Refractive lens exchange versus iris-claw Artisan phakic intraocular lens for hyperopia

PURPOSE: To study a paired-match comparison between refractive lens exchange with pseudophakic IOL implant (RLE) and Artisan phakic IOL for high hyperopia. METHODS: Nineteen eyes (12 patients, 20 to 41 years old) with an Artisan phakic IOL (Model 203: 1.00-D increment) for hyperopia from +2.75 to +9.25 D were matched to 19 eyes (15 patients, 26 to 46 yr) with hyperopia from +2.75 to +7.50 D, who had refractive lens exchange (pseudophakic IOL implantation; lenses: 0.50-D increment). Average paired-match difference was 1.13 D and 7.7 years of age. RESULTS: At 1 month after surgery, 84% of refractive lens exchange/pseudophakic IOL eyes and 94% of Artisan phakic IOL eyes had a spherical equivalent refraction within +/- 1.00 D of emmetropia; 58% and 68% of eyes, respectively, were within +/- 0.50 D (P = .97). No eye lost lines of best spectacle-corrected visual acuity (BSCVA) and no significant changes in BSCVA were found in any eye at 1 month after surgery (P = .17). The percentage of eyes with uncorrected visual acuity (UCVA) of 20/40 or better improved from 79% to 89% of eyes at 1 to 2 months after phakic IOL; it remained at 89% to 82% of eyes from 1 to 2 months after refractive lens exchange/ pseudophakic IOL. The coefficient of correlation showed statistically better accuracy (intended vs. achieved refraction; P = .035) for the Artisan phakic IOL (R = 0.83) than for refractive lens exchange/ pseudophakic IOL (R = 0.50). CONCLUSIONS: Spherical equivalent refraction outcome and BSCVA after surgery were similar for both procedures. The Artisan phakic IOL in carefully selected patients provided a better overall outcome for young patients with high hyperopia whose accommodation was preserved, as compared to refractive lens exchange.     

Toric phakic intraocular lens: European multicenter study

OBJECTIVE: To evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after implantation of Artisan toric phakic intraocular lenses (TPIOLs) for the correction of myopia or hyperopia with astigmatism. DESIGN: Prospective, nonrandomized, comparative (self-controlled) multicenter trial. PARTICIPANTS: Seventy eyes of 53 patients (mean, 35 years; range, 22-59 years) with preoperative spherical equivalent between +6.50 and -21.25 diopters (D) and cylinder between 1.50 and 7.25 D. METHODS: Seventy eyes underwent implantation of a TPIOL with an optical zone of 5.0 mm (Artisan, Ophtec, Groningen, The Netherlands). The dioptric power of the intraocular lens was calculated by considering refraction, keratometry, and anterior chamber depth. The follow-up was 6 months in all cases. Lenses were available in powers ranging from +12.0 D to -23.5 D (spherical equivalent) in 0.5-D increments, with additional cylinder from 1.0 D to 7.0 D, also in 0.5-D increments. MAIN OUTCOME MEASURES: The main parameters assessed were best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), refraction, endothelial cell count (ECC), intraocular pressure, slit-lamp biomicroscopy, indirect ophthalmoscopy, subjective complaints, and patient satisfaction. RESULTS: Eyes were divided into group A, myopia (n = 48), with an average preoperative spherical equivalent of -8.90 +/- 4.52 D, and group B, hyperopia (n = 22), with an average preoperative spherical equivalent of +3.25 +/- 1.98 D. No eyes in either group experienced a loss in BSCVA, and 46 eyes gained 1 or more lines of their preoperative BSCVA. In 62 eyes (88.6%), UCVA was 20/40 or better. There was a significant reduction in spherical errors and astigmatism in all cases after surgery. All eyes of both groups were within +/-1.00 D of target refraction, and 51 eyes (72.9%) were within +/-0.50 D of target refraction. There was a 4.5% mean total loss of ECC during the first 6 months. No serious complications were observed. Overall patient satisfaction was very high. CONCLUSIONS: Six-month clinical trial results demonstrate that implantation of the Artisan TPIOL safely, predictably, and effectively reduced or eliminated high ametropia and astigmatism with one procedure. The refractive effect was stable at 6 months after surgery.     

