Functional outcomes after implantation of Tecnis ZM900 and Array SA40 multifocal intraocular lenses

PURPOSE: To evaluate the functional outcome after implantation of the Tecnis ZM900 multifocal intraocular lens (IOL) (AMO) and the Array SA40 multifocal IOL (AMO). SETTING: Department of Ophthalmology, Bundesknappschaft s Hospital, Sulzbach, and the Department of Ophthalmology, Marienhospital, Aachen, Germany. METHODS: In a prospective comparative 2-center trial, Tecnis ZM900 and the Array SA40 multifocal IOLs were bilaterally implanted in 50 patients (50 eyes Tecnis, 50 eyes Array) by 1 surgeon at each center. The following parameters were assessed 30 to 60 days and 120 to 180 days after surgery in both eyes: refraction, pupil size, uncorrected and best corrected visual acuities for distance and near at different contrast levels, and photopic and mesopic contrast sensitivity at different spatial frequencies. Patient satisfaction (spectacle independence, photic phenomena, overall satisfaction) was assessed by a questionnaire. RESULTS: The main differences between the 2 multifocal IOLs were the better uncorrected near visual acuity (P<.001), distance-corrected near visual acuity (P<.001), the mesopic contrast sensitivity at high spatial frequencies (P<.05) as well as greater independence from spectacles in patients with the Tecnis multifocal IOL, resulting in higher levels of patient satisfaction. CONCLUSION: The aspherical diffractive Tecnis multifocal IOL gave better outcomes than the Array multifocal IOL.     

双眼植入不同类型多焦点人工晶状体术后视功能的临床观察

目的 探讨超声乳化白内障吸除联合双眼分别植入折射型与衍射型多焦点人工晶状体(MIOL)术后的波前像差、对比敏感度(CS)及立体视功能.方法 前瞻性研究.将年龄相关性白内障患者分为MIOL组与单焦点人工晶状体(SIOL)组,每组各15例(30只眼),行超声乳化白内障吸除联合人工晶状体(IOL)植入术.MIOL组为主导眼植入ReZoom NXG1 IOL(即NXG1组),对侧眼植入Tecnis ZM900 IOL(即ZM900组);SIOL组为同期双眼植入Sensar AR40e IOL(即AR40e组).观察患者术后波前像差、CS、眩光敏感度(GS)及近立体视锐度.两组中波前像差和近立体视锐度比较分别采用单因素方差分析,CS和GS比较采用析因设计方差分析,两两比较采用ISD检验.结果 术后1个月观察发现,ReZoom NXG1 IOL眼、Tecnis ZM900 IOL眼的球差明显低于Sensar AR40e IOL眼的球差(F=11.734;P=0.001,0.000),三者之间的总体像差和高阶像差间的差异无统计学意义(F=0.724,0.173;P=0.493.0.842).ReZoom NXG1 IOL眼、Tecnis ZM900 IOL眼和Sensar R40e IOL眼在各视角的CS及CS比较,差异均无统计学意义(CS:F=0.959,0.978,2.779,0.590,0.485,0175; P=0.398,0.388,0.079,0.564,0.625,0.847;GS:F=0.117,0.479,0.806,1.235,0.531,1.144;P=0.902,0.627,0.458,0.309,0.597,0.383).MIOL组患者术后近立体视锐度可达45.6弧秒,与SIOL组比较差异有统计学意义(F=2.923;P=0.010,0.014).结论 双眼联合植入折射型与衍射型IOL,在一定程度上可以使患者获得良好的视功能.     

Reading ability and stereoacuity with combined implantation of refractive and diffractive multifocal intraocular lenses

Purpose: To evaluate reading ability and stereoscopic vision with combined implantation of refractive and diffractive multifocal intraocular lenses (IOLs). Methods: Thirty‐one cataract patients (62 eyes) were assigned to receive either a ReZoom NXG1 IOL in the dominant eye and a Tecnis ZM900 IOL in the fellow eye (MIOL group), or Sensar AR40e IOLs bilaterally (SIOL group). The uncorrected visual acuity (UCVA) at 500 cm, best spectacle‐corrected visual acuity (BSCVA) at 500 cm, reading acuity, reading speed, near stereoacuity and questionnaire were assessed 3 months postoperatively. Results: Three months postoperatively, monocular and binocular UCVA and BSCVA at 500 cm showed no significant differences in both groups. The uncorrected reading acuity and reading speed in the MIOL group were significantly better than those in the SIOL group and were similar to that with correction in the SIOL group. The uncorrected mean near stereoacuity in the MIOL group was significantly better than that in the SIOL group (69 ± 50 seconds of arc in the MIOL group versus 180 ± 160 seconds of arc in the SIOL group). Patients in the MIOL group had a high level of satisfaction and more than 80% of them had an increased independence from spectacles for brief reading. Conclusion: The combined implantation of refractive and diffractive multifocal IOLs was effective in improving reading ability and near stereoacuity with a good visual quality.     

Image quality with multifocal intraocular lenses and the effect of pupil size: comparison of refractive and hybrid refractive-diffractive designs

PURPOSE: To analyze the image quality with a refractive and 2 hybrid refractive-diffractive multifocal intraocular lenses (IOLs) in vitro to determine the IOL modulation transfer function (MTF) following the EN-ISO international standard for distance and near vision and to study the IOLs' behavior with different pupil sizes. SETTING: Fundación Oftalmológica del Mediterráneo, Valencia, Spain. METHODS: This study evaluated 4 IOLs: the hybrid refractive-diffractive AcrySof ReSTOR SN60D3 (Alcon) and Tecnis ZM900 (AMO), the refractive ReZoom NXG (AMO), and the monofocal AcrySof SN60WF (Alcon). The MTF was calculated from the cross-line spread function recorded with the OPAL Vector System (Image Science Ltd.) using fast Fourier transform techniques. The artificial eye model simulated in vivo conditions of the anterior chamber and included an artificial cornea and physiological solution, in which the IOLs were positioned. The pupil sizes varied between 2.0 mm and 5.0 mm in steps of 0.5 mm. RESULTS: For distance vision and small pupils (2.0 to 3.5 mm), the refractive IOL provided better image quality than the 2 hybrid IOLs. When the pupil was larger, the distance vision was similar with all IOLs. The 2 hybrid IOLs gave better image quality than the refractive IOL for near vision with any pupil size. With the refractive IOL and pupils smaller than 3.5 mm, near focusing did not occur, resulting in poor image quality. Of the hybrid IOLs, the AcrySof ReSTOR SN60D3 provided better distance image quality and the Tecnis ZM900 provided better near image quality. CONCLUSIONS: The refractive IOL gave better image quality than the hybrid IOLs at distance and with small pupils. With pupils larger than 3.5 mm, the quality was similar. Hybrid IOLs gave significantly better image quality for near vision with all pupil sizes. AcrySof ReSTOR SN60D3 IOLs give better distance vision than Tecnis ZM900 IOLs; the latter gave better near vision. The reference monofocal IOL provided better distance images than any multifocal IOL with all pupil sizes.     

Wavefront measurements of diffractive and refractive multifocal intraocular lenses in an artificial eye

PURPOSE: To investigate whether wavefront measurements taken in eyes that have implanted multifocal intraocular lenses (IOLs) are reliable when creating laser refractive surgical treatments to remove residual refractive error from these eyes. METHODS: A specially designed fluid-filled model eye holding a multifocal IOL was refracted using a commercial wavefront eye refractor. The wavefront findings were then compared to the expected refractive error. The fluid-filled model was designed to match the optical characteristics of a human eye and to hold the IOL at the same distance from the cornea as in a human eye. Lenses tested were AMO Tecnis ZM900 series (diffractive design, +25.00 D, +4.00 D add), AMO ReZoom NXG1 series (refractive design, 25.00 D, +4.00 D add), and AMO 811E (diffractive with aspheric design 25.00 D, +4.00 add). The visible pupil diameter was 5.75 mm. RESULTS: Diffractive bifocal IOLs were found to create spot doubling in the Shack-Hartmann sensor image as expected from theoretical considerations. However, the residual sphere power and cylinder power reported were those expected. In addition, the higher order aberrations reported were reasonable in light of expected results. Refractive multifocal IOLs were found to create distorted Shack-Hartmann images as expected. The residual sphere power and cylinder power reported were not those expected nor were the higher order aberrations. In addition, the higher order values were sensitive to the position of the eye with respect to the refractor. CONCLUSIONS: Wavefront measurements from eyes with diffractive IOLs can be used, with caution, to plan laser refractive treatments. Wavefront measurements from eyes with refractive multifocal IOLs should not be used to plan post-implant laser refractive correction.     

