Long-term objective and subjective outcomes following bilateral implantation of diffractive bifocal or trifocal intraocular lenses.

OBJECTIVE: To evaluate and compare the objective and subjective outcomes after the bilateral implantation of a diffractive bifocal and trifocal intraocular lens. METHODS: This is a case-control, single-center observational study which included 27 patients; 16 patients were implanted bilaterally with the bifocal AcrySof IQ ReSTOR+3.0D and 11 patients with the trifocal AT LISA tri 839MP. Uncorrected visual acuity at distance, intermediate, and near under mesopic and photopic conditions using ETDRS charts with 10% and 100% contrast, corrected distance visual acuity, and binocular defocus curve in photopic conditions; binocular contrast sensitivity under mesopic and photopic conditions for far and near distances were assessed. The Visual Function Questionnaire-25 questionnaire was used to assess patients' satisfaction. All the measurements were performed 6-24 months after cataract surgery. RESULTS: The ReSTOR group had better binocular uncorrected near visual acuity in photopic conditions with low and high contrast charts (p = 0.040 and p = 0.033, respectively), as well as in far contrast sensitivity measurement under mesopic conditions with a spatial frequency of 3 cycles per degree (p = 0.034). There was not a significant difference between the two study groups in uncorrected near, intermediate or distance vision under mesopic conditions. The AT LISA tri study group had better subjective outcomes. CONCLUSION: Both intraocular lenses restore visual acuity after cataract surgery. The ReSTOR intraocular lens provides better objective outcomes than the AT LISA tri, although the latter provides better subjective outcomes. The relevance of this study is the evaluation of both objective and subjective outcomes.

Transepithelial Surface Ablation With Mitomycin C for the Treatment of Chronic Central Corneal Scars Following Adenoviral Keratoconjunctivitis.

PURPOSE: To assess visual and refractive outcomes and recurrence rates of subepithelial infiltrates after corneal surface ablation with mitomycin C (MMC) 0.02% for the treatment of chronic corneal scars following epidemic keratoconjunctivitis and to compare these results with a control group receiving only medical treatment. METHODS: This was a retrospective case series enrolling patients with central corneal scars following epidemic keratoconjunctivitis. Patients were divided into two groups: (1) control with clinical follow-up and refractive correction with glasses or rigid gas-permeable contact lenses when necessary and (2) transepithelial phototherapeutic keratectomy (PTK) with MMC 0.02%, combined with photorefractive keratectomy (PRK) in selected cases (treatment group). Signs and symptoms, corrected distance visual acuity (CDVA) in logMAR units, manifest and cycloplegic refraction, and depth of the corneal opacities were assessed. RESULTS: Thirty-five eyes of 27 patients (11 men [40.7%] and 16 women [59.3%]) were enrolled, with a mean follow-up of 54.4 ± 19.7 and 27.5 ± 22.8 months in the control and treatment groups, respectively. Mean improvement in CDVA was 0.13 ± 0.17 logMAR (P = .007) in the control group and 0.29 ± 0.24 logMAR (P = .001) in the treatment group. Intergroup comparison showed a greater improvement in the treatment group (P = .041). Mean hyperopic shift induced in the treatment group was +0.46 ± 1.20 diopters. The recurrence rate of subepithelial infiltrates was 77.7% in the control group and 11.7% in the treatment group throughout the follow-up (54.4 ± 19.7 and 27.5 ± 22.8 months, respectively). CONCLUSIONS: Corneal surface ablation with MMC 0.02% was efficient in treating corneal scars following adenoviral epidemic keratoconjunctivitis, with greater visual improvement in comparison to clinical treatment and a decreased rate of infiltrate recurrence. [J Refract Surg. 2020;36(1):55-61.].

Long-term results of a diffractive trifocal intraocular lens: Visual, aberrometric and patient satisfaction results.

