[Mid- and Longterm Experiences with the Boston-Keratoprosthesis. The Cologne and Salzburg Perspective]. / Mittel- und langfristige Erfahrungen mit der Boston-Keratoprothese. Die Kölner und Salzburger Perspektive.

Background Eyes with severe corneal opacifications and insufficient prognosis for high-risk corneal transplantation can be considered for the implantation of a Boston-keratoprosthesis. Since 2013, this technique of "artificial" corneal replacement is provided to high-risk eyes at the Department of Ophthalmology, University of Cologne and for 9 years at the University of Salzburg. In the meantime, a type I Boston keratoprosthesis (BI-KPro) has been implanted in 24 eyes in Cologne and in 28 eyes in Salzburg. Methods In this article, results and complications according to BI-KPro are discussed, both from the literature in PubMed, as well as from our own experiences. Results Twenty-four eyes of 22 patients had been provided with a BI-KPro since September 2013, of which only one keratoprosthesis could not be obtained thus far, and an increase in visual acuity could be achieved in 23 eyes (96%). On average, 1.5 revisions per eye were required during the postoperative course. Since 2007, a BI-KPro has been implanted in 28 eyes in Salzburg. In 62% (16 of 26 eyes), visual acuity increased postoperatively, with a complication rate of 81% in a longer follow-up period. In both cohorts, the spectrum of complications ranged from retroprosthetic membrane formation, to secondary glaucoma, to infectious keratitis with or without graft melting, to vitritis, to endophthalmitis. Conclusion The range of possible complications according to BI-KPro is broad, but the BI-KPro represents currently the most widely used form of artificial corneal replacement in high-risk eyes and leads to visual improvement in most patients.

Acoustic Structure Quantification Analysis of the Thyroid in Patients with Diffuse Autoimmune Thyroid Disease.

The aim of this study was to assess whether acoustic structure quantification (ASQ) can differentiate normal from pathological thyroid parenchyma in patients with diffuse autoimmune thyroid disease (AITD). We evaluated 83 subjects (72 [87%] women and 11 [13%] men) aged 19 to 94 years with a mean age of 53 years. We performed a prospective study (from March 2011 to November 2014) that included 43 (52%) patients with chronic autoimmune thyroiditis (CAT), 22 (26%) patients with Graves' disease (GD), and 18 (22%) healthy volunteers. The ASQ values were significantly lower in normal subjects than in subjects with CAT and GD (p < 0.001). In contrast, the differences between the GD and the CAT patients (p = 0.23) were not statistically significant. The optimal cutoff ASQ value for which the sum of sensitivity and specificity was the highest for the prediction of diffuse thyroid pathology was 103 (95% confidence interval = [0.79, 0.95]). At this cutoff value, the sensitivity was 83% and the specificity was 89%. Our findings suggest that ASQ is a useful method for the assessment of the thyroid in patients with AITD.

Long-term outcomes after monocular corneal inlay implantation for the surgical compensation of presbyopia.

PURPOSE: To evaluate long-term outcomes of small-aperture corneal inlay implantation for the surgical compensation of presbyopia. SETTING: Paracelsus Medical University, Salzburg, Austria. DESIGN: Prospective interventional cohort study. METHODS: Monocular implantation of a Kamra small-aperture inlay (model ACI7000) (1.6 mm central aperture) was performed in emmetropic presbyopic eyes. The preoperative and postoperative parameters included monocular and binocular uncorrected (UDVA) and corrected (CDVA) distance visual acuities, uncorrected intermediate visual acuity (UIVA), and uncorrected (UNVA) and corrected (CNVA) near visual acuities; refraction; patient satisfaction; and complications. RESULTS: From September 4, 2006, to May 21, 2007, a small-aperture inlay (1.6 mm central aperture) was implanted in 32 emmetropic presbyopic eyes. The mean binocular uncorrected visual acuities improved as follows: UNVA from Jaeger (J) 6 ± 1.2 lines (∼20/50) to J2 ± 1.8 lines (∼20/25) (P < .001) and UIVA from 0.2 logMAR ± 1.3 lines (∼20/32) to 0.1 logMAR ± 1.3 lines (∼20/25) (P = .04). The UDVA decreased from -0.2 logMAR ± 0.2 lines (∼20/12.5) to -0.1 logMAR ± 0.6 lines (∼20/16) (P < .001). At 60 months, 74.2% of patients had a UNVA of J3 (∼20/32) or better, 87.1% had a UIVA of 0.2 logMAR (∼20/32) or better, and 93.5% had a UDVA of 0.0 logMAR (∼20/20) or better. One inlay was removed after 36 months because of patient dissatisfaction with vision after a hyperopic shift in the surgical eye, with no loss of CDVA or CNVA 2 years after removal. CONCLUSION: Long-term results of monocular corneal inlay implantation indicate increased UNVA and UIVA and slightly compromised UDVA in emmetropic presbyopic eyes. FINANCIAL DISCLOSURE: Dr. Grabner was reimbursed for travel expenses from Acufocus. Dr. Riha is a consultant to Acufocus. No other author has a financial or proprietary interest in any material or method mentioned.

