewki trójogniskowej Alcon AcrySof® IQ PanOptix® – kontrowersja czy standard

Refractive lens exchange is still relatively new and slightly controversial method of correcting the refractive errors. The surgery consists of extracting the patient’s own lens using phacoemulsification technique in non-existent or irrelevant for sight opacifications in lens and implant of artificial intraocular lens. With modern surgery technique improvements and higher multifocal intraocular lens availability allowing the wide spectrum of acute vision, this technique becomes an attractive alternative to laser vision correction, especially in societies with higher presbyopia rates. The study included 7 patients (11 eyes) operated solely for refractive errors and/or presbyopia with Alcon AcrySof® IQ PanOptix® implant. In examination we evaluated refractive errors, both corrected and uncorrected visual acuity for distance and near, and improved quality of life and patient satisfaction after surgery. Refractive lens exchange is an effective alternative to laser eye surgery, at the same time being free from laser limitations such as high myopia or hyperopia, cornea thickness or dry eye syndrome.

Refrakcyjna wymiana soczewki a laserowa chirurgia refrakcyjna w prezbiopii. Kogo i dlaczego kwalifikować?

Presbyopia is a problem which affects most of the adult population of over forty-year-old and almost all after fifty-year-old. Both corneal refractive surgery or lens exchange procedures bring a solution to the problem. First of mentioned methods which have a longer history, constitute a certain compromise in accommodation loss treatment, whereas refraction surgery based on lens exchange procedures using multifocal lenses is currently a more satisfactory solution to the problem. The key to obtain success after surgery, is to adequately select the patient. Our own experience concerning Alcon AcrySof® IQ Pan- Optix® and PanOptix Toric® (Alcon) multifocal lenses shows that this has been the best solution to the problem of presbyopia so far.

13 000 oczu po wszczepieniu soczewek multifokalnych – analiza danych z badań retrospektywnych

Purpose of paper is to evaluate clinical outcomes and satisfaction after implantation of multifocal intraocular lens. Nowadays patients after their forties more often ask about surgical methods of presbyopia correction. Among available methods refractive lens exchange deserves special attention. Numerous publications as well as own experience shows that combined with proper qualification process, RLE is considered safe and highly recommended procedure.

Two-stage procedure in the management of selected cases of keratoconus: clear lens extraction with aspherical IOL implantation followed by WFG-PRK.

To assess the objective and subjective results of a two-stage procedure for management of keratoconus: clear lensectomy with aspherical intraocular lens (IOL) implantation followed by wave front-guided photorefractive keratotomy (WFG-PRK). This prospective interventional non-randomized study included patients aged 35 years old or more with grade I and II stable keratoconus, a clear visual axis, minimal corneal thickness (MCT) 420 µm or more and average keratometric reading (K) less than 54 diopter (D). Refraction of all selected eyes should be -8.00 D sphere or more with less than -6.00 D cylinder and could be corrected two lines or more with spectacles or contact lenses. All studied eyes underwent a two-stage approach treatment: first refractive lens exchange and aspherical IOL implantation followed, after at least 3mo, by WFG-PRK. Pre and postoperative complete ophthalmological examination were performed. Topographical, visual and aberrometric results were recorded and evaluated during 6mo follow up period. Moreover, patient satisfaction and other subjective outcomes were also analyzed. The 13 eyes of 11 patients diagnosed with stable keratoconus and aged from 39 to 49y (42.4±6.2y) were enrolled in the study. At baseline, 8 eyes had grade I and 5 eyes had grade II keratoconus. The manifest sphere was -10.3±4.2 D (ranged from -8.0 to -14.0 D) and the manifest cylinder was -4.2±1.2 D (ranged from -1.75 to -5.50 D). After the two-stage procedure, sphere and cylinder reduced significantly to -0.43±0.22 D and -1.3±0.72 D respectively (P<0.001). There was also a highly significant improvement in the mean uncorrected distance visual acuity (UDVA) from logMAR 1.41±0.49 preoperatively to 0.51±0.16 postoperatively (P<0.001) and the mean corrected distance visual acuity (CDVA) from 0.76±0.24 preoperatively to 0.49±0.13 after the operation (P<0.001). All aberrometric and mesopic vision parameters and most of the topographical indices demonstrated highly significant improvement that remains stable until the end of follow up. All recorded subjective data revealed a high degree of patient satisfaction. Two-stage approach (clear lens exchange with monofocal IOL followed by WFG-PRK) in selected cases of keratoconus is a safe, effective and highly predictable procedure with satisfactory visual and refractive results.

