Refractive Lensectomy Research Articles

Рефракционная замена хрусталика при рефракционной амблиопии: «лечение» или диагностика?

Relevance. Refractive amblyopia is one of conditions that reduce best corrected visual acuity (BCVA) in patients. With the advent of new methods of refractive surgery, we note new features of the course of refractive amblyopia in adult patients after refractive surgery. Purpose. Determination of changes in uncorrected visual acuity and BCVA as well as changes in the degree of amblyopia in patients with high-grade refractive errors after implantation of toricIOLs during refractive lens replacement (RLL). Materials and methods. Retrospective evaluation of functional outcomes in 20 patients over 18 years (28 eyes) who received surgical treatment in the form of refractive lens replacement for myopic and hypermetropic astigmatism in the presence of high-grade ametropia with amblyopia. Results. In 35.3% of patients with myopic refraction, the diagnosis of amblyopia was removed. In 41.2%, we saw reducing the degree of amblyopia, 23.5% added 1 line of BCVA without changing the degree of amblyopia. When comparing the BCVA of patients with myopic refraction before and after surgical treatment, significant differences were obtained. In all eyes with hypermetropic refraction, there was no change in the degree of amblyopia after surgery, 22% of operated ones received an increase in BCVA by 1 line. There were no significant differences of BCVA a week after surgery in patients with hyperopic refraction. Conclusion. The revealed change in the degree of amblyopia in patients in early stages after RLL makes us clarify diagnosis and doubt sufficiency of standard methods for diagnosing amblyopia and determining its degree. In amblyopic patients with high myopia, in comparison with patients with hyperopia, refractive replacement of the transparent lens in most cases leads to an increase in BCVA in a short time after. Refractive lensectomy, is a amblyopia treatment, and is an important tool to exclude the diagnosis of amblyopia or reduce its degree. Key words: amblyopia, lens, refractive surgery, myopia, hypermetropia

Первый опыт имплантации недифракционной ИОЛ с расширенной глубиной фокуса, формирующей волновой фронт

Aim. Analysis of short-term clinical and functional results of implantation of a new nondiffractive IOL with expanded depth of focus. Material and methods. The study included 27 patients (35 eyes) after bilateral (8 patients) or monolateral (19 patients) AcrySof IQ Vivity IOL implantation (Alcon, USA) with mean follow-up of 3.8 ± 0.3 (3–5) months. In all cases, IOL implantation was preceded by cataract phacoemulsification or refractive lensectomy. Women accounted for 63% (n = 17) and men for 37% (n = 10). AcrySof IQ Vivity DFT015 IOLs were implanted in 24 eyes and toric AcrySof IQ Vivity DFT315, DFT415 and DFT515 IOLs in 11 eyes with clinically significant (more than 1.0 D) astigmatism. Results. There was a significant (p < 0.05) increase in distance and intermediate uncorrected and best corrected visual acuity starting from the 1st day after surgery. An increase from 0.31 ± 0.09 to 0.58 ± 0.12 at the 1st day after the operation, and further up to 0.63 ± 0.13 at the follow-up period of 3 months (p < 0.05) was also registered while assessing near uncorrected visual acuity. In spite of some increase of best corrected near visual acuity in the follow-up period of 3 months in comparison with preoperative period (0.68 ± 0.19 and 0.57 ± 0.16, respectively), these differences were not statistically significant (p > 0.05). After IOL implantation, the spherical refractive index was shown to decrease from –2.75 ± 1.4 in the preoperative period to –0.10 ± 0.73 in the follow-up period of 3 months. Permanent or periodic optical phenomena were detected in 4 patients out of 27 (14.8%), of them 2 patients (7.4%) had glare and 2 (7.4%) – halo. Patients did not complain of difficulties in driving in the dark. In 11 cases out of 27 (40.7%), patients required spectacle correction for reading. In spite of the need for spectacle correction for near vision in 40% of cases, the vast majority of patients (n = 24; 88.9%) rated the result of surgery as «excellent» and three (11.1%) as good. Conclusion. This work presents the first experience in Russia of implantation of a new non-diffractive intraocular lens with an expanded depth of focus forming a wavefront in 35 eyes. The presented data testify to the high efficacy of this IOL for medium distance and far distance vision correction and to the possibility of providing functional near vision. Implantation of the investigated IOL was associated with a low incidence of adverse optical phenomena, such as halo, glare, and discomfort when driving in the dark. The use of this IOL in clinical practice may be an option to achieve the desired outcome in cataract surgery. Keywords: cataract, presbyopia, multifocal IOL, IOL with extended depth of focus, EDOF, Vivity.

