Implantation Of Monofocal IOL Research Articles

Comparative Accuracy of Barrett Integrated Keratometry Toric Calculator With Predicted Versus Measured Posterior Corneal Astigmatism.

To compare the prediction accuracy of the Barrett toric calculator using standard or integrated keratometry (IK) mode in combination with predicted or measured posterior corneal astigmatism (PCA) in a group of patients with cataract implanted with non-toric IOLs. In this retrospective clinical cohort study, the medical records of patients with age-related cataract who underwent phacoemulsification with the implantation of an aspheric monofocal IOL were reviewed. Four methods, including standard keratometry with predicted PCA (PPCA), IK combined with predicted PCA (IK-PPCA), and IK combined with measured PCA derived from IOLMaster 700 (Carl Zeiss Meditec AG) or CASIA2 (Tomey) (IK-MMPCA or IK-CMPCA), were applied to the Barrett toric calculator to calculate the predicted residual astigmatism. The mean absolute prediction error (MAPE), centroid of the prediction error, and proportion of eyes within the prediction error of ±0.50, ±0.75, and ±1.00 diopters (D) were all ciphered out from the four methods, respectively. Data from 129 eyes of 129 patients were included in this study. The MAPE of the IK-PPCA method (0.57 ± 0.36 D) was significantly smaller than that of the PPCA (0.62 ± 0.38 D) and IK-CMPCA (0.63 ± 0.46 D) methods (P = .048 and .014, respectively). There were no significant differences in the centroid vectors of prediction errors and predictability rates among the four methods (all P > .05). In the current version of the Barrett toric calculator, the predictive accuracy of the IK mode incorporating PPCA was slightly superior to using the standard keratometry mode or incorporating MPCA. [J Refract Surg. 2024;40(7):e453-e459.].

Unilateral intraindividual comparison and bilateral performance of a monofocal spherical and diffractive extended depth of field intraocular lens mix-and-match approach.

To evaluate the intraindividual visual performance of a spherical and extended depth of field (EDOF) IOL used in a mix-and-match approach. Single centre (tertiary care centre), retrospective consecutive case series. Included patients had uneventful cataract surgery with implantation of a spherical monofocal IOL (CT Spheris 204) in the dominant eye and a diffractive EDOF IOL (AT LARA 829) in the non-dominant eye. Monocular and binocular defocus curves and visual acuity at various distances were assessed. In addition, binocular reading speed, contrast sensitivity, and patient satisfaction using QOV, Catquest 9SF, and glare/halo questionnaires are reported. A total of 29 patients (58 eyes) were included. We observed significant intra-individual differences for monocular DCIVA, DCNVA, UIVA, and UNVA. There were no differences in monocular BCDVA or UDVA. The monocular defocus curves for the two IOLs significantly differed at defocus steps between -1.0 and -3.5 D. 93.10% of patients reported they would opt for the same combination of IOLs. Excellent uncorrected and corrected distance visual acuity was demonstrated in both groups. The mix-and-match approach described in this study yielded good intermediate vision and improved near vision with high-patient satisfaction.

Head-to-Head Comparison of Intermediate Vision of Two Monofocal Intraocular Lenses.

To compare intermediate visual outcomes in patients previously implanted with bilateral Clareon monofocal IOLs versus bilateral Eyhance IOLs. This was a non-interventional, single-center, examiner-masked, comparative study. Participants were cataract patients presenting at least 3 months after uncomplicated, bilateral implantation of either Clareon or Eyhance non-toric and toric IOLs. Outcomes measures included binocular distance-corrected intermediate visual acuity (DCIVA), binocular corrected distance visual acuity (CDVA), binocular best-corrected defocus curve, postoperative mean residual spherical equivalent (MRSE), and residual astigmatism. A total of 620 eyes of 310 subjects (155 subjects per group) were evaluated. The mean difference in DCIVA was 0.05 logMAR between the Eyhance and Clareon IOLs which was significant (p < 0.01), but within the 0.1 logMAR non-inferiority margin. Mean CDVA of the Clareon group was 0.01 ± 0.03 logMAR compared to 0.02 ± 0.03 logMAR of the Eyhance Group (p > 0.05). Defocus curves from +1.0 D to -3.0 D were not clinically nor statistically different between the Clareon and Eyhance groups (p > 0.05). The results of this study show that bilateral implantation of Clareon monofocal IOLs and Eyhance monofocal IOLs lead to similar distance and intermediate visual outcomes.

