Long-term experience with mixing and matching refractive array and diffractive CeeOn multifocal intraocular lenses.

PURPOSE: To compare visual performance of the refractive Array SA40N and the diffractive CeeOn 811E multifocal intraocular lenses (IOLs) and to evaluate the potential benefits of combining both multifocal IOLs in the same patient. METHODS: Two groups of cataract patients were unilaterally implanted with either the CeeOn diffractive (n = 10) or the Array refractive multifocal IOL (n = 10). Another group was bilaterally implanted with one of each multifocal IOLs (mix & match group, n = 10). Visual acuity, spectacle independence, depth of focus, contrast sensitivity, presence of photic phenomena, and patient satisfaction were assessed postoperatively. RESULTS: All eyes achieved good distance visual acuity but better uncorrected near vision was achieved with the CeeOn diffractive design. Contrast sensitivity with either multifocal IOL was at the lower limit of the normal range but when multifocal IOLs were combined in the same patient, contrast sensitivity was not significantly different from phakic controls. Defocus curves revealed a superiority of CeeOn diffractive design for near and Array refractive design for intermediate but mix & match patients performed better overall than the other patients, particularly for intermediate distances, which was reflected by total independence from spectacles in 90% of patients compared to 60% in the other groups. Visual outcomes remained unchanged over time (1 month vs 6 month vs > 3 years). CONCLUSIONS: Bilateral implantation with a diffractive multifocal IOL in one eye and a refractive multifocal IOL in the fellow eye is safe and could provide patients with better intermediate vision, increased depth of focus and contrast sensitivity, and also less dependence on spectacles.

Disappointment of patients on antidepressant therapy after excimer laser treatment.

We describe 2 patients who were receiving antidepressant therapy before excimer laser surgery, at the time of surgery, and after surgery. Both patients experienced the ocular side effects of antidepressant drugs, ie, symptoms due to dry eyes and mydriasis.

Intraocular lens haptic fracturing with the neodymium:YAG laser In vitro study.

PURPOSE: To determine the neodymium:YAG (Nd:YAG) laser energy threshold to fracture the haptic of various currently marketed intraocular lenses. SETTING: Dokuz Eylul University, Ophthalmology Department, Izmir, Turkey. METHODS: Four haptic materials-poly(methyl methacrylate) (PMMA), hydrophobic acrylic, hydrophilic acrylic, and polyvinylidene fluoride-were tested. The intraocular lenses (IOLs) were grouped according to haptic material. Each group comprised 9 IOLs. Beginning laser energy was 4 mJ. If no crack was noted, energy was increased by 0.5 mJ at every 20 shots and the procedure continued until a fracture was noted. If the fracture could not be developed despite reaching an energy level of 10 mJ, the procedure was terminated. Statistical analysis was performed to determine the differences within groups. RESULTS: Hydrophobic acrylic and polyvinylidene fluoride haptics required higher energy and more laser shots to create a fracture than hydrophilic acrylic and PMMA haptics. CONCLUSIONS: Neodymium:YAG laser haptic fracturing can be a viable option to cut the fibrosed haptic before explanting any IOL. It was demonstrated in vitro that it is easier to fracture hydrophilic acrylic and PMMA haptics than hydrophobic acrylic and polyvinylidene fluoride haptics.

Staining of vitreous with triamcinolone acetonide in retained lens surgery with phacofragmentation.

PURPOSE: To evaluate the beneficial effects of triamcinolone-assisted vitrectomy during management of retained nuclei with phacofragmentation. SETTING: Dokuz Eylul University, Medical Faculty, Ophthalmology Department, and Retina Eye Center, Izmir, Turkey. METHODS: Twelve eyes of 12 patients were operated on between January 2002 and September 2003. Eleven patients were referred because of nucleus drop during phacoemulsification surgery. Six of these patients had mature white cataracts, and in 5 cases total nucleus luxation into vitreous cavity had occurred. In 1 case, approximately half of the nucleus was luxated. Five of the referred patients had pseudoexfoliation (PEX), 3 of whom also had phacodonesis. All of these patients had luxated nucleus segments of more than half. One patient was referred with an intraocular lens (IOL) implanted in the sulcus region. One patient who was not referred also had PEX, iridodonesis, and phacodonesis; total drop of nucleus had occurred in this case. All patients were treated with pars plana vitrectomy with triamcinolone acetonide staining of the vitreous material and phacofragmentation of the dropped nucleus segments. In 2 cases, transscleral foldable IOL fixation surgery was combined simultaneously. One patient already had an IOL at the time of referral. Nine patients were left aphakic for secondary procedures. RESULTS: All patients except 1 with subretinal neovascular membrane achieved best corrected visual acuities of equal or better than 0.5. No intraoperative or postoperative retinal complications were observed after 9 to 15 months of follow-up. CONCLUSION: Staining of the vitreous material with triamcinolone acetonide during vitrectomy and phacofragmentation surgery for luxated nuclei helped in total removal of the vitreous body, thus preventing the aspiration of peripheral vitreous fibrils by the phaco tip, which might induce retinal detachment intraoperatively or postoperatively.