Influence of primary diagnosis and complications on visual outcome in patients receiving a Boston type 1 keratoprosthesis.

PURPOSE: To analyse how primary diagnosis and complications affect the evolution of post-operative visual acuity (VA). METHODS: We performed retrospective chart analysis on 59 eyes in 57 patients with various diagnoses, most of which were non-standard indications for Boston type 1 keratoprosthesis (Kpro) implantation. The follow-up period was at least 3 months. Patients were classified based on the evolution of post-operative VA: group A demonstrated stable VA improvement, group B lost VA improvement and group C no significant VA improvement. RESULTS: We assigned 46% of our cases to group A with stable VA improvement, 32% to group B with lost VA improvement, and 22% to group C with no VA improvement. The number of graft failures before Kpro implantation did not influence VA outcome. Except for the relatively good VA outcome in chemical burn and radiation injury patients, there seems to be no association between primary diagnosis and positive or negative VA outcome. Only 9% of patients with posterior segment complications and 20% with infections and associated pathologies were assigned to group A. CONCLUSION: Most cases (78%) showed improvement in VA after Boston type 1 Kpro (groups A and B). Posterior segment complications and infections mostly resulted in persistent loss of vision. These complications should be prevented and carefully treated.

Anatomical survival and visual prognosis of Boston type I keratoprosthesis in challenging cases.

PURPOSE: To describe the outcome of patients with Boston type 1 keratoprosthesis, with regard to anatomical and visual success. METHODS: Retrospective case series of patients who underwent Boston type I keratoprosthesis surgery at the Centro de Oftalmología Barraquer in Barcelona and at the University Eye Clinic in Salzburg between May 2006 and December 2011. Sixty-seven eyes were included. Anatomical success, visual acuity, and complication rate were evaluated and correlated with the initial diagnosis. RESULTS: The mean age of patients was 54 years; 62 % were male and 38 % were female. Eleven patients underwent Type I Boston Kpro implantation as a primary procedure, while the other 52 patients had previous graft failure. The most frequent diagnoses were autoimmune diseases (16 eyes), severe chemical or thermal burn (12 eyes), leukoma post-infectious keratitis (seven eyes) and bullous keratopathy (six eyes). The mean follow-up time was 26 months. Retention of the prosthesis was achieved in 95 % at 1 year and 78 % at 4.5 years. Two eyes suffered extrusion of the KPro, six underwent successful exchange of the prosthesis either due to infection, necrosis or extrusion, three KPro's had to be explantated, and two eyes ended up in enucleation due to panophthalmitis. The outcome of the autoimmune cases was similar to the group with "other diagnoses" and better than those with chemical/thermal burn. The most frequent complication was development of a retroprosthetic membrane in 21 eyes (34 %). Visual acuity (LogMAR) in the chemical/thermal burn group was 2.30 preoperatively, 0.69 at 1 year, 0.52 at 2 years and 0.39 at 3 years; in the autoimmune group visual acuity was 2.3 preoperatively, 0.65 at 1 year, 0.15 at 2 years, and 1.5 at 3 years. CONCLUSIONS: Boston type 1 keratoprosthesis is a viable option for patients with repeated graft failure, even for those with challenging diagnoses such as ocular burns and autoimmune syndromes.

Reliability of automatic biometric iris recognition after phacoemulsification or drug-induced pupil dilation.