Refractive outcomes of femtosecond laser–assisted secondary arcuate incisions in patients with residual refractive astigmatism after trifocal intraocular lens implantations

To evaluate the refractive and visual outcomes of arcuate incisions performed with the femtosecond laser in patients with a residual refractive astigmatism after refractive lens exchange (RLE) with trifocal intraocular lenses (IOLs). EuroEyes Clinical Group, Hamburg, Germany. Retrospective interventional case series. Pseudophakic patients with remaining refractive astigmatism after RLE with a trifocal IOL were treated with femtosecond laser-assisted corneal arcuate incisions. Patients who had a previous corneal treatment were excluded. Outcome measures were uncorrected (UDVA) and corrected distance visual acuities, manifest refraction, and a power vector analysis. The study enrolled 95 eyes of 70 patients. The mean follow-up was 5.6months±4.9 (SD). Constructing an astigmatic power vector (APV) with Jackson cross-cylinder axes at 180 degrees and 90 degrees and Jackson cross-cylinder axes at 45 degrees and 135 degrees, the mean preoperative vector length was 0.46±0.16 diopter (D). Themean postoperative APV was 0.17±0.16 D. This difference was statistically significant (P<.001). The difference between the UDVA preoperatively (0.17±0.15) and postoperatively (0.08±0.10) was statistically significant (P<.001). No intraoperative or postoperative complications were observed. Femtosecond laser-assisted corneal arcuate incisions were safe, efficient, and feasible to reduce refractive astigmatism after trifocal IOL implantation.

Informed consent in refractive surgery: in-person vs telemedicine approach.

PurposeThe aim of this study was to compare the quality of consent process in refractive surgery between patients who had a preoperative consent discussion with the surgeon using a telemedicine approach and those who had a face-to-face discussion.MethodsPatients treated between January and December 2017 (8,184 laser vision correction [LVC] and 3,754 refractive lens exchange [RLE] patients) that attended day 1 and 1-month postoperative visit were retrospectively reviewed. Preoperative consent preparation included a consultation with an optometrist, observation of an educational video, and written information. Patients then selected either a face-to-face appointment with their surgeon (in-clinic group) or a telemedicine appointment (remote group) for their consent discussion, according to their preference. Patient experience questionnaire and clinical data were included in a multivariate model to explore factors associated with consent quality.ResultsPrior to surgery, 80.1% of LVC and 47.9% of RLE patients selected remote consent. Of all LVC patients, 97.5% of in-clinic and 98.3% of remote patients responded that they were adequately consented for surgery (P=0.04). Similar percentages in the RLE group were 97.6% for in-clinic and 97.9% for remote patients (P=0.47). In a multivariate model, the major predictor of patient’s satisfaction with the consent process was postoperative satisfaction with visual acuity, responsible for 80.4% of variance explained by the model. Other significant contributors were postoperative visual phenomena and dry eyes, difficulty with night driving, close-up and distance vision, postoperative uncorrected distance visual acuity, change in corrected distance visual acuity, and satisfaction with the surgeon’s approach. The type of consent (remote or in-clinic) had no impact on patient’s perception of consent quality in the regression model.ConclusionThe majority of patients opted for telemedicine-assisted consent. Those who chose it were equally satisfied as those who had a face-to-face meeting with their surgeon. Dissatisfaction with surgical outcome was the major factor affecting patient’s perception of consent quality, regardless of the method of their consent.

PMD27 - LENS EXPLANTATION AND LENS EXCHANGE RATES WITH MULTIFOCAL IOLS: A SYSTEMATIC LITERATURE REVIEW

Multifocal IOLs are indicated for the correction of presbyopia alongside cataract surgery and could provide greater improvement in visual outcomes than monofocal IOLs. However, multifocal implantations can be associated with unexpected visual disturbances leading to dissatisfactory visual outcomes necessitating lens explantation and consequently exchange with a new IOL. The objective of this systematic literature review was to report published lens explantation and exchange rates associated with multifocal IOLs. Embase, Cochrane and Medline databases were searched from inception to February 2018. English language studies reporting explantation and exchange rate in patients implanted with multifocals were included. In an RCT study, the reported 12 month explantation and exchange rate for multifocal vs. monofocal IOLs was 5.7% and 0.0% respectively; in all affected patients the exchanged lens was monofocal. In another RCT study, the reported 3 month explantation and exchange rate for multifocals vs. monofocals was 0.8% and 0.0% respectively; exchanged lens type was not reported. Two recently conducted RCTs with follow-up of 6-24 months reported 0% explantation rate for both multifocal and monofocal IOLs. A comparative prospective observational study reported a 12 month rate of 1.4% for multifocal explantation and exchange vs. 0.0% for monofocal IOLs. In this study, all affected patients were implanted monofocal IOL as exchanged lens. Further, we identified six RCTs reporting explantation and exchange rates with different multifocal IOL models at follow-up time-points between 7 days and 6 months. The reported multifocal explantation and exchange rates were between 0.0% and 4%; type of exchanged IOL (monofocal) was reported only in one study. Limited evidence suggests that multifocal could be associated with a higher explantation and lens exchange rates vs. monofocal IOLs. The data is inconsistently reported across studies and requires better reporting in future studies.