Имплантация недифракционной интраокулярной линзы с расширенной глубиной фокуса

Aim. An analysis of short-term clinical and functional results of implantation of a new non-diffractive IOL with extended depth of focus. Methods. The study included 27 patients (35 eyes) after bilateral (8 patients) or monolateral (19 patients) AcrySof IQ Vivity IOL implantation (Alcon, USA) with mean follow-up of 3.8±0.3 (3–5) months. In all cases, IOL implantation was preceded by cataract phacoemulsification or refractive lensectomy. Women accounted for 63 % (n=17) and men for 37 % (n=10). AcrySof IQ Vivity DFT015 IOLs were implanted in 24 eyes and toric AcrySof IQ Vivity DFT315, DFT415 and DFT515 IOLs in 11 eyes with clinically significant (more than 1.0 D) astigmatism. Results. There was a significant (p<0.05) increase in distance and intermediate uncorrected and best corrected visual acuity starting from the 1st day after surgery. An increase from 0.31±0.09 to 0.58±0.12 at the 1st day after the operation, and further up to 0.63±0.13 at the follow-up period of 3 months (p<0,05) was also registered while assessing near uncorrected visual acuity. In spite of some increase of best corrected near visual acuity in the follow-up period of 3 months in comparison with preoperative period (0.68±0.19 and 0.57±0.16, respectively), these differences were not statistically significant (p>0.05). After IOL implantation, the spherical equivalent was shown to decrease from –2.75±1.4 in the preoperative period to –0.10±0.73 in the follow-up period of 3 months. Permanent or periodic optical phenomena were detected in 4 patients out of 27 (14.8 %), 2 of them (7.4 %) had glare and 2 (7.4 %) – halo. Patients did not complain of difficulties in driving in the dark. In 11 cases out of 27 (40.7 %), patients required spectacle correction for reading. In spite of the need for spectacle correction for near vision in 40% of cases, the vast majority of patients (n=24; 88.9 %) rated the result of surgery as “excellent” and three (11.1 %) as “good”. Conclusion. This work presents the first experience in Russia of implantation of a new non-diffractive intraocular lens with an extended depth of focus forming a wavefront in 35 eyes. The presented data indicate high efficacy of this IOL for intermediate distance and far distance vision correction and possibility of providing functional near vision. Implantation of the investigated IOL was associated with low incidence of adverse optical phenomena, such as halo, glare, and discomfort when driving in the dark. The use of this IOL in clinical practice may be an option to achieve the desired outcome in cataract surgery. Key words: cataract; presbyopia; multifocal IOL; IOL with extended depth of focus; EDOF; Vivity

Calculation of IOL Optical Power Using OKULIX Ray-Tracing Software in Real Clinical Practice

Purpose. Comparative analysis of the accuracy of IOL optical power calculation using different biometric devices.Patients and methods. The study included 30 patients (30 eyes) after monolateral implantation of different monofocal and multifocal IOL models with a mean follow-up of 3.0 ± 0.2 (3–4) months. The mean age was 63.5 ± 6.5 (48–84) years. In all cases, IOL implantation was preceded by cataract phacoemulsification or refractive lensectomy. For all patients, IOL optic power, axial length and keratometry data were obtained using IOLMaster 500, Pentacam HR, and Pentacam AXL+OKULIX devices. Clareon, IQ Vivity, Hoya 250/251, and XY1-SP Vivinex IOLs were implanted.Results. The mean optical power for all implanted IOLs was +21.38 ± 3.50 D, range of values was +10.0 to +29.0 D. The average values of axial eye length were 23.50 ± 0.90 mm (21.25 to 25.19 mm). The target refractive IOLs optic power calculated with the three biometric systems did not differ significantly and was -0.464 ± 0.120 D, -0.502 ± 0.140 D, and -0.400 ± 0.110 D for IOLMaster, Pentacam, and Pentacam+OKULIX, respectively (p > 0.05). The Pentacam HR and Pentacam AXL+OKULIX had slightly lower MAE values; however, no significant differences were found in calculating IOL optical power for the three devices used (p > 0.05). When comparing the devices under study, significant differences were found for the rate of refractive power within ±0.5 D when using the IOLMaster on the one hand and OKULIX on the other (p < 0.05). The refractive error rate of ±1.0 D using the biometric devices did not differ significantly (p > 0.05).Conclusion. This paper presents the first Russian experience of using OKULIX ray-tracing software in clinical practice to increase the accuracy of optical power calculation of various IOL models. The advantage of Pentacam AXL+OKULIX over the IOLMaster 500 biometer in achieving a target refraction of ±0.5 D is shown.

