Prospective functional and clinical comparison of bilateral ReZoom and ReSTOR intraocular lenses in patients 70 years or younger.

PURPOSE: To compare clinical outcomes, functional vision, and spectacle freedom in patients 70 years or younger with bilateral ReSTOR (Alcon Laboratories) or ReZoom (Advanced Medical Optics) intraocular lenses (IOLs). SETTING: Private practice, Los Altos, California, USA. METHODS: Thirty patients had nonrandomized bilateral implantation of a ReZoom or ReSTOR multifocal IOL. Patients were 70 years or younger with operable bilateral cataracts and otherwise healthy eyes. Outcome measures recorded 6 months postoperatively were uncorrected (UCVA) and distance-corrected (far, intermediate, near) visual acuities, contrast sensitivity (photopic, mesopic, mesopic with glare), pupil size, and stereopsis. Patients completed a quality-of-life questionnaire and an interactive functional evaluation using real-life props. RESULTS: The UCVA at all distances was excellent in both groups, with the ReSTOR IOL performing significantly better at 31 cm. This near superiority was also evident with distance correction or at the patient's preferred reading distance and correlated with subjective and functional vision testing results. Intermediate vision at 50 cm was comparable. The incidence of halos was similar; however, severity was higher in the ReZoom group, with 2 of 15 patients refusing a second IOL for this reason. Spectacle freedom was achieved by 50.0% in the ReZoom group and 72.7% in the ReSTOR group. CONCLUSIONS: Both multifocal IOL designs provided excellent UCVA. ReSTOR patients had better clinical and functional vision at near and comparable clinical and functional intermediate performance. Halos were more severe in the ReZoom group. Although the ReSTOR IOL gave higher rates of spectacle freedom, patient satisfaction was high in both groups.     

ReSTOR intraocular lens implantation in cataract surgery: quality of vision

PURPOSE: To compare the visual outcome and subjective visual symptoms in patients who had implantation of the AcrySof ReSTOR multifocal intraocular lens (IOL) (Alcon Laboratories) with those in patients who received the AcrySof SA60AT monofocal IOL (Alcon Laboratories) in cataract surgery. SETTING: Southend Hospital, Essex, United Kingdom. METHODS: Eighty eyes of 40 patients received the ReSTOR multifocal IOL after cataract extraction. They were closely paired in age, sex, and ocular findings with patients who had monofocal IOL implantation during the same period. The distance and near visual acuities were compared, and patient satisfaction with their vision, visual symptoms, and spectacle dependence was assessed using a standardized questionnaire. RESULTS: There was no significant difference in the mean uncorrected and best corrected distance visual acuities between the groups. An uncorrected distance visual acuity of 20/30 or better was achieved in 93.8% eyes in the multifocal group and 82.5% in the monofocal group and of 20/20 or better in 57.5% and 40.0%, respectively (P = .18). Uncorrected near visual acuity was 20/30 or better in 75.0% of eyes in the multifocal group and 3.8% in the monofocal group. Reading glasses were required by 2.5% in the multifocal group and by 92.5% in the monofocal group. Satisfactory uncorrected intermediate distance vision was achieved in 75.0% of eyes in the multifocal group and 87.5% in the monofocal group (P = .089); 85.0% of patients in the multifocal group and 7.5% in the monofocal group never had to wear glasses. Moderate glare was reported by 21.3% in the multifocal group and 7.5% in the monofocal group (P = .008); no patient reported severe glare. In the multifocal group, severe halos and moderate halos occurred in 3.8% [corrected] of eyes and 16.3% [corrected] of eyes, respectively. CONCLUSIONS: The AcrySof ReSTOR IOL provided predictably good uncorrected distance and uncorrected near acuities. Spectacle independence was significantly higher with this multifocal IOL, which outweighed the photic symptoms it caused.     