Maximising Refractive Outcomes with an Extended Depth of Focus IOL.

Objective:To assess the impact of the magnitude of preoperative and postoperative corneal astigmatism on refractive outcomes in patients undergoing cataract surgery or lens exchange with an extended depth of focus intraocular lens. To compare visual outcomes of steep and temporal on-axis corneal incisions.Setting:Department of Ophthalmology, Blackrock Clinic, Dublin, Ireland.Design:Prospective cohort analysis.Methods:Fifty-three consecutive adult patients (94 eyes) undergoing routine phacoemulsification with Symfony IOL implantation were analysed. Exclusion criteria: targets for mini-monovision, incomplete data, other ocular pathology. Data were prospectively collected on pre- and postoperative refraction, keratometry, distance vision, near vision, surgical wound site and Surgically Induced Astigmatism (SIA).Results:The average postoperative monocular Uncorrected Distance and Near visual acuities (UDVA and UNVA) were 0.12 LogMAR (± 0.1) (6/7.5+1) and 0.34 LogMAR (± 0.09) respectively. The average binocular UDVA and UNVA were 0.05 (± 0.07) and 0.29 LogMAR (± 0.06) respectively. Low levels of preoperative corneal astigmatism (0-0.99 D) were associated with better LogMAR UDVA and UNVA when compared with higher levels (> 0.99 D): 0.11 (CI 0.103-0.107) vs. 0.206 (CI 0.122-0.290) (p =0.015, CI 95%) and 0.33 (CI 0.316 - 0.356) vs. 0.39 (CI 0.34-0.43) (p =0.034, CI 95%) respectively. When patients with steep on-axis corneal incisions were compared with temporal on-axis corneal incisions, no difference was detected in visual outcome or SIA.Conclusion:The Symfony IOL is an effective surgical means of addressing presbyopia and reducing postoperative spectacle dependence. We stress caution when offering potential spectacle independence for patients with over 1D of preoperative corneal astigmatism as these patients achieve statistically significantly inferior and less predictable visual results.

Functional assessment of a new extended depth-of-focus intraocular lens.

This study aimed to investigate the visual performance of a new extended depth-of-focus intraocular lens (EDOF-IOL). In this multicenter, prospective, observational study, we enrolled 97 patients who underwent cataract surgery or refractive lens exchange with implantation of the Mini Well EDOF-IOL (SIFI, Italy). Patients underwent postoperatively the following examinations between 4 and 8 weeks after surgery: corrected distance visual acuity (CDVA), reading speed with Radner's chart, distance-corrected near visual acuity (DCNVA), defocus curve, contrast sensitivity, and haloes quantitative assessment. In the whole sample, the mean monocular CDVA and DCNVA were, respectively, 0.02 ± 0.07 logMAR and 0.38 ± 0.15 logRAD (logarithm of the reading acuity determination). In the 67 bilaterally implanted patients, binocular CDVA and DCNVA were better (0.00 ± 0.05 logMAR and 0.26 ± 0.13 logRAD) than the corresponding monocular values (p = 0.02 and p = 0.0002, respectively). Ninety-two percent of patients bilaterally implanted reached a binocular reading speed >80 words per minute at a 0.5 logRAD print size (corresponding to the common book print size). The defocus curves showed that the EDOF-IOL provided increased depth of focus through 2.0 D of defocus, with the best performance at 1.0 and 1.5 D. Contrast sensitivity was within normal limits at all spatial frequencies. The mean visual disturbance index was 0.08 ± 0.12, suggesting low night visual disturbances. The new EDOF-IOL provided good visual acuity for distance, intermediate, and near vision, with no loss of contrast sensitivity and low risk of night visual disturbances.

Intraocular lens implantation in children with unilateral congenital cataract in the first 4 years of life.