Non-Diffractive Wavefront-Shaping Intraocular Lens with Extended Depth of Focus: First Implantation Experience

Purpose. Analysis of short-term clinical and functional results of implantation of a new non-diffractive IOL with expanded depth of focus.Patients and methods. The study included 27 patients (35 eyes) after bilateral (8 patients) or monolateral (19 patients) AcrySof IQ Vivity IOL implantation (Alcon, USA) with mean follow-up of 3.8 ± 0.3 (3–5) months. In all cases, IOL implantation was preceded by cataract phacoemulsification or refractive lensectomy. Women accounted for 63 % (n = 17) and men for 37 % (n = 10). AcrySof IQ Vivity DFT015 IOLs were implanted in 24 eyes and toric AcrySof IQ Vivity DFT315, DFT415 and DFT515 IOLs in 11 eyes with clinically significant (more than 1.0 D) astigmatism.Results. There was a significant (p < 0.05) increase in distance and intermediate uncorrected and best corrected visual acuity starting from the 1st day after surgery. An increase from 0.31 ± 0.09 to 0.58 ± 0.12 at the 1st day after the operation, and further up to 0.63 ± 0.13 at the follow-up period of 3 months (p < 0.05) was also registered while assessing near uncorrected visual acuity. In spite of some increase of best corrected near visual acuity in the follow-up period of 3 months in comparison with preoperative period (0.68 ± 0.19 and 0.57 ± 0.16, respectively), these differences were not statisticallysignificant (p > 0.05). After IOL implantation, the spherical refractive index was shown to decrease from –2.75 ± 1.4 in the preoperative period to –0.10 ± 0.73 in the follow-up period of 3 months. Permanent or periodic optical phenomena were detected in 4 patients out of 27 (14.8 %), of them 2 patients (7.4 %) had glare and 2 (7.4 %) — halo. Patients did not complain of difficulties in driving in the dark. In 11 oof 27 cases (40.7 %), patients required spectacle correction for reading. In spite of the need for spectacle correction for near vision in 40 % cases, the vast majority of patients (n = 24; 88.9 %) rated the result of surgery as “excellent” and three (11.1 %) as good.Conclusion. This work presents the first experience in Russia of implantation of a new non-diffractive intraocular lens with an expanded depth of focus forming a wavefront in 35 eyes. The presented data testify to the high efficacy of this IOL for medium distance and far distance vision correction and to the possibility of providing functional near vision. Implantation of the investigated IOL was associated with a low incidence of adverse optical phenomena, such as halo, glare, and discomfort when driving in the dark. The use of this IOL in clinical practice may be an option to achieve the desired outcome in cataract surgery.

Результаты имплантации и особенности расчета ИОЛ с расширенной глубиной фокуса vivity dft015: первый опыт

Purpose. To evaluate the results of implantation of the Vivity IOL in patients with cataract and refractive lensectomy. Material and methods. The study included 25 patients (42 eyes) who underwent phacoemulsification or refractive lens exchange with Vivity IOL implantation. The mean age of the patients was 56.4 ± 11.75 years. The results were evaluated 1 month after the surgery. Postoperative visual acuity was measured monocularly at a distance and at an intermediate. The IOL was calculated using three formulas: Kane, Hill-RBF, EVO. The mean absolute (MAE) and median (MedAE) calculation errors were calculated. Results. One month after the surgery patients with lens exchange and cataracts distance and intermediate visual acuity was 0.88 ± 0.17 and 0.76 ± 0.12, 0.91 ± 0.23 and 0.81 ± 0.11 respectively. The mean absolute error according to the formulas ranged from 0.31 to 0.33 D. Pairwise comparison of the calculation accuracy revealed no significant differences (p > 0.05). Conclusion. The new non-diffractive EDOF IOL Vivity DFT015 demonstrated high visual functions at long and medium distances, as well as high calculation accuracy using three modern calculators. Keywords: phacoemulsification, IOL with extended depth of focus, cataract.

