Desarrollo de los lentes intraoculares para la cirugía de catarata por facoemulsificación / Development of intraocular lenses for phacoemulsification cataract surgery

RESUMEN La tecnología de los lentes intraoculares se desarrolla constantemente, por las necesidades visuales cada vez mayores de los pacientes después de operados de catarata; de ahí que nos propusimos realizar una búsqueda acerca de los diferentes modelos de lentes, como los monofocales, los bifocales, los trifocales, los trifocales tóricos y los de foco extendido. Esta nueva tecnología exige exámenes preoperatorios cada vez de más calidad y precisión, para que los resultados quirúrgicos respondan al concepto de cirugía refractiva del cristalino, por lo que concluimos que en el futuro la tecnología de las lentes intraoculares debe estar encaminada a recuperar la visión funcional. En este sentido, cada uno tiene puntos fuertes y débiles; por lo tanto, no hay una solución universal. Se debe crear un reporte de las ventajas y desventajas para trabajar en los puntos a mejorar, sobre todo en la estandarización de la curva de desenfoque, el modulation transfer function y la sensibilidad al contraste, así como trabajar conjuntamente entre los pacientes, cirujanos y fabricantes(AU)

ABSTRACT Intraocular lens technology is in a process of permanent development, due to the increasing visual needs of patients undergoing cataract surgery. That is why we set out to do a search about the different lens models of lenses are offered, including the monofocal, bifocal, trifocal, toric trifocal and extended focus types. This new technology requires rigorous and accurate preoperative tests, so that surgical results respond to the concept of refractive crystalline lens surgery. We therefore conclude that future intraocular lens technology should be aimed at recovering functional vision. Each of the lens types has its own strengths and weaknesses, and so a universal solution does not exist. A report should be developed of advantages and disadvantages, so that work can be done on aspects requiring improvement, mainly the standardization of the improper focusing curve, the modulation transfer function and contrast sensitivity, as well as the implementation of actions to be performed jointly by patients, surgeons and manufacturers(AU)

Therapeutic effects of phacoemulsification respectively combined with diffractive multifocal IOL and monofocal IOL implantation in the treatment of cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the therapeutic effects of phacoemulsification respectively combined with diffractive multifocal intraocular lens(IOL)and monofocal IOL implantation in the treatment of cataract. <p>METHODS: A total of 99 cataract patients(145 eyes)who underwent phacoemulsification combined with IOL implantation in the hospital from January 2015 to February 2019 were divided into observation group(<i>n</i>=51, 75 eyes)and control group(<i>n</i>=48, 70 eyes)according to the non-randomized clinical trial and patient voluntary principles. The observation group was treated with diffractive multifocal IOL implantation, while the control group was treated with monofocal IOL implantation. The visual acuity, corneal endothelial cell count, loss rate of corneal endothelial cells, results of corneal topography, and contrast sensitivity(CS)in daytime, day glare time, nighttime and night glare time were compared between two groups. The complications and spectacles-independent rate were counted. <p>RESULTS: At 1wk, 1mo and 3mo, there were no significant differences in the best corrected distance visual acuity(BCDVA)and best corrected near visual acuity(BCNVA)between two groups(<i>P</i>>0.05). However, the uncorrected distance visual acuity(UCDVA)at 1wk and 1mo, the uncorrected near visual acuity(UCNVA)and the distance corrected near visual acuity(DCNVA)at 1wk, 1mo and 3mo of the observation group were significantly lower than those of the control group(<i>P</i><0.05). After surgery, corneal endothelial cell counts and astigmatism of two groups decreased significantly. No significant differences were found in corneal endothelial cell count, loss rate of corneal cells and astigmatism between two groups(<i>P</i>>0.05). CS in daytime of 1.5c/d frequency band, in day glare time of 1.5c/d, 3c/d and 6c/d frequency bands, in nighttime of 3c/d and 18c/d frequency bands, in night glare time of 3c/d, 6c/d and 18 c/d frequency bands were significantly lower, while CS in daytime of 12c/d frequency band was significantly higher in the observation group than in the control group. There was no significant difference in the incidence of complications between two groups(<i>P<</i>0.05), but the spectacles-independent rate was significantly higher in the observation group than in the control group(<i>P</i><0.05). <p>CONCLUSION: Phacoemulsification combined with diffractive multifocal IOL implantation can obtain good total range visual acuity, with a higher spectacles-independent rate and relatively low CS after surgery.