PURPOSE: To investigate the reliability of a biometric iris recognition system for personal authentication after cataract surgery or iatrogenic pupil dilation. METHODS: This was a prospective, nonrandomized, single-center, cohort study for evaluating the performance of an iris recognition system 2-24 hours after phacoemulsification and intraocular lens implantation (group 1) and before and after iatrogenic pupil dilation (group 2). RESULTS: Of the 173 eyes that could be enrolled before cataract surgery, 164 (94.8%) were easily recognized postoperatively, whereas in 9 (5.2%) this was not possible. However, these 9 eyes could be reenrolled and afterwards recognized successfully. In group 2, of a total of 184 eyes that were enrolled in miosis, a total of 22 (11.9%) could not be recognized in mydriasis and therefore needed reenrollment. No single case of false-positive acceptance occurred in either group. CONCLUSIONS: The results of this trial indicate that standard cataract surgery seems not to be a limiting factor for iris recognition in the large majority of cases. Some patients (5.2% in this study) might need "reenrollment" after cataract surgery. Iris recognition was primarily successful in eyes with medically dilated pupils in nearly 9 out of 10 eyes. No single case of false-positive acceptance occurred in either group in this trial. It seems therefore that iris recognition is a valid biometric method in the majority of cases after cataract surgery or after pupil dilation.

Profiles of intraocular pressure in human donor eyes during femtosecond laser procedures--a comparative study.

PURPOSE: To compare four different femtosecond laser devices (IntraLase FS, Zeiss VisuMAX, and Ziemer Femto LDV, and a prototype Schwind SmartTech Nanolaser) in human donor eyes with regard to their effects on IOP during femtosecond laser flap cutting. In order to get cuts parallel to the corneal surface, the cornea has to be forced into a defined shape and current femtosecond laser devices either use a flat or a curved patient interface design to achieve applanation. METHODS: IOP was measured in enucleated eyeballs (n = 46) not suitable for keratoplasty by direct cannulation of the vitreous body. A second cannula was inserted to adjust IOP to a baseline pressure of 20 mm Hg. The eyeballs were lifted by custom made supporting stands to achieve an appropriate height and put under the femto-LASIK devices. RESULTS: The flat patient interfaces gave rise to higher IOPs (IOP max = 328.3 ± 29.8, 228.8 ± 28.4, and 201.09 ± 21.4 mm Hg), whereas the curved patient interface caused lower IOPs in response to attachment and suction (IOP max = 104.9 ± 13.4 mm Hg). CONCLUSIONS: Based on previous findings of visual field defects after LASIK, and as a consequence of the present study, it seems feasible to design patient interfaces in a more physiologic manner to prevent high IOPs during refractive procedures.

Femtosecond laser-assisted small-aperture corneal inlay implantation for corneal compensation of presbyopia: two-year follow-up.

PURPOSE: To report the 2-year postoperative safety and efficacy outcomes after monocular Kamra corneal inlay (ACI7000PDT) implantation in femtosecond laser-created corneal pockets of emmetropic presbyopic patients to improve near and intermediate vision. SETTING: University Eye Clinic, Paracelsus Medical University, Salzburg, Austria. DESIGN: Prospective interventional case series. METHODS: Patients had corneal inlay implantation in the nondominant eye. Emmetropic presbyopic patients between 45 and 60 years old with an uncorrected distance visual acuity (UDVA) of 20/20 or better in both eyes and without additional ocular pathology were eligible. Contrast sensitivity, visual field examinations, endothelial cell count (ECC), and central corneal thickness (CCT) measurements were assessed preoperatively and 12 and 24 months postoperatively. The UDVA, uncorrected intermediate visual acuity (UIVA), and near visual acuity (UNVA) were assessed preoperatively and 1 day, 1 week, and 1, 3, 6, 9, 12, 18, and 24 months postoperatively. The minimum postoperative follow-up was 24 months. RESULTS: After 24 months, the mean binocular UNVA improved from 20/50 to 20/25; 20 patients (83%) had a UNVA of 20/25 or better. The mean binocular UIVA was 20/20. The mean UDVA was 20/20 in the surgical eye and 20/16 binocularly after 24 months. Contrast sensitivity under photopic and mesopic conditions remained in the range of the normal population. No patient had detectable central visual field defect. No inlay was explanted. No inflammatory reactions were observed. The ECC and CCT remained stable. CONCLUSION: The corneal inlay implanted in femtosecond laser-created pockets was effective and safe for the corneal compensation of presbyopia in emmetropic patients after 24 months. FINANCIAL DISCLOSURE: Acufocus Inc., Irvine, California, USA, financially supports the Research Foundation for Promoting Ophthalmology, Salzburg, Austria, as the clinical research center of the University Eye Clinic (Paracelsus Medical University). Dr. Grabner received travel expenses from Acufocus, Inc. Dr. Riha currently also works as a clinical application specialist for Acufocus, Inc. No other author has a financial or proprietary interest in any material or method mentioned.