新型衍射型非球面多焦点人工晶状体的临床应用

目的比较白内障超声乳化联合植入新型衍射型非球面多焦点人工晶状体Tecnis AMO00及非球面单焦点人工晶状体Tecnis的临床效果。方法选择老年性白内障患者,根据植入的晶状体不同分为2组:多焦点组46例62眼,植入Tecnis AMO00新型衍射型非球面多焦点人工晶状体,单焦点组42例68眼,植入Tecnis非球面单焦点人工晶状体。术后1个月和3个月随访,观察术后裸眼远视力、裸眼近视力、最佳矫正远视力、最佳矫正近视力及中间距离视力,术后3个月进行角膜内皮计数及角膜地形图检查,问卷调查了解视觉症状和视觉满意度。结果术后1个月及3个月两组间患者裸眼远视力、最佳矫正远视力和最佳矫正近视力均无显著差异。术后1个月及3个月多焦点组裸眼近视力分别为0.65±0.27和0.68±0.28,中间距离视力分别为0.64±0.22和0.67±0.25,相比单焦点组术后1个月及3个月的裸眼近视力(分别为0.28±0.26和0.30±0.25)和中间距离视力(分别为0.27±0.25和0.29±0.27),具有明显优越性,差异均有统计学意义(均为P<0.05)。两组患者术前、术后的散光状态差异均有统计学意义(均为P<0.01),术前、术后的角膜内皮细胞计数差异亦均有统计学意义(均为P<0.01),两组之间术后角膜内皮细胞丢失率差异无统计学意义(P>0.05)。多焦点组脱镜率(96.77%)明显高于单焦点组(25.00%),差异有统计学意义(P<0.01)。多焦点组4例患者诉轻度光晕、眩光,但在可以忍受范围内。结论新型衍射型非球面多焦点人工晶状体Tecnis AMO00能提供良好的全程视力,有效降低患者对老视镜的依赖,提高白内障患者术后的视觉质量。     

Comparison of visual performance of silicone and acrylic multifocal IOLs utilizing the same diffractive design

Purpose: To compare the visual outcomes in patients implanted with a diffractive silicone multifocal in one eye and a diffractive acrylic multifocal IOL in their fellow eye. Setting: Augenklinik, Bad Hersfeld, Germany. Methods: Forty‐two eyes of 21 cataract surgery patients were randomized to undergo implantation with either a silicone diffractive multifocal IOL (Tecnis ZM900, Abbott Medical Optics, Santa Ana, CA, USA) or an acrylic diffractive multifocal IOL (Tecnis ZMA00, AMO). The two IOLs share the same design platform. Outcome measurements included uncorrected and best‐corrected distance and near visual acuity, spherical equivalent, reading speed and reading acuity, as well as photic phenomena. Patients were followed for 6 months following surgery. Results: The mean spherical equivalent was 0.161 D (acrylic) and 0.065 D (silicone). The mean uncorrected visual acuity was 0.17 logMAR for the acrylic eyes and 0.17 logMAR for the silicone eyes, a difference of 0.01 (p = 0.861). The mean best‐corrected visual acuity (BCVA) was 0.08 for the acrylic eyes and 0.10 for the silicone lens, a difference of 0.03 (p = 0.321). Conclusions: Given that the designs of the lenses are identical and that this was a contralateral eye study, it is reasonable to expect that the results between the two eyes and two types of lenses were similar. Both versions of this lens provide excellent visual function.     