Точность расчета трифокальной ИОЛ по данным эквивалентных кератометрических показателей в различных зонах

Purpose. To identify the equivalent K-readings (EKR) data and keratometry zones for accurate calculation of trifocal IOL according to 7 formulas. Material and methods. The study involved 42 patients (42 eyes). All patients underwent surgical treatment of age-related cataracts or a refractive lensectomy with femtolaser accompaniment and implanted a trifocal IOL. All patients underwent optical biometrics (OA-2000 Tomey, Japan) and keratotomography (Pentacam-HR, Oculus, Germany). Preoperative calculation of IOL was carried out according to the data of the optical biometer OA-2000 (Tomey, Japan). After the period of refraction stabilization, IOL was retrospectively calculated using seven formulas (Haigis, Hoffer Q, Holladay 1, SRK/T, Barrett 2 Universal, Olsen and Holladay 2), biometric data OA-2000 and keratometric indicators Pentacam HR (EKR 65 %) in 10 corneal zones (from 0.5 to 5.0 mm in 0.5mm increments). For each formula/zone combination, the postoperative predicted refraction, mean absolute errors, and median absolute errors were calculated. Results. The lowest variance, mean absolute error and median absolute error of predicted postoperative refraction were obtained using the Haigis formula in the 3.5 mm zone. Conclusions. The most accurate calculation of trifocal IOL using EKR data is determined using the Haigis formula in the 3.5 mm zone. Keywords: keratometry, «Pentacam HR», keratotomography, equivalent K-readings, keratometry zone, IOL calculation.

Patient Satisfaction Based on IOL Implantation Results

Purpose: to found the relationship between the obtained postoperative visual acuity, the increase in visual acuity in the lines and the subjective satisfaction of patients with the results of the operation.Material and methods. The study included 165 patients (186 eyes) who received cataract phacoemulsification surgery with IOL implantation (n = 170) or refractive lensectomy with IOL implantation (n = 16). The average age of the subjects was 70.23 ± 10.14 years. The group included patients without concomitant systemic or ophthalmic pathology, without previous surgical interventions in the eye for any purpose. At least 1 month after the operation, patients filled out a questionnaire in order to find out the subjective satisfaction with the treatment (scale from 0 to 4 points). The results of the questionnaire were compared with postoperative BCVA, and increased vision (postoperative BCVA — preoperative BCVA). Preoperative BCVA — Me 0.4 (Q1–Q3: 0.1–0.68), postoperative BCVA — Me 1.0 (Q1–Q3: 0.95–1.0), increased vision — Me 0.6 (Q1–Q3: 0.3–0.9) according to Snellen’s table.Results. Visual acuity in satisfaction subgroups: 0 points — Me 1.0 (Q1–Q3: 0.9–1.0) / n = 5 (2.7 %); 1 point — 1 case, postoperative BCVA 1.16 (0.5 %); 2 points — Me 0.95 (Q1–Q3: 0.84–1.0) / n = 14 (7.5 %); 3 points — Me 1.0 (Q1–Q3: 0.9–1.16) / n = 57 (30.6 %); 4 points — Me 1.0 (Q1–Q3: 0.96–1.0) / n = 109 (58.6 %). Postoperative BCVA and increased in visual acuity do not have statistically significant differences depending on satisfaction with treatment (p > 0.05). The correlation between postoperative BCVA and satisfaction is not statistically significant (p = 0.65; rxy = 0.136), as well as between vision improvement and satisfaction (p = 0.55; rxy = 0.141).Conclusion. There was a lack of a statistically significant relationship between postoperative BCVA and improved vision with subjective patient satisfaction with treatment. Identification of factors affecting subjective assessment requires a deeper analysis. Practicing ophthalmologists should remember the importance of the dialogue between the doctor and the patient at the preoperative stage, informing the patient about the expected results of the operation and the possible course after the operation period.

Perception of Trifocal IOL Performance in Young Adults with High Astigmatism and Hyperopia and its Improvement Using Small Incision Lenticule Extraction.

