ASCRS calculator formula accuracy in multifocal intraocular lens implantation in hyperopic corneal refractive laser surgery eyes.

PURPOSE: To evaluate the accuracy of different intraocular lens (IOL) power calculation formulas available on the American Society of Cataract and Refractive Surgery calculator in calculating multifocal IOL power in eyes with previous hyperopic corneal refractive laser surgery. DESIGN: Retrospective case series. SETTING: Amsterdam University Medical Center, University of Amsterdam, and Retina Total Eye Care, Driebergen, the Netherlands. METHODS: This study compared the accuracy of 3 formulas using historical refractive data (ie, Masket, modified Masket, and Barrett True-K) and 3 formulas using no previous refractive data (ie, Shammas, Haigis-L, and Barrett True-K no-history). RESULTS: Sixty-four eyes were included. The variance of the prediction error of the various formulas was similar and ranged from 0.27 D2 to 0.33 D2 (P = .99). The modified Masket formula had a significantly higher median absolute prediction error than the Masket formula, Barrett True-K formula, and mean value of all formulas (P < .001). CONCLUSION: All formulas showed comparable accuracy in predicting IOL power in eyes after hyperopic corneal refractive laser surgery except for the modified Masket formula, which performed less accurately than the Masket formula, Barrett True-K formula, and mean value of all formulas.

Evaluation of Different IOL Calculation Formulas of the ASCRS Calculator in Eyes After Corneal Refractive Laser Surgery for Myopia With Multifocal IOL Implantation.

PURPOSE: To compare the accuracy of different intraocular lens (IOL) calculation formulas available on the American Society of Cataract and Refractive Surgery (ASCRS) post-refractive surgery IOL power calculator for the prediction of multifocal IOL power after previous corneal refractive laser surgery for myopia. METHODS: An analysis and comparison were performed of the accuracy of three methods using surgically induced change in refraction (ie, Masket, Modified Masket, and Barrett True-K formulas) and three methods using no previous data (ie, Shammas, Haigis-L, and Barrett True-K No History formulas). The average of all formulas was also analyzed and compared. RESULTS: Thirty-six eyes of 36 patients were included. All formulas, except for the Masket, Modified Masket, and Barrett True-K formulas, had myopic mean numerical errors that were significantly different from zero (P ⩽ .01). The median absolute error of the Shammas formula (0.52 diopters [D]) was significantly higher compared to all of the other formulas (P < .05), except for the Haigis-L formula (P = .09). Comparing the formulas using no previous data, the Barrett True-K No History formula had the lowest median absolute error (0.33 D, P < .001). CONCLUSIONS: The Shammas formula showed the least accuracy in predicting IOL power in eyes with multifocal IOL implantation after previous corneal refractive laser surgery for myopia. In eyes with all available data, all formulas performed equally except for the Shammas formula, whereas in eyes lacking historical data, the Barrett True-K No History formula performed best. [J Refract Surg. 2019;35(1):54-59.].

Multifocal intraocular lens implantation after previous hyperopic corneal refractive laser surgery.

PURPOSE: To describe the outcomes in terms of the refraction and visual acuity of multifocal intraocular lens (IOL) implantation in patients with previous hyperopic corneal refractive laser surgery. SETTING: Academic Medical Center, University of Amsterdam, Amsterdam, and Retina Total Eye Care, Driebergen, the Netherlands. DESIGN: Retrospective case series. METHODS: Results were analyzed 3 months after implantation of a multifocal IOL (Acrysof Restor SN6AD1) in patients after previous corneal refractive laser surgery for hyperopia. The primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and refraction. The secondary outcome measures were the number of laser enhancements and posterior capsule opacification (PCO) rates. RESULTS: Forty eyes of 40 patients were included. Sixteen eyes (40.0%) had lens extraction because of cataract, and 24 eyes (60.0%) had refractive lens exchange. The mean postoperative UDVA was 0.16 logarithm of the minimum angle of resolution (logMAR) ± 0.18 (SD), and the mean postoperative CDVA was 0.01 ± 0.08 logMAR. The mean postoperative spherical equivalent was 0.04 ± 0.92 diopter (D). Twenty-five eyes (62.5%) were within ±0.50 D of emmetropia, and 35 eyes (87.5%) were within ±1.0 D of emmetropia. Nine eyes (22.5%) had a laser enhancement because of a residual refraction error. Eleven eyes (27.5%) had a neodymium:YAG laser capsulotomy because of PCO. CONCLUSIONS: In general, multifocal IOL implantation after corneal refractive laser surgery for hyperopia resulted in good visual acuity and refraction. The magnitude of previous hyperopia did not influence the refractive predictability.