Bilateral reading performance of 4 multifocal intraocular lens models and a monofocal intraocular lens under bright lighting conditions.

PURPOSE: To compare changes in reading performance parameters after implantation of 4 multifocal intraocular lens (IOL) models and a monofocal IOL. SETTING: Department of Ophthalmology, Paracelsus Medical University, Salzburg, Austria. DESIGN: Prospective randomized controlled clinical trial. METHODS: Patients with bilateral cataract without additional ocular pathology were scheduled for bilateral implantation of Acri.Smart 48S monofocal, Acrysof Restor SN6AD3 apodized multifocal, AT LISA 366D diffractive multifocal, Tecnis ZMA00 diffractive multifocal, or Rezoom refractive multifocal IOLs. Bilateral corrected and uncorrected reading acuity, reading distance, mean and maximum reading speeds, and smallest log-scaled print size of a Radner reading chart were evaluated under bright lighting conditions (500 lux) using the Salzburg Reading Desk. Pupil size was not measured throughout the trial. The minimum follow-up was 12 months. RESULTS: The diffractive multifocal groups had significantly better uncorrected reading acuity and uncorrected smallest print size than the monofocal and refractive multifocal groups 1, 6, and 12 months postoperatively. The diffractive IOL groups had comparable uncorrected reading distance of approximately 32 cm, which was larger in the monofocal group (38.9 ± 8.4 cm) and refractive multifocal group (37.1 ± 7.3 cm) at the last visit. Patients with diffractive IOLs could read print sizes of approximately 0.74 to 0.87 mm, which was much better than in the monofocal and refractive multifocal groups. The diffractive AT LISA IOL provided the best reading speed values (mean and maximum, corrected and uncorrected). CONCLUSION: Multifocal IOLs with a diffractive component provided good reading performance that was significantly better than that obtained with a refractive multifocal or monofocal IOL. FINANCIAL DISCLOSURE: Drs. Grabner and Dexl were patent owners of the Salzburg Reading Desk technology (now owned by SRD-Vision, LLC). No other author has a financial or proprietary interest in any material or method mentioned.

Reading performance and patient satisfaction after corneal inlay implantation for presbyopia correction: two-year follow-up.

PURPOSE: To evaluate change in reading performance parameters after monocular Kamra corneal inlay implantation for the surgical correction of presbyopia. SETTING: University surgical outpatient center. DESIGN: Prospective interventional case series. METHODS: A corneal inlay was implanted in the nondominant eye. Naturally emmetropic and presbyopic patients between 45 years and 60 years old with an uncorrected distance visual acuity of at least 20/20 in both eyes without additional ocular pathology were eligible for inclusion. Bilateral uncorrected reading acuity, reading distance, mean and maximum reading speed, and the smallest log-scaled print size (lower case letter of a Radner reading chart) were evaluated using the Salzburg Reading Desk. The minimum postoperative follow-up was 24 months. RESULTS: Twenty-four patients were enrolled. The mean reading distance was 46.7 cm ± 6.3 (SD) preoperatively and 39.5 ± 6.4 cm 24 months postoperatively (P<.001). The mean reading acuity at best distance improved (0.33 ± 0.13 logRAD versus 0.23 ± 0.11 logRAD) (P=.004). The mean reading speed increased from 141 ± 20 words per minute (wpm) to 146 ± 20 wpm, respectively (P=.261), and the mean maximum reading speed from 171 ± 28 wpm to 180 ± 22 wpm, respectively (P=.110). The smallest print size improved from 1.50 ± 0.42 mm to 1.01 ± 0.22 mm, respectively (P<.001). CONCLUSION: Improving the depth of focus by monocular implantation of a small-aperture optic caused statistically significant changes in all tested reading performance parameters except reading speed metrics in emmetropic presbyopic patients.