Clinical and Diagnostic Efficiency of the Study of the Quality of Life According to the Questionnaires PHEC-22 and Catquest-9SF after Bilateral Cataract Phacoemulsification and Monofocal IOL Implantation

Purpose: сomparative clinical and diagnostic efficiency of the quality of life (QОL) according to the PHEC-22 and Catquest-9SF questionnaires after bilateral cataract phacoemulsification and monofocal IOL implantation. Patients and Methods. We observed 148 patients with binocular cataract (mean age 58.6 ± 1.8 years). All patients underwent standard cataract phacoemulsification with implantation of a monofocal IOL. Patients were examined before and after (one month after surgery on the second eye) surgery. The results of the survey on the questionnaires PHEC-22 and Catquest-9SF were evaluated by the general indicator of testing (GIT) as the sum of points for all questions (taking into account the “weight” coefficients in the questionnaire PHEC-22). Along with this, each of the patients underwent a study of binocular BCVA. Results. A statistically significantly higher clinical and diagnostic efficiency of the PHEC-22 questionnaire compared to Catquest-9SF was established, which is confirmed by a higher (by 0.17 rel. units, p &lt; 0.01) level of correlation with BCVA, as well as a higher probability of compliance of the QOL level with the BCVA range, especially at low (0.4 and less rel. units, by 18.5 %, p &lt; 0.01) and medium (0.5–0,8 relative units, by 7.3 %, p &lt; 0.05) values of BCVA, while in the range of BCVA 0.9–1.0 relative units, no significant differences between the questionnaires were found (p &gt; 0.05). Conclusion. The results of a comparative study after bilateral cataract phacoemulsification and monofocal IOL implantation using the PHEC-22 and Catquest-9SF questionnaires revealed a significantly higher clinical and diagnostic efficiency of the PHEC-22 questionnaire, which is associated with the methodological principles for developing a questionnaire based on the “social model” of health with the involvement of expert ophthalmologists and the use of the optimal procedure for scaling the patient’s responses. The results obtained (taking into account clinical normalization) allow us to recommend the PHEC-22 questionnaire for inclusion in the complex diagnosis of patients with cataracts both before and after surgery in solving a number of urgent problems — a comparative assessment of IOL, a study of the effectiveness of methods for postoperative rehabilitation of patients, the choice of the optimal formula for calculating IOL and some others.

Results of Implantation of a New Hydrophobic Acrylic Monofocal Intraocular Lens in a Preloaded Injector

Purpose. To evaluate clinical and functional results of implantation of a new hydrophobic acrylic monofocal IOL in a preloaded injector.Methods. The prospective study included 60 patients (66 eyes) after Hoya iSert® 250/251 IOL implantation (31 patients, 35 eyes, group 1) and a new Hoya Vivinex Multisert® XY1-SP IOL (29 patients, 31 eyes, group 2). The mean age was 75.1 ± 7.9 years. The mean follow-up period after surgery was 3.1 ± 0.4 months. IOL viscoimplantation was performed in 100 % of cases in group 1, in group 2 — in 45.1 % of cases, and in 54.9 % — hydroimplantation was performed. Intraoperatively, the size of the corneal incision was measured with a ruler before and after IOL implantation. IOL optic power was calculated with SRK/T and Barrett Universal formulas. In the postoperative period, surgically induced astigmatism was assessed.Results. In both groups, there was a statistically significant (p &lt; 0.05) increase of UCDVA from 0.28 ± 0.09 in the preoperative period to 0.70 ± 0.17 3 months after surgery in group 1 and from 0.24 ± 0.10 in the preoperative period to 0.84 ± 0.18 3 months after surgery in group 2. Slightly lower values of UCDVA in group 1 may be associated with a higher level of SIA in this group. Similar dynamics were shown for the BCDVA (from 0.52 ± 0.21 before surgery to 0.95 ± 0.19 after 3 months of follow-up in group 1 and from 0.55 ± 0.20 before surgery to 0.98 ± 0.21 after 3 months of follow-up in group 2). No differences were found between the studied groups. After IOL implantation, there was an increase in incision size to 2.40 ± 0.12 mm in group 1 and 2.10 ± 0.08 mm in group 2 (p = 0.04). In group 1, the mean SIA after 3 months of observation was 1.10 ± 0.16 D and in group 2, 0.48 ± 0.07 D (p = 0.0007).Conclusion. This study presents the first domestic experience with the implantation of a new monofocal hydrophobic acrylic Hoya Vivinex IOL in a Multisert® preloaded injector. A comparative analysis of implantation results with monofocal Hoya 250/251 IOLs in an Isert® injector was performed. The advantage of the new IOL implantation in reducing the incidence of surgically induced astigmatism was shown.

Influence of isofocal intraocular lenses on objective refraction based on autorefraction and aberrometry.