Clear lens extraction with intraocular lens followed by photorefractive keratectomy or laser in situ keratomileusis

OBJECTIVE: To study photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK) after clear lens extraction (CLE) with intraocular lens (IOL) implantation for hyperopia or astigmatism. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: Sixty-five eyes (55 subjects) had CLE with posterior chamber IOL implants for hyperopia up to 12.25 diopters (D); 31 eyes were retreated with PRK, and 34 eyes were retreated with LASIK for residual ametropias. INTERVENTION: For PRK and LASIK, the refractive surgery was performed with the slit-scanning excimer laser Nidek EC-5000, Nidek Co., Tokyo, Japan. MAIN OUTCOME MEASURES: Manifest refraction, best-spectacle and uncorrected Snellen visual acuity, haze, and halos were evaluated before surgery and at 1, 3, 6, and 12 months postoperative. RESULTS: Forty-seven eyes were evaluated at the 12-month postoperative examination: 96% of these eyes had spherical equivalents (SE) within +/-2 D of emmetropia, 79% of eyes had SE within +/-1 D of emmetropia and 51% of eyes had SE within +/-0.50 D of emmetropia. Eighty-five percent of the eyes at 12 months postoperative had uncorrected visual acuity of 20/40 or better, and 46% of eyes had uncorrected visual acuity of 20/20 or better. Eighty-seven percent of the eyes at 12 months postoperative had uncorrected visual acuity within 1 Snellen line of their initial best spectacle-corrected visual acuity (BSCVA) before all treatment. No eye lost 2 Snellen lines of BSCVA at 3, 6, or 12 months after PRK or after LASIK. CONCLUSIONS: IOL implantation for CLE, although an invasive technique, resulted in better refractive outcomes without laser-related clinical complications after PRK or LASIK adjustment.     

Pseudoaccommodation and visual acuity with Technovision presbyLASIK and a theoretical simulated Array multifocal intraocular lens

PURPOSE: To compare the visual results of presbyLASIK patients to the best theoretical pseudoaccommodation that could be achieved using a multifocal refractive intraocular lens (IOL) model based on the optical structure of a simulated AMO Array multifocal IOL. METHODS: The study included 10 hyperopic eyes that underwent central presbyLASIK surgery using a Technovision excimer laser platform. Mean patient age was 57 years, and mean preoperative spherical equivalent refraction was 1.28+/-0.87 diopters. The optical quality was evaluated by objective distance and near decimal visual acuities calculated using a Fresnel propagation algorithm based on a realistic eye model. Results of the presbyLASIK technique were compared with the theoretical results obtained for the same eye with an ideal, best-fit multifocal IOL (simulated Array multifocal IOL) substituted for the crystalline lens. RESULTS: For near objective visual acuity (from 25 cm to 1 m), the ideal, theoretical Array-like lens provided values of visual acuity above 0.5 for all object distances, whereas presbyLASIK also provided good visual responses for distances beyond 45 cm. For distance vision (from 1.5 to 6 m), both the IOL and presbyLASIK visual acuities were over 0.5, but the optical performance of the ideal Array-like lens was slightly worse than with presbyLASIK. CONCLUSIONS: Overall near to distance visual acuity obtained with the presbyLASIK technique is comparable to the best visual acuity that could be achieved with a simulated Array multifocal IOL. Near visual acuity with presbyLASIK falls off from the ideal.     

Combined posterior chamber phakic intraocular lens and laser in situ keratomileusis: bioptics for extreme myopia.

