Clinical Outcome of in-the-Bag Single-Piece Aspheric Intraocular Lens Implantation after Microincision Cataract Surgery

PURPOSE: To evaluate the stability and optical performance of the newly developed single-piece aspheric intraocular lens (IOL) by comparing the clinical outcome of the aspheric IOL with the new optic profile design (HOYA iSert, HOYA iMics) and the aspheric IOL (Akreos MI60), which has been proven effective and safe. METHODS: iSert, iMics, and MI60 were inserted into 55 eyes, 60 eyes, and 50 eyes, respectively, after microincision phacoemulsification cataract surgery. Best corrected visual acuity (BCVA), refraction in spherical equivalent, anterior chamber depth (ACD), total higher order aberration (HOA), contrast sensitivity, and surgically induced astigmatism (SIA) were measured and each IOL was evaluated on the functional stability, anterior-posterior stability, centration in the capsular bag, and quality of vision. RESULTS: No statistical differences in preoperative and postoperative BCVA among the 3 IOL groups were observed, however, MI60 showed significant myopic shift postoperatively. Anterior-posterior stability assessed with postoperative change in refractive error and ACD was slightly lower in the MI60 group. In terms of vision quality, while total aberration, total HOA, coma aberration, and contrast sensitivity for the 3 IOLs were not different significantly, spherical aberration of the MI60 group was higher than the other groups at 6 months postoperative. SIA was significantly increased in eyes implanted with iSert than in eyes with iMics or MI60 at 1 month postoperatively, however, the differences were no longer evident after 3 months postoperatively. CONCLUSIONS: The new aspheric IOLs, iSert and iMics, showed good stability and visual outcome equal to MI60 at the 6-month postoperative follow-up.

Visual Function and Patient Satisfaction in Pseudophakic Monovision

PURPOSE: To evaluate visual performance as well as patient satisfaction and to explore factors associated with clinical outcomes in pseudophakic monovision acquired after bilateral phacoemulsification and sequential monofocal intraocular lens (IOL) implantation. METHODS: The present retrospective study examined patients with pseudophakic monovision. Preoperative and postoperative binocular uncorrected distant visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), refractive errors and postoperative near stereopsis were measured. Postoperative measurements were obtained at least 6 months after the fellow eye surgery. Patient satisfaction and independence from glasses were evaluated using a questionnaire. RESULTS: Preoperative and postoperative binocular UCDVA, UCNVA, and differences in spherical equivalent refractive error were statistically significant. Postoperative near stereopsis was 107.1 arcsec. Questionnaire responses showed that 71.4% of patients were less dependent on glasses and 85.7% were satisfied with the postoperative visual performance. Various designs of monovision, such as crossed monovision or customized minimonovision with moderate myopic defocus showed the same level of patient satisfaction. Patients who were older than 60 years or had poorer preoperative binocular UCDVA showed higher satisfaction. CONCLUSIONS: Pseudophakic monovision is an effective approach for managing loss of accommodation after cataract surgery, especially in patients older than 60 years.

One-year Outcome of Monocular Implant of Aspheric Multifocal IOL

PURPOSE: To evaluate near and far visual acuity, subjective visual symptoms, and patient satisfaction with a monocular implant of aspheric multifocal IOL (AMO Tecnis ZM900(R)). METHODS: Thirty eyes of 30 patients received phacoemulsifications and monocular implantation of Tecnis ZM900 IOL. The main outcome measures at postoperative 1 week, 1 month, 3 months, and 1 year were uncorrected and corrected near and distant visual acuity, refractory errors, contrast sensitivity, subjective visual symptoms (glare and halo), spectacle independency, and satisfaction. RESULTS: At a 3 month postoperative visit, the mean uncorrected near and distant visual acuities were 0.29+/-0.17 (logMAR) and 0.16+/-0.12 (logMAR),respectively. At 1 year, the mean uncorrected near and distant visual acuities were 0.25+/-0.17 (logMAR) and 0.11+/-0.08 (logMAR). Glare and halo decreased, and contrast sensitivity increased upon 1-year follow-up after monocular implantation of ZM900. Most patients (87%) were satisfied with their visual outcome. CONCLUSIONS: Monocular implantation of multifocal IOL Tecnis ZM900 shows stable surgical outcomes with a high satisfaction rate and enables a high rate of spectacle independency. Postoperative glare and halo, youth, and residual refractive error could be risk factors for dissatisfaction with monocular implantation of multifocal IOL Tecnis ZM900. Proper patient selection can lead to satisfying outcomes.