Differences in contrast sensitivity between monofocal,multifocal and accommodating intraocular lenses: long‐term results

Background: To evaluate long‐term contrast sensitivity (CS) and visual acuity following implantation of monofocal, accommodating, refractive and diffractive multifocal intraocular lenses (IOLs) in patients with unilateral cataract Methods: In this prospective non‐randomized clinical trial, 87 patients with unilateral cataract were enrolled in four groups for phacoemulsification and IOL implantation in Ophthalmology Department of Goztepe Training and Research Hospital. Twenty‐four patients had monofocal (Alcon Acrysof; group 1), 21 patients accommodating (Human Optics 1CU; group 2), 22 patients diffractive multifocal (Tecnis ZM900; group 3) and 20 patients refractive multifocal (AMO Rezoom; group 4) IOL implantations. Ages of patients were between 40 and 70. Parameters analysed at the 18th postoperative month were subjective refractions, monocular and binocular distance and near photopic CSs, visual acuities. Results: Near visual acuities were statistically better in group 3 than the other groups (P < 0.05). At low spatial frequencies, mean monocular distance CSs of group 1 and mean monocular near CSs of groups 1 and 2 were statistically higher than those of group 4 (P < 0.05). There was no significant difference between binocular CSs of group 4 and the other groups at low spatial frequencies. At high spatial frequencies, monocular and binocular CSs of groups 1 and 2 were statistically higher than those of groups 3 and 4 (P < 0.05). Near CSs was better in group 3 than group 4. Conclusions: In patients with unilateral cataract, monofocal, accommodating and partially diffractive multifocal IOL provided higher CS scores when compared with refractive multifocal IOL and in multifocal IOL groups binocular CSs were better than monocular CSs when compared with other groups.     

Visual outcome and optical quality after bilateral implantation of aspheric diffractive multifocal, aspheric monofocal and spherical monofocal intraocular lenses:a prospective comparison

AIM:To evaluate the visual function after bilateral implantation of aspheric diffractive multifocal Tecnis ZMA00, aspheric monofocal ZA9003 versus spherical monofocal Akreos Adapt intraocular lenses (IOLs).METHODS:Tecnis ZMA00, Tecnis ZA9003 or Akreos Adapt IOLs were bilaterally implanted in 180 eyes from 90 patients. The following parameters were assessed 3 months postoperatively:monocular and binocular uncorrected visual acuity (UCVA) and distance-corrected visual acuity (DCVA) for distance, intermediate and near, spherical aberration (SA), contrast and glare sensitivity, near point refractive power, uncorrected and best-corrected near stereoscopic acuity (NSA). Patient satisfaction was assessed by a questionnaire.RESULTS:Three months postoperatively, the monocular and binocular UCVA and DCVA at near of Tecnis ZMA00 were significantly better than other two groups. The mean SA for 5.0mm optical zone in Tecnis ZMA00 and Tecnis ZA9003 was significantly lower than that in Akreos Adapt. Mean contrast sensitivity and glare sensitivity were better for Tecnis ZA9003 group than for other two groups. Patients with Tecnis ZMA00 had higher monocular and binocular near point refractive power and uncorrected NSA than monofocal groups. The patients in Tecnis ZMA00 had higher mean values for halo compared with other two groups.CONCLUSION:Tecnis ZMA00 provided better near VA and uncorrected NSA and higher near point refractive power than monofocal IOLs and patients were spectacle independent. The IOLs with Tecnis aspheric design improved contrast and glare sensitivity. Patients with Tecnis ZMA00 reported more disturbances on visual phenomena of halo.     

Visualization of the retinal image in an eye model with spherical and aspheric, diffractive, and refractive multifocal intraocular lenses

PURPOSE: To present a method that visually demonstrates how spherical, aspheric, diffractive, and refractive multifocal intraocular lenses (IOLs) process light received from the cornea. METHODS: Monochromatic green light was projected through an Average Cornea Eye (ACE) Model with a cornea in front of the IOL. The model simulates a human cornea with average spherical aberration and visualizes the converging bundle of light leaving the IOL. Additionally, a US Air Force target was projected through the model, and the projected (retinal) image was captured. Various IOLs of differing designs were evaluated using this test setup. Multifocal IOLs included the aspheric diffractive Tecnis ZM900 and ZMA00 lenses; the refractive ReZoom NXG1 lens; the spherical AcrySof ReSTOR SA60D3 apodized diffractive lens; and the spherical diffractive CeeOn 811E lens. Monofocal IOLs included the spherical CeeOnEdge 911A IOL and the aspheric SofPort LI61AO, AcrySof IQ SN60WF, and Tecnis Z9000 and ZA9003 IOLs. RESULTS: The light paths of the different diffractive and refractive multifocal IOLs showed the variations in the processing of incoming light, illustrating the functional differences of IOL concepts. The US Air Force target projections in the ACE Model gave an impression of the functional optical quality of the different lenses. The value of this visualization method was demonstrated by comparing the results with modulation transfer function measurements. CONCLUSIONS: This visualization technique furthers the understanding of the working principles and quality of the retinal images produced by different mono- and multifocal IOLs.     