PURPOSE: To examine the efficacy, predictability, stability, and safety of combined posterior chamber phakic intraocular lens (IOL) implantation and laser in situ keratomileusis (LASIK) in eyes with extreme myopia. METHODS: We analyzed the results of 67 eyes that received a posterior chamber hydrogel-collagen plate phakic IOL (STAAR Collamer Implantable Contact Lens) and also underwent secondary LASIK for the correction of extreme myopia. Mean follow-up was 3 months after the LASIK portion of the procedure (range, 1 day to 6 mo after LASIK). RESULTS: Mean preoperative spherical equivalent refraction was -23.00 +/- 3.60 D (range, -18.75 to -35.00 D), and mean refractive cylinder was 1.50 +/- 1.20 D (range, 0 to 5.00 D). Mean spherical equivalent refraction after IOL implantation and before LASIK was -6.00 +/- 2.80 D (range, -2.00 to -14.38 D) and mean refractive cylinder 1.50 +/- 1.10 D (range, 0 to 5.00 D). Mean postoperative spherical equivalent refraction at last examination after the LASIK portion of the two-part phakic IOL-LASIK procedure was -0.20 +/- 0.90 D (range, +1.75 to -5.13 D), and mean refractive cylinder was 0.50 +/- 0.50 (range, 0 to 2.25 D). Eighty-five percent (57 eyes) were within +/- 1.00 D and 67% (45 eyes) were within +/- 0.50 D of emmetropia at last examination. The refractions remained stable with a statistically insignificant change (P > .05 at each interval) during follow-up. Postoperative uncorrected visual acuity at last examination was 20/20 or better in 3% (2 eyes) and 20/40 or better in 69% (46 eyes). A gain of 2 or more lines of spectacle-corrected visual acuity was seen in 51 eyes (76%) and no eyes lost 2 or more lines of spectacle-corrected visual acuity at last examination. CONCLUSION: Combined posterior chamber phakic IOL implantation with the STAAR Collamer plate lens and LASIK (bioptics) is an effective and reasonably predictable method for correcting myopia from -18 to -35 D. Gains in spectacle-corrected visual acuity were common, and results demonstrated good short-term safety and refractive stability.     

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。     

Clinical results with the medennium phakic refractive lens for the correction of high myopia

PURPOSE: To evaluate the predictability, safety, stability, complications, and biocompatibility of the phakic refractive lens (PRL) as a posterior chamber intraocular lens to correct high myopia. METHODS: Fifty eyes of 31 patients who underwent posterior chamber PRL implantation were evaluated prospectively. Mean preoperative myopia was -12.54 +/- 4.22 diopters (D) (range: -4.50 to -23.50 D) and mean astigmatic refractive power was -1.38 +/- 1.24 D (range: -1.00 to -4.50 D). Surgical implantation was performed through a 3.0- to 4.0-mm clear cornea sutureless incision using parabulbar (sub-Tenon's) anesthesia. Intra- and postoperative complications were recorded. RESULTS: Three months after surgery, the mean spherical equivalent refraction was -0.21 +/- 0.42 D (range: +1.00 to -1.75 D). At 6 and 12 months, mean spherical equivalent refraction was -0.23 +/- 0.38 D (range: 0 to -1.25 D). At the last examination, uncorrected visual acuity was > or = 20/40 in 41 (82%) eyes and > or = 20/20 in 22 (44%) eyes. Best spectacle-corrected visual acuity (BSCVA) was > or = 20/40 in 42 (84%) eyes and > or = 20/20 in 27 (54%) eyes. Comparison of pre- and postoperative BSCVA at 12 months showed that 12 (36.4%) of 33 eyes gained > or =1 lines of BSCVA and 7 (21.2%) of 33 eyes gained > or =2 lines. One (2%) eye developed anterior subcapsular cataract requiring lens exchange, and 1 (2%) eye developed acute angle closure glaucoma requiring YAG-iridotomy. One (2%) eye developed macular hemorrhage. CONCLUSIONS: At 6 months and 1 and 2 years, PRL implantation yielded encouraging visual and refractive results with excellent biocompatibility. The efficacy, stability, and short-term safety of this lens was established. Serious complications, such as cataract and acute angle closure glaucoma, may occur, and long-term safety needs to be evaluated.     

