Diffractive trifocal pseudophakic intraocular lenses in high myopic eyes: 2-year assessment after implantation.

PURPOSE: To assess the visual outcomes and ocular safety when implanting diffractive trifocal intraocular lenses in a population of high myopic eyes. METHODS: This is a retrospective cumulative clinical study. Two hundred five myopic eyes consecutively operated in the hospitals of Clínica Baviera, Spain, were included. All eyes presented an axial length equal or greater than 26 mm and were treated and examined following the same methodology for at least 2 years. Refractive and visual outcomes and also intraoperative or postoperative complications were tabulated for later analysis. Furthermore, a subjective questionnaire was completed by all patients at the end of the follow-up period. RESULTS: The percentage of eyes that lost two or more lines of corrected distance visual acuity (CDVA) was 5.9%, 11.5% and 10.7% 3, 12 and 48 months after surgeries respectively. However, 33% of eyes gained two or more lines of CDVA 2 years after implantation. Excimer laser correction of residual refractive error was performed after implants in 29.75% of eyes. Uncorrected distance visual acuities (UDVAs) were significantly better 1 year (0.10 ± 0.3 logMAR) and 2 years after the surgeries (0.10 ± 0.14 logMAR) compared with those estimated 3 months postoperatively (0.14 ± 0.15 logMAR; Kruskal-Wallis; p < 0.001). Mean near and intermediate uncorrected visual acuities remained stable from the first to the last postoperative visit (Kruskal-Wallis; p > 0.05 for all comparisons). Of the eyes, 27.31% were diagnosed and treated with yttrium aluminum garnet (YAG) laser after being diagnosed as having posterior capsular opacification. Retinal detachment (RD) was diagnosed in six eyes (2.92%). CONCLUSIONS: Diffractive trifocal IOLs have good efficacy and predictability in high myopic eyes. Retinal concerns should lead the surgeons to explore other alternatives for refractive surgery in young patients without cataracts.

Validity of automated refraction after segmented refractive multifocal intraocular lens implantation.

AIM: To evaluate the clinical utility of automated refraction (AR) and keratometry (KR) compared with subjective or manifest refraction (MR) after cataract or refractive lens exchange surgery with implantation of Lentis Mplus X (Oculentis GmbH) refractive multifocal intraocular lens (IOL). METHODS: Eighty-six eyes implanted with the Lentis Mplus X multifocal IOL were included. MR was performed in all patients followed by three consecutive AR measurements using the Topcon KR-8000 autorefractor. Assessment of repeatability of consecutive AR before and after dilation with phenylephrine 10%, and comparison of the AR and KR with MR using vector analysis were performed at 3mo follow-up. RESULTS: Analysis showed excellent repeatability of the AR measurements. Linear regression of AR versus MR showed good correlation for sphere and spherical equivalent, whereas the correlation for astigmatism was low. The mean difference AR-MR was -1.28±0.29 diopters (D) for sphere. Astigmatism showed better correlation between KR and MR. CONCLUSION: We suggest AR sphere plus 1.25 D and the KR cylinder as the starting point for MR in eyes with a Lentis Mplus X multifocal IOL. If AR measurements are equal to MR, decentration of the IOL should be suspected.

Pinhole iris-fixated intraocular lens for dysphotopsia and photophobia.

UNLABELLED: We present the pinhole iris-fixated diaphragm intraocular lens (IOL), which is a 1-piece black polycarbonate IOL with rigid iris-fixated haptics, an 8.5 mm overall length, a 6.0 mm diameter optic, and a central opening, the pinhole. The IOL was implanted in a 36-year-old man who had a history of debilitating dysphotopsia (star burst, halos, glare, and ghosting) and severe light sensitivity in his right eye following several interventions for keratoconus. The diameter of the central opening of the pinhole IOL, 2.0 mm, was based on the patient's corneal aberration profile. Postoperatively, the dysphotopic symptoms and photophobia markedly improved. We recommend the use of the pinhole iris-fixated IOL in patients with severe photophobia or dysphotopsia refractory to other treatment modalities. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Add-on sulcus-based versus primary in-the-bag multifocal intraocular lens: intraindividual study.