Optical performance measurement and night driving simulation of ReSTOR, ReZoom, and Tecnis multifocal intraocular lenses in a model eye

PURPOSE: To measure the optical properties of multifocal intraocular lenses (IOLs) for different pupil sizes. METHODS: An artificial eye was fabricated that had both the average spherical aberration and chromatic aberration levels found in the human eye. This model eye contained a saline-filled wet cell into which various IOLs can be mounted. Pupil sizes of 3 and 6 mm were explored with the system. Using the model eye, the following IOLs were examined: Alcon ReSTOR apodized diffractive, AMO ReZoom zonal refractive, and Tecnis ZM900 full-aperture diffractive. The modulation transfer function (MTF) for the lenses was calculated. The model eye was also used as a portable device to photograph nighttime driving scenes. RESULTS: For 3-mm pupils, the apodized and full-aperture diffractive IOLs balance contrast between near and distance vision, whereas the zonal refractive IOL performs poorly for near vision. For 6-mm pupils, the apodized diffractive shifts performance from near vision to distance vision, whereas the zonal refractive and full-aperture diffractive IOLs continue to balance performance between distance and near. Subjectively, the night driving photographs showed much more stray light artifacts for the zonal refractive and the full-aperture and apodized diffractive IOLs. CONCLUSIONS: Under dark conditions, the shift of optical performance of the apodized diffractive lens towards distance vision reduces artifacts that appear under night driving conditions. These artifacts remain for the zonal refractive and full-aperture diffractive lenses.     

Tecnis MF和ReZoom两种人工晶状体的临床对比研究

目的:比较应用Tecnis MF和ReZoom两种多焦点人工晶状体植入术后1mo患者视力及对比敏感度(contrast sensitivity,CS)变化情况。方法:采用同期随机对照研究,选取年龄相关性白内障患者58例(74眼),随机分为两组,ReZoom IOL组(28例,28眼)植入人工晶状体ReZoom,Tecnis MFIOL组(30例,46眼)植入Tecnis MFIOL。术后第1mo检查矫正视力、无眩光及眩光环境下对比敏感度。结果:Tecnis MF近视力优于ReZoom(P<0.05),ReZoom中视力优于Tecnis MF(P<0.05),两者远视力无显著差异。Tecnis MF在空间频率为18c/d和24c/d时对比敏感度优于ReZoom(P<0.05)。两者眩光对比敏感度在各空间频率均无显著差异。结论:Tecnis MF及ReZoom在屈光晶状体手术中,对患者预后的影响各异,因此个性化使用Tecnis MF和ReZoom IOL为影响患者预后的关键环节。     

Wavefront-guided excimer laser vision correction after multifocal IOL implantation