Correction of high myopia with the PRL phakic intraocular lens

PURPOSE: To assess the predictability, efficacy, safety, and complications of the PRL (CIBA Vision) phakic intraocular lens (pIOL) in the correction of high myopia. SETTING: Clínica Oftalmológica Pasteur, Santiago, Chile. METHODS: This prospective study comprised 53 eyes of 39 patients who received a PRL pIOL. The spherical equivalent (SE), uncorrected visual acuity (UCVA), efficacy index (postoperative UCVA/preoperative best spectacle-corrected visual acuity [BSCVA]), safety index (BSCVA/preoperative BSCVA), intraocular pressure (IOP), iridocorneal angle, and distance between the crystalline lens and PRL were prospectively assessed during the follow-up period. RESULTS: The mean patient age was 39 years. The mean power of the implanted pIOL was -12.73 diopters (D) +/- 2.87 (SD) (range -20.00 to -7.00 D), for a preoperative SE of -17.27 +/- 4.58 D (range -31.50 to -8.75 D). The mean preoperative BSCVA was 0.50 +/- 0.70 (logMAR equivalent), and the mean follow-up was 8 +/- 9.4 months. The mean postoperative SE was -0.23 +/- 1.05 D; 71.2% of eyes were within +/-1.00 D. Sixty percent of patients had UCVA of 20/40 or better, and 88.2% of patients had BSCVA of 20/40 or better. Ninety-two percent maintained or gained 1 or more lines of BSCVA; 5.7% lost more than 1 line. There was no significant change in IOP (P = .40), and the mean distance between the crystalline lens and pIOL was 370 microm (ultrasound) and 604 microm (optical coherence tomography). Late complications included 1 case each of retinal detachment and lens subluxation. CONCLUSIONS: Although PRL implantation in high myopia was predictable and effective, retinal detachment and IOL subluxations occurred. Other posterior chamber pIOLs should be used until the complications associated with the PRL pIOL are resolved.     

Iris-fixated toric phakic intraocular lens: Three-year follow-up

PURPOSE: To evaluate the 3-year safety, efficacy, predictability, and stability of iris-fixated toric phakic intraocular lens (pIOL) implantation for the correction of myopia or hyperopia with astigmatism. SETTING: Department of Ophthalmology, Johannes Gutenberg University, Mainz, and Department of Ophthalmology, University Clinic, Bochum, Germany. METHODS: A prospective clinical trial of 40 eyes of 23 patients with high ametropia and astigmatism was conducted. Best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity, refraction, astigmatism, intraocular pressure, slitlamp biomicroscopy, and indirect ophthalmoscopy were measured preoperatively and postoperatively. RESULTS: Of the 40 eyes, 28 were myopic and 12 were hyperopic. Three years postoperatively, 70% of eyes were within +/-1.00 diopter (D) of the targeted refraction. In the myopic group, mean preoperative BSCVA was 20/40 and improved postoperatively to 20/25. Sixty-six percent of eyes gained 1 or more lines from the preoperative BSCVA. The mean cylinder decreased from -3.58 D +/- 1.26 (SD) preoperatively to -1.15 +/- 1.01 D postoperatively. In the hyperopic group, preoperative BSCVA was 20/25 and improved to 20/20 postoperatively. Thirty-six percent of eyes gained 1 or more lines from the preoperative BSCVA. The mean cylinder decreased from -3.37 +/- 0.88 D to -1.53 +/- 0.69 D postoperatively. The correction was stable in all eyes 3 years after surgery. No potentially sight-threatening complications occurred. CONCLUSION: The 3-year follow-up showed the iris-fixated toric pIOL was effective in correcting high ametropia and astigmatism.     

Acrysof IQ Restor多焦点Toric人工晶状体植入术后临床效果观察

目的：评价白内障患者超声乳化术中植入Acrysof IQ Restor多焦点Toric人工晶体矫正术前规则角膜散光的早期临床效果、安全性,以及术后人工晶状体眼的视功能状态。方法：搜集自2013年至今在我院行白内障超声乳化术并植入Acrysof IQ Restor多焦点Toric人工晶状体的白内障患者18例(23眼)进行分析,术前患者散光均大于1.0 D。术后随访3个月,分别观察术后1周、1个月以及3个月的裸眼远视力,最佳矫正远视力以及裸眼近视力,术前散光以及术后3个月时残余散光、等效球镜度数和人工晶状体的旋转度。结果：术后3个月患者裸眼远视力0.89±0.21,最佳矫正远视力0.95±0.38,等效球镜为?0.5~+0.25D,裸眼近视力为0.82±0.19。术后3个月验光全眼散光为(0.38±0.15) D,较术前散光(1.79±0.43) D有明显降低(P<0.05)。术后3个月人工晶状体的轴位平均偏离(3.48±1.21)°。结论：Acrysof IQ Restor多焦点Toric人工晶状体为白内障患者提供了良好的术后全程视力和视觉质量,并校正了术前角膜散光,实现了患者高度满意率和脱镜率,可预测性好,并有良好的旋转稳定性。     

