Comparison of two acrylic intraocular lenses with different haptic designs in patients with combined phacoemulsification and pars plana vitrectomy

PURPOSE: The intra- and postoperative characteristics of two foldable single-piece intraocular lenses (IOL) with identical hydrophilic acrylic material, but different haptic designs (Akreos Adapt and Akreos Fit), were compared in combined phacoemulsification and pars plana vitrectomy (PPV).METHODS: This was a prospective, randomized study in patients with simultaneous cataract and vitreoretinal surgery. Group A (n=47 patients) included implantation of Akreos Fit IOL (two-point haptic) and group B (n=46 patients) implantation of Akreos Adapt IOL (four-point haptic). All intraoperative modifications of small-incision phacoemulsification and three-port PPV and IOL implantation and centration were documented. At 1 and 2 days and 6 months after surgery, best-corrected visual acuity (BCVA), slit-lamp appearance (including inflammation, IOL centration, capsulorhexis diameter, posterior capsule opacification (PCO), tonometry, and fundus findings were evaluated. RESULTS: The groups did not differ with respect to age, surgical indications and modifications, intraoperative IOL handling, and centration. At day 2, inflammation and capsulorhexis diameters were similar, but IOL decentration was slightly more frequent with Akreos-Fit IOLs. Six months after surgery, the rates of PCO, posterior synechiae, and BCVA were similar. Akreos-Fit had slightly smaller capsulorhexis diameters and slightly more capsular contraction and IOL decentration (P>0.05). CONCLUSIONS: Both of the Akreos IOL are feasible for combined phacoemulsification and PPV. Although similar in intraoperative handling, BCVA, and PCO, IOL centration was slightly better with Akreos-Adapt than with Akreos-Fit after combined surgery.     

Anterior chamber depth and change in axial intraocular lens position after cataract surgery with primary posterior capsulorhexis and posterior optic buttonholing

PURPOSE: To compare axial position changes of the intraocular lens (IOL) by measuring anterior chamber depth (ACD) after small-incision cataract surgery with primary posterior continuous curvilinear capsulorhexis (PPCCC) and posterior optic buttonholing (POBH) of the IOL and after conventional cataract surgery with phacoemulsification and in-the-bag IOL implantation. SETTING: Department of Ophthalmology, Medical University of Vienna, Austria. METHODS: This prospective comparative study comprised 23 patients (46 eyes) with age-related cataract who had bilateral cataract surgery and implantation of an acrylic IOL (YA-60BB, Hoya). In randomized order, cataract surgery with PPCCC and POBH of the IOL was performed in 1 eye of each patient. In the fellow eyes, conventional phacoemulsification cataract surgery with in-the-bag IOL implantation was performed. The ACD was measured 1 to 2, 6, and 24 hours as well as 7 and 30 days postoperatively using high-resolution partial coherence laser interferometry. A baseline measurement was taken preoperatively in all patients. RESULTS: Ten patients completed 10 to 12 months of follow-up. Postoperatively, the axial IOL position was stable in eyes with PPCCC-POBH (P>.05). In contrast, a significant axial shift of the IOL in the anterior direction was observed in control eyes with in-the-bag IOL implantation (P<.001). The resulting refractive shift was significantly higher in control eyes than in eyes with PPCCC-POBH (P<.001). CONCLUSION: Combined PPCCC and POBH for cataract surgery significantly reduced postoperative anterior movement of the IOL.     

同轴微切口白内障手术后视觉质量及IOL的稳定性

目的 观察同轴微切口白内障超声乳化吸除联合微切口IOL植入术后的视觉质量和IOL偏心及倾斜,评估微切口IOL的稳定性.方法 回顾性系列病例研究.选择在中国医科大学附属第四医院眼科行1.8 mm同轴微切口超声乳化白内障吸除联合Akreos MI60 IOL植入的患者20例（20眼）.观察术后3个月、6个月的UCVA、BCVA、像差、散射光、IOL倾斜及偏心等.采用连续测量的方差分析对数据进行处理.结果 术后3个月及6个月,患者UCVA、BCVA与术前相比差异均有统计学意义（P＜0.05）,20例患者术前散射光为2.56±0.28,与术后3个月及术后6个月矫正后比较差异均有统计学意义（F=0.532,P＜0.05）.术后1周、3个月和6个月,IOL的偏心量差异无统计学意义（F=2.066,P＞0.05）,IOL的倾斜度变化无统计学意义（F=2.734,P＞0.05）.术后1周、3个月和6个月平均高阶像差值变化无统计学意义（F=0.692,P＞0.05）.结论 1.8 mm同轴微切口超声乳化白内障吸除联合Akreos MI60 IOL植入在手术后具有良好的稳定性,患者可以获稳定的UCVA.     