To evaluate and compare the objective refractions obtained by autorefraction and aberrometry under different lighting conditions with an isofocal intraocular lens (Isopure, BVI medical, Liége, Belgium) compared to a monofocal control lens (Micropure, BVI medical, Liége, Belgium) with the same platform and material. Prospective, comparative and randomized study on patients undergoing cataract surgery and bilateral isofocal or monofocal IOL implantation. A total of 44 subjects were randomly assigned to either the isofocal group (n = 22) or the Micropure (n = 22). Manifest refraction (MR) was always performed under the same lighting conditions for all the patients. For objective refraction the autorefractor KR8800 and the aberrometer OPD-Scan III (Nidek Inc., Tokyo, Japan.) were used. For each eye included in the study, six result sets were collected: MR, AR (autorefraction measured with the autorefractor), WF-P and WF-M (Zernike-coefficients-based objective refraction, photopic and mesopic pupil size), OPD-C and OPD-M (autorefraction measured with the aberrometer in photopic and mesopic conditions). The mean sphere for MR was 0.03 ± 0.32D for the Isopure group and 0.24 ± 0.22D for the monofocal group (p = 0.013). For the Isopure group, Friedman analysis showed statistically significant differences for sphere measured with WF-P (p = 0.035), WF-M (p = 0.018) and OPD-M (p = 0.000), and SE measured with OPD-M (p = 0.004). In the Micropure lens group, the Friedman analysis showed differences for all values studied (p < 0.05). Correlation coefficients showed that AR is the objective method with the strongest correlation values for all components of refraction for both groups. The modification of the surfaces of the isofocal lens does not have a negative impact on the refraction obtained by AR compared to a standard monofocal intraocular lens.

Use of Spectacles after Cataract Surgery.

The goal of this study was to investigate the use of spectacles in everyday life after bilateral cataract surgery with a preoperative refractive target of emmetropia in both eyes. In addition, we analyzed the total cost of spectacles and the patient's visual satisfaction at least 6 months after surgery. Patients after bilateral cataract surgery with implantation of an aspheric monofocal IOL (Tecnis 1, Johnson & Johnson) with a preoperative refractive target of emmetropia in both eyes and a documented refractive outcome were included in this prospective observational study. In a phone interview ≥ 6 months after surgery, the following items were assessed: type of spectacles purchased and overall cost, type of activity with and duration of spectacle wear, and satisfaction with the visual situation. Seventy patients were included in this study. Depending on their postoperative refraction, patients were divided into group A (n = 27) with perfect emmetropia in both eyes (i.e., spherical equivalent [SE] of ≥ - 0.25 D to ≤ + 0.25 D), group B (n = 21) with achieved emmetropia in one eye (i.e., SE of ≥ - 0.25 D to ≤ + 0.25 D) and a myopic refraction in the other eye (< - 0.25 D), and group C (n = 22) with bilateral myopic results (SE of < - 0.25 D). Overall, 84% of patients had purchased new spectacles, mostly varifocals (59%) or reading glasses (24%) at the median cost of 980 Swiss Francs (mean: CHF 912 ± 746). Despite patients' initial reasoning for their lens choice to require reading glasses only, varifocal glasses were worn for more than 50% or all of awake time by 48% of patients in group A, 43% in group B, and 68% in group C. Despite their regular spectacles use, patients' visual satisfaction was very high in all three groups. Most patients who achieve perfect bilateral emmetropia after implantation of monofocal aspheric lenses buy varifocal spectacles within 6 months, and more than half of all patients use their varifocal spectacles for more than 50% of their awakening time. The costs for such spectacles are high.

Эффективность имплантации новой асферической гидрофобной акриловой монофокальной ИОЛ в краткосрочном периоде наблюдения