高度近视合并白内障患者植入Array多焦点人工晶状体的临床观察

目的:评价白内障超声乳化吸除联合Array SA40N多焦点人工晶状体植入术治疗高度近视合并白内障的临床疗效及其安全性。方法:对25例(31眼)高度近视合并白内障患者行超声乳化白内障吸除联合低度数Array多焦点人工晶状体植入术,观察术中和术后并发症、术后视力和屈光状态。结果:所有患者术中均无并发症发生。术后6mo,所有患者裸眼远视力≥0.5者25眼(81%);最佳矫正远视力≥0.5者28眼(90%)。裸眼近视力≥0.5者12眼(39%);最佳矫正近视力≥0.5者22眼(71%)。术后屈光度数偏差值≤±0.50D者为24眼(77%)。结论:超声乳化白内障吸除联合低度数ArraySA40N多焦点折叠式人工晶状体植入术,是治疗高度近视合并白内障患者安全、有效的手术方法。     

Comparative analysis of visual quality between unilateral implantation of a trifocal intraocular lens and a rotationally asymmetric refractive multifocal intraocular lens

AIM: To compare visual quality after unilateral cataract surgery with implantation of trifocal intraocular lens (IOL) and asymmetric refractive multifocal IOL. METHODS: The prospective nonrandom, comparative study consisted of 60 eyes of 60 patients suffering unilateral cataract surgery with implantation of two different IOLs: AT LISA tri 839MP (30 eyes; Carl Zeiss Meditec, Germany) and LS-313 MF30 (30 eyes; Oculentis GmbH, Germany). Visual acuity, refractive outcome, contrast sensitivity, defocus curves, quality of vision, and optical phenomena were evaluated at 3mo postoperatively. RESULTS: There were no statistical differences between groups in uncorrected distance visual acuity (P=0.13) and uncorrected near visual acuity (P=0.54). In contrast, uncorrected intermediate visual acuity was better in trifocal group compared to the refractive multifocal group (P=0.02). No significant statistical between-group difference was detected in cylinder (P=0.43). Compared to trifocal group, spherical refraction and spherical equivalent in refractive multi focal group were more myopic (P<0.01). Under photopic conditions, no significant statistical differences were found between groups in contrast sensitivity at 3 and 6 cycles per degree (cpd). The refractive multifocal group performed better at 12 and 18 cpd than the trifocal group (P=0.01, P=0.034, respectively). The questionnaires of quality of vision and optical phenomena showed no differences between groups. CONCLUSION: Trifocal IOL is superior to refractive multifocal IOL in intermediate visual acuity. Rotationally asymmetric refractive multifocal IOL is more myopic in automated refraction and significantly better for the photopic contrast sensitivity at high frequency.     

Microincision multifocal intraocular lens with and without a capsular tension ring: optical quality and clinical outcomes

PURPOSE: To study the effect of a capsular tension ring (CTR) on the visual, refractive, and intraocular optical quality of a multifocal intraocular lens (IOL) with diffractive asymmetrical light distribution. SETTING: Vissum-Instituto de Oftalmológico de Alicante, Alicante, Spain. METHODS: An Acri.Lisa 366D IOL was implanted without CTR implantation in 54 eyes (Group 1) or with Acri.Ring BR 11 CTR implantation in 40 eyes (Group 2). Intraocular optical quality in vivo was characterized by the difference between the postoperative total and corneal optical aberrations. Visual, refractive, and intraocular optical outcomes were evaluated 3 months postoperatively. Main outcome measures included postoperative residual refraction, uncorrected and corrected far and near visual acuities, intraocular aberrations, the Strehl ratio, and the modulation transfer function (MTF). RESULTS: The postoperative means in Group 1 were spherical equivalent, 0.31 +/- 0.45 diopters (D); uncorrected distance acuity, 0.79 +/- 0.19; best corrected distance acuity, 0.95 +/- 0.11; uncorrected near acuity, 0.77 +/- 0.21; best corrected near acuity, 0.89 +/- 0.14; best distance-corrected acuity, 0.90 +/- 0.12. The Group 2 means were -0.18 +/- 0.60 D, 0.74 +/- 0.23, 0.98 +/- 0.07, 0.72 +/- 0.22, 0.86 +/- 0.14, and 0.86 +/- 0.14, respectively. Group 2 had a statistically significant reduction in intraocular aberrations and a significant increase in MTF values and Strehl ratios compared with Group 1. CONCLUSION: Combined use of the CTR and Acri.Lisa 366D IOL provided good efficacy, predictability, and safety and increased the intraocular optical performance, suggesting better IOL stability.     