Full range of vision and pseudoaccommodation in early stage after multifocal intraocular lens implantation / 眼科新进展

Objective To evaluate the clinical effectiveness and pseudoaccommodation in the early stage after AcrySof ReSTOR multifocal intraocular lens (IOL) and monofocal IOL implantation.Methods A total of 138 patients (158 eyes) with age-related cataract underwent phacoemulsification and IOL implantation were chosen,73eyes of 60 patients with a multifocal IOL implantation as observation group and 85 eyes of 78 patients with monofocal IOL implantation as control group.The uncorrected visual acuity,best corrected visual acuity was evaluated at 1 week,1 month,and 3 months after operation,pseudoaccommodation and quality of life was evaluated at 3 months after operation.Results The patients of both observation group and control group were able to obtain a satisfactory distance vision at 1 week,1 month,and 3 months.The uncorrected intermediate visual acuity of observation group were 0.49 ± 0.19,0.72 ± 0.21,0.77 ±0.23,which of control group were 0.24 ± 0.21,0.27 ± 0.22,0.28 ± 0.24,there were statistical differences between two groups (all P ＜ 0.05).The uncorrected near visual acuity of observation group were 0.47 ± 0.20,0.70 ± 0.22,0.80 ± 0.24,which of control group were 0.21 ±0.23,0.23 ±0.19,0.26 ±0.18,there were statistical differences between two groups (all P ＜ 0.05).There was no significant difference in the uncorrected near visual acuity,best corrected distance,intermediate and near visual acuity between observation group and control group (all P ＞ 0.05).At 3 months,the distance and near pseudoaccommodation of observation group were (2.56 ± 0.82) D,(3.19 ±1.13)D,which of control group were (0.87 ±0.57)D,(1.03 ±0.59) D,there were statistical differences between two groups (all P ＜ 0.05).At 3 months,VF-14 scale score and wearing glasses as near score of observation group were 92.21 ±4.22,4.23 ±0.85,which of control group were 71.23 ± 3.96,2.01 ± 0.71,there were statistical differences between two groups (all P ＜ 0.05).Conclusion AcrySof ReSTOR multifocal intraocular lens implantation can provide a higher level of visual acuity,pseudoaccommodation and satisfaction compared with monofocal intraocular lens.

Monovisión con lente intraocular monofocal en pacientes présbitas / Monovision with monofocal intraocular lens in prebyopic patients

OBJETIVO: Describir los resultados refractivos obtenidos mediante la cirugía del cristalino en pacientes présbitas hipermétropes y miopes con monovisión. MÉTODOS: Se realizó un estudio descriptivo, prospectivo, longitudinal con 21 pacientes, 13 miopes y 8 hipermétropes sometidos a cirugía del cristalino para corregir la presbicia con el método de la monovisión en el Servicio de Microcirugía del Instituto Cubano de Oftalmología Ramón Pando Ferrer entre febrero del 2009 y febrero del 2010. Las variables utilizadas fueron: agudeza visual con corrección preoperatoria y posoperatoria y sin ella, lejos y cerca, y equivalentes esféricos. Se utilizó la media y desviación estándar para presentar la información. RESULTADOS: En el preoperatorio la agudeza visual promedio mejoraba de un valor de 0,7 y 0,9 corregida para miopes e hipermétropes respectivamente a 0,88 y 0,94 de agudeza visual binocular sin corrección para estos mismos grupos en el posoperatorio, corrigiendo de esta manera equivalentes esféricos promedios de -8,27 D y +6,26 D en cada grupo. La agudeza visual cercana promedio para ambos grupos fue de Jeager 2 y los equivalentes esféricos promedios alcanzados para visi¾n lejana fueron de -0,32 D para miopes y +0,26 D para hipermétropes; en visión cercana, o sea, en el ojo no dominante es de -1,6 D para el primer grupo y -1,3 D para el segundo grupo. CONCLUSIONES: Se halló mejoría indudable de la agudeza visual sin corrección tanto para la visión lejana como para la cercana después de la cirugía. Los equivalentes esféricos fueron ampliamente modificados para ambos grupos tanto en los ojos dominantes como en los no dominantes para facilitar el resultado visual en ambas distancias. Los resultados obtenidos corroboran que la monovisión produce un mayor beneficio en la visión cercana que el perjuicio que provoca en la visión lejana lo que la hace muy exitosa para cierto grupo de pacientes