Perpose. To evaluate the results of implantation of a new hydrophobic acrylic monofocal IOL in an automated preloaded delivery system in the short-term follow-up period. Material and methods. The prospective study included 89 patients (114 eyes) after bilateral or monolateral Clareon IOL implantation with a mean follow-up of 2.1 ± 0.4 (1–4) months. The age range was 53 to 87 (71.1 ± 5.2) years. A corneal incision of 1.8 mm was used in all cases. For implantation using the AutonoMe® system, the incision was enlarged by 0.2 mm for implantation IOL 26 D and higher. IOL optical power was calculated using the SRK/T formula; retrospective analysis was performed using the Hoffer Q, Haigis, Holladay II, Olsen, Barrett Universal II, and Kane formulas. Results. In all studied periods (1 day, 1 week and 1 month) there was statistically significant (p &lt; 0.05) increase both of NCDVA (from 0.13 ± 0.02 in the preoperative period to 0.81 ± 0.07 in 1 month after surgical intervention), and BCDVA (from 0.32 ± 0.15 before surgery to 0.94 ± 0.11 after surgery). When assessing the percentage of eyes with an BCDVA of 0.9 or higher, a statistically significant (p &lt; 0.05) difference was shown in all studied periods. The lowest MAE was shown for the Barrett Universal II (0.292), SRK/T (0.312) Kane (0.301), and Olsen (0.325) formulas. For the Hoffer Q and Holladay 2 formulas, MAE values were significantly higher (p &lt; 0.05). The highest frequency of achieving the target refraction of ±0.25 D was shown for the Barrett Universal II and Kane formulas (68 and 69 %, respectively), and the lowest for the Hoffer Q and Holladay 2 formulas (28 and 35 %, respectively). The primary endpoint of the study (BCDVA =1.0) was achieved in 95.6 % (n = 109), with a deviation in BCVA of ±0.1 noted in 4 eyes (3.5 %). No glistening was detected in the follow-up period up to 4 months. Conclusion. The paper presents an analysis of the first experience with the implantation of new Clareon monofocal IOLs in Russian Federation. The results of implantation of a new hydrophobic acrylic monofocal IOL in an automated preloaded delivery system showed a good clinical and functional effect, a high frequency of achieving the target result and the absence of significant side effects. The Kane, Barrett Universal II, and SRK/T formulas, using the Verion diagnostic navigation system, are recommended for calculating the optical power of the new IOL. Keywords: cataract; monofocal IOL; Clareon; glistening.

Efficacy and Safety Analysis of the New Aspheric Hydrophobic Acrylic Monofocal IOL Implantation at Short-Term Follow-Up

Aim. To evaluate the results of implantation of a new hydrophobic acrylic monofocal IOL in an automated preloaded delivery system in the short-term follow-up period.Patients and methods. The prospective study included 89 patients (114 eyes) after bilateral or monolateral Clareon IOL implantation with a mean follow-up of 2.1 ± 0.4 (1–4) months. The age range was 53 to 87 (71.1 ± 5.2) years. A corneal incision of 1.8 mm was used in all cases. For implantation using the AutonoMe® system , the incision was enlarged by 0.2 mm for implantation IOL 26 D and higher. IOL optical power was calculated using the SRK/T formula; retrospective analysis was performed using the Hoffer Q, Haigis, Holladay II, Olsen, Barrett Universal II, and Kane formulas.Results. In all studied periods (1 day, 1 week and 1 month) there was statistically significant (p &lt; 0.05) increase both of NCDVA (from 0.13 ± 0.02 in the preoperative period to 0.81 ± 0.07 in 1 month after surgical intervention), and BCDVA (from 0.32 ± 0.15 before surgery to 0.94 ± 0.11 after surgery). When assessing the percentage of eyes with an BCDVA of 0.9 or higher, a statistically significant (p &lt; 0.05) difference was shown in all studied periods. The lowest MAE was shown for the Barrett Universal II (0.292), SRK/T (0.312) Kane (0.301), and Olsen (0.325) formulas. For the Hoffer Q and Holladay 2 formulas, MAE values were significantly higher (p &lt; 0.05). The highest frequency of achieving the target refraction of ± 0.25 D was shown for the Barrett Universal II and Kane formulas (68 and 69 %, respectively), and the lowest for the Hoffer Q and Holladay 2 formulas (28 and 35 %, respectively). The primary endpoint of the study (BCDVA = 1.0) was achieved in 95.6 % (n = 109), with a deviation in BCVA of ± 0.1 noted in 4 eyes (3.5 %). No glistening was detected in the follow-up period up to 4 months.Conclusion. The paper presents an analysis of the first experience with the implantation of new Clareon monofocal IOLs in Russian Federation. The results of implantation of a new hydrophobic acrylic monofocal IOL in an automated preloaded delivery system showed a good clinical and functional effect, a high frequency of achieving the target result and the absence of significant side effects. The Kane, Barrett Universal II, and SRK/T formulas, using the Verion diagnostic navigation system, are recommended for calculating the optical power of the new IOL.

Accuracy of intraocular lens power calculation for cataract surgery after deep anterior lamellar keratoplasty.