Background:Hyperopia is a kind of refractive error in which incoming light is focused behind, instead of on, the retina wall due to insufficient accommodation by the lens. It is likely affected by ethnicity, geography, and a family history of hyperopia or accommodative esotropia and is categorized as low (≤ 2.00D), moderate (2.00–4.00 D), and high (> 4.00D). Beyond hyperopia refractive error, patients may have poor accommodative function or visual perceptual skills.Objective:This study aimed to present the latest approaches to planning trifocal intraocular lens (IOL) and toric trifocal IOL implantation for residual refractive errors in young adults with high astigmatism and hyperopia and increase the patients’ best visual outcome and satisfaction using Small Incision Lenticule Extraction (SMILE) after implantation.Methods:Eighty eyes of 40 consecutive patients who underwent refractive lensectomy were included in this retrospective study. It included patients aged 20–45 years seeking spectacle independence with pre-operative high spherical hypermetropia of 4D or higher and astigmatism of 3D or higher. Patients’ treatment status was categorized as trifocal IOL (n=40) and toric trifocal IOL (n=40).The mean patient follow-up time was six months after IOL implantation. First, we assessed visual acuity and satisfaction for both groups and then examined laser vision correction results of patients who were dissatisfied after IOL implantation (trifocal IOL group) and underwent SMILE surgery to increase satisfaction level.Results:There were no statistically significant differences between trifocal IOL and toric trifocal IOL for near (UNVA), intermediate (UIVA), and distance (UDVA) uncorrected visual acuity. Comparisons related to patient satisfaction six months after IOL implantation were statistically significant for using a computer and night driving. In the trifocal IOL group, compared to pre-operative values, sphere and cylinder at six months were significantly improved.Conclusion:In young adults, toric trifocal and trifocal IOL provided sufficient results in visual acuity; however, patients were dissatisfied after implantation. This study reported patient satisfaction levels, including quality of life and life without glasses by using Small Incision Lenticule Extraction (SMILE) surgery.

Keratorefractive Surgery for Residual Refractive Error Correction in Pseudophakic Patients

Purpose. Evaluation of the visual and refractive results of additional correction using LASIK and PRK methods in patients with residual refractive error after previous cataract surgery.Patients and methods.The prospective open study included 57 patients (79 eyes) who previously underwent cataract phacoemulsification (n = 37) or refractive lensectomy (n = 42) with various IOL models implantation (2012–2017). The average age of patients was 50.8 ± 13.9 (19–79) years. Operations LASIK (91.1 %) and PRK (8.9 %) were carried out according to standard methods. In 6 cases, femtosecond laser supported by laser correction. The target refraction ranged from –0.25 to 0.25 D in most (97.5 %) cases. The follow-up period ranged from 6 to 9 months.Results. The patients were divided into groups according to the type of residual refractive error (Group 1 — myopia, group II — emmetropia and group III — hyperopia). Statistically significant differences were determined for the species of previously implanted IOLs — in group II, the frequency of monofocal IOLs was significantly higher (p < 0.05). In group II, the values of the cylindrical component of refraction were significantly higher compared with groups I and III (p < 0.05). In group I, a significant (p < 0.05) decrease in the spherical component of refraction from –1.36 ± 0.92 to –0.2 ± 0.8 D was observed. In patients of group II, there was a slight increase in the spherical component of refraction from 0 ± 0.20 to 0.25 ± 0.29 D (p > 0.05). In group III, a significant (p < 0.05) decrease was observed in the spherical component of refraction from 1.27 ± 0.69 to 0.43 ± 0.49 D. When analyzing the cylindrical component of refraction in group I, its decline was noted from –0.69 ± 0.5 to –0.38 ± 0.46 D (p > 0.05). In group II, the largest decrease in the cylindrical component was observed from –1.6 ± 1.0 to 0.03 ± 1.10 Dptr (p < 0.01). In all the studied groups, a statistically significant (p < 0.05) increase in UCFVA was revealed in the postoperative period. Indicators K1 and K2 did not significantly change.Conclusion. The high efficiency of the correction using the LASIK, PRK and femtoLASIK methods on pseudophakic eyes with the achievement of the target refraction in most of the studied cases was shown. This method can be used as an alternative to spectacle and contact correction in patients with residual refractive error after cataract phacoemulsification and refractive lensectomy with IOL implantation.