Visual outcomes and complications of posterior chamber intraocular lens implantation in the first year of life

PURPOSE: To document the visual outcome and postoperative complications in infants who had congenital cataract surgery with posterior chamber intraocular lens (PC IOL) implantation in the first year of life. SETTING: The Children's Hospital, Dublin, Ireland. METHODS: Twenty-seven eyes of 20 infants were reviewed. Seven infants (14 eyes) had bilateral congenital cataract and 13 (13 eyes), uniocular cataract. The mean age at surgery was 4 months (range 3 weeks to 11 months). A standard surgical technique involved anterior capsulorhexis, phacoemulsification with or without posterior capsulorhexis with in-the-bag PC IOL implantation, and no anterior vitrectomy. Surgery was performed by 1 surgeon. The mean follow-up was 41 months (range 6 to 88 months). RESULTS: The main complication was lens reproliferation into the visual axis. Of the 11 eyes that did not have a primary posterior capsulorhexis, 10 had 1 or more capsulotomies. Seven required a neodymium:YAG (Nd:YAG) laser capsulotomy a mean of 6 months postoperatively, and 2 had 2 Nd:YAG capsulotomies. Six eyes also had a surgical capsulotomy when the membrane was deemed too thick for further laser treatment. Fourteen of 25 eyes had a primary posterior capsulorhexis; 8 had no further intervention. Four eyes had persistent hyperplastic primary vitreous (PHPV), 3 required a surgical capsulotomy, 2 had an Nd:YAG laser capsulotomy, 2 had an anterior vitrectomy, and 1 developed open-angle glaucoma. There was a mean refractive shift of 6.0 diopters after a mean follow-up of 41 months, with most of the myopic shift occurring in the first 24 months. CONCLUSIONS: Visual axis reopacification was the main complication of IOL implantation in infants, with PHPV leading to more complications and repeat procedures. Anterior vitrectomy appeared to reduce the reoperation rate. Results indicate that primary posterior capsulorhexis is important and Nd:YAG capsulotomy is not satisfactory in infants. In addition, the reduction in glaucoma with IOL implantation, if borne out over the long term, is a significant advantage in cases of congenital cataract.     

Two-stage capsulorhexis for endocapsular phacoemulsification

The continuous tear anterior capsulotomy or capsulorhexis technique is important for safe, successful cataract extraction and intraocular lens (IOL) implantation surgery. A two-stage continuous tear capsulotomy or capsulorhexis extends the possibility of achieving continuous tear capsulotomy to challenging and complicated cases. In endocapsular phacoemulsification this technique preserves the integrity of the capsule because it prevents the extension of radial tears in the capsule and thus facilitates safe cataract extraction and secure in-the-bag IOL placement. The benefits and advantages of the continuous tear capsulotomy are preserved by two-stage capsulorhexis.     