To describe the outcome of phacoaspiration with intraocular lens implantation in children with unilateral congenital cataract in the first 4 years of life. A retrospective chart review of children with visually significant unilateral congenital cataract presenting in the first 4 years of life was done. Children with a minimum postsurgical follow-up of 1 year were included. Outcome measures were mean spherical equivalent, visual axis clarity, visual acuity and complications till the last follow-up. Ninety-three children met the inclusion criteria. The mean age of surgery was 13.23 ± 11.89 months and the mean follow-up period was 24.37 ± 17.35 months. Nearly 40% of children presented during their first year of life. No difference was noted between the subgroups in terms of age ( p = 0.310), sex ( p = 0.475) or laterality ( p = 0.349). Surgical membranectomy was performed in 22 eyes (23.6%) after an average period of 4.85 ± 2.58 months after surgery. One eye underwent piggy back intraocular lens and four eyes underwent intraocular lens exchange after a mean duration of 50 months (range 40-60 months). The mean visual acuity was 0.79 ± 0.11 (log MAR chart). A total of 60.7% of these children ( n = 31) achieved best corrected visual acuity or 20/80 or better. The results of our study suggest that primary intraocular lens implantation in children with unilateral congenital cataract gives good structural and functional results. Besides a meticulous surgery, visual outcome is affected by the time of presentation and postoperative compliance to amblyopia therapy.

Rotational stability and visual performance 3 months after bilateral implantation of a new toric extended range of vision intraocular lens.

PurposeTo evaluate the clinical outcomes after implantation of Symfony® toric extended range of vision (ERV) intraocular lenses (IOLs) in subjects with preoperative corneal astigmatism.SettingIfocus Øyeklinikk, Haugesund, Norway.DesignProspective non-comparative study.Patients and methodsThe study population consisted of 30 patients, with preoperative corneal astigmatism between 0.88 and 3.29 D, undergoing bilateral cataract removal or refractive lens exchange with implantation of Tecnis Symfony toric ERV IOLs. Main outcome measures were visual acuity, refraction, IOL axis rotational stability, patient and surgeon satisfaction, photic phenomena, and quality of life at 3 months.ResultsPostoperatively, mean binocular uncorrected distance, intermediate, and near visual acuities (logMAR) were −0.05±0.11, −0.03±0.08, and 0.09±0.10, respectively. A significant reduction in manifest cylinder (P<0.001) and spherical equivalent (P=0.001) was found after 3 months. Monocular and binocular corrected distance visual acuity also improved significantly with surgery (P<0.001). In terms of binocular uncorrected intermediate and near visual acuity, a total of 96% and 82% of patients achieved 0.1 logMAR (Snellen: 20/25) or better, respectively. Toric IOL axis showed a median rotation of 2.0 degrees (range 0.0–16.0 degrees) from the end of surgery to 3 months. The median patient satisfaction scores for distance, intermediate, and near vision were 9.0, 9.0, and 8.0, respectively. Fifty percent of patients reported complete spectacle independence and most patients (89%) were not bothered by any photic phenomena.ConclusionBilateral implantation of the Symfony toric ERV IOL appeared to be safe and achieved good visual performance and high satisfaction.

New advances in amblyopia therapy II: refractive therapies

The treatment of anisometropic or ametropic amblyopia has traditionally enjoyed a high treatment success rate. Early initiation and consistent use of spectacle correction can completely resolve amblyopia in a majority...

To exercise caution in developing intraocular lens exchange

Nowadays cataract extraction combined intraocular lens (IOL) implantation has become the conventional treatment for cataract. Numbers of IOL exchange after cataract extraction combined IOL implantation have been increasing in recent years. As a non-routine surgery, IOL exchange is normally combined with other surgeries and accompanied by some complications to various extents. Is IOL exchange necessary for all abnomal IOLs? Can IOL exchange be avoided? How to avoid IOL exchange? The purpose of this article is to stress the importance of indication of IOL exchange and how to avoid IOL exchange. (Chin J Ophthalmol, 2018, 54: 324-327).

