Evaluation of an accommodating intraocular lens

Introduction: Conventional intraocular lenses [IOLs] that focus light at a fixed distance provide excellent visual outcomes in most patients who have cataract extraction. However, most patients require reading glasses or bifocals for near vision, Steinert et al, [1999]. Replacing the natural lens with a multifocal intraocular lens that provides multiple focal distances for both near and distance vision offers an alternative to patients who need near vision correction after cataract surgery, Wolffsohn, et al. [2006]. The optical quality of the retinal image is worse than the retinal image produced with a monofocal IOL. The loss of image quality can affect visual performance and has led to an interest in alternative modalities for correcting near vision in pseudophakic patients, Steinert et al, [1999]. By using the new accommodating IOLs, ophthalmic surgeons will be able to provide a full range of visual focus in each eye of a patient to maintain binocular function while also avoiding visual disturbances that are experienced with monovision and multifocal IOLs, Doane [2004] . The Crystalens AT-45 [Eyeonics], is an accommodating, foldable, multi-piece plate shaped IOL. [Eyeonics Crystalens fact sheet]

Aim of the work: This research was designed to study the efficiency of the foldable accommodating IOL; Crystalens [AT-45] in the restoration of both distant and near visual acuity after phacoemulsification. Also, assessment of the IOL's possible displacement during accommodation and the accompanying modifications of the ciliary body and anterior chamber depth by using ultrasound biomicroscopy [UBM]

Patients and methods: This study comprised twenty five eyes of 25 patients [12 females and 13 males]. Patients had no preexisting ocular conditions other than cataract. All patients were subjected to phacoemulsification and Crystalens AT-45 [Eyeonics Inc.] implantation. All patients were above 45 years old and expressed a preference for spectacle independence. Postoperatively, measuring the monocular distant visual acuity [uncorrected and best corrected] and visual acuity for near [uncorrected, through a distance correction and best corrected with near add] were done. UBM was used to examine the anterior chamber depth and the shift of the IOL along the visual axis in response to ciliary muscle pharmacological stimulation

Results: The mean age was 52.23 +/- 5.3 years [Ranged from 45 to 65 years]. All surgeries were uneventful with no complications or adverse events. The mean preoperative decimal uncorrected visual acuity [UCVA] was 0.08 + 0.05. The mean preoperative best corrected visual acuity [BCVA] was 0.1 +/- 0.06. After 6 months follow up, the mean postoperative UCVA was 0.52 +/- 0.17; BCVA was 0.94 +/- 0.18. The mean uncorrected near visual acuity [UCNVA] was J5; distance corrected near visual acuity [DCNVA] was J5. The mean Add near correction was +/- 1.58 +/- 0.21 D. The mean postoperative anterior chamber depth was 4 mm +/- 0.55 and after pharmacological stimulation with 2% Pilocarpine, the mean depth was 3.5 +/- 0.35mm. The amplitude of accommodation was calculated by both an objective and subjective methods. The mean postoperative amplitude of accommodation was 0.91 +/- 0.27 D. Faint opacification was observed in 3 eyes at the first month postoperatively, and in 8 eyes at six months postoperatively

Conclusions: Accommodating IOL provides patients with excellent visual acuities both for distance and near. It should be considered to allow cataract patients to be spectacle independent. We have the clinical impression that the degree of pseudophakic accommodation provided with Crystalens is useful for patients' daily life. The accommodation range depends on the displacement of optic which is controlled by the range of ciliary body effect [contraction and anterior rotation]

Frontalis sling using expanded poly tetra fluoro ethylene [EPTFE] material through an open approach

Purpose: To evaluate the proposed material [EPTFE] and approach as a suitable alternative for the correction of poor levator function ptosis

Method: Twenty-one eyes with unilateral and bilateral poor levator function ptosis were subjected to the proposed frontalis sling procedure using an open approach with internal fixation using EPTFE material. Follow up ranged 1 year to 3 years

Result: All cases showed functional improvement with an average increase of 2.7 mm in palpebral fissure measurements. Regression of results was documented up to 3 months postoperative, after which lid height seemed to stabilize. No cases of slippage, extrusion or granuloma formation were encountered

Conclusion: EPTFE material, internally fixated through an open approach is a reliable and effective alternative to other materials used with conventional closed frontalis sling approach

simple and safe capsular stainer

Continuous curvilinear capsalorhexis [ccc] in cataracts without red reflex offers a difficulty and challenge to the cataract surgeons due to poor visibility. Different techniques have been developed to solve the problem. The capsular staining using different stains like fluorescein sodium. Indocyanin green, trypan blue and gentian violet helps in better visualization. However the toxicity of these dyes has not been completely excluded So. in order to minimize these effects, the minimal amount of these dyes with the least concentration must be used. A new capsular stainer has been developed which utilizes the idea of a simple dropper is presented by which a microdrop of the stain is relieved above the anterior capsule before dispersing it forming a homogenous layer of stain. This newly designed instrument has the advantages of being completely controllable, using only one hand with the least amount of dye[s] and best quality capsular staining preventing the unavoidable excessive staining of the ocular tissues met with when an ordinary insulin syringe has been used

Comparison between different methods of subincisional cortex removal in phacoemulsification

This work compares between 4 methods used for removal of the subincisional cortex in phacoemulsification including the use of the standard irrigation aspiration [I/P] tip of the machine, the use of curved tips, the use of bimanual technique and lastly removal after putting the implant using It to dislodge the cortex before aspiration. 56 eyes in which phacoemulsification was chosen for removal of their cataracts and in which the procedure was completed till the end were devided randomly to 4 groups, in the first, the standard I/A probe was used and in the second, a curved one had been used while a reusable I/A bimanual set was utelized in the third group. Latsly, removal was completed after putting the I O.L. in the bag and using it to dislodge the remnants of the cortex and then aspirating them. The bimanual technique used in the third group proved to be easier, faster with less incidence of posterior capsule injury followed by using the curved tips and then the use of the implant to dislodge the material. Lastly, the use of the standard I/A tips in the first group was found to be the least satisfactory. The use of the bimanual technique in removing the subincisional cortex utelizing the side ports is very effective, faster with the least complications