Functional outcomes of acrylic intraocular lenses in pediatric cataract surgery

PURPOSE: To evaluate the functional outcomes of in-the-bag implantation of acrylic intraocular lenses (IOLs) with posterior continuous curvilinear capsulorhexis (PCCC), without PCCC, with PCCC and anterior vitrectomy, and with PCCC and optic capture in pediatric cataract surgery. SETTING: Pediatric Ophthalmology Service, Guru Nanak Eye Centre, New Delhi, India. METHODS: Forty-two eyes of 25 children were included in this prospective study. All eyes had in-the-bag implantation of an AcrySof IOL (Alcon). Twenty-five eyes had had an anterior continuous curvilinear capsulorhexis (ACCC) (Group A). Seventeen eyes had PCCC along with ACCC (Group B), 4 had anterior vitrectomy combined with PCCC (Group C), and 6 had PCCC with IOL optic capture through the PCCC (Group D). Secondary opacification of the visual axis, visual acuity, and possible complications were observed and analyzed. RESULTS: The mean age of the patients was 78 months (range 36 to 144 months). The mean follow-up was 13 months (range 6 to 18 months). Four eyes (16%) in Group A developed visually significant posterior capsule opacification (PCO) involving the central visual axis and required secondary capsulotomy. All eyes in Groups B, C, and D had a clear visual axis at the last follow-up and did not require a secondary procedure. Minimal postoperative inflammation (ie, aqueous flare and IOL deposits ) was seen in all groups. The mean preoperative decimal best corrected visual acuity (BCVA) in Groups A, B, C, and D was 0.095, 0.055, 0.174, and 0.039, respectively. Postoperatively, the BCVA was 0.54, 0.66, 0.66, and 0.66, respectively. CONCLUSIONS: An optimal-sized ACCC followed by in-the-bag implantation of a foldable acrylic IOL helped maintain a clear visual axis by delaying the onset of PCO and leading to milder PCO. The benefits of a foldable acrylic IOL in pediatric cataract surgery can be increased by combining it with PCCC, with or without anterior vitrectomy, or with optic capture of the IOL.     

Objective assessment of intraocular flare after cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing in adults

AIM: Combining primary posterior capsulorhexis (PPC) and posterior optic buttonholing (POBH) in cataract surgery is an innovative approach to prevent after-cataract formation effectively and to increase postoperative stability of the intraocular lens (IOL). The present study was designed to compare the postoperative intraocular flare after cataract surgery with combined PPC and POBH to conventional in-the-bag implantation of the IOL. METHODS: Fifty consecutive age-related cataract patients with cataract surgery under topical anaesthesia in both eyes were enrolled prospectively into a prospective, randomised clinical trial. In randomised order, cataract surgery with combined PPC and POBH was performed in one eye; in the other eye cataract surgery was performed conventionally with in-the-bag IOL implantation keeping the posterior lens capsule intact. Intraocular flare was measured 1, 2, 4, 6, 12 and 24 h postoperatively, as well as 1 week and 1 month postoperatively, using a KOWA FC-1000 laser flare cell meter. RESULTS: The peak of intraocular flare was observed in POBH eyes and eyes with in-the-bag IOL implantation 1 h postoperatively. In both groups, the response was steadily decreasing thereafter. During measurements at day 1, small though statistically significant higher flare measurements were observed in eyes with in-the-bag IOL implantation (p<0.05). At 1 week and 1 month postoperatively, intraocular flare measurements were comparable again (p>0.05). CONCLUSION: Cataract surgery with combined PPC/POBH showed slightly lower postoperative anterior chamber reaction compared to conventional in-the-bag implantation during 4-week follow-up, indicating that POBH might trigger somewhat less inflammatory response. This could be explained by the posterior capsule sandwiching between the optic and the anterior capsule, preventing direct contact-mediated myofibroblastic trans-differentiation of anterior lens epithelial cells with consecutive cytokine depletion.     

Pseudo-accommodation with intraocular lenses implanted in the bag

PURPOSE: To evaluate the accommodation potential in eyes after intraocular lens in-the-bag implantation. METHODS: Fifty-one consecutive patients were included in the study. Group 1 included 26 eyes that had phacoemulsification with continuous curvilinear capsulorhexis and in-the-bag implanted foldable IOL. Twenty-five eyes in Group 2 had capsulotomy with extracapsular cataract extraction and were implanted with polymethylmethacrylate IOL. Time elapsed from surgery was at least 6 months. There was no significant difference for age or gender between groups (P > .05). We measured accommodation amplitude and depth of the anterior chamber at distance and near fixation with an ultrasonic biometry device. The results were compared using the unpaired Student t-test. RESULTS: The anterior chamber depths while fixating at a distant object were not significantly different between groups (P>.05), however, at near the difference was statistically significant (P=.008). The change in depths between far and near fixation was significantly different (P=.002) and was more pronounced in the the capsulorhexis group (P < .001). The accommodation amplitudes in this group were significantly greater than in the capsulotomy group (P = .025). CONCLUSION: Patients who had uncomplicated small incision phacoemulsification surgery with continuous curvilinear capsulorhexis and in-the-bag implanted lens seemed to preserve some pseudo-accommodation after surgery.     