PURPOSE: To compare the clinical outcomes of add-on sulcus-based multifocal and standard in-the-bag multifocal intraocular lens (IOL) implantation. METHODS: Twenty-one patients with unilateral monofocal pseudophakia underwent add-on sulcus-based Acri. LISA 536D multifocal IOL (Carl Zeiss Meditec, Jena, Germany) implantation (add-on multifocal IOL group) and contralateral phacoemulsification with in-the-bag Acri.LISA 376D multifocal IOL (Carl Zeiss Meditec) implantation (primary multifocal IOL group). Uncorrected distance visual acuity, uncorrected near visual acuity, corrected distance visual acuity, distance-corrected near visual acuity, photopic (90 cd/m(2)) distance, near contrast sensitivity, mesopic (5 cd/m(2)) distance contrast sensitivity with and without glare, wavefront aberrations, and complications were measured 6 months postoperatively. RESULTS: Primary in-the-bag multifocal IOLs provided slightly but significantly better uncorrected distance visual acuity (0.08 ± 0.10 vs 0.17 ± 0.15 logMAR, P = .028), uncorrected near visual acuity (0.09 ± 0.17 vs 0.18 ± 0.11 logMAR, P = .005), and corrected distance visual acuity (0.01 ± 0.04 vs 0.04 ± 0.05 logMAR, P = .038). There were no significant differences in distance-corrected near visual acuity, photopic or mesopic contrast sensitivity under different conditions, and wavefront aberrations. Complications included pigment dispersion in one eye (4.8%) and pupillary capture in 2 eyes (9.5%) of the add-on multifocal IOL group. CONCLUSIONS: The secondary add-on sulcus-based multifocal IOL provided useful pseudoaccommodation with vision quality similar to the primary in-the-bag multifocal IOL. The technique should be considered in patients diagnosed as having unilateral or bilateral monofocal pseudophakia seeking near spectacle independence.

Serous macular detachment associated with dome-shaped macula and tilted disc.

INTRODUCTION: An entirely new type of staphyloma has been recently described as dome-shaped macula (DSM). It is characterized by an abnormal convex macular contour within the concavity of a posterior staphyloma. We found DSM associated with serous macular detachment (SMD) and tilted disc in two consecutive cases. CASE REPORTS: Case 1: A 37-year-old female presented to our department because of sudden onset blurred vision in her right eye (OD). The best-corrected visual acuity (BCVA) was 0.5 in both eyes. Funduscopy evidenced bilateral tilted disc associated with posterior staphyloma. Optical coherence tomography (OCT) demonstrated a DSM with SMD in her OD. After 15 months of follow-up, BCVA of her OD remained stable with chronic SMD. Case 2: A 32-year-old female presented to our department because of blurred vision in her OD. The BCVA was 0.4 in the OD and 1.0 in the left eye (OS). Bilateral tilted disc and posterior staphyloma were evidenced in the funduscopy. OCT demonstrated a bilateral DSM with SMD in her OD. After 45 months of follow-up, two further episodes of transient SMD were observed in her OD and seven in her OS. The final BCVA was 0.63 in the OD and 0.8 in the OS. DISCUSSION: SMD associated with tilted disc constitutes a potential cause of subretinal fluid accumulation in myopic patients. OCT is essential for the detection of both SMD and DSM.

Doppler ultrasound and giant cell arteritis.

OBJECTIVE: To evaluate the utility of ultrasound in aiding the diagnosis of giant cell arteritis (GCA), in monitoring the response to corticotherapy, and in detecting early relapses. METHODS: A pilot study, prospective, included 10 patients with suspected GCA. All patients underwent ultrasound examination of both temporal arteries before temporal artery biopsy (TAB), 3 weeks after starting treatment, and 3 months after diagnosis. For this study, the histological findings alone were used to define if patients were suffering from GCA. The findings on ultrasound were compared with the results of biopsy. The best place to perform TAB was observed by ultrasound. RESULTS: All patients with positive biopsy were detected with ultrasound. No false positives were observed on ultrasound. The results presented give a sensibility, specificity, and positive predictive value of 100% for the use of ultrasound in the diagnosis of GCA. Two relapses were detected early by ultrasound during the follow-up. CONCLUSIONS: This pilot study suggests that eco-doppler may be a useful tool in diagnosis and clinic follow-up in patients with suspected GCA.