超声乳化透明晶状体吸除术治疗高度近视的临床研究

目的探讨超声乳化透明晶状体吸除联合人工晶状体植入术治疗高度近视的有效性和安全性.方法对26例(36只眼)高度近视患者行巩膜隧道切口超声乳化透明晶状体吸除联合人工晶状本植入术.平均年龄53.9岁,术前矫正视力0.2～1.0,平均近视度数(-13.1l±4.33)D,平均散光度数(0.72±0.91)D,平均眼轴长度(28.02±2.14)mm,平均植入人工晶状体屈光度数(+8.62±4.76)D.结果术后所有患者裸眼视力提高;25只眼(69.4%)裸眼视力≥0.5;27只眼(75.0%)矫正视力较术前提高.35只眼(97.2%)矫正视力≥0.5.术后平均近视度数(-1.51±0.60)D,平均散光度数(0.64±0.80)D.术后平均随访时间23.5个月.术后发生晶状体后囊膜混浊2只眼(5.6%),未见视网膜裂孔、视网膜脱离及黄斑囊样水肿.结论超声乳化透明晶状体吸除联合人工晶状体植入术是矫治高度近视安全、有效的方法,具有术后视力好、并发症少、预测屈光状态准确性及稳定性好等优点.     

Decentration, tilt, and near vision of the array multifocal intraocular lens

PURPOSE: To study the periodic changes in decentration, tilt, and near vision in eyes with the Array(R) multifocal intraocular lens (IOL). SETTING: Department of Ophthalmology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. METHOD: This study comprised 20 eyes of 10 patients older than 60 years who had binocular cataract and bilateral implantation of the Array multifocal IOL. Mean patient age was 66.0 years (range 60 to 75 years). After a clear corneal incision and continuous curvilinear capsulorhexis were made, each eye had phacoemulsification and in-the-bag IOL implantation. The amount of IOL decentration and degree of tilt were evaluated using the EAS-1000 anterior eye segment analysis system 1 day and 1 and 2 months postoperatively. Near and far visual acuities were measured at the same examinations. RESULTS: No statistically significant differences were observed in decentration (P =.13) or tilt (P =.32) throughout the follow-up. Mean uncorrected distance visual acuity was 0.68 +/- 0.27 (SD), and mean uncorrected near acuity was 0.49 +/- 0.15 2 months postoperatively. Uncorrected distance acuity better than 0.5 was achieved in 14 eyes (77.8%), in which the mean uncorrected distance acuity was 0.80 +/- 0.18 and the mean uncorrected near acuity was 0. 53 +/- 0.14 2 months postoperatively. CONCLUSIONS: Tilt and decentration of the Array multifocal IOL showed no significant progression up to 2 months after implantation. For near acuity, the Array IOL may be an effective aid.     

Secondary Artisan-Verysise aphakic lens implantation

PURPOSE: To evaluate efficacy, predictability and safety of Artisan-Verysise intraocular lens (IOL) secondary implantation for aphakia correction. SETTING: Instituto de Microcirugía Ocular, and Autonoma University of Barcelona, Barcelona, Spain. METHODS: Uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), manifest refraction, endothelial cell count, and clinical complications were evaluated. Sixteen consecutive eyes of 14 patients with aphakia were submitted to surgery. Postoperative examinations were done at 6 weeks, 6 months, 1 year, and every year for at least 3 years. An iris-supported Artisan-Verysise IOL was implanted for aphakia correction. RESULTS: Thirty-six months after Artisan-Verysise lens implantation, BSCVA was 20/40 or better in 6 eyes (37.5%). Preoperatively, 5 eyes had the same BSCVA (31.25%). Mean postoperative spherical equivalent (SE) was 0.46 diopter (D). Mean endothelial cell loss was 10.9% 36 months postoperatively. The cell loss occurred predominantly during the first year (7.78%). Cystoid macular edema was observed in 2 cases, 1 of them associated with chronic unresponsive low intraocular pressure. No other serious complications were observed. CONCLUSION: Artisan-Verysise IOL implantation seems a safe, predictable, and effective option for aphakic eyes without capsule support.     