PURPOSE: To investigate the use of wavefront-guided LASIK after multifocal intraocular lens (IOL) implantation to correct residual ametropia and higher order aberrations. METHODS: In a prospective, nonrandomized case series, wavefront-guided LASIK was performed in 27 eyes (19 patients) after multifocal IOL implantation (Tecnis diffractive IOL, n = 20; ReSTOR diffractive IOL, n = 4; ReZoom refractive IOL, n = 3) using the VISX STAR S4 IR excimer laser. Visual acuity, manifest refraction, and wavefront error were examined pre- and 3 months postoperatively. RESULTS: In the Tecnis group, results before (after) LASIK were: sphere +1.06 +/- 0.77 diopters (D) (-0.03 +/- 0.28 D; P = .0001), cylinder -1.13 +/- 0.73 D (-0.14 +/- 0.25 D; P = .00004), distance uncorrected visual acuity (UCVA) 20/45 +/- 0.09 (20/29 +/- 0.16; P = .00004), near UCVA 20/30 +/- 0.24 (20/25 +/- 0.16; P = .001), and higher order aberrations (4-mm pupil) 0.14 +/- 0.05 microm (0.18 +/-0.03 microm; P = .02). Distance and near best spectacle-corrected visual acuity (BSCVA) did not change. In the ReSTOR group, results before (after) LASIK were: sphere +0.75 +/- 0.56 D (+0.13 +/- 0.22 D), cylinder -1.50 +/- 0.47 D (-0.13 +/- 0.22 D), distance UCVA 20/40 +/- 0.07 (20/26 +/- 0.07), near UCVA 20/44 +/- 0.05 (20/25 +/- 0.0), and higher order aberrations (4-mm pupil) 0.14 +/- 0.03 microm (0.20 +/- 0.02 microm). Distance and near BSCVA did not change. In the ReZoom group, results before (after) LASIK were: sphere +0.08 +/- 1.20 D (0.00 D), cylinder -0.83 +/- 0.120 D (0.00 D), distance UCVA 20/40 +/- 0 (20/25 +/- 0), near UCVA 20/60 +/- 0.09 (20/150 +/- 0.18), and higher order aberrations (4-mm pupil) 0.43 +/- 0.04 microm (0.39 +/- 0.03 microm). Patients lost one line of distance BSCVA and two lines of near BSCVA. CONCLUSIONS: Wavefront-guided LASIK is safe and effective in diffractive multifocal IOLs to correct residual refractive error, but higher order aberrations did not improve. It is not recommended in refractive multifocal IOLs, as these cannot be measured reliably with current wavefront sensors.     

Depth of focus in eyes with diffractive bifocal and refractive multifocal intraocular lenses

PURPOSE: To evaluate monocular and binocular depth of focus in eyes with different multifocal intraocular lens (IOLs) systems. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: In this comparative interventional study, binocular implantation of multifocal IOLs was performed in 3 groups. In the first group, 26 eyes of 13 patients received asymmetric Acri.Twin (Acri.Tec) IOLs, a near-weighted 733D in 1 eye and a distance-weighted 737D in the fellow eye. In the second group, 26 eyes of 13 patients received a diffractive 811E IOL (Pharmacia). In the third group, 26 eyes of 13 patients received a refractive Array IOL (AMO). The visual acuity was tested monocularly and binocularly starting at 6 m in 0.50 diopter (D) defocusing steps. RESULTS: Distance visual acuity was best in eyes with the distance-dominated 737D IOL; eyes with the other IOLs had comparable results. Binocular distance visual acuity was comparable between the Acri.Twin group and the 811E group. The Acri.Twin group had better distance visual acuity than the Array group (P< or =.048). Near visual acuity was best in eyes with the near-weighted 733D, followed by the 737D and the 811E. Patients with Array IOLs had worse visual acuities at reading distance (between 33 cm and 40 cm) (P< or =.001). Patients with diffractive bifocal IOLs had better results than patients with refractive multifocal IOLs at reading distance (P< or =.018). CONCLUSION: The diffractive IOLs performed better than refractive IOLs. Asymmetric-weighted IOLs provided better binocular depth of field.     

Long-term experience with mixing and matching refractive array and diffractive CeeOn multifocal intraocular lenses

PURPOSE: To compare visual performance of the refractive Array SA40N and the diffractive CeeOn 811E multifocal intraocular lenses (IOLs) and to evaluate the potential benefits of combining both multifocal IOLs in the same patient. METHODS: Two groups of cataract patients were unilaterally implanted with either the CeeOn diffractive (n = 10) or the Array refractive multifocal IOL (n = 10). Another group was bilaterally implanted with one of each multifocal IOLs (mix & match group, n = 10). Visual acuity, spectacle independence, depth of focus, contrast sensitivity, presence of photic phenomena, and patient satisfaction were assessed postoperatively. RESULTS: All eyes achieved good distance visual acuity but better uncorrected near vision was achieved with the CeeOn diffractive design. Contrast sensitivity with either multifocal IOL was at the lower limit of the normal range but when multifocal IOLs were combined in the same patient, contrast sensitivity was not significantly different from phakic controls. Defocus curves revealed a superiority of CeeOn diffractive design for near and Array refractive design for intermediate but mix & match patients performed better overall than the other patients, particularly for intermediate distances, which was reflected by total independence from spectacles in 90% of patients compared to 60% in the other groups. Visual outcomes remained unchanged over time (1 month vs 6 month vs > 3 years). CONCLUSIONS: Bilateral implantation with a diffractive multifocal IOL in one eye and a refractive multifocal IOL in the fellow eye is safe and could provide patients with better intermediate vision, increased depth of focus and contrast sensitivity, and also less dependence on spectacles.     

