Clinical outcomes of the piggyback secondary implantation of a novel multifocal lens in the ciliary sulcus: A case series.

PURPOSE: Evaluate the clinical outcomes of the secondary piggyback add-on IOL implantation in the ciliary sulcus for pseudophakic patients previously implanted with a monofocal IOL, who pursue a spectacle-free option after IOL surgery. METHODS: A prospective case series including seven pseudophakic patients who underwent an in-the-bag monofocal IOL implantation. All eyes underwent a piggyback IOL implantation of the new sulcus designed A4 AddOn IOL in the ciliary sulcus as a secondary procedure for pseudophakic patients pursuing a spectacle-free option for near and intermediate distance after IOL surgery. RESULTS: Seven eyes from six patients were included in this study, from which 4 (71.43%) were female, with a mean age of 58.33 ± 3.5 years (range 54-63; 95% CI 54.66, 62.01). The postoperative spherical equivalent at the 3-month visit was -0.10 m ± 0.82. Also, the UDVA was 0.11 ± 0.08 logMAR, the UIVA 0.01 ± 0.03, and the UNVA 0.01 ± 0.03 3 months after their surgical procedure. CONCLUSIONS: The A4 AddOn multifocal IOL's secondary piggyback implant is an efficient alternative for monofocal pseudophakic patients seeking presbyopia solutions. This sulcus-designed IOL provides an optimal visual outcome for near and distance vision.

The Influence of Angle Alpha, Angle Kappa, and Optical Aberrations on Visual Outcomes after the Implantation of a High-Addition Trifocal IOL.

The aim of our investigation was to examine the possible correlations between optical aberrations, angle kappa, angle alpha, and visual outcomes following cataract surgery. In total, 56 eyes of 28 patients were implanted with the Liberty 677MY trifocal intraocular lens (IOL). Pre- and postoperative higher-order aberrations, coma, astigmatism, angle alpha, and angle kappa were registered, along with uncorrected and corrected visual acuities at multiple distances. Visual acuity and contrast sensitivity defocus curves were plotted, and the areas under the curve were calculated 1 and 3 months postoperatively. Excellent visual outcomes were found at all distances. Patients reported low levels of dysphotopsia, and 96.4% of patients achieved complete spectacle independence. While angle kappa significantly decreased during cataract surgery (p = 0.0007), angle alpha remained unchanged (p = 0.5158). Angle alpha correlated with postoperative HOAs and had a negative impact on near vision (p = 0.0543). Preoperative corneal HOA and coma had a strong adverse effect on future intermediate and near vision. Residual astigmatism significantly affected postoperative intermediate vision (p = 0.0091). Our results suggest that angle kappa is not an optimal predictive factor for future visual outcomes, while angle alpha and the preoperative screening of optical aberrations might help patient selection prior to multifocal IOL implantation.

Impact of correlation of angle α with ocular biometry variables.

PURPOSE: To analyze the association between angle α and ocular biometry in the general population at a third-level ophthalmology hospital. SETTING: Anterior Segment Surgery Department, Asociación para Evitar la Ceguera en México I.A.P., Mexico City, Mexico. DESIGN: Prospective, cross-sectional study. METHODS: Healthy subjects who attended the hospital for a comprehensive ophthalmological evaluation were examined, and general data were collected. A complete ophthalmological assessment and biomicroscopy evaluation were performed and biometry and clinical data were obtained, including visual acuity, axial length (AL), keratometry (K), white-to-white (WTW) measurement. An OPD-Scan III analyzer was used to assess both the angle α distance and biometry parameters. RESULTS: 74 eyes from the same number of patients were included; 43 (58.10%) were women. A statistically significant inverse correlation was found between the angle α and the AL (r = -0.585; P < .0001) and between the WTW distance and the mean K (r = 0.557; P < .0001). A significant correlation was found between the mean K and the angle α (r = 0.271; P = .019). A significant inverse correlation was observed regarding the WTW distance and angle α (r = -0.359; P = .001). By contrast, a direct correlation was evidenced between the WTW and the AL (r = 0.385; P = .0007). CONCLUSIONS: There was a significant inverse correlation between the AL and the angle α magnitude. Hyperopic patients demonstrated significantly higher angle α values when compared with those of myopic patients. In addition, hyperopic eyes with steeper mean K and lesser WTW distance were associated with an increased angle α.

