Monte Carlo simulation of expected outcomes with the AcrySof® toric intraocular lens

Background

To use a Monte Carlo simulation to predict postoperative results with the AcrySof^® Toric lens, evaluating the likelihood of over- or under-correction using various toric lens selection criteria.

Methods

Keratometric data were obtained from a large patient population with preoperative corneal astigmatism <= 2.50D (2,000 eyes). The probability distributions for toric marking accuracy, surgically induced astigmatism and lens rotation were estimated using available data. Anticipated residual astigmatism was calculated using a Monte Carlo simulation under two different lens selection scenarios.

Results

This simulation demonstrated that random errors in alignment, surgically induced astigmatism and lens rotation slightly reduced the overall effect of the toric lens. Residual astigmatism was statistically significantly higher under the simulation of surgery relative to an exact calculation (p < 0.05). The simulation also demonstrated that more aggressive lens selection criteria could produce clinically significant reductions in residual astigmatism in a high percentage of patients.

Conclusion

Monte Carlo simulation suggests that surgical variability and lens orientation/rotation variability may combine to produce small reductions in the correction achieved with the AcrySof^® Toric^® IOL. Adopting more aggressive lens selection criteria may yield significantly lower residual astigmatism values for many patients, with negligible overcorrections. Surgeons are encouraged to evaluate their AcrySof^® Toric^® outcomes to determine if they should modify their individual lens selection criteria, or their default surgically induced astigmatism value, to benefit their patients.     

Clinical outcomes after implantation of extended depth-of-focus AcrySof® Vivity® intraocular lens in eyes with low-grade epiretinal membrane

Graefe's Archive for Clinical and Experimental Ophthalmology - To evaluate the clinical outcomes of extended depth-of-focus (EDoF) AcrySof® Vivity® intraocular lens in eyes with...     

Cataract surgery and intraocular lens implantation in patients with Behçet's disease

PURPOSE: To evaluate the outcome of cataract surgery in patients with Beh?et's disease. METHODS: The results of 27 eyes of 19 patients with Beh?et's disease that had undergone cataract surgery with or without intraocular lens implantation from October 1993 to December 1996 were retrospectively analyzed. The postoperative follow-up period ranged from 13 to 50 months (average, 28 months). FINDINGS: Visual acuity improved postoperatively in 25 eyes, to 20/40 or better in 9 eyes. In 19 eyes, ocular attacks were seen within the preoperative 6 months in 2 eyes, and within the postoperative 6 months in 8 eyes. In 8 eyes, the first ocular attacks occurred within 2 months after the surgery. The frequency of ocular attacks increased after the surgery in 7 patients who received immunosuppressive a gents, with relatively short duration of the disease. CONCLUSION: These results suggest that the frequency of ocular attacks increases after cataract surgery in some patients who use immunosuppressive agents for controlling ocular attacks, even though they had no inflammatory history for a long period before the surgery.     

The results of cataract extraction and intraocular lens implantation in patients with Behçet's disease

PURPOSE: To evaluate the results of extracapsular cataract extraction (ECCE) and intraocular lens (IOL) implantation in patients with Beh?et's disease. METHODS: Retrospective study was based on 19 uveitic eyes of 12 patients with Beh?et's disease who underwent classic ECCE with IOL implantation in 5 eyes and phacoemulsification with IOL implantation in 14 eyes between 1993-1999. RESULTS: In eyes with Beh?et's uveitis 0.5 or better postoperative visual acuity was found in 21% at the end of mean 34.2-4.6 (range 5 to 66) months follow-up. The most frequent postoperative complications were posterior capsule opacification in 9 (47%), posterior synechiae in 5 (26%), anterior synechiae in 3 (16%). Anterior and posterior synechiae in the phacoemulsification group were less than those in the ECCE group (respectively p<0.05 and p<0.01). CONCLUSIONS: In eyes with chronic Beh?et's uveitis, cataract extraction and IOL implantation by phacoemulsification had fewer postoperative complication than ECCE, but most of the patients had low visual acuity due to preoperatively existing optic atrophy and/or inflammatory degeneration or edema of macula.     