Macular morphology after cataract surgery with primary posterior capsulorhexis and posterior optic buttonholing

PURPOSE: To evaluate possible changes in macular morphology after cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing in comparison to conventional in-the-bag intraocular lens (IOL) implantation. DESIGN: Prospective randomized study. METHODS: Fifty consecutive age-related cataract patients with normal macular morphology and function waiting for bilateral cataract surgery were enrolled. Cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing was performed in one eye; in the fellow eye cataract surgery was performed with in-the-bag IOL implantation, leaving the posterior lens capsule untouched. Optical coherence tomography measurements were performed one week and one month postoperatively. RESULTS: During follow-up, no statistically significant changes of macular morphology could be observed in any of the tested patients. Mean central retinal thickness, minimum and maximum retinal thickness, and central retinal volume were all statistically comparable between the eyes with combined primary posterior capsulorhexis and posterior optic buttonholing and the control eyes (P > .05). Best-corrected visual acuity was full in all patients (Snellen 20/25 and better). No cases of subclinical macular edema were observed. CONCLUSION: Cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing apparently does not increase the risk for postoperative macular edema in patients with a normal macula, since no cases of biomicroscopically noticeable macular edema with visual loss were observed in the first 1,000 eyes with primary posterior capsulorhexis/posterior optic buttonholing cataract surgery and no case of subclinical macular edema was found in this prospective randomized study.     

高龄白内障患者同轴1．8 mm 微切口超声乳化术后黄斑区视网膜厚度的临床观察

目的：探讨同轴1．8 mm微切口白内障超声乳化吸除人工晶状体植入术对高龄白内障患者黄斑区平均视网膜厚度的影响。方法前瞻性随机对照研究。选择80岁以上高龄老年性白内障患者46例（46只眼）,随机分为2组,A组患者23例（23只眼）行1．8 mm白内障超声乳化吸除联合Akreos MI60人工晶状体植入术,B组23例（23只眼）行3．0 mm白内障超声乳化吸除联合Tecnis ZA9003人工晶状体植入术。分别于术前、术后1个月及术后3个月观察黄斑区平均视网膜厚度的变化。采用SPSS 15．0统计学软件进行数据分析。结果所有患者术后术眼最佳矫正视力均较术前提高,OCT检查结果提示术后1个月A组黄斑区平均视网膜厚度（269．71±32．35）μm,B组黄斑区平均视网膜厚度（278．89±37．39）μm,两组比较差异有统计学意义（ P ＜0．05）;术后3个月A组黄斑区平均视网膜厚度（257．86±27．42）μm,B组黄斑区平均视网膜厚度（261．18±25．17）μm,两组比较差异有统计学意义（ P ＜0．05）。结论与传统3．0 mm小切口手术相比,1．8 mm微切口白内障超声乳化吸除术治疗高龄白内障可显著减轻手术对黄斑区视网膜的影响,从而保持稳定的视觉质量。     

Dislocation of a plate-haptic silicone intraocular lens into the anterior chamber

Posterior dislocation is a well-described complication of plate-haptic intraocular lenses (IOLs). It usually occurs after an opening in the posterior capsule, either intraoperatively or after a neodymium: YAG capsulotomy occurs. We report a case of anterior luxation of a plate-haptic silicone IOL occurring 4 months after uneventful cataract surgery. This case emphasizes the need for a small and continuous capsulorhexis as well as in-the-bag implantation of plate-haptic IOLs.     

Comparison of epilenticular IOL implantation vs technique of anterior and primary posterior capsulorhexis with anterior vitrectomy in paediatric cataract surgery

PURPOSE: To compare the functional outcome of epilenticular intraocular lens (IOL) implantation vs the technique of anterior continuous curvilinear capsulorhexis (ACCC), posterior continuous curvilinear capsulorhexis (PCCC) with vitrectomy and in-the-bag IOL implantation in paediatric cataract surgery. METHODS: Forty eyes of 33 children with developmental or traumatic cataract, whose mean age was 2-12 years, were randomly divided into two groups A and B. Group A patients underwent epilenticular IOL implantation while in group B patients, ACCC, PCCC with anterior vitrectomy with in-the-bag IOL implantation was performed. Equal number of eyes (10 each) with developmental cataracts (subgroups A1 and B1) and traumatic cataracts (subgroups A2 and B2) were allotted to both the groups. Postoperative visual acuity, opacification of the visual axis, and possible complications were observed and analysed. RESULTS: Four eyes in subgroup B2 had fibrous or ruptured capsules, and were managed by epilenticular IOL implantation technique. One eye in subgroup B2 developed central posterior capsular opacification and hence required a secondary capsulotomy. All cases in group A maintained a clear visual axis at the last follow-up. Minimal postoperative inflammation was noticed in all groups, which subsided with anti-inflammatory medication. At the last follow-up, all eyes in group A gained visual acuity >/=6/18. Whereas in group B, visual acuity >/=6/18 was obtained in 85.7% cases with the epilenticular IOL implantation technique and in 83.3% cases with ACCC and PCCC with anterior vitrectomy technique. CONCLUSION: Epilenticular IOL implantation offers a safe and effective alternative for management of paediatric cataract. In selected cases of traumatic cataract, it is the preferred treatment modality.     

Pseudophakic accommodation with 2 models of foldable intraocular lenses

PURPOSE: To evaluate the amplitude of pseudophakic accommodation of 2 foldable intraocular lenses (IOLs) by measuring the anterior chamber depth (ACD) shift during a 1-year follow-up. SETTING: Department of Ophthalmology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary. METHODS: This prospective study comprised 44 eyes of 44 cataract patients operated on with phacoemulsification and in-the-bag implantation of Akreos Disc (22 eyes) or AcrySof MA60BM (22 eyes) IOLs. The ACD was measured by A-scan during fixation at 30 cm and again after instillation of cyclopentolate 1%. The ACD shift was calculated by subtracting the ACD under cyclopentolate from the ACD during fixation at 30 cm. Follow-up measurements were performed 3, 6, and 12 months after surgery. Statistical analysis concerning the difference between the 2 groups was done by the Student unpaired t test. RESULTS: The ACD shift was greater in the AcrySof group than in the Akreos Disc group at all 3 follow-up examinations. The difference was highly significant between the 2 groups at 6 and 12 months (both P = .004). After the operation, the ACD shift increased continuously with time in both groups. The mean ACD shift reached 0.57 mm +/- 0.25 (SD) in the AcrySof group and 0.42 +/- 0.24 mm in the Akreos group at 12 months. CONCLUSIONS: The 3-piece AcrySof MA60BM IOL with 10-degree posterior angulation had a significantly higher capacity for pseudophakic accommodation than the 1-piece plate-haptic Akreos Disc IOL. The continuous increase in the ACD shift in the postoperative period may mean that patients learn to achieve better accommodation with an IOL as time goes on.     

超高度近视白内障不同撕囊口直径下术后人工晶状体稳定性观察

目的：：比较超高度近视白内障患者不同撕囊口直径下行超声乳化人工晶状体植入术后的人工晶状体囊袋内稳定性差异。方法：选择双眼超高度近视拟行白内障患者14例,双眼先后均行Phaco+IOL植入术,随机选择一眼作为5 mm撕囊口直径观察组,对侧眼作为6 mm撕囊口直径观察组,娴熟手术医师完成白内障摘除联合囊袋内人工晶状体植入同型亲水丙烯酸非球面人工晶状体( MCX11),手术经过均顺利,所有入组患者术后次日经Image-pro plus6.0图像分析软件测量确认主要子午线囊口直径与目标撕囊直径不超过±0.2mm。术后1wk;1,3,6mo行散瞳后囊口形态、人工晶状体位置形态观察,屈光状态检查,前房深度测量,观察囊袋内人工晶状体的稳定性。结果：与术后1 wk相比,两组术后1 mo前囊口直径轻度缩小,两组间无显著差异。5 mm组在1~3 mo随访期内有轻度远视漂移,6mm组在术后1mo内有轻度远视漂移,1mo后则趋于稳定。屈光变化与前房深度变化同步。5 mm组3 mo随访期有3眼发生襻缘轻度变形。结论：超高度近视患者采用较小的撕囊口可能引起囊袋-IOL复合体的不均匀收缩或前后移位。术后1 mo屈光状态的进行性变化可早期提示人工晶状体稳定性的变化,及时进行干预可减少远期并发症的发生。     

Capsule Contraction Syndrome with a Microincision Foldable Hydrophilic Acrylic Intraocular Lens: Two Case Reports and Review of the Literature

Here we present 2 cases of capsule contraction syndrome (CCS). In both cases, a hydrophilic acrylic Akreos MI60 (Bausch and Lomb) intraocular lens (IOL) was implanted in the capsular bag through microincision cataract surgery, and the literature on the subject is reviewed. Since CCS has been described after the implantation of every IOL type, it is unlikely that the Akreos MI60 chemical and physical properties may cause CCS. When CCS occurs with IOLs composed of increasingly flexible materials that are inserted through incisions of decreasing size, a severe dislocation and deformation of IOL optics and haptics may develop. In both cases illustrated here, Nd:YAG laser anterior capsulotomy was highly effective. Hence, also based on the literature, which reports severe complications as a result of surgical intervention, it is suggested that Nd:YAG laser anterior capsulotomy be the first line of CCS treatment when the luxation of an IOL capsular bag is absent.Key words: Cataract surgery, Capsulorhexis, Capsule contraction syndrome     

Massive anterior capsule shrinkage after plate-haptic silicone lens implantation in uveitis

Two patients, both with bilateral uveitis, had synechiolysis, continuous curvilinear capsulorhexis (CCC), phacoemulsification, and in-the-bag implantation of a foldable single-piece plate-haptic silicone intraocular lens (IOL) in 1 eye. Several weeks postoperatively, massive anterior capsule shrinkage with obstruction of the visual axis occurred in both patients. Surgical revision was performed in both eyes. Both patients had CCC and phacoemulsification and confirmed in-the-bag acrylic IOL implantation in the second eye months after surgery in the first eye. Follow-up examinations showed no significant shrinkage of the anterior capsule opening in any eye. In patients with uveitis, intraoperative lens epithelial cell removal, creation of a large CCC, and careful selection of IOL style and material may prevent occlusion of the anterior capsule opening.     

Performance of the Acri. Smart 46S intraocular lens in pediatric microincision cataract surgery

PURPOSE: To evaluate the performance of the microincision Acri.Smart 46S intraocular lens (IOL) (Acri.Tec) in pediatric cataract surgery. SETTING: Department of Ophthalmology, Ludwig-Maximilians University, Munich, Germany. METHODS: Thirty-two consecutive eyes of 22 children who had cataract surgery with planned IOL implantation were retrospectively analyzed. Intraoperative and postoperative IOL performance, posterior capsule opacification (PCO) formation, best corrected far and near visual acuities, and astigmatism were analyzed. The minimum follow-up was 12 months. RESULTS: The median patient age was 4.5 years (range 2 to 13 years) and the median follow-up, 21 months (range 12 to 29 months). In 94% of eyes, the IOL was implanted in the capsular bag; in 6%, it was placed in the ciliary sulcus. A primary posterior capsule opening was created in 12.5% of eyes. The posterior capsule was intact at the end of surgery in 81% of eyes. Capsule rupture occurred during lens aspiration in 3% of eyes, and a primary capsular defect was present in a patient with traumatic cataract. Posterior capsule opacification that required a second intervention during the follow-up period developed in 35% of eyes. All IOLs were well centered and had a clear optical axis at the end of follow-up. CONCLUSIONS: The Acri.Smart (46S) IOL was found to be suitable for pediatric bimanual microincision cataract surgery. The feasibility of inserting the IOL through of the sub-2.0 mm paracentesis minimizes manipulation of the juvenile eye.     