PURPOSE: To evaluate the long-term objective and subjective results of a trifocal intraocular lens. METHODS: Prospective observational study enrolling 24 eyes that underwent uneventful microincisional cataract surgery with bilateral implantation of a diffractive trifocal intraocular lens (FineVision Micro F, PhysIOL, Belgium). After a mean follow-up period of 60 ± 2 months, patients answered the 10-item Near Activity Vision Questionnaire (NAVQ-10) and were assessed for uncorrected and corrected distance, intermediate and near visual acuity, defocus curve, light-distortion analysis, and total ocular aberrometry with a pyramidal wavefront sensor (Osiris, CSO, Italy). RESULTS: There was significant improvement of uncorrected visual acuity at all distances in all eyes (p < 0.01). The distorsion index and best-fit circle radius were significantly lower in binocular conditions (p = 0.02). Mean Rasch score at NAVQ-10 was 16.29 ± 11.57. Patients reported to be completely, very, and moderately satisfied with their uncorrected near vision in 67%, 25%, and 8% of cases, respectively. We found no significant correlation between patient satisfaction scores at near vision satisfaction questionnaire and other variables such as light-distortion analysis or wavefront aberrometry parameters. CONCLUSION: The studied diffractive trifocal intraocular lens provides good and stable long-term results for distance, intermediate, and near vision, with high levels of patient satisfaction at long-term follow-up. The intraocular lens' light-distortion effect is less disturbing in binocular conditions and may have its perception down-modulated by neuroadaptation over time.

Optical behavior of the eye implanted with extreme intraocular lens powers.

PURPOSE: To evaluate the induced ocular aberrations after cataract surgery with extreme low- powered and high-powered spherical monofocal intraocular lenses (IOLs) using a new pyramidal wavefront sensor aberrometer. SETTING: Vissum Instituto Oftalmológico, Alicante, Spain. DESIGN: Prospective observational comparative study. METHODS: This study included patients who had cataract surgery with implantation of a spherical monofocal IOL. The patients were divided into three groups according to the IOL power. Group 1: +20 diopters (D) to +23 D; Group 2: less than +10 D; and Group 3: +29 D or more. Assessment after 3 months included: uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, contrast sensitivity function test (Ginsburg), corneal aberrometry, and total ocular aberrometry with a pyramidal wavefront sensor aberrometer (Osiris) for 4.0 mm, 4.5 mm, and 5.0 mm pupil diameters. RESULTS: The study comprised 88 eyes of 56 patients. There were no differences between all groups in terms of refractive error, corneal aberrometry, or total ocular higher-order aberrations at any analyzed pupil diameter. The ocular spherical aberration (SA) was not significantly different between groups with a 4.0 mm pupil. The SA was significantly lower in Group 2 when compared with Group 1 and Group 3 for both 4.5 mm (P = .01 and P = .001, respectively) and 5.0 mm (P = .002 and P = .002, respectively). There was no significant difference in SA between Group 1 (+20 D to 23 D) and Group 3 (≥+29 D) at any analyzed pupil diameter. Higher SA did not correlate to lower contrast sensitivity. CONCLUSIONS: Despite the theoretical evidence, only a negligible amount of clinically insignificant aberrations were induced by high-powered positive IOLs. Low-powered IOLs did not induce significant levels of SAs.

Autologous Platelet-Rich Plasma Eye Drops for the Treatment of Post-LASIK Chronic Ocular Surface Syndrome.

PURPOSE: To evaluate the efficacy of autologous platelet-rich plasma (E-PRP) eye drops for the treatment of chronic ocular surface syndrome (OSS) following laser in situ keratomileusis (LASIK). METHODS: This prospective interventional consecutive clinical study include 156 eyes of 80 patients affected by post-LASIK chronic OSS who were treated with autologous E-PRP 6 times a day as monotherapy for 6 weeks. RESULTS: Dry eye symptoms improved in 85% of the cases. A decrease in at least one quadrant to total disappearance on CFS was observed in 89.6% of the patients who had positive CFS before treatment. Three eyes presented severe punctate keratitis (1.9%) at baseline, all of which healed completely. Conjunctival hyperemia improved in 93.3% of the patients with previous signs of ocular surface inflammation. There was a significant improvement in logMAR CDVA from 0.14 ± 0.19 to 0.06 ± 0.12 (p = 0.000), and 74 (71.4%) eyes improved at least 1 line in CDVA. CONCLUSION: Monotherapy with autologous E-PRP is a well-tolerated, safe, and effective treatment for the management of post-LASIK ocular surface syndrome. PRECIS: Monotherapy with autologous platelet-rich plasma eye drops has been shown to be an adequate option for the treatment of post-LASIK chronic ocular surface syndrome. This trial is registered with NCT03322917.