【In Press】 Phacoemulsification combined with transpupillary removal of silicone oil and intracapsular intraocular lens implantation

AIM:To evaluate phacoemulsification combined with transpupillary silicone oil removal and foldable intraocular lens (IOL) implantation through corneal incision. METHODS: Candidate patients for intraocular silicone oil removal and cataract extraction underwent combined phacoemulsi?cation and transpupillary drainage of silicone oil through a planned posterior capsulorrhexis and without the use of a pars plana infusion line. RESULTS: The surgery was successfully completed in all eyes. Best corrected visual acuity (BCVA) improved (143 eyes) or stabilized (25 eyes) in all patients at the last follow-up visit. The mean BCVA statistically improved from 20/400±0.02 to 20/100±0.15 (P<0.001) and mean postoperative IOP was 13.85±2.18 mm Hg (P=0.415). No intraoperative complications were reported. CONCLUSION: Combined phacoemulsi?cation and transpupillary drainage of silicone oil is a safe and effective technique. In general, it enables a rapid visual rehabilitation with low complication rate.     

Ocular attacks after phacoemulsification and intraocular lens implantation in patients with Behçet disease

PURPOSE: To elucidate factors related to ocular inflammatory attacks after cataract surgery, limited to a single procedure of phacoemulsification and intraocular lens implantation, in patients with Beh?et disease. METHODS: This retrospective study included 12 consecutive patients (16 eyes) with Beh?et disease, who underwent phacoemulsification and intraocular lens implantation during 4 years from January 1995 to December 1998 at three institutions. Their medical records were reviewed, and factors related to the ocular attacks were analyzed. RESULTS: Four eyes of 3 patients experienced ocular attacks during 1 year before cataract surgery, while 4 eyes of 4 patients developed ocular attacks during 1 year after the surgery. The development of ocular attacks after cataract surgery was significantly related with the presence of ocular attacks during 1 year before the surgery (p = 0.0286, chi(2) test). The patients' age or gender, the duration of Beh?et disease or oral medications for Beh?et disease did not show any relationship with the presence or absence of ocular attacks after cataract surgery. The visual acuity improved in all patients after the surgery, including those who developed ocular attacks. CONCLUSIONS: The experience of ocular attacks during 1 year before cataract surgery is related to postoperative ocular attacks. Despite postoperative ocular attacks, phacoemulsification with intraocular lens implantation is a safe procedure to expect a good visual outcome in patients with Beh?et disease.     

【In Press】Comparison of myopia control between toric and spherical periphery design orthokeratology in myopic children with moderate-to-high corneal astigmatism

AIM: To compare clinical results between toric and spherical periphery design orthokeratology (ortho-k) in myopic children with moderate-to-high corneal astigmatism. METHODS: This retrospective study enrolled 62 eyes of 62 subjects using toric ortho-k lenses. These subjects were assigned to the toric group. Based on the one-to-one match principle (same age, proximate spherical equivalent and corneal astigmatism), 62 eyes of 62 subjects were enrolled and included in the spherical group. At one-year follow-up visit, visual acuity, corneal astigmatism, treatment zone decentration, axial elongation and adverse reaction were compared between these two groups. RESULTS: At the one-year visit, corneal astigmatism was significantly lower in the toric group (1.22±0.76 D) than in the spherical group (2.05±0.85 D) (P=0.012). The mean magnitude of the treatment zone decentration was 0.62±0.42 mm in the toric group and 1.07±0.40 mm in the spherical group (P=0.004). Axial elongation was significantly slower in the toric group (0.04±0.13 mm) than in the spherical group (0.09±0.13 mm) (P=0.001). The one-year axial elongation was significantly correlated with initial age (r=-0.487, P<0.001) and periphery design of ortho-k lens (r=0.315, P<0.001). The incidence of corneal staining was lower in the toric group (8.1%) than in the spherical group (19.4%) (P<0.001). CONCLUSION: Toric periphery design ortho-k lenses may provide lower corneal astigmatism, better centration, slower axial elongation and lower incidence of corneal staining in myopic children with moderate-to-high corneal astigmatism.     

