Dual intraocular lens implantation: Monofocal lens in the bag and additional diffractive multifocal lens in the sulcus.

PURPOSE: To evaluate a new diffractive multifocal intraocular lens (IOL) as an additional (add-on) IOL for sulcus-based implantation. SETTING: Augenklinik am Neumarkt, Köln, Germany. METHODS: In this prospective study, cataract patients had phacoemulsification and IOL implantation. After phacoemulsification, an aspheric silicone monofocal IOL (MS 612 ASP-Y) with a power range of +4.00 to +27.00 diopters [D]) was implanted in the capsular bag. This was followed by sulcus placement of an add-on multifocal IOL (MS 714 PB) with a +3.50 D diffractive element for near but zero refractive power for distance. RESULTS: The study included 56 eyes of 30 patients. Three months postoperatively, the mean monocular uncorrected distance visual acuity was 0.10 logMAR +/- 0.11 (SD) (median 1.00 decimal; 20/20 Snellen), with a remaining mean postoperative spherical equivalent of 0.01 +/- 0.51 D. The mean uncorrected intermediate visual acuity was 0.20 +/- 0.15 logMAR (median 0.63 decimal; 20/30 Snellen) with a luminance of 500 lux at 1 m. The mean uncorrected near visual acuity (Early Treatment Diabetic Retinopathy chart) was 0.16 +/- 0.13 logMAR (median 0.80 decimal; Jaeger 2). No major complications (eg, iris chafing, iris capture, lens epithelial cell ingrowth, glaucoma) were associated with the add-on IOL in the sulcus. CONCLUSIONS: Combined implantation of an add-on diffractive sulcus IOL and a monofocal capsular bag IOL was safe and effective in improving far and near visual acuity in cataract surgery. Preliminary visual acuity results were similar to those in eyes with a single 1-piece diffractive multifocal IOL.

Outcomes of hyperopic LASIK with the NIDEK NAVEX platform centered on the visual axis or line of sight.

PURPOSE: To report refractive outcomes of hyperopic LASIK with automated centration on the visual axis compared with centration on the line of sight (LOS). METHODS: The NIDEK Advanced Vision Excimer Laser platform (NAVEX) was used to treat 181 hyperopic eyes with centration on the LOS (LOS group) and 64 hyperopic eyes with centration on the visual axis (visual axis group). The coordinates of the visual axis were digitally transferred to the excimer laser system based on the positional relationship between the LOS and the coaxially sighted corneal light reflex. All eyes were treated with a 6.5-mm optical zone and 9.0-mm transition zone. Three-month postoperative outcomes were retrospectively analyzed. RESULTS: The preoperative manifest refraction spherical equivalent (MRSE) was +2.57+/-1.26 diopters (D) (range: 0.13 to 5.63 D) in the visual axis group and +2.46+/-1.32 D (range: 0.38 to 5.63 D) in the LOS group. The postoperative MRSE was +0.29+/-0.70 D (range: -1.00 to 1.75 D) in the visual axis group and +0.19+/-0.57 D (range: -0.75 to 1.75 D) in the LOS group. Postoperatively, 81% (38/47) of eyes in the visual axis group and 64% (74/116) of eyes in the LOS group were +/-0.50 D. In the visual axis group, 91% (44/52) of eyes and 92% (102/109) of eyes in the LOS group maintained best spectacle-corrected visual acuity within one line compared with preoperatively. CONCLUSIONS: Initial experience with hyperopic LASIK centered on the visual axis indicated safe and predictable outcomes.

Topographic- and wavefront-guided customized ablations with the NIDEK-EC5000CXII in LASIK for myopia.

PURPOSE: To assess refractive outcomes, changes in the total higher order root mean square (RMS) aberration, and changes in higher order wavefront aberrations after LASIK for myopia and myopic astigmatism with the NIDEK Advanced Vision Excimer Laser platform (NAVEX) using either an aspheric or topography-based or whole eye wavefront ablation algorithm. METHODS: This was a retrospective study of 1459 eyes that underwent LASIK for myopia and myopic astigmatism. The mean preoperative spherical equivalent refraction was -4.68 diopters (D) (range: -0.50 to -9.63 D) with astigmatism up to -4.50 D. Treatments were classified into three categories depending on the type of ablation algorithm used--optimized aspheric transition zone (OATz) denoted eyes that underwent aspheric treatment zones; customized aspheric treatment zone (CATz) denoted eyes that underwent customized ablations based on corneal topography; and OPDCAT denoted eyes that underwent customized ablation based on the whole eye wavefront profile. Follow-up data are reported at 3 months (69%) and 12 months (17%) postoperatively. RESULTS: Three months after LASIK, the predictability (10.5 D from target refraction) was 80% for OATz, 91% for CATz, and 76% for OPDCAT. Of all eyes, 96% were within +/- 1.0 D of intended refraction 3 months postoperatively and 100% after 12 months (87% +/- 0.5 D). In the aspheric and custom groups, a notable improvement of uncorrected visual acuity was noted between 3 and 12 months after LASIK. No eye lost >1 line of best spectacle-corrected visual acuity. Mean higher order RMS increased in all groups. CONCLUSIONS: The data support that the treatment of myopia and myopic astigmatism is safe and effective with NAVEX. Customized ablation based on corneal topography rather than on total wavefront error was more predictable.

Early results of nidek customized aspheric transition zones (CATz) in laser in situ keratomileusis.

PURPOSE: Standard ablation profiles for myopia and myopic astigmatism are spherical in shape and usually induce spherical aberration, often resulting in glare, halo, and other night vision problems. New ablation algorithms with aspheric transition zones may help reduce the amount of induced spherical aberrations in refractive surgery. METHODS: Between September and November 2002, 52 eyes were treated with bilateral laser in situ keratomileusis (LASIK) using a new ablation profile with customized aspherical transition zone (CATz). Results were analyzed from examinations performed 1 day, 1 and 3 months (if available) after surgery, and compared to a standard LASIK patient group. RESULTS: Refractive outcome of patients was within +/- 0.50 D of intended correction in 72% on day 1, and 82% at 1 month after surgery. At 1 month after LASIK, mean spherical equivalent refraction was changed from preoperative mean -6.73 +/- 2.04 D to postoperative mean -0.43 +/- 0.80 D (range -2.00 to +1.50 D). No eye lost more than 1 line of visual acuity; 10% gained 1 line and 80% remained unchanged 1 month after surgery. The topographically visible effective optical zone size was larger than in comparable treatments with standard ablation profiles. Spherical aberration was reduced and no patient complained about night vision problems after surgery. CONCLUSIONS: Customized aspheric transition zones may help reduce induction of spherical aberration in refractive surgical correction of myopia and myopic astigmatism.