The purpose of this study was to assess the accuracy of intraocular lens power (IOL) formulas for cataract surgery after deep anterior lamellar keratoplasty (DALK). This retrospective study included eyes which had previously undergone DALK and underwent standard phacoemulsification with monofocal IOL implantation between January 2012 and January 2021 at Ospedali Privati Forlì "Villa Igea" (Forlì, Italy). The predicted spherical equivalent (SE) was calculated using the Barrett Universal II, Emmetropia Verifying Optical (EVO), Haigis, Hoffer Q, Hoffer QST, Holladay 1, Holladay II, Kane and SRK/T formulas. Prediction error (PE) was calculated as the actual postoperative SE refraction minus the SE predicted refraction. Eighty-two eyes of 82 patients were included. The mean PE was negative using all formulas. Friedman test revealed a statistically significant difference of the median absolute PE (MedAE) among the different IOL formulas (P=0.005). On the basis of the MedAE, the formulas were ranked as follows: SRK/T (0.805 D), Kane (0.810 D), EVO (0.845 D), Hoffer QST (0.847 D), Barrett (0.895 D), Holladay 1 (0.915 D), Haigis (1.010 D) and Hoffer Q (1.070 D) formulas. All formulas had a tendency towards a myopic refractive shift in post-DALK eyes. Although the SRK/T, Kane, EVO and Hoffer QST formulas were more accurate, predictability of refractive outcomes was lower than in virgin eyes.

Clinical outcomes of the piggyback secondary implantation of a novel multifocal lens in the ciliary sulcus: A case series.

Evaluate the clinical outcomes of the secondary piggyback add-on IOL implantation in the ciliary sulcus for pseudophakic patients previously implanted with a monofocal IOL, who pursue a spectacle-free option after IOL surgery. A prospective case series including seven pseudophakic patients who underwent an in-the-bag monofocal IOL implantation. All eyes underwent a piggyback IOL implantation of the new sulcus designed A4 AddOn IOL in the ciliary sulcus as a secondary procedure for pseudophakic patients pursuing a spectacle-free option for near and intermediate distance after IOL surgery. Seven eyes from six patients were included in this study, from which 4 (71.43%) were female, with a mean age of 58.33 ± 3.5 years (range 54-63; 95% CI 54.66, 62.01). The postoperative spherical equivalent at the 3-month visit was -0.10 m ± 0.82. Also, the UDVA was 0.11 ± 0.08 logMAR, the UIVA 0.01 ± 0.03, and the UNVA 0.01 ± 0.03 3 months after their surgical procedure. The A4 AddOn multifocal IOL's secondary piggyback implant is an efficient alternative for monofocal pseudophakic patients seeking presbyopia solutions. This sulcus-designed IOL provides an optimal visual outcome for near and distance vision.

Visual and Refractive Outcomes and Patient Satisfaction Following Implantation of Monofocal IOL in One Eye and ERV IOL in the Contralateral Eye with Mini-Monovision.

TitleVisual and refractive outcomes and patient satisfaction following implantation of monofocal intraocular lens in one eye and ERV intraocular lens in the contralateral eye with mini-monovision.PurposeTo evaluate the outcomes following implantation of monofocal intraocular lens in one eye and ERV intraocular lens in the contralateral eye with mini-monovision.MethodsTwenty-five subjects underwent bilateral cataract surgery, wherein the dominant eye received monofocal Tecnis-1 IOL, while in the contralateral eye received the Tecnis Symphony ERV IOL. The dominant eye was targeted for emmetropia and the non-dominant eye for myopia of −0.50 to −0.75D. Binocular uncorrected and corrected distance (UDVA, CDVA), intermediate (UIVA, CIVA), and near (UNVA, DCNVA) visual acuity; reading speeds, defocus curve and contrast sensitivity were studied at 6 months post-operatively.ResultsAt 6 months post-operatively the mean binocular UDVA, CDVA, UNVA and DCNVA were 0.007±0.07, −0.13±0.06, 0.26±0.09 and 0.44±0.10 LogMAR, respectively. Binocular UIVA and DCIVA at 60 cm were 0.22±0.10 and 0.18±0.08 LogMAR and at 80 cm was 0.16±0.11 and 0.15±0.10 LogMAR, respectively. Mean uncorrected reading speeds evaluated with SRD at 40, 60 and 80 cm were 114.4±6.9, 126.4±7.9 and 123.16±5.8 words per minute. Contrast sensitivity values did not show significant difference for any spatial frequency tested. At 6 months, only 12% (3 patients) reported mild halos. Spectacle independence satisfaction scores were 96%, 100% and 88% for distance, intermediate and near.ConclusionImplantation of monofocal intraocular lens in one eye and ERV intraocular lens in the contralateral with mini-monovision resulted in good outcomes for far and intermediate, and satisfactory outcomes for near vision, with good tolerance to mini-monovision at the end of 6 months.

Clinical outcomes and rotational stability following implantation of Eyecryl toric intraocular lens - Results of a 12-months prospective study.