Influence of Angle κ and Higher-Order Aberrations on Visual Quality Employing Two Diffractive Trifocal IOLs.

Prospective, randomized, comparative, and controlled study to estimate the association between angle κ distance and higher-order aberrations (HOAs) with postoperative visual acuity after presbyopia-correcting IOL implantation. Forty-three eyes from 43 patients were included and randomly assigned in two groups for either AT LISA tri 839MP or Acrysof IQ PanOptix IOL implantation. The OPD-Scan III analyzer was utilized to assess the angle κ distance and higher-order aberration (HOAs). Twenty-three eyes were in the Acrysof IQ PanOptix group and 20 patients in the AT LISA tri 839MP group. The uncorrected distance visual acuity (UDVA) for the PanOptix group was 0.092 ± 0.10, whereas for AT LISA tri was 0.050 ± 0.06 (P=0.229). The uncorrected intermediate visual acuity (UIVA) for the PanOptix group was 0.173 ± 0.18, whereas for AT LISA tri, it was 0.182 ± 0.11 (P=0.669). Uncorrected near visual acuity (UNVA) was 0.068 ± 0.04 and 0.085 ± 0.07, respectively (P=0.221). Also, correlation coefficient between HOAs and the Strehl ratio for each group were -0.768 (P < 0.0001) and -0.863 (P=0.0001). Patients implanted with both trifocal IOLs showed excellent postoperative visual performance at all distances at the six-month follow-up visit. No association was found between angle κ distance and postoperative visual acuity regardless of the angle κ magnitude or the two trifocal IOLs inner optical diameter. Also, internal aberrations demonstrated a significant inverse correlation with the Strehl ratio for both trifocal IOLs.

Femtosecond laser-assisted cataract surgery in pediatric patients.

Pediatric cataract surgery poses a significant challenge for the cataract surgeon, in part because an elastic anterior capsule can make capsulorhexis difficult. With the use of femtosecond laser-assisted cataract surgery (FLACS), however, the continuous curvilinear capsulorhexis can be made with predictable size, circular shape, centration, and accuracy. In addition, topical anesthesia can be used for the FLACS docking procedure in cooperative children above 6 years of age, using transparent adhesive polyurethane film segments.

Comparison of biometric measurements obtained by the Verion Image-Guided System versus the auto-refracto-keratometer.

PURPOSE: To compare the biometric measurements obtained from the Verion Image-Guided System to those obtained by auto-refracto-keratometer in normal eyes. METHODS: This is a prospective, observational, comparative study conducted at the Asociación para Evitar la Ceguera en México I.A.P., Mexico. Three sets of keratometry measurements were obtained using the image-guided system to assess the coefficient of variation, the within-subject standard deviation and intraclass correlation coefficient (ICC). A paired Student t test was used to assess statistical significance between the Verion and the auto-refracto-keratometer. A Pearson's correlation coefficient (r) was obtained for all measurements, and the level of agreement was verified using Bland-Altman plots. RESULTS: The right eyes of 73 patients were evaluated by each platform. The Verion coefficient of variation was 0.3% for the flat and steep keratometry, with the ICC being greater than 0.9 for all parameters measured. Paired t test showed statistically significant differences between groups (P = 0.0001). A good correlation was evidenced for keratometry values between platforms (r = 0.903, P = 0.0001 for K1, and r = 0.890, P = 0.0001). Bland-Altman plots showed a wide data spread for all variables. CONCLUSION: The image-guided system provided highly repeatable corneal power and keratometry measurements. However, significant differences were evidenced between the two platforms, and although values were highly correlated, they showed a wide data spread for all analysed variables; therefore, their interchangeable use for biometry assessment is not advisable.

Vitreous humor thermodynamics during phacoemulsification.