Microincisional cataract surgery and Thinoptx rollable intraocular lens implantation.

BACKGROUND: Microincisional cataract surgery is a safe procedure with a very short learning period for an experienced cataract surgeon and rollable ultrathin intraocular lenses eliminate the need for enlargement of corneal incision. The purpose of the study was to evaluate the safety and efficacy of cataract surgery through a corneal microincision and implantation of rollable ultrathin intraocular lenses. The setting was Dokuz Eylul University Medical Faculty, Ophthalmology Department, Izmir, Turkey and SSK Okmeydani Hospital, Ophthalmology Clinic, Istanbul, Turkey. PATIENTS AND METHODS: Ninety eyes in 85 patients were operated on through clear corneal microincisions with sleeveless phacoemulsification and rollable intraocular lenses were implanted. Forty-six of the patients were men and 39 were women between the ages of 27 and 83, with a mean of 51 years. Two eyes had atrophic senile macular degeneration, 4 eyes had nonspecific retinal pigment epithelial changes with chorioretinal atrophy, and 4 patients had diabetes mellitus without retinopathy. Three eyes had posterior capsular opacifications of unknown etiology. Two eyes had primary open angle glaucoma (PAAG) with cup to disc ratios of about 0.5. Three eyes had dense nuclear sclerosis of grade 4 with very low visibility of retinal structures. Other patients had no ocular or systemic pathology other than nuclear/corticonuclear cataract of grade 2-3. Uncorrected and best spectacle-corrected distance and near visual acuities, keratometric values, and refractive status were noted preoperatively and 1 week, 1 month, and 6 months postoperatively. Statistical analysis of keratometric changes between preoperative and postoperative findings was performed using the paired samples t test. RESULTS: At 6 months postoperatively, 1 patient had a best spectacle-corrected visual acuity (BSCVA) of 0.2, the patient with atrophic senile macular degeneration. The rest of the eyes achieved a BSCVA of 0.63 or better. At 6 months postoperatively, 55 (61.11%) eyes had uncorrected visual acuities (UCVA) equal to or better than 0.8 and 83 (92.22%) eyes had BSCVA equal to or better than 0.8 according to the Snellen chart. The mean postoperative corneal astigmatisms at 1 week, 1 month, and 6 months were 0.69+/-0.43 D, 0.66+/-0.46 D and 0.65+/-0.48 D respectively. Statistical analysis revealed a significant change in corneal astigmatisms at the 1st week visit (p<0.05), but not at the 1st and 6th month visits (p>0.05) compared with preoperative findings. CONCLUSION: Based on the limited data in the literature and in this study, it is not possible to make concrete decisions about the benefits and disadvantages of the ThinOptx IOL for longer durations. Intraoperatively, this IOL apparently eliminates the need for enlargement of the corneal incision during implantation. However, the statistical insignificance of induced astigmatisms after microincisions and classical phacoincisions should also be taken into consideration. We conclude that ThinOptx IOL is a pioneering intraocular lens implant that will contribute to the exciting future of cataract refractive surgical procedures. However, both clinical and laboratory investigations are needed to clearly describe the long-term effectiveness of this new rollable IOL.

Microbial growth in various perfluorocarbon liquids.

A prospective in vitro study was conducted to investigate the potential for various perfluorocarbon liquids to support the growth of microbes, which may be introduced into these liquids as contaminants during intraocular surgery. Perfluorodecaline, perfluoro-noctane, and perfluorophenanthrene were tested for the growth of Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans by using tryptone soy broth, pancreatic digest of casein, and Sabouraud broth as culture media for up to 10 days. No microbial growth was observed in any of these perfluorocarbon liquids. Perfluorocarbon liquids do not promote microbial growth. Thus, they do not increase the risk of endophthalmitis in vitreoretinal surgery.