Validity of autorefraction after cataract surgery with multifocal ReZoom intraocular lens implantation

PURPOSE: To evaluate the clinical utility of spherocylindrical automated refraction (AR) compared with subjective manifest refraction (MR) after cataract surgery with implantation of ReZoom refractive multifocal intraocular lenses (IOLs) (Advanced Medical Optics, Inc.). SETTING: Private Practice. METHODS: This prospective nonrandomized interventional study consisted of 72 patients with bilateral cataract and a potential visual acuity of at least 20/40. Patients had bilateral nonsimultaneous cataract surgery and implantation of a ReZoom IOL. Manifest refraction was performed in all patients followed by 3 consecutive measurements using the Topcon KR-8000 autorefractor with nondilated and dilated pupils. Assessment of repeatability of multiple consecutive ARs and comparison of the AR and MR using power vector analysis were performed at the 6-month follow-up. The main outcome measures were the correlation between AR and MR with sphere, spherical equivalent, and astigmatism as well as the repeatability of AR before and after dilation with phenylephrine 10%. RESULTS: Repeatability analysis showed that the initial nondilated AR was not significantly different from the mean of the 3 refractions for nondilated and dilated measurements. The mean difference between the initial AR and the MR was -0.84 +/- 0.62 diopters (D) for sphere (SD), -1.00 +/- 0.61 D for spherical equivalent, and -0.06 +/- 0.19 D and -0.01 +/- 0.17 D, respectively, for J(0) and J(45), the 2 components of astigmatism. Linear regression of AR versus MR data showed poor correlation for sphere (R(2) = 0.4852) and spherical equivalent (R(2) = 0.5529), whereas the correlation for the 2 astigmatic components of vector analysis was excellent (J(0), R(2) = 0.8881; J(45), R(2) = 0.8640). Correlation was better when the MR residual refractive defect was higher. CONCLUSIONS: Although autorefraction showed excellent agreement with subjective refractive astigmatism, correlation with spherical values was poor, with a trend toward more negative values. Autorefraction after ReZoom IOL implantation can be used as a good starting point for subjective refraction of astigmatism; however, spherical values should be underestimated.     

ReZoom折射型多焦点人工晶状体植入术后的近期中距离视力观察

目的观察白内障超声乳化吸除联合折射型多焦点人工晶状体（ReZoom）植入术后的近期中距离视力。方法将36例（46只眼）年龄相关性白内障患者，随机分为实验组和对照组。行白内障超声乳化吸除术后，实验组植入折射型多焦点人工晶状体（ReZoom NXG1）。对照组植人单焦点人工晶状体（Sensar AR40e）。术后1周、1个月和3个月检查中距离视力（包括100、63cm和40cm共3种距离的高对比度和低对比度视力）。结果两组患者术后不同距离的高对比度和低对比度视力，差异均有显著的统计学意义（P〈0．05）。术后3个月时，3种距离的高对比度视力均达0．5或以上者，ReZoom眼78．3％，Sensar眼21．7％；达0．4或以上者，ReZoom眼95．7％，Senstir眼39．1％；3种距离的低对比度视力均达0．5或以上者，ReZoom眼73．9％，Sensar眼17．4％；达0．4或以上者，ReZoom眼91．3％，Sensar眼34．8％。结论ReZoom折射型多焦点人工晶状体可以提供良好的中距离视力。未发现因ReZoom折射型多焦点人工晶状体植入引起的并发症，并具有与单焦点人工晶状体一样的安全性。     

多焦点人工晶状体和单焦点非球面人工晶状体植入术后患者视功能及生存质量比较

目的　比较植入多焦点人工晶状体（ｉｎｔｒａｏｃｕｌａｒｌｅｎｓ,ＩＯＬ）和单焦点非球面ＩＯＬ对单纯白内障患者术后视功能及生存质量的影响。方法　采用前瞻性和回顾性调查研究,共纳入７２例（１４４眼）老年性白内障患者,均行超声乳化联合ＩＯＬ植入术,其中２０例植入折叠式多焦点ＩＯＬ（多焦点ＩＯＬ组）,５２例植入折叠式单焦点非球面ＩＯＬ（单焦点ＩＯＬ组）,问卷调查并比较患者术前和术后６个月的视功能及生存质量。结果　术后两组患者总体视功能及生存质量之间的差异均无统计学意义（均为Ｐ＞０．０５）,但较术前均有提高,差异均有统计学意义（均为Ｐ＜０．０５）。在活动能力、社会交际能力和心理健康方面,单焦点非球面ＩＯＬ植入后却表现出较为明显的优势,差异均有统计学意义（均为Ｐ＜０．０５）;多焦点ＩＯＬ的术后脱镜率明显高于单焦点非球面ＩＯＬ（Ｐ＜０．０５）;而在术后视功能、生存质量的其他具体方面（与视力有关的日常活动限制、周边视野、感觉适应、立体觉和自理能力）,两组之间的差异均无统计学意义（均为Ｐ＞０．０５）。结论　单焦点ＩＯＬ和多焦点ＩＯＬ在改变视功能和生存质量方面总体效果相同,但多焦点ＩＯＬ在患者脱镜方面有明显优势,而单焦晶状体在价格上表现出比较明显的优势。     