Evaluation of retinal light scattering, visual acuity, refraction and subjective satisfaction in patients after Acrysof IQ PanOptix intraocular lens implantation.

To evaluate the retinal light scattering, visual acuity, refraction and subjective satisfaction in patients after implantation of Acrysof IQ PanOptix intraocular lens. Our group included 32 eyes of 21 patients who underwent cataract surgery or refractive lensectomy with Acrysof IQ PanOptix multifocal intraocular lens implantation at the Ophthalmology Clinic of Faculty Hospital Hradec Králové during the time from September 2015 to December 2017. The observed parameters were visual acuity, subjective refraction, retinal light scattering and patient subjective satisfaction. Preoperative refractive values and visual acuity values were compared with results obtained on day 1, 1 month and at an average of 27 months postoperatively. Subjective satisfaction and degree of light scattering on the retina were evaluated at the end of the follow-up period. Preoperative, uncorrected distant visual acuity improved from an average of 0,51 ± 0,29 (expressed in decimal values) to 0,94 ± 0,10 at the end of the follow-up period. Preoperative best-corrected distance visual acuity improved from an average of 0,95 ± 0,19 to 1,00 ± 0,09 at the end of the follow-up period. The mean value of preoperative uncorrected near visual acuity was 8,29 ± 4,93 of Jaeger charts, the mean value of uncorrected near visual acuity at the end of the follow-up period was 1,00 ± 0 of Jaeger charts. Subjective satisfaction was assessed using astandardized VF-14 questionnaire at least 1 year after surgery (mean follow-up of 27 months). Retinal light scattering was examined using an Oculus C-Quant instrument. The retinal light scattering value in our sample was 1,12 ± 0,19. In only 6 eyes of 4 patients, the resulting value was outside the physiological range used for eyes with lens crystallina Conclusion: The value of light scattering on the retina is afactor affecting the degree of sensitivity to glare after implantation of multifocal intraocular lenses. In our group, we observed adeviation from the physiological range of retinal light scattering in only 6 eyes of 4 patients, but this did not lead to adeterioration in subjective postoperative satisfaction.

Коррекция аметропии у детей с использованием рефракционной ленсэктомии с имплантацией ИОЛ

Коррекция аметропии у детей с использованием рефракционной ленсэктомии с имплантацией ИОЛ

BINOCULAR IMPLANTATION OF NEW DIFFRACTIVE TRIFOCAL INTRAOCULAR LENS FOR PRESBYOPIA CORRECTION

Aim. Evaluation of the visual and functional results of bilateral implantation of the diffractive trifocal intraocular lens (IOL), the incidence of adverse optical phenomena and the degree of patient satisfaction. Methods. A prospective, open-label study included 82 patients (164 eyes) with presbyopia who underwent cataract phacoemulsification (n = 128) or refractive lensectomy (n = 36) with bilateral implantation of a new multifocal IOL AT LISA tri 839MP. The mean age of the patients was 61.2 ± 11.8 (32-84) years. The period of observation of patients was from 6 to 36 (18.3 ± 3.9) months. Results. After 1 year of follow-up, the increase in UCNVA was observed from 0.19 ± 0.17 to 0.89 ± 0.21, UCIVA from 0.18 ± 0.20 to 0.78 ± 0.17, UCDVA from 0.26 ± 0, 23 to 0.9 ± 0.12 (p

Visual outcomes and patient satisfaction after bilateral implantation of a new trifocal diffractive intraocular lens

PurposeTo assess the visual outcomes, patient satisfaction and spectacle independence following implantation of new diffractive trifocal intraocular lenses. Setting2 centers (university-based practice and a private practice set up). Patients and methodsProspective nonrandomized study in which 74 AT LISA TRI 839MP and 8 AT LISA TORIC TRI 939MP IOLs implanted bilaterally in 41 patients following either cataract extraction or refractive lensectomy, follow-up was done at 1st, 2nd and 3rd months to assess the visual and refractive outcomes. Also, a questionnaire was used to assess patient satisfaction, spectacle independence and photic phenomena after the surgery. ResultsMean uncorrected monocular distance decimal visual acuity (UDVA) was preoperatively 0.35. The averages of uncorrected monocular distance/intermediate/near (UDVA/UIVA/UNVA) postoperatively were 0.90/0.87/0.91 at 3 months. 87.5% patients had SE within ±0.50 by the 3rd month. Nearly all the patients were satisfied with the surgical outcome and the reported photic phenomena by some patients were non-disturbing with noticeable high level of patient’s satisfaction by the third month. ConclusionDiffractive trifocal IOLs can provide with satisfactory visual and refractive results along with positive impact on the performance of vision-related daily activities with minimal level of non-disturbing photic phenomena to patients.