Functional vision with bilateral ReZoom and ReSTOR intraocular lenses 6 months after cataract surgery

PURPOSE: To compare the visual outcomes in patients with bilateral implantation of AcrySof ReSTOR multifocal intraocular lenses (IOLs) (Alcon Laboratories) or ReZoom multifocal IOLs (Advanced Medical Optics) 6 months after cataract surgery. SETTING: Orsett and Southend Hospital, Essex, United Kingdom. METHODS: This study comprised patients who had uneventful bilateral cataract extraction with implantation of ReZoom (n = 50) or ReSTOR (n = 50) multifocal IOLs. Parameters analyzed included binocular uncorrected distance, intermediate, and near acuities; spectacle independence; subjective visual symptoms; and patient satisfaction. All parameters were evaluated 6 months after second-eye surgery. RESULTS: All patients had binocular uncorrected distance visual acuity of 20/32 or better; there was no statistically significant difference between the 2 groups. The mean binocular uncorrected near acuity was 20/26 (J1.22) in the ReSTOR group and 20/34 (J2.34) in the ReZoom group (P<.0001). The mean binocular uncorrected intermediate visual acuity was 20/42 and 20/34, respectively (P = .003). Patients in the ReZoom group reported greater satisfaction with intermediate vision (P = .04). No statistically significant difference was found in satisfaction with near vision. Eighty-six percent of ReSTOR patients and 70% of ReZoom patients did not wear glasses for daily activities; the overall satisfaction was not statistically significantly different between groups. There was no significant difference between groups in photic phenomena. CONCLUSIONS: The ReSTOR IOL provided better near vision and the ReZoom IOL better intermediate vision. Both multifocal IOLs gave excellent distance vision. Photic phenomena were comparable and clinically acceptable. ReSTOR patients had greater spectacle independence for near vision and ReZoom patients for intermediate vision. Overall spectacle independence was not statistically significantly different.     

Primary piggyback implantation using the Tecnis ZM900 multifocal intraocular lens: case series

PURPOSE: To assess the postoperative outcomes of primary piggyback implantation using the Tecnis ZM900 multifocal intraocular lens (IOL) (Advanced Medical Optics). SETTING: Hospital Oftalmológico de Brasília, Brasília, Brazil. METHODS: Patients who had phacoemulsification with primary piggyback IOL implantation were analyzed prospectively. In all cases, a Tecnis ZM900 multifocal IOL was implanted in the capsular bag and a second silicone IOL was implanted in the ciliary sulcus. Information collected included near and distance uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and the spherical equivalent (SE) before and after the surgery. RESULTS: Twenty eyes of 12 patients were included in the study. They were followed for 6 months. The mean preoperative distance UCVA was 20/400. At the last follow-up (6 months), the mean distance UCVA was 20/29, significantly better than before referral (P<.001). The mean preoperative SE was +6.35 diopters (D) +/- 2.25 (SD). Six months after surgery, the mean SE was -0.25 +/- 0.40 D (range -1.00 to +0.50 D), significantly better than before referral (P<.001). No patient lost lines of BCVA after surgery. At the last follow-up, 90% of the eyes achieved a near UCVA of J1 and 83.3% of patients were spectacle independent for near and distance vision. A second refractive procedure was performed in 2 eyes. CONCLUSIONS: Primary piggyback implantation using the Tecnis ZM900 multifocal IOL was a simple, safe, and accurate option for patients with high hyperopia who wanted to reduce their dependency on spectacles.     