OBJECTIVES: To describe the refractive results achieved in presbyopic patients, both hyperopic and myopic, with monovision METHODS: A prospective, longitudinal and descriptive study was carried out in 21 patients, 13 myopic and 8 hyperopic, who underwent lens surgery to correct presbyopia based on the monovision procedure at the Microsurgery Service of the Ramón Pando Ferrer Cuban Institute of Ophthalmology from February 2009 to February 2010. The variables were pre and postoperative visual acuity with/without correction, both near and distant, and spheral equivalents. Mean and standard deviation values were used to present all variables. RESULTS: It was found that average visual acuity with correction improved from 0,7 and 0,9 in myopic and hyperopic patients respectively to 0,88 and 0,94 of binocular visual acuity without correction in the postoperative phase, thus correcting their average spheral equivalents of 8,27 diopters (D) and +6,26 D in each group. The average visual acuity for near vision for both groups was Jeager (J) 2 and the average spheral equivalents reached for distant vision were -0,32 D for myopic and +0,26 D for hyperopic patients. For near vision, i.e. in the non- dominant eye, the spheral equivalent values were 1,6 D for the first group and 1,3 D for the second group. CONCLUSIONS: After surgery there was an undoubted improvement in visual acuity without correction, in near as well as in distant vision. Spherical equivalents were widely modified for both groups in both the dominant and the non-dominant eye, improving vision at both distances. The achieved results corroborate that the benefits brought about by monovision in near vision are more important than the damages it causes in distant vision, making it very successful for certain groups of patients

Comparison of Optical Aberrations and Contrast Sensitivity between Monofocal and Multifocal Intraocular Lens

PURPOSE: The purpose of this study was to compare the postoperative contrast sensitivity and optical aberration between monofocal and multifocal IOL implanted patients. METHODS: Postoperative contrast sensitivity and optical aberration were measured for 7 cataract patients, 12 eyes that underwent monofocal IOL implantation and for 8 cataract patients, 9 eyes that underwent multifocal IOL implantation. Phacoemulsification was conducted on all patients prior to either multifocal or monofocal IOL implantation, and Multivison Contrast Tester (MCT 8000, Vistech, Dayton, U.S.A.) and WaveScan WavefrontT M system (VISX, Santa Clara, U.S.A.) were used to measure contrast sensitivity and optical aberration. RESULTS: Under the nighttime contrast sensitivity mode, the multifocal-group displayed a statistically significant decrease in contrast sensitivity compared to the monofocal-group (P< 0.01), while there was no statistical difference in the optical aberration index of the two groups. (the multi-group; 0.36, the monogroup; 0.31, p=0.64) CONCLUSIONS: After cataract extraction, there was no difference in the optical aberration between the multifocal IOL implantated patients and the monofocal IOL implanted patients. The decrease in postoperative contrast sensitivity was subjectively greater for multifocal IOL implantated patients than the monofocal IOL implanted patients.