Purpose:To evaluate the clinical performance and rotational stability after implantation of Eyecryl Toric monofocal IOL following cataract surgery.Methods:Patients undergoing phacoemulsification for age-related cataract and satisfying the eligibility criteria were implanted with Eyecryl Toric IOL. All implantations were done under balanced salt solution. A marker-less system Callisto Eye (Carl Zeiss Meditec, Germany) was used to guide the intra-operative alignment of the toric IOL.Results:A total of 50 eyes from 39 patients with mean age of 68.2 ± 8.7 years were included in the study. At 12 months, 82% (41) eyes had cumulative UDVA of 20/20 or better. Post-op SE refraction accuracy was within ± 0.50 D for 94% (n = 47) eyes and refractive cylinder accuracy was within ≤0.50 D in 98% (n = 49) eyes. Average post-op rotation at 1 year was 4.06 ± 2.15 degrees. Eighty-four percent of eyes were within 5 degrees and 16% were within 6-10 degrees of intended axis. Two eyes required IOL re-positioning due to significant rotation of the toric IOL (>10 degrees), identified within the 1st week after surgery.Conclusion:Eyecryl toric IOL demonstrated the ability to achieve a significant reduction in astigmatism, improved UDVA outcomes, high levels of spectacle independence, low rates of intra-operative injector related complications and good rotational stability at 12 months post-op.

Visual function and subjective perception of vision after bilateral implantation of monofocal and multifocal IOLs: a randomized controlled trial.

To examine monocular and binocular visual function and patient-reported outcomes after implantation of multifocal IOLs (mIOLs) or monofocal IOLs, using a rigorous series of clinical assessments. BMI Southend Hospital, United Kingdom. Prospective, randomized, double-masked clinical trial. One hundred patients were randomized for bilateral implantation of either a Bi-Flex 677MY mIOL or a Bi-Flex 677AB IOL and were assessed at 3 to 6 months (V1) and 12 to 18 months (V2). Primary outcomes included distance, intermediate, and near logarithm of the minimum angle of resolution (logMAR) visual acuities (VAs) and defocus curve profile assessment. Secondary outcomes included reading speed, contrast sensitivity (CS), and the subjective perception of quality of vision. Forty-seven subjects with monofocal IOL and 43 mIOL subjects completed the study. Uncorrected (mIOL: 0.10 ± 0.09 logMAR; IOL: 0.09 ± 0.11 logMAR) and corrected (mIOL: 0.04 ± 0.06 logMAR; IOL: 0.01 ± 0.07 logMAR) distance VAs were comparable (P > .05). Uncorrected near VA (mIOL: 0.23 ± 0.13 logMAR; IOL: 0.55 ± 0.20 logMAR, P < .001) and distance-corrected near VA (mIOL: 0.24 ± 0.13 logMAR; IOL: 0.54 ± 0.17 logMAR, P < .001) were significantly improved with mIOLs. There was no significant difference in distance-corrected intermediate VA (mIOL: 0.38 ± 0.13 logMAR; IOL: 0.39 ± 0.13 logMAR, P = .431). Defocus curves demonstrated an increased range-of-focus among mIOLs (mIOL: 4.14 ± 1.10 diopter [D]; IOL: 2.57 ± 0.77 D). Pelli-Robson CS was different at V1 (P < .001) but similar by V2 (P = .059). Overall satisfaction was high (>90%) in both groups for distance tasks whereas significantly different for near tasks (mIOL, 18.45 ± 16.53 logUnits; IOL, 55.59 ± 22.52 logUnits). Uncorrected near visual acuity was demonstrably better with mIOLs and there was greater subjective satisfaction with quality of near vision. Halos reported by the mIOL group were significant compared with the IOL group but did not show an adverse effect on overall satisfaction.

Visual function after bilateral implantation of multifocal versus monofocal IOLs in children below 5 years of age

Background: Since pediatric ophthalmologists still prefer to implant monofocal IOL and experience with multifocal IOL implantation in children is limited. Therefore, the aim of the study was to evaluate visual results after bilateral implantation of multifocal versus monofocal IOLs in children aged 1–5 years with congenital cataract. Methods: Children between 1 and 5 years of age with bilateral cataract who underwent cataract removal implantation of an multifocal IOL – Lentis Mplusx , Oculentis GmbH, Germany (55 children – group A) or monofocal IOL – C-flex Aspheric Monofocal, Rayner Intraocular Lenses Limited, UK (55 children – group B). The distance corrected visual acuity, distance corrected near visual acuity, binocular function using the Worth 4-dot test, stereopsis using the TNO test were evaluated. Results: At the final follow-up visit after 12 months, the mean best corrected distant visual acuity was not significantly different between groups A and B but the best corrected near visual acuity, binocular vision and stereopsis were significantly better in patients from group A as compared to group B. Conclusion: Implantation of a multifocal IOL in children aged 1–5 years with bilateral cataract provides a better level of near vision and considerably improves the development of stereopsis in comparison with children after monofocal IOL implantation.