【In Press】Complications and outcomes of descemet stripping automated endothelial keratoplasty with Artisan aphakia intraocular lens implantation

AIM: To evaluate the complications and outcomes of descemet stripping automated endothelial keratoplasty (DSAEK) combined with Artisan aphakia intraocular lens (IOL) implantation in severely damaged eyes without capsular support. METHODS: DSAEK combined with Artisan iris claw IOL implantation was performed on 29 eyes. All eyes were of abnormal structure due to complications from prior intraocular surgeries and ocular trauma. Ocular complications observed included graft dislocations, high intraocular pressure (IOP), IOL dislocations, macular edema, and hyphema. Best-corrected visual acuity (BCVA), IOP, and mean central endothelial cell density (ECD) were recorded. RESULTS: Thirteen eyes had a history of ocular trauma, 10 eyes had an anterior chamber IOL, and 16 eyes had prior vitrectomy. The iris was abnormal in 22 cases. Graft dislocation occurred in 5 (17%) of 29 eyes. IOL dislocation occurred in 2 eyes (6.9%). High IOP was found in 9 eyes and was controlled with treatment. The preoperative mean BCVA was 20/286. The 6mo postoperative mean BCVA was 20/42. The average center ECD was 1965.3 cells/mm2 at 6mo, and the rate of the donor cell loss was 34.7%. CONCLUSION: DSAEK combined with Artisan aphakia intraocular lens implantation is an alternative option for resolving endothelial and lens disorders in aphakic eyes without capsular support. However, it should be performed cautiously for eyes with severe iris defects.     

Is assessment of complications following intra- and extracapsular cataract extraction with lens implantation biased?

Extracapsular Cataract extraction with implantation of a posterior chamber lens has become the standard procedure in cataract surgery. Excellent results are accomplished with this method. It is remarkable, however, that there are scarcely any data about the rate of complications, e.g. capsular fibrosis with the necessity of YAG-laser-capsulotomy and its sequelae. Similarly, data on decentration of the lens, its consequences and correction are rare. The arguments against ICCE with implantation of a Choyce-Mark-IX anterior chamber lens like higher rate of retinal detachment, cystoid macular edema and corneal decompensation can not be confirmed by us on the basis of prospective clinical studies. With an appropriate operation technique equivalent results can be obtained as in ECCE. The debates about cataract surgery are carried out more on the basis of clinical impressions than on the basis of thorough scientific data. Surgery should not be a matter of "trends".     

Visual results and complications of primary intraocular lens implantation in infants aged 6 to 12 months

Background  

To present the visual results and the complications of primary intraocular lens (IOL) implantation in infants aged 6 to 12 months between January 2002 and July 2007.     

Characteristics of posterior corneal astigmatism and aberration in cataract patients with high myopia北大核心CSCD