The purpose of this study is to determine baseline vitreous humor temperature during a combined phacoemulsification and pars plana vitrectomy (PPV) procedure; to determine what is the temperature variation during phacoemulsification; and to compare vitreous temperature to sublingual temperature. The methods used are prospective, interventional and comparative study. Patients with a diagnosis of cataract and vitreous hemorrhage, programed for a combined procedure of phacoemulsification and PPV, were included. Patients were excluded if posterior capsular rupture existed during the anterior segment procedure. A thermoprobe was inserted through a PPV trocar. Measurement of the vitreous temperature was obtained at baseline and throughout phacoemulsification, at the end of every surgical step, and every 5 min. Sublingual temperature was measured with the same probe at the end of the surgery. Room temperature was registered. Seventeen eyes of 17 patients were included. Mean sublingual temperature was 36.5 °C (standard deviation [σ] 0.26 °C). Mean total vitreous temperature was 31.47 °C (σ 2.1 °C). Mean baseline vitreous temperature was 33.04 °C (σ 0.99 °C). Comparison of sublingual temperature with baseline vitreous temperature resulted in a significant difference (t test P < 0.000. 95 % confidence interval 2.93-3.98). Temperature measured by surgical step and surgical time presented a significant decrease in temperature from baseline (Kruskal-Wallis P < 0.000, P = 0.003, respectively). Vitreous humor is significantly hypothermic when compared to sublingual temperature. Vitreous temperature decreases significantly during phacoemulsification.

High-cylinder acrylic toric intraocular lenses: a case series of eyes with cataracts and large amounts of corneal astigmatism.

PURPOSE: To examine the stability and efficacy of high-cylinder power AcrySof toric intraocular lenses (IOLs), models SN60T6, SN60T7, SN60T8, and SN60T9 (Alcon Laboratories Inc). METHODS: Eligible eyes had cataract and symmetric corneal astigmatism > 2.25 diopters (D). Outcomes included monocular uncorrected distance visual acuity (UDVA), manifest refraction, and assessment of IOL axis. RESULTS: Nineteen eyes from 14 patients had preoperative corneal astigmatism of 4.00 ± 1.10 D. Postoperatively, residual refractive cylinder was 0.55 ± 0.60 D at 3 months. Uncorrected distance visual acuity was 1.3 ± 0.5 logMAR preoperatively and improved to 0.11 ± 0.09 logMAR 3 months postoperatively (P<.0001). All IOLs were stable within 5°. CONCLUSIONS: The IOLs were stable and effective in correcting high amounts of preexisting astigmatism at the time of cataract surgery.

Inhibition of surgically induced miosis and prevention of postoperative macular edema with nepafenac.

OBJECTIVE: To evaluate the effectiveness of prophylactic administration of nepafenac 0.1% in maintaining mydriasis and in preventing postoperative macular edema following cataract surgery. METHODS: This was a prospective, randomized, single-masked comparative study in 60 patients undergoing phacoemulsification cataract surgery. Patients were randomized to either the nepafenac or the control group. Nepafenac was administered 3 times daily 1 day before surgery and continued for 6 weeks. The control group received tobramycin-dexamethasone treatment only. Trans-operative mydriasis was measured before surgery, after nuclear emulsification, following cortex aspiration, and at the conclusion of surgery. Macular optical coherence tomography determined central foveal thickness (FT) and total macular volume (TMV) before surgery and at 2 and 6 weeks after surgery. All patients received tobramycin-dexamethasone for 2 weeks after surgery. RESULTS: The difference in mean pupil size, at the end of surgery, between the control group (6.84 +/- 0.93 mm) and the nepafenac group (7.91 +/- 0.74 mm) was statistically significant (p < 0.001). There were no significant differences in FT values between the two groups at any time point; however, TMV at 2 and at 6 weeks was statistically significantly different (p < 0.001), with higher TMV in the control group. CONCLUSION: Prophylactic use of nepafenac was effective in reducing macular edema after cataract surgery and in maintaining trans-operative mydriasis.

Extensive dynamics in location, shape, and size of aneurysms in a patient with idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome. Idiopathic retinal vasculitis, aneurysms, and neuroretinitis.

PURPOSE: To describe an unusual case of idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome with rapid dynamics in the number and appearance of the aneurysms. DESIGN: Observational case report. METHODS: Clinical and angiographic data of the patient were reviewed. RESULTS: In the course of only 6 months, preexisting retinal aneurysms resolved while new ones appeared. Changes were observed in the shape and size of preexisting lesions. The resolution of lesions in eyes previously untreated by laser is reported for the first time. CONCLUSIONS: Vascular lesions in IRVAN syndrome may show an unusually rapid turnover. The resolution of aneurysms is a part of the natural course of the disease and may occur without previous retinal laser photocoagulation.