ReZOOM与ReSTOR多焦点人工晶状体应用效果的Meta分析

目的：系统评价ReZOOM与ReSTOR两种多焦点人工晶状体（multifocal intraocular lens,MIOL）的临床应用效果。方法：计算机检索CENTRAL、MEDLINE、EMbase、万方医学网数据库、维普中文生物医学期刊全文数据库、中国生物医学文献数据库、中国期刊全文数据库,手工检索相关会议文献,纳入所有ReZOOM与ReSTOR对照的超声乳化白内障吸出联合IOL植入的随机对照试验。采用Cochrane系统评价方法,由两名评价员分别提取资料,评价方法学质量后,应用RevMan 5.2软件进行Meta分析。结果：共纳入7个随机对照试验（846眼）。结果显示：裸眼远视力：ReZOOM组与ReSTOR组间差异无统计学意义[WMD=-0.03,95% CI为（-0.06,0.01）,P=0.15]。裸眼中距视力：ReZOOM组与ReSTOR组间差异无统计学意义[WMD=-0.04,95% CI为（-0.09,0.01）,P=0.10]。裸眼近视力：ReZOOM组与ReSTOR组间差异有统计学意义[WMD =0.09,95% CI为（0.05,0.14）,P〈0.00001]。最佳矫正远视力：ReZOOM组与ReSTOR组间差异无统计学意义[WMD=-0.01,95% CI为（-0.04,0.02）,P=0.55]。最佳矫正远视下的中距视力：ReZOOM组与ReSTOR组间差异有统计学意义[WMD=-0.11,95% CI为（-0.16,-0.06）,P〈0.0001]。最佳矫正远视下的近视力：ReZOOM组与ReSTOR组间差异无统计学意义[WMD=0.06,95% CI为（-0.06,0.17）,P=0.32]。脱镜率：ReZOOM组与ReSTOR组间差异有统计学意义[WMD=2.62,95% CI为（1.76,3.91）,P〈0.00001]。光晕发生率：ReZOOM组与ReSTOR组间差异有统计学意义[WMD= 1.35,95% CI为（1.15,1.60）,P=0.0004]。眩光发生率：ReZOOM组与ReSTOR组间差异有统计学意义[WMD=1.29,95% CI为（1.09,1.53）,P=0.003]。结论：本研究表明,两种MIOL相比较,ReSTOR表现出更好的裸眼近视力,出现光晕、眩光等视觉不良反应的可能性更小,裸眼远视力及中距视力表现相同; 在戴镜矫正状况下,ReZOOM的中距视力表现更佳,两种MIOL的远、近视力无差别。     

Visual performance of patients with bilateral vs combination Crystalens, ReZoom, and ReSTOR intraocular lens implants

PURPOSE: To compare the visual performance of patients with bilateral vs combination Crystalens, ReZoom, and ReSTOR intraocular lens (IOLs) implants. DESIGN: Prospective, nonrandomized study. METHODS: Forty-nine patients were implanted with bilateral Crystalens (Eyeonics, Aliso Viejo, California, USA), ReSTOR (Alcon Laboratories, Fort Worth, Texas, USA), and ReZoom (American Medical Optics, Santa Clara, California, USA) or combined Crystalens and ReSTOR or Crystalens and ReZoom IOLs after phacoemulsification. Monocular and binocular testing four to six months after surgery included uncorrected and best-spectacle corrected visual acuity at distance, intermediate, and near vision; mesopic contrast sensitivity function with and without glare; and quality-of-life and vision surveys six months after surgery. RESULTS: Monocular testing showed that eyes with Crystalens accommodating IOL had statistically better best-spectacle corrected distance, uncorrected and distance-corrected intermediate, and best-corrected near vision. Eyes with the ReSTOR multifocal IOL had better uncorrected near vision, required the lowest reading add, and had the lowest uncorrected and distance-corrected intermediate vision. Monocular mesopic contrast sensitivity with and without glare was better with the Crystalens IOL vs either multifocal IOL at specific spatial frequencies. The binocular subjective quality of vision and quality of life questionnaires were favorable for the bilateral Crystalens group. CONCLUSIONS: Any combination of Crystalens in one or both eyes was better for intermediate vision. Any combination of ReSTOR in one or both eyes was better for near vision. The Crystalens and ReSTOR combination had better mean intermediate and near vision overall. A multifocal IOL in one or both eyes was associated with lower contrast sensitivity and more subjective reports of photic phenomena. The accommodating and multifocal IOL combinations elicited less night glare symptoms than in patients with either bilateral multifocal IOL, but more than with bilateral Crystalens implantation.     