Correction of myopic astigmatism with a foldable iris-claw toric phakic intraocular lens: short-term follow-up.

PURPOSE: To evaluate the efficacy, predictability, stability, and complications after implantation of a foldable iris-fixated toric phakic intraocular lens (pIOL) to correct myopic astigmatism. SETTING: University Eye Clinic, Paracelsus Medical University, Salzburg, Austria. DESIGN: Retrospective nonrandomized observational case series. METHODS: The study assessed eyes having implantation of an Artiflex toric pIOL with spherical power ranging from -1.0 to -13.5 diopters (D) and additional cylinder from -1.0 to -5.0 D, both in 0.5 D increments. The main parameters were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction stability, slitlamp biomicroscopy, tonometry, and central endothelial cell count (ECC). RESULTS: The study enrolled 42 eyes of 24 patients with a mean age of 35 years (range 18 to 52 years), a mean spherical equivalent of -7.52 D ± 2.22 (SD) (range -2.63 to -13.0 D), and a mean preoperative cylinder of -1.82 ± 0.96 D (range -1.0 to -5.0 D). Six months postoperatively, the UDVA (Snellen lines) was 1.0 or better in 38 eyes (90%). The CDVA improved by 1 line in 22 eyes (52%) and by 2 lines in 2 eyes (5%); no eye lost lines. All eyes were within ±0.50 of the target refraction (spherical equivalent); the mean refractive astigmatism was -0.18 ± 0.30 D. Refraction was stable from 1 day postoperatively. A slight ECC loss (-0.72%) occurred at 6 months. There were no serious complications. CONCLUSION: After a short-time follow-up, toric pIOL implantation was effective, predictable, stable, and safe for the correction of myopic astigmatism.

Reading performance after implantation of a modified corneal inlay design for the surgical correction of presbyopia: 1-year follow-up.

PURPOSE: To evaluate change in different reading performance parameters after monocular ACI7000PDT corneal inlay implantation for the improvement of near and intermediate vision. DESIGN: Prospective, interventional case series. METHODS: Twenty-four patients were scheduled for corneal inlay implantation in the nondominant eye in a university outpatient surgery center. Naturally emmetropic and presbyopic patients between 45 and 60 years of age, with uncorrected distance visual acuity of at least 20/20 in both eyes, without any additional ocular pathology were eligible for inclusion. Bilateral uncorrected reading acuity, mean and maximum reading speed, and smallest log-scaled print size were evaluated with the standardized Radner Reading Charts. Measurements of reading parameters and reading distance were performed with the Salzburg Reading Desk (SRD). Minimum postoperative follow-up was 12 months. RESULTS: The reading desk results showed significant changes in each parameter tested. After 12 months the mean reading distance changed from the preoperative value of 46.7 cm (95% CI: 44.1-49.3) to 42.8 cm (95% CI: 40.3-45.3, P < .004), and the mean reading acuity "at best distance" improved from 0.33 logRAD (95% CI: 0.27-0.39) to 0.24 logRAD (95% CI: 0.20-0.28, P < .005). Mean reading speed increased from 141 words per minute (wpm, 95% CI: 133-150) to 156 wpm (95% CI: 145-167, P < .003), maximum reading speed increased from 171 wpm (95% CI: 159-183) to 196 wpm (95% CI: 180-212, P = .001), and the smallest print size improved from 1.50 mm (95% CI: 1.32-1.67) to 1.12 mm (95% CI: 1.03-1.22, P < .001). CONCLUSIONS: After ACI7000PDT implantation, there were significant changes in all tested reading performance parameters in emmetropic presbyopic patients. These 1-year results indicate that the inlay seems to be an effective treatment for presbyopia.

Small-aperture corneal inlay for the correction of presbyopia: 3-year follow-up.