Changes in the Lipidomic Profile of Aqueous Humor in Open-Angle Glaucoma

To identify and determine differences in lipid profiles of aqueous humor (AH) in patients with open-angle glaucoma (OAG). The lipidomic profile of 10 samples of AH of patients with OAG and 10 controls was analyzed. Patients with a history of anterior segment surgery, anterior segment pathology, or intraocular injections were excluded. Topical ocular medications within the last 6 months were reported. AH was obtained during the first step of nonperforating deep sclerotomy in OAG patients and during refractive lensectomy in controls. Lipidomic ultra-performance liquid chromatography mass spectrometry was used to perform an optimal profiling of glycerolipids, sterol lipids, sphingolipids, and glycerophospholipids. Metabolite extraction was accomplished by fractionating the samples into pools of species with similar physicochemical properties. The levels of 37 of 110 lipids changed in OAG when compared with controls samples. The concentration of most diacylglycerophosphocholines and 1-ether, 2-acylglycerophosphocholines increases in OAG when compared with healthy controls. In addition, 14 sphingomyelins increased significantly, up to 2.75-fold, in OAG. 5 cholesteryl esters are also present at higher levels in OAG when compared with controls. The lipid composition of AH in OAG patients shows differences when compared with healthy individuals. Changes in lipid synthesis may relate to oxidative stress metabolic response in OAG and may play an important role in the pathophysiology of the disease.

Changes in lipidomic profile of aqueous humour in Fuchs endothelial dystrophy.

To identify and determine differences in lipid profile of aqueous humour (AH) in patients with Fuchs endothelial corneal dystrophy (FECD). Lipidomic profile of eight AH samples of FECD patients and 10 control samples was analysed. Patients with previous history of anterior segment surgery, anterior segment pathology or intraocular injections were excluded. Topical ocular medications within the last 6months were reported. Aqueous humour (AH) was obtained during the first step of Descemet membrane endothelial keratoplasty in FECD patients and during refractive lensectomy in the control group. Lipidomic ultra-performance liquid chromatography mass spectrometry was used to perform an optimal profiling of glycerolipids, sterol lipids, sphingolipids and glycerophospholipids. Metabolite extraction was accomplished by fractionating the samples into pools of species with similar physicochemical properties. The levels of 27 of 110 lipids change significantly in the AH of FECD eyes when compared to control samples. The concentration of most diacylglycerophosphocholines and 1-ether, 2-acylglycerophosphocholines increases in the AH of FECD eyes when compared to healthy controls. In addition, eight sphingomyelins and up to two long-chain highly unsaturated cholesteryl esters present higher levels in FECD samples when compared to controls. The lipid composition of AH in FECD patients differs from that of healthy subjects. Those changes may reflect oxidative stress-related changes in the lipid metabolism of the corneal endothelial cells in FECD.

Refractive lensectomy outcomes and complications for myopia and hyperopia: A 15-year retrospective study

Purpose: To investigate the type and rate of ophthalmic complications that may occur following refractive lensectomies.Methods: This is a retrospective consecutive case series exploring the incidence of complications in 437 eyes that received refractive lensectomies by a single surgeon from 1993 to 2000. All participants had a clear crystalline lens and a best-corrected visual acuity (BCVA) of 20/40 or better prior to the lens exchange. Main outcome measures included uncorrected visual acuity (UCVA) and BCVA after clear lensectomy, the rate of posterior capsular fibrosis formation, and retinal complications such as retinal detachments (RD) and cystoid macular edema (CME).Results: Following the refractive lensectomy, all subjects experienced an improvement in UCVA and BCVA as compared to pre-operative levels (p<0.05). During the greater than 15-year follow-up period, 36% of subjects experienced posterior capsule opacification (PCO) requiring a Neodymium-doped ytrium aluminum garnet laser (Nd:YAG) capsulotomy, 0.23% experienced retinal detachments, and 0.46% experienced cystoid macular edema. The overall rate of retinal complications following refractive lensectomy was 0.69%. All patients with complications were treated appropriately with good outcomes.Conclusion: This series demonstrated excellent visual acuity outcomes following refractive lensectomy. Although studies suggest that refractive lensectomy leads to high rates of retinal complications and detachments, with modern surgery it can be a safe option for patients seeking refractive surgery. Careful and continuous follow-up is essential.Brief Summary Statement: In this retrospective case series, the incidence of ocular complications was assessed in 437 eyes that have undergone refractive lensectomies with up to 15 years of follow up. Our results show that refractive lensectomies have a superior efficacy and safety profile, with a 0.69% overall rate of retinal complications, including retinal detachments and cystoid macular edema.

Pediatric refractive surgery: Corneal and intraocular techniques and beyond

Refractive surgery has now been used successfully to treat severe anisometropia and isoametropia associated with amblyopia in children who cannot wear standard spectacles or contact lenses. Extraocular techniques include photorefractive keratectomy, laser-assisted subepithelial keratomileusis, and laser-assisted in situ keratomileusis. Intraocular techniques include refractive lensectomy and phakic intraocular lenses and are still being investigated in children for refractive errors outside the treatment dose capabilities of the excimer laser. This workshop discusses the various techniques, how and when to use each, and their risks and benefits. Newer techniques currently being used in adults that may someday be used in children are also introduced.

Aspects en OCT Visante ® de décollement descémétique après lensectomie réfractive : à propos d’un cas

Descemet membrane detachment (DMD) is a rare complication that occurs mainly after cataract surgery. We report the case of a 55-years-old woman who underwent refractive lensectomy. The Day-1postoperative examination was unremarkable, the Day-7examination showed corneal oedema related to DMD, which was confirmed by Visante(®) OCT. An intracameral injection of SF6expansive gas allowed the reapplication of the membrane and the receding of corneal oedema. Through this observation, we discuss the pathogenesis of this uncommon entity and the contribution of Visante(®) OCT.

Refractive surgery for high bilateral myopia in children with neurobehavioral disorders: 1. Clear lens extraction and refractive lens exchange

Introduction: A subpopulation of children with high myopia and neurobehavioral disorders is noncompliant with spectacle wear and ill-suited to correction using contact lenses. We report the results of refractive surgery in a series of these children treated using lensectomy alone (clear lens extraction), or lensectomy with simultaneous implantation of an intraocular lens (refractive lens exchange). Methods: Clinical course and outcome data were collated prospectively in a group of 13 children (mean age 10.4 years, range 1 to 18 years) with neurobehavioral disorders exacerbated by chronic noncompliance with spectacle wear, causing profoundly low functional vision. Myopia in the 26 eyes ranged from −14.25 to −26.00 D (mean −19.1 D). Goal refraction was approximately +1 D. Correction was achieved by lensectomy alone in 10 eyes, and lensectomy with intraocular lens implantation in 16 eyes. Primary posterior capsulectomy/subtotal vitrectomy was performed during the primary procedure in 11 eyes (42%). Mean follow-up was 4.5 years (range 1.3 to 7.5 years). Results: Myopia correction averaged 19.9 D. Eighty-one percent (21 eyes) were corrected to within ±2 D of goal refraction and the remaining 19% (5 eyes) to within ±4 D. Uncorrected acuity improved substantially (ie, an average 2 log units) in all 26 eyes, with commensurate gains in behavior and environmental visual interaction in 88% of children (14/16). Myopic regression averaged −0.16 D/year. Capsular regrowth and/or opacification necessitated vitrector or YAG-laser membranectomy in 12 eyes (46%). Focal retinal detachment (successfully repaired) occurred after eye contusion in one eye (4%) with cicatricial retinopathy of prematurity. Conclusions: Bilateral refractive lensectomy is effective for improving functional vision in neurobehaviorally impaired children who have high myopia (beyond the range of excimer laser correction: see companion publication) and difficulties wearing glasses. Posterior capsule regrowth/opacification is common, necessitating secondary membranectomy. Further study is indicated to determine the long-term safety of this procedure in similar pediatric populations.