Three-year incidence of Nd:YAG capsulotomy and posterior capsule opacification and its relationship to monofocal acrylic IOL biomaterial: a UK Real World Evidence study

PurposeTo evaluate 3-year incidence of Nd:YAG capsulotomy and PCO and compare the effect of different IOL materials.MethodsData were retrospectively collected from seven UK ophthalmology clinics using Medisoft electronic medical records. Eyes from patients ≥65 years undergoing cataract surgery with implantation of acrylic monofocal IOLs during 2010–2013 and 3-year follow-up were analysed. Nd:YAG capsulotomy and PCO incidence proportions were reported for 3 IOL cohorts: AcrySof, other hydrophobic and hydrophilic acrylic IOLs. Unadjusted/adjusted odds ratios (OR) of Nd:YAG capsulotomy were calculated through logistic regression for non-AcrySof cohorts versus AcrySof. A sub-group analysis in single-piece IOLs (>90% of sample eyes) was also performed.ResultsThe AcrySof cohort included 13,329 eyes, non-AcrySof hydrophobic 19,025 and non-AcrySof hydrophilic 19,808. The 3-year Nd:YAG capsulotomy incidence (95% CI) for AcrySof (2.4%, 2.2–2.7%) was approximately two times lower than non-AcrySof hydrophobic IOLs (4.4%, 4.1–4.7%) and approximately fourfold lower than non-AcrySof hydrophilic IOLs (10.9%, 10.5–11.3%). Trends were similar in PCO incidence (AcrySof: 4.7%; non-AcrySof hydrophobic: 6.3%; non-AcrySof hydrophilic: 14.8%). Also in the analysis restricted to single-piece IOLs, the pattern remained (2.4% vs 5.1% vs. 10.9%, respectively). Adjusted regression analysis showed a approximately two and fivefold increased odds of Nd:YAG for non-AcrySof hydrophobic and hydrophilic acrylic IOLs respectively vs. AcrySof IOLs. Nd:YAG capsulotomy ORs were similar and remained statistically significant in the single-piece IOL sub-group.ConclusionsReal-world evidence shows that within 3 years following implantation, AcrySof IOLs are significantly superior in reducing Nd:YAG capsulotomy and PCO incidence compared to other hydrophilic and hydrophobic acrylic IOLs.

ОСОБЕННОСТИ ЗРИТЕЛЬНОГО ВОСПРИЯТИЯ У ПАЦИЕНТОВ С ПРЕСБИОПИЕЙ В ЗАВИСИМОСТИ ОТ ВИДА ИНТРАОКУЛЯРНОЙ КОРРЕКЦИИ

Purpose. To assess the long-term results of presbyopia correction in patients with primary cataract depending on type of implantable IOLs.Material and methods. A profound study of visual functions and assessment of visual quality of 90patients (mean age 63.3±1.2years) with partial cataracts and presbyopia. The studies were conducted before surgery and in late post-operative period after bilateral cataract phacoemulsification with implantation of different models IOLs that provide a high visual acuity in distance and at close range. Results. Bilateral implantation of monofocal IOLs for monovision principle leads to a significant increase in far visual acuity of leading the eye and near visual acuity of slave eye. However, patients need long-term adaptation to artificial anisometropia. As a result of bilateral implantation of accommodating IOLs a significant improvement in visual acuity at distance and near occurs. Surgical treatment provides best visual quality of patients up to 6 months after surgery. In period from 12 to 24months after surgery, there was a decrease of visual functions as a result of fibrosis of capsular bag. The correction of presbyopia by creating a multifocal optical system as a result of bilateral multifocal refractive IOL implantation leads to a stable improvement of visual acuity at far and close distance. But thus the contrast sensitivity deteriorates, especially in low- and high-frequency ranges.Conclusion. Intraocular correction of presbyopia is a highly effective method of treatment, allowing obtaining high visual acuity in distance and at close range. However, the results depend on chosen strategy of intraocular correction.

The Analysis of Refraction and Accommodation of Extreme Myopia with Cataract after Phacoemulsification and IOL Implantation

Background: To assess the refractive status of cataract patients with extreme myopia and to measure their accommodative capability after monofocal IOL implantation. Design: Prospective non-randomized study conducted at Tianjin Medical University Eye Centre. Participants: 18 patients with 34 extreme myopic eyes (≥-10 Diopter, ≥27mm axial length), and 14 patients with 27 non-myopic eyes that had uneventful phacoemulsification and monofocal IOL implantation. Methods: The accommodation amplitude of the two groups was compared pre- and post-operatively using subjective minus-lenses-to-blur method. In the extreme myopic group, the postoperative target refraction was selected to be myopic, and they were evaluated for predicted postoperative spherical power consistency. Extreme myopic eyes anterior chamber depth was measured by pentacam, and axial length was measured by the immersion vector A/B-scan biometry. All measurements were done preoperatively and at 1, 3, 6 months postoperatively. Main Outcome Measures: Predicted spherical power, amplitude of accommodation, anterior chamber depth, axial length. Results: There was a significant difference between pre and postoperative results of Mean predicted spherical power (P=0.001). The differences between pre- and postoperative anterior chamber depth measurements were statistically significant (P=0.001). No significant differences were detected between pre- and postoperative measurements of axial length (P＞0.05). There was no significant difference in amplitude of accommodation between the two groups pre or postoperatively ( P＞0.05). Conclusions: The study yielded a hyperopic shift of the predicted postoperative spherical power of extreme myopic eyes. No significant difference was observed between extreme myopic and non-myopic eyes in

Refractive, anterior corneal and internal astigmatism in the pseudophakic eye

To evaluate the correlation between refractive astigmatism (RA) and anterior corneal astigmatism (ACA), and determine the internal astigmatism (IA) in 184 pseudophakic eyes. The study was a prospective non-masked single-centre study. Patients were examined 8 weeks after phacoemulsification with implantation of aspheric one-piece monofocal IOLs. Examination included autokeratometry and subjective refraction. All refractive data were converted to the corneal plane. The corneal refractive index, taken to be 1.376, was used to estimate the ACA. All astigmatisms were converted to net curvital and net torsional powers with the steeper corneal plane as the reference meridian. Curvital power is the force acting along a given meridian, and torsion is the power twisting the astigmatic direction out of that plane. The internal astigmatism (IA) was calculated as the difference between RA and ACA. For curvital powers, the refractive astigmatism (KP(Φ)RA ) could be described as a function of anterior corneal astigmatic magnitude (KP(Φ)ACA ) and direction α by the multiple linear regression equation: KP(Φ)RA = -0.09 + 0.61*KP(Φ)ACA + 0.33*cos2α, (r(2) = 0.59, p < 0.0001). The average internal astigmatism amounted to 0.47 D inclined 92° relative to the steeper anterior corneal meridian. The magnitude of internal astigmatism depended on the angle α of the steeper anterior corneal meridian, averaging 0.86 D at 91° for with-the-rule, 0.37 D at 95° for oblique and 0.17 D at 97° for against-the-rule corneal astigmatisms. The internal astigmatism varies as a function of the direction of the anterior steeper corneal meridian. In patient candidates to surgical correction of astigmatism, measuring only the curvature of the anterior corneal surface and neglecting that of the posterior corneal surface can lead to inaccurate evaluation of total corneal astigmatism.

Implants multifocaux chez le grand myope, résultats à 6 ans

Currently, the use of multifocal IOL's remains controversial for patients with high myopia, especially because of the risk of retinal complications and poor quality of vision. Our goal was to evaluate this retinal risk and clarify the benefits obtained in this population in terms of visual acuity.Twenty-nine highly myopic patients (52 eyes with over 6 diopters of myopia) aged 40-69 years with early cataract by LOCSIII were selected for multifocal lens implantation, based on a healthy endothelium and retina as well as better visual acuity corrected to at least 0.5 - J2. Thirteen of them (21 eyes) had been previously implanted with a phakic IOL. The AT Lisa IOL (Zeiss©) was chosen because of the low powers available and ease of exchange. Data collection was conducted prospectively, at each visit. The main study parameters were the development of retinal complications, occurrence of PCO, patient satisfaction rate and rate of spectacle independence.At the end of the 6-year follow-up, we found 2 rhegmatogenous retinal detachments (3.8%) occurring at approximately 20 months and favorably treated without IOL explantation. We also found one case of macular atrophy secondary to cystoid edema. Twenty-seven uncomplicated YAG posterior capsulotomies were performed for posterior capsule opacification. Ninety-eight percent of patients reached best corrected visual acuity of at least 0.5 and 38% of at least 0.8 without correction. Finally, 85% of patients achieved spectacle independence, and all would be willing to undergo the same procedure.Multifocal IOL implantation in the high myope provided favorable results at 6 years, in carefully selected cases, providing optimal binocular visual comfort, including near vision. However, the fragility of the highly myopic retina mandates long-term follow-up. It would be beneficial to compare results of multifocal vs. monofocal IOL implantation in terms of visual performance and safety.