PURPOSE: To report the 3-year postoperative safety and efficacy outcomes of the Acufocus corneal inlay. SETTING: University Eye Clinic, Paracelsus Medical University, Salzburg, Austria. DESIGN: Prospective nonrandomized noncomparative cohort study. METHODS: The corneal inlay was implanted in the nondominant eye of naturally emmetropic presbyopic patients. Refraction, uncorrected near (UNVA), intermediate (UIVA), and distance (UDVA) visual acuities; corrected distance visual acuity (CDVA); contrast sensitivity; visual fields; subjective patient satisfaction and symptoms; and operative and postoperative adverse events and complications were evaluated. RESULTS: The study enrolled 32 patients. The mean UNVA improved from Jaeger (J) 6 preoperatively to J1 at 3 years and the mean UIVA, from 20/40 to 20/25, respectively. At 3 years, 97% of eyes had a UNVA of J3 or better and 91% had a UIVA of 20/32 or better. The mean UDVA was 20/20, with all eyes achieving 20/32 or better. Nine eyes (28.3%) lost 1 line of CDVA, 1 eye (3.1%) lost more than 2 lines (3.8 lines), and 3 eyes (9.3%) gained 1 line. No inlay was explanted, and no inflammatory reactions were observed. At 3 years, 15.6% of patients reported severe night-vision problems and 6.3% (versus 87.5% preoperatively) reported being dependent on reading glasses. CONCLUSIONS: These 3-year results support the safety and efficacy of the corneal inlay to correct presbyopia in naturally emmetropic presbyopic patients. However, despite a significant gain in UNVA and UIVA, 28.3% of patients lost 1 line of CDVA.

One-year visual outcomes and patient satisfaction after surgical correction of presbyopia with an intracorneal inlay of a new design.

PURPOSE: To evaluate the safety and efficacy of the third-generation Kamra corneal inlay (ACI 7000PDT) implanted monocularly in corneal pockets of emmetropic presbyopic patients to improve near and intermediate vision. SETTING: University Eye Clinic, Paracelsus Medical University, Salzburg, Austria. DESIGN: Cohort study. METHODS: The corneal inlay was implanted in the nondominant eye over the line of sight by creating a corneal pocket with a femtosecond laser. The minimum postoperative follow-up was 12 months. Distance, intermediate, and near visual acuities were assessed over the follow-up. Other examinations included slitlamp evaluation, central keratometry, computerized corneal topography, endothelial cell count, and central corneal thickness. Patients completed satisfaction questionnaires preoperatively and 3, 6, and 12 months postoperatively. RESULTS: The study evaluated 24 patients. After a mean follow-up of 12 months, 92% of patients read Jaeger (J) 3 or better with the surgical eye, the mean binocular uncorrected near visual acuity improved from J5 preoperatively to J2, and the mean binocular uncorrected intermediate visual acuity was 20/20 (67% ≥ 20/20). At 12 months, the mean uncorrected distance visual acuity was 20/20 in the surgical eye and 20/16 binocularly. Patients reported no change in distance vision, and their need for reading glasses decreased significantly (P<.001). No inlay was explanted and or recentered during the reported follow-up. CONCLUSION: The new corneal inlay was a safe and effective treatment for presbyopia over a 1-year follow-up.

Central and peripheral corneal iron deposits after implantation of a small-aperture corneal inlay for correction of presbyopia.

PURPOSE: To describe central and peripheral corneal iron deposition after implantation of the AcuFocus corneal inlay (ACI 7000, AcuFocus Inc) for the surgical correction of presbyopia. METHODS: Patients who underwent inlay implantation between September 2006 and May 2007 and displaying corneal iron deposits were enrolled in the study. RESULTS: Eighteen (56%) eyes of 32 patients developed corneal iron deposition within 36 months after corneal inlay implantation. One (5.5%) eye had a central spot-like iron deposition only, 10 (55.5%) eyes had formation of deposits in a half-moon shape in the inferior cornea parallel to the outer margin of the inlay or a complete circular ring formation, and 7 (39%) eyes demonstrated deposits in both areas. The median interval between implantation and diagnosis of corneal iron deposition was 18 ± 9 months. CONCLUSIONS: Corneal iron deposition can develop in different shapes after implantation of the small-aperture ACI 7000. Alterations in tear film thickness, its composition, and corneal epithelial basal cell storage, resulting from changes in corneal topography, may be contributing factors for these specific iron depositions.

Postoperative bilateral reading performance with 4 intraocular lens models: six-month results.