Objective: This study was to investigate the characteristics of posterior corneal astigmatism (PCA) and aberration in cataract patients with high myopia. Methods: A retrospective study was designed. Two hundred and eighty-two eligible eyes of 190 cataract patients were enrolled in Eye and ENT Hospital of Fudan University from September to December, 2014.The eyes were classified into two groups according to axial length (AL): high myopia group with 139 eyes (AL≥26 mm) and control group with 143 eyes (AL was 20 to 25 mm). The mean keratometric mid-radius of curvature (Km), corneal central thickness (CCT), astigmatism and aberrations were measured by the rotating Scheimpflug System (Pentacam), and the AL were measured by the partial coherence interferometry (IOL Master). This study followed the Helsinki declaration, and was approved by the Ethic Committee of Eye and ENT Hospital, Fudan University. Informed consent was signed from each patient. Results: In high myopia group, the mean PCA was 0.3 D (range 0~0.9 D) and 92.8% eyes had PCA values <0.5 D. The steep corneal meridian was aligned vertically (60°~120°) in 87.1% eyes for the posterior corneal surface. There was no significant difference in PCA between the high myopia group and the control group (P=0.797). Significant positive linear correlations was found between PCA and anterior corneal astigmatism (ACA), PCA and anterior corneal root mean square (RMS), PCA and anterior lower-order RMS, PCA and posterior corneal RMS, PCA and posterior high-order RMS, PCA and posterior lower-order RMS (r=0.235, P=0.005; r=0.217, P=0.010; r=0.229, P=0.007; r=0.395, P=0.000; r=0.243, P=0.004; r=0.384, P=0.000). Compared with total corneal astigmatism (TCA), anterior corneal measurements overestimated with-the-rule astigmatism (WTR) by a mean of (0.27±0.18)D in 65.67% eyes, underestimated against-the-rule astigmatism (ATR) by (0.27±0.18)D in 88.10% eyes and underestimated oblique astigmatism (Obl) by (0.22±0.10)D in 63.33% eyes. Compared with total corneal aberrations, anterior corneal aberrations measurements overestimated by (0.275±0.176)μm in 87.05% eyes, and the anterior corneal astigmatism types had no effect on the result. Conclusions: In high myopia group, 92.8% eyes had PCA values <0.5 D and the main astigmatism type in posterior corneal surface was ATR. The posterior corneal astigmatism and aberration were needed to consider in choosing intraocular lens (IOL) before cataract surgery. Copyright © 2018 by the Chinese Medical Association.     

【In Press】 Comparison of visual outcomes with implantation of trifocal versus bifocal intraocular lens after phacoemulsification: a Meta-analysis

AIM: To compare a trifocal intraocular lens (IOL) and a bifocal IOL implantation in improving visual function after cataract surgery. METHODS: Eligible literatures were systematically searched through EMBSE and PubMed databases. The inclusion criteria were prospective comparative clinical trials on cataract surgery comparing trifocal IOL with bifocal IOL implantation that assessed visual acuity, contrast sensitivity and subjective vision quality. The effects were computed as standardized mean differences and pooled using fixed-effect or random-effect models. RESULTS: Four prospective randomized controlled trials (RCTs) and five cohorts provided data and were included by a systematic review, comprising 265 eyes implanted with trifocal IOLs and 264 eyes implanted with bifocal IOLs. Monocular distance visual acuity (VA) showed a statistically significant but small difference that favored trifocal IOLs (MD=-0.06; 95%CI, -0.10 to -0.02; Z=2.90, P=0.004 for UDVA and MD=-0.02; 95%CI, -0.03 to -0.00; Z=2.02, P=0.04 for CDVA), but the data did not suggest that the effect of trifocal IOL implantation would clinically outperform bifocal IOL implantation. There was no significant difference in monocular near VA (MD=-0.01; 95% CI, -0.07 to 0.04; Z=0.42, P=0.68 for UNVA, and MD=-0.01; 95% CI, -0.06 to 0.03; Z=0.55, P=0.58 for DCNVA) or refraction between two groups. Contrast sensitivity and subjective visual quality had no conclusive results. CONCLUSION: All results indicate that trifocal IOL and bifocal IOL had similar levels of monocular distance and near visual acuities. Besides, contrast sensitivity and subjective visual quality have no conclusive results.     

【In Press】 Short and long-term outcomes of angle supported phakic intraocular lens implantation in high myopic eyes

This cohort study included 36 eyes of 21 patients with high myopia treated with angle supported phakic intraocular lens (pIOL). Endothelial cell density (ECD) at baseline, 6mo and 3y were 3017±296, 2775±265 and 2558±299 cells/mm2 respectively. ECD loss at 6mo was 7.2% and annual ECD loss was 3% over three years. Corrected distance visual acuity (CDVA) at 3y was 0.4 logMAR in 32 (88%) eyes. Intraocular pressure did not change (p=0.9). No eyes developed cataract, retinal detachment or pupillary distortion. Angle supported pIOL gives good visual outcome. Endothelial cell loss should be monitored.     

【In Press】Regarding successful use of 23G cutter for anterior vitrectomy and scleral-fixated intraocular lens implantation

Comment and response