A comparison of surgical efficacy between a 1.8-mm microincision and 3.2-mm and 5.5-mm incisions for phacoemulsification

Phacoemulsification is a commonly used surgical method in cataract surgery. This paper observes and compares the surgical efficacy of three incisions of different length for phacoemulsification to identify the optimal method for cataract surgery. Ninety patients were enrolled in the present study and divided into three groups. The 1.8-mm group received Bausch & Lomb MI60 foldable intraocular lens (IOL) implantation (n=30), 3.2-mm group received Bausch & Lomb Akreos AO foldable lens implantation (n=30), and 5.5-mm group received Alcon TYPE 05 rigid IOL implantation (n=30). Visual acuity, Oculyzer-based anterior segment analysis, and corneal endothelial cell count before surgery, and 3, 7, 30, and 90d after surgery were recorded and compared. Pseudophakic accommodation three days, one week, one month, and three months after surgery was determined. Intraoperative ultrasound time and ultrasonic energy were recorded. It was finally concluded that for phacoemulsification with the same phaco tip, a 1.8-mm microincision can lead to quicker recovery of visual acuity, more stable astigmatism, and higher pseudophakic accommodation than conventional incision.     

Economic considerations related to choice of intraocular lens (IOL) and posterior capsule opacification frequency – a comparison of three different IOLs

Purpose:  To evaluate the posterior capsule opacification (PCO) rates in three different modern standard intraocular lenses (IOL) and analyse the related cost. Methods:  Retrospective study of medical records from 1527 patients who underwent uneventful cataract surgery by phacoemulsification with posterior chamber implantation of either AcrySof SN60 (n = 375), Akreos Adapt (n = 350) or Tecnis Acryl IOL (n = 801). All surgeries were performed by the same surgeon using the same surgical technique and equipment. Primary end‐point was neodymium:yttrium‐aluminium‐garnet (Nd:YAG) capsulotomy for visual impairment secondary to PCO. Cost of IOL material and Nd:YAG capsulotomy for PCO was then evaluated and compared between the IOLs. Results:  Mean follow‐up was 41.5 months, and the only statistically significant variable of developing PCO was IOL type and individual follow‐up time. Nd:YAG capsulotomy was performed in 7.47% in the AcrySof group, 17.71% in the Akreos group and 3.75% in the Tecnis group. Average cost for Nd:YAG capsulotomy per surgery was €18.75 in the AcrySof SN60 group, €44.25 in the Akreos Adapt group and €9.25 in the Tecnis Acryl group. The combined cost of cataract surgery and PCO treatment was €9.81 higher in for the Akreos Adapt group than the other two combined. Conclusions:  This retrospective study shows that the risk of PCO and Nd:YAG capsulotomy is significantly higher in hydrophilic Akreos IOL compared with both AcrySof and Tecnis hydrophobic IOLs. The increased risk of PCO in the hydrophilic IOL is related to higher total average costs for cataract surgery.     

One-year follow-up of bag-in-the-lens intraocular lens implantation in 60 eyes

PURPOSE: To report the feasibility and clinical results of implanting a bag-in-the-lens intraocular lens (IOL) designed to prevent posterior capsule opacification after cataract surgery. SETTING: Departments of Ophthalmology, University of Antwerp, Antwerp, Belgium, and University of Munich, Munich, Germany. METHODS: This prospective study comprised 63 eyes (55 patients; 7 children, 48 adults) scheduled for cataract surgery and bag-in-the-lens IOL implantation. A posterior curvilinear capsulorhexis the same size as the anterior capsulorhexis was created for IOL insertion. After surgery, lens epithelial cell (LEC) proliferation was documented every 6 months with a minimum follow-up of 12 months. RESULTS: Sixty of 63 eyes (95%) had implantation of the bag-in-the-lens IOL. Conversion to a conventional IOL was necessary in 2 cases. In 1 eye, postoperative luxation of the IOL into the vitreous occurred as a result of an oversized anterior and posterior capsulorhexis. Three eyes had early postoperative iris incarceration in the lens groove that required surgery. No LEC proliferation on the optic occurred during a mean follow-up of 22.7 months (range 12 to 64 months); LEC proliferation was confined to the peripheral capsular bag. CONCLUSION: Lens epithelial cell proliferation was mild and confined to the periphery of the capsular bag during follow-up, and the bag-in-the-lens IOL optic remained clear.