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.     

Intermediate vision and reading speed with array, Tecnis, and ReSTOR intraocular lenses

PURPOSE: To retrospectively evaluate reading performance at intermediate distances of three types of multifocal intraocular lenses (IOLs) under different light conditions based on reading acuity and reading speed tests. METHODS: Thirty cataract patients (60 eyes) randomly assigned to receive the Array SA40N lens (n = 20 eyes), the Tecnis ZM001 lens (n = 20 eyes), and the ReSTOR lens (n = 20 eyes) were retrospectively tested for their reading abilities at distances of 40 cm, 60 cm, and 80 cm under low light conditions (6 cd/m2) and bright light conditions (100 cd/m2). RESULTS: LogMAR distance-corrected acuity in dim (bright) light at 40 cm was 0.456 (0.363) (Array), 0.446 (0.293) (ReSTOR), and 0.299 (0.140) (Tecnis); at 60 cm, it was 0.417 (0.259) (Array), 0.448 (0.318) (ReSTOR), and 0.381 (0.121) (Tecnis); at 80 cm, it was 0.359 (0.195) (Array), 0.395 (0.245) (ReSTOR), and 0.373 (0.124) (Tecnis). Uncorrected reading speed (words/min) in dim (bright) light at 40 cm was 25 (69) (Array), 58 (138) (ReSTOR), and 110 (166) (Tecnis); at 60 cm, it was 65 (129) (Array), 58 (129) (ReSTOR), and 135 (173) (Tecnis); and at 80 cm, it was 59 (153) (Array), 79 (164) (ReSTOR), and 121 (176 (Tecnis). CONCLUSIONS: Our study indicates that Array, ReSTOR, and Tecnis IOLs provide functional intermediate vision in bright light. In dim light, however, the Tecnis IOL provides better uncorrected reading speed at intermediate distances than Array and ReSTOR IOLs.     

双眼阶梯渐进衍射型多焦点人工晶状体植入术的视觉质量观察

目的 比较双眼行超声乳化白内障吸除联合植入ReSTOR阶梯渐进衍射型多焦点人工晶状体(MIOL)和单焦点人工晶状体(SIOL)的术后视觉质量.方法 回顾性比较性系列病例研究.回顾性分析25例(50只眼)双眼行超声乳化白内障吸除联合ReSTOR MIOL植入(多焦点组)和28例(56只眼)双眼行超声乳化白内障吸除术联合Natural SIOL植入(单焦点组)的年龄相关性白内障患者的临床资料.观察术后3个月时裸眼远、近视力,最佳矫正远、近视力,远矫正状态下近视力、对比敏感度和眩光敏感度,视觉干扰以及脱镜率.两组间计量资料采用t检验;两组间计数资料采用X2检验.结果 术后3个月,多焦点组94%(47/50)和单焦点组96%(54/56)患眼术后裸眼远视力≥0.6(X2=0.347,P＞0.05);多焦点组88%(44/50)和单焦点组13%(7/56)患眼裸眼近视力等于或好于J3(X2=60.315,P＜0.01);多焦点组90%(45/50)和单焦点组11%(6/56)患眼远矫正状态下裸眼近视力等于或好于J3(X2=66.515,P＜0.01);两组各空间频段的对比敏感度和眩光敏感度差异均无统计学意义(P＞0.05);多焦点组12%(3/25)和单焦点组7%(2/28)患者术后出现轻度以上的眩光感(X2=0.365,P＞0.05);多焦点组8%(2/25)和单焦点组4%(1/28)患者术后出现轻度以上的光晕(X2=0.485,P＞0.05);两组均有96%(24/25、27/28)的患者术后视远完全脱镜(X2=0.007,P＞0.05);多焦点组80%(20/25)和单焦点组11%(3/28)患者术后视近完全脱镜(X2=25.811,P＜0.01).结论 ReSTOR阶梯渐进衍射型MIOL能同时提供良好的远、近视力,减少了患者术后对眼镜的依赖,具有较好的视觉质量.     