PURPOSE: To compare bilateral reading performance within the first 6 months after implantation of 4 intraocular lens (IOL) models. SETTING: Vissum-Instituto de Oftalmológico de Alicante, Alicante, Spain, and University Eye Clinic, Paracelsus Medical University, Salzburg, Austria. DESIGN: Comparative case series. METHODS: Patients had bilateral phacoemulsification and implantation of Acri.Smart 48S monofocal, Acrysof Restor SN6AD3 apodized multifocal, Acri.LISA 366D diffractive multifocal, or Rezoom refractive multifocal IOLs. Bilateral reading performance with and without near correction was evaluated preoperatively and postoperatively using the Salzburg Reading Desk. RESULTS: The study comprised 304 eyes of 152 patients 51 to 90 years old. All groups had a significant improvement in uncorrected and corrected distance visual acuities postoperatively (P≤.01). The apodized multifocal and diffractive multifocal groups had significantly better uncorrected reading acuity than the monofocal and refractive multifocal groups 1 month and 6 months postoperatively (P<.01). Uncorrected reading speed was significantly worse in the refractive multifocal group than in the monofocal group at 1 month (P<.01). The monofocal group had the greatest uncorrected reading distance at 1 month and 6 months (P<.01). CONCLUSION: Multifocal IOLs with a diffractive component provided a comparable reading performance that was significantly better than the one obtained with refractive multifocal and monofocal IOLs.

Reading performance after implantation of a small-aperture corneal inlay for the surgical correction of presbyopia: Two-year follow-up.

PURPOSE: To evaluate the change in reading-performance parameters after implantation of the Kamra small-aperture intracorneal inlay over a 2-year follow-up. SETTING: University Eye Clinic, Paracelsus Medical University, Salzburg, Austria. DESIGN: Cohort study. METHODS: This study comprised naturally emmetropic presbyopic patients. Bilateral reading acuity, reading distance, reading speed, and the smallest log-scaled sentence were evaluated in a standardized testing procedure using the Salzburg Reading Desk. The minimum postoperative follow-up was 24 months. RESULTS: The study enrolled 32 patients. The reading desk results showed a significant improvement in each parameter tested. After a mean follow-up of 24.2 months ± 0.8 (SD), the mean reading distance changed from the preoperative value of 48.1 ± 5.5 cm to 38.9 ± 6.3 cm (P < .0001), the mean reading acuity at best distance improved from 0.3 ± 0.14 logRAD to 0.24 ± 0.11 logRAD (P < .000001), and the mean reading speed increased from 142 ± 13 words per minute (wpm) to 149 ± 17 wpm (P=.029). One patient lost 1 line, and 1 patient had no change. The improvement was up to 6 log-scaled lines (mean improvement 2.7 ± 1.6 lines) in the other 30 patients. CONCLUSIONS: After implantation of the small-aperture intracorneal inlay, there was an improvement in all tested reading performance parameters in emmetropic presbyopic patients; the improvement was the result of an increased depth of field. These 2-year results indicate that the inlay is an effective treatment for presbyopia.

Refractive surgical correction of presbyopia with the AcuFocus small aperture corneal inlay: two-year follow-up.

PURPOSE: To evaluate the safety and efficacy of the AcuFocus Corneal Inlay 7000 (ACI 7000) implanted in emmetropic presbyopic patients for the improvement of near and intermediate vision over 2-year follow-up. METHODS: This prospective, non-randomized, non-comparative study included 32 naturally emmetropic presbyopic patients. The intracorneal inlay was implanted in the non-dominant eye over the pupil by creating a superior-hinged flap with the IntraLase 60-kHz femtosecond laser (Abbott Medical Optics). Inlay centration was over the line of sight. Minimum postoperative follow-up was 24 months. RESULTS: After mean follow-up of 24.2±0.8 months (range: 24 to 26 months), 96.9% of patients read J3 or better in the implanted eye. Mean binocular uncorrected near visual acuity improved from J6 preoperatively to J1 after 24 months. Mean binocular uncorrected intermediate visual acuity (UIVA) was 20/20 at 1 month and remained 20/20 throughout 24-month follow-up, with 71.9% of eyes reaching UIVA of 20/20 or better. At 24 months, mean uncorrected distance visual acuity was 20/20 in the implanted eye and 20/16 binocularly. No inlay was explanted during the study. Two decentered inlays were recentered after 6 months because of in-sufficient increase in near and intermediate visual acuity. Both patients' near and intermediate visual acuity improved significantly after recentration. CONCLUSIONS: The ACI 7000 seems to provide a safe and effective treatment for presbyopia over follow-up of 2 years.