Comparison of anterior segment parameters and axial length measurements performed on a Scheimpflug device with biometry function and a reference optical biometer

PurposeTo compare measurements of axial length (AL), corneal curvature (K), anterior chamber depth (ACD) and white-to-white (WTW) distance on a new device combining Scheimpflug camera and partial coherence interferometry (Pentacam AXL) with a reference optical biometer (IOL Master 500). To evaluate differences between IOL power calculations based on the two biometers.MethodsNinety-seven eyes of 97 consecutive cataract or refractive lens exchange patients were examined preoperatively on IOL Master 500 and Pentacam AXL units. Comparisons between two devices were performed for AL, K, ACD and WTW. Intraocular lens (IOL) power targeting emmetropia was calculated with SRK/T and Haigis formulas on both devices and compared.ResultsThere were statistically significant differences between two devices for all measured parameters (P < 0.05), except ACD (P = 0.36). Corneal curvature measured with Pentacam AXL was significantly flatter then with IOL Master. The mean difference in AL was clinically insignificant (0.01 mm; 95% LoA 0.16 mm). Pentacam AXL yielded higher IOL power in 75% of eyes for Haigis formula and in 62% of eyes for SRK/T formula, with a mean difference within ± 0.5 D for 72 and 86% of eyes, respectively.ConclusionsThere were statistically significant differences between AL, K and WTW measurements obtained with the compared biometers. Flatter corneal curvature measurements on Pentacam AXL necessitate formulas optimisation for Pentacam AXL.

Investigating the impact of preoperative corneal astigmatism orientation on the postoperative spherical equivalent refraction following intraocular lens implantation

BackgroundTo investigate the impact of the orientation of preoperative corneal astigmatism on achieving the postoperative target refraction following monofocal intraocular lens (IOL) implantation.MethodsThis study enrolled 339 eyes who had uneventful cataract surgery or refractive lens exchange (RLE) with subsequent monofocal IOL implantation. Eyes were initially categorized dependent upon axial length and then on the orientation of preoperative anterior corneal astigmatism. Group 1 had against-the-rule (ATR) anterior corneal astigmatism, group 2 had with-the-rule (WTR) anterior corneal astigmatism, and group 3 had oblique (OB) anterior corneal astigmatism. The preoperative corneal astigmatism was determined by the IOLMaster (Carl Zeiss Meditec AG). Postoperative refraction was completed for all eyes, and the results were calculated and compared for the separate groups.ResultsIn eyes with axial lengths greater than 22.0 mm and less than 25.0 mm there was a significant difference between the magnitude of preoperative corneal astigmatism between groups 2 and 3 with 0.827 ± 0.376 D in group 2, and 0.677 ± 0.387 D in group 3. The mean postoperative spherical equivalent (SE) prediction error was − 0.132 ± 0.475 D in group 1, 0.026 ± 0.497 D in group 2, and − 0.130 ± 0.477 D in group 3. There was a significant difference between groups 1 and 2. There was no significant difference in the magnitude of preoperative corneal astigmatism and postoperative SE prediction error between the anterior corneal astigmatism orientation groups in eyes with axial lengths of less than or equal to 22.0 mm and greater than or equal to 25.0 mm.ConclusionsThe orientation of preoperative anterior corneal astigmatism significantly affected the postoperative biometry prediction error in eyes with astigmatism of 1.75 D or less in eyes with the axial length between 22.0 mm and 25.0 mm. However, the results were not clinically significant.

Multifocal intraocular lens implantation after previous hyperopic corneal refractive laser surgery

To describe the outcomes in terms of the refraction and visual acuity of multifocal intraocular lens (IOL) implantation in patients with previous hyperopic corneal refractive laser surgery. Academic Medical Center, University of Amsterdam, Amsterdam, and Retina Total Eye Care, Driebergen, the Netherlands. Retrospective case series. Results were analyzed 3months after implantation of a multifocal IOL (Acrysof Restor SN6AD1) in patients after previous corneal refractive laser surgery for hyperopia. The primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and refraction. The secondary outcome measures were the number of laser enhancements and posterior capsule opacification (PCO) rates. Forty eyes of 40 patients were included. Sixteen eyes (40.0%) had lens extraction because of cataract, and 24 eyes (60.0%) had refractive lens exchange. The mean postoperative UDVA was 0.16 logarithm of the minimum angle of resolution (logMAR)±0.18 (SD), and the mean postoperative CDVA was 0.01±0.08 logMAR. The mean postoperative spherical equivalent was 0.04±0.92 diopter (D). Twenty-five eyes (62.5%) were within ±0.50 D of emmetropia, and 35 eyes (87.5%) were within ±1.0 D of emmetropia. Nine eyes (22.5%) had a laser enhancement because of a residual refraction error. Eleven eyes (27.5%) had a neodymium:YAG laser capsulotomy because of PCO. In general, multifocal IOL implantation after corneal refractive laser surgery for hyperopia resulted in good visual acuity and refraction. The magnitude of previous hyperopia did not influence the refractive predictability.