Effect of postoperative refractive error on visual acuity and patient satisfaction after implantation of the Array multifocal intraocular lens

PURPOSE: To determine the ideal target refraction to optimize visual acuity (VA) and patient satisfaction after implantation of Array SA40N multifocal intraocular lens (IOL) (AMO). SETTING: Inha University College of Medicine, Incheon, Korea. METHODS: The study prospectively enrolled 188 eyes of 163 patients and assigned them to 1 of 3 groups according to their postoperative refractive status: Group 1 (43 myopic eyes, -0.50 diopter [D] to -1.50 D), Group 2 (114 emmetropic eyes, -0.50 D to +0.50 D) and Group 3 (31 hyperopic eyes, +0.50 D to +1.50 D). Uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), UCDVA under glare conditions, contrast sensitivity, and patient satisfaction were then compared between the 3 groups. RESULTS: Three months postoperatively, UCDVA, UCNVA, UCDVA under glare conditions, and contrast sensitivity were good in all eyes and more than 72% of patients never wore glasses for near vision. In Group 2, UCDVA was significantly better (0.74 +/- 0.20; P<.05) compared with Groups 1 and 3 (0.40 +/- 0.24 and 0.38 +/- 0.30, respectively); UCNVA was also significantly better in Group 2 (0.68 +/- 0.08; P<.05) than in Groups 1 and 3 (0.45 +/- 0.21 and 0.41 +/- 0.17, respectively). However, there were no significant differences in patient satisfaction, contrast sensitivity, and UCDVA under glare conditions between the 3 groups (P>.05). CONCLUSIONS: Aiming for emmetropia rather than myopia when calculating the power for the multifocal intraocular lens may improve visual acuity. However, patients must be considered on an individual basis to meet their expectations and requirements.     

Refractive outcomes after bilateral multifocal intraocular lens implantation

PURPOSE: To evaluate the efficacy and safety of bilateral multifocal intraocular lens (IOL) implantation after cataract surgery. SETTING: Oftalmológico de Valencia-CEOVAL, Valencia, Venezuela. METHODS: This retrospective study evaluated patient charts for the patient selection method, preoperative evaluation, surgical technique, postoperative visual and refractive outcomes, and complications. It included 70 eyes of 35 patients who had lens extraction with bilateral implantation of an Array multifocal IOL. Fourteen eyes of 7 patients had hyperopia with presbyopia, and 56 eyes of 28 patients had cataract. RESULTS: All eyes achieved an uncorrected distance acuity of 20/40 or better and an uncorrected near acuity of J5 or better. Six patients (18%) reported moderate halos, and 22 patients (63%) occasionally wore glasses. CONCLUSION: Bilateral multifocal IOL implantation was effective and safe in cataract and hyperopic patients with presbyopia, providing good uncorrected distance and near acuities.     

Phakic refractive lens (Medennium) for correction of +4.00 to +6.00 diopters: 1-year follow-up

PURPOSE: To study the efficacy and safety of phakic refractive lens (PRL) implantation to correct high hyperopia. METHODS: Inclusion criteria for this prospective, observer-masked, interventional study were spherical equivalent > or =+4.00 diopters (D) of cycloplegic hyperopia, best spectacle-corrected visual acuity (BSCVA) > or =0.5, anterior chamber depth > or =3 mm, and mesopic pupil size < or =6 mm. Lenses were implanted in all cases under regional anesthesia using forceps. RESULTS: Sixteen eyes of nine patients were included in the study. Mean preoperative spherical equivalent refraction was +5.65+/-1.41 D (range: +3.25 to +5.75 D). Mean 1-year postoperative spherical equivalent refraction was +0.07+/-0.43 D (range: -0.50 to 0.75 D). Fifteen (93.75%) eyes were within +/-0.50 D of emmetropia, and 16 (100%) eyes were within +/-1.00 D of emmetropia. Safety and efficacy indexes were 0.9 and 0.8, respectively. Eight (50%) eyes needed LASIK to correct residual astigmatism. Five (31.25%) eyes lost one line of BSCVA; no eye lost two or more lines of BSCVA. The BSCVA did not increase in any eye. No significant intraocular complications developed. CONCLUSIONS: Phakic refractive lens implantation to correct high hyperopia seems to be a safe and accurate procedure. A mild but significant loss in BSCVA can be anticipated.     

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.