Meridional ocular magnification after cataract surgery with toric and non-toric intraocular lenses

Graefe's Archive for Clinical and Experimental Ophthalmology - Overall ocular magnification (OOM) and meridional ocular magnification (MOM) with consequent image distortions have been widely...     

Pigment deposits on hydrophilic intraocular lenses after phacoemulsification cataract surgery

A heterogeneous group of conditions can cause changes to the intraocular lens (IOL) during or after implantation in uneventful cataract surgery.We describe a series of 5 patients presenting distinctive deposits on the surface of hydrophilic intraocular lenses, implanted during routine cataract surgery, with a follow-up of 1 to 24 months.Disposable forceps were found to be the source of the pigmented marks when used to hold the lens during the injector loading process. At the slit-lamp examination, the pigments were located in the centre of the lens optic, easily detectable. Although involving the visual axis, none of the patients were visually affected.To our knowledge, this is the first time such unusual occurrence has been described. The reported case-series shows the importance of in-house follow-up after cataract surgery.     

Advances in microincision cataract surgery intraocular lenses

PURPOSE OF REVIEW: This paper reviews the recent developments in microincision cataract surgery intraocular lenses. RECENT FINDINGS: Seven intraocular lenses are currently available for implantation through sub-2.0-mm incision. From the intraocular lenses available, two microincision cataract surgery intraocular lenses were included in clinical studies and their results were reviewed. The available lenses were implanted through a clear corneal incision of 1.5-1.9 mm and showed excellent biocompatibility. The behavior of the microincision cataract surgery in vivo is similar to the conventional lenses in terms of optical quality and retinal image quality. The clinical results of microincision cataract surgery intraocular lenses such as Acri.Smart 48S showed that a certain degree of pseudoaccommodation could be achieved with this lens. SUMMARY: Cataract removal through sub-2.0 mm incision is possible with implantation of microincision cataract surgery intraocular lenses through the same undilated incision. The current technique allows cataract removal through 1.7 mm and the available microincision cataract surgery intraocular lenses showed optical quality and biocompatibility similar to conventional intraocular lenses.     

Visual function and complications after cataract surgery with bilateral multifocal intraocular lens implantation

PURPOSE: To evaluate the visual function and complications after cataract surgery with bilateral Array SA 40N multifocal intraocular lens (IOL) implantation. MATERIAL AND METHODS: This prospective study comprised 40 eyes of selected 20 patients undergoing cataract surgery with bilateral implantation of Array SA 40N (AMO). multifocal IOL. Three months after bilateral surgery distance and near visual acuity, contrast sensitivity, complications and adverse effects were evaluated. Patients' satisfaction was assessed using a subjective TyPE Questionnaire. RESULTS: Thirty-five eyes (35/40 - 87.5%) achieved the uncorrected distance visual acuity 20/40 and the uncorrected near visual acuity of J5 or better. Eighty-two and a half percent of the operated eyes achieved UCDVA 20/20 and J4 or better. Contrast sensitivity for distance and near measured binocularly were within normal limits, although for higher spatial frequency, contrast sensitivity values for near were slightly above the lower limit of normal range. Intraoperative and postoperative complications were few and only in one eye, further surgical intervention was necessary (IOL recentration). Three patients (3/20 - 15%) reported moderate glare and halo. Overall visual satisfaction measured with TyPE Questionnaire was very high (8.7/10). CONCLUSIONS: Bilateral multifocal IOL implantation was effective and safe in selected cataract patients, providing very good uncorrected distance and near visual acuity. Slightly reduced contrast sensitivity and increased perception of glare/halo were an acceptable compromise for near, as well as distance vision improvement.     

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.