Quality of image of grating target placed in vitreous of isolated pig eyes photographed through different implanted multifocal intraocular lenses

Purpose: To determine the quality of the image of a grating target placed in the vitreous of isolated pig eyes and photographed through implanted refractive and diffractive multifocal intraocular lenses (IOL). Methods: Refractive multifocal (NXG1, PY60MV), diffractive multifocal (ZM900, SA60D3) and monofocal (SA60AT, ZA9003) IOL were implanted in the capsular bag of isolated pig eyes. A grating target was placed in the vitreous and photographed through a flat or a wide‐field viewing contact lens. The contrast of the grating targets of different spatial frequencies was measured. Results: With the flat corneal contact lens, the gratings appeared clear and not distorted when viewed through the optics of the NXG1 and PY60MV for far vision but were distorted with reduced contrast when viewed through the optical zone for near vision. The images through the diffractive zone of the ZM900 and SA60D3 were more defocused than with the monofocal IOL (p < 0.005). Ghost images oriented centrifugally of the original image were seen with the ZM900 resulting in lower contrast at higher spatial frequencies than with the SA60D3 with less defocused images only in the central area. With the wide‐field viewing contact lens, the images were less defocused and the contrast was comparable to both refractive and diffractive multifocal IOL. Conclusion: Both refractive and diffractive multifocal IOL reduced the contrast of the retinal image when viewed through a flat corneal contact lens but less defocused when viewed through a wide‐field viewing contact lens.     

衍射型多焦点人工晶状体植入术后临床效果

目的:探讨衍射型多焦点人工晶状体植入术后的临床效果。方法:所有患者按照植入的人工晶状体类型分成多焦组和单焦组。多焦组植入衍射型多焦点人工晶状体AcrySof ReSTOR(Alcon),72例(109眼);单焦组植入单焦点人工晶状体AcrySof SA60AT(Alcon)作为对照,88例(130眼)。术后随访6~24mo,观察瞳孔直径,远近视力,最佳矫正视力,脱镜率,术后屈光状态、夜间视觉干扰现象等指标。结果:两组间在远视力和最佳矫正远近视力方面没有显著性差异,而近视力多焦组达到或超过J3的患者101眼(92.7%),单焦组12眼(9.2%),差异具有显著性(χ2=166.44,P=0.00)。两组完全脱镜率分别为98眼(89.9%)和9眼(6.9%)。多焦组完全脱镜的患者术后平均等效球镜为-0.03±0.45D(-1.0~+0.50D),6例7眼(6.4%)视近远时都需戴镜矫正,术后平均等效球镜+1.14D。结论:衍射型多焦点人工晶状体植入后能够使患者获得理想的远近视力,大大降低了患者对眼镜的依赖性。人工晶状体的屈光力测量精确性是增加术后脱镜率的重要因素,应该尽量避免术后等效球镜大于+0.50D。     

Einfluss verschiedener multifokaler Intraokularlinsenkonzepte auf den Streulichtparameter

Purpose

Multifocal intraocular lenses (MIOL) are known to induce various photic phenomena depending on the optical principle. The aim of this study was to investigate the correlation between stray light measurements performed with the C-Quant (Oculus, Germany) and the results of a subjective patient questionnaire.

Patients and methods

In this study three different MIOLs were compared: AMO ReZoom (refractive design, n=10), AMO ZM900 (diffractive design, n=10) and Oculentis Mplus (near segment design, n=10). Cataract and refractive patients were enrolled in the study. Functional results were evaluated at least 3 months postoperatively followed by stray light measurements and a subjective questionnaire.

Results

Surgery was performed for all patients without complications. The three groups were matched for age, IOL power and corrected distance visual acuity (CDVA). Significantly different stray light (median) values log(s) were found (Kruskal-Wallis test, p<0.05): 1.12 log (refractive), 1.13 log (segment) and 1.28 log (diffractive). The subjective questionnaire did not show differences in glare perception but refractive MIOL patients noticed more halos surrounding light sources than the diffractive and segment MIOL patients.

Conclusions

Stray light and subjective photopic phenomena do not show any basic correlation. Measurements in patients with refractive MIOLs showed less stray light than near segment or diffractive MIOLs. However, refractive MIOLs induced more halos compared to the other groups analyzed.