Multifocal intraocular lens implantation after previous corneal refractive laser surgery for myopia.

PURPOSE: To describe the refraction and visual acuity outcomes of multifocal intraocular lens (IOL) implantation in patients with previous corneal refractive laser surgery for myopia. SETTING: Academic Medical Center, University of Amsterdam, Amsterdam, and Retina Total Eye Care, Driebergen, the Netherlands. DESIGN: Retrospective cohort study. METHODS: The 3-month results after implantation of a multifocal IOL (Acrysof Restor) in patients who had corneal refractive laser surgery for myopia were analyzed. The primary outcome measures were corrected distance visual acuity, uncorrected distance visual acuity (UDVA), and refraction. The secondary outcome measures were number of laser enhancements, corneal irregularity, pre-laser magnitude of myopia, and posterior capsule opacification (PCO) rate. RESULTS: Seventy-seven eyes of 43 patients were included. Twenty-nine eyes had lens extraction because of cataract, and 48 eyes had a refractive lens exchange. The mean postoperative UDVA was 0.14 logarithm of minimum angle of resolution ± 0.22 (SD). The mean postoperative spherical equivalent was -0.38 ± 0.78 diopter (D). Fifty-seven percent of eyes were within ±0.50 D of emmetropia, and 86% were within ±1.0 D. Sixteen eyes (20.8%) had laser enhancement because of residual refraction. Fourteen eyes (18.2%) had a neodymium:YAG laser capsulotomy because of PCO. Eyes with pre-laser myopia greater than 6.0 D had a less predictable outcome than eyes with pre-laser myopia less than 6.0 D (P = .026). CONCLUSIONS: Multifocal IOL implantation after corneal refractive laser surgery for myopia resulted in good visual acuity and refraction. Results were less predictable with myopia greater than 6.0 D.

Mobile ultra-clean unidirectional airflow screen reduces air contamination in a simulated setting for intra-vitreal injection.

The aim of this study is to determine whether the use of a mobile ultra-clean laminar airflow screen reduces the air-borne particle counts in the setting of a simulated procedure of an intra-vitreal injection. A mobile ultra-clean unidirectional airflow (UDF) screen was tested in a simulated procedure for intra-vitreal injections in a treatment room without mechanical ventilation. One UDF was passed over the instrument tray and the surgical area. The concentration of particles was measured in the background, over the instrument table, and next to the ocular area. The degree of protection was calculated at the instrument table and at the surgical site. Use of the UDF mobile screen reduced the mean particle concentration (particles > 0.3 microns) on the instrument table by a factor of at least 100.000 (p < 0.05), and over the patient's eye by at least a factor of 436 (p < 0.05), which in clinical practice translates into significantly reduced air contamination. Mobile UDF screen reduces the mean particle concentration substantially. The mobile UDF screen may therefore allow for a safer procedural environment for ambulatory care procedures such as intra-vitreal injections in treatment rooms.

Straylight Measurements in Two Different Apodized Diffractive Multifocal Intraocular Lenses.

PURPOSE: To evaluate differences in straylight between eyes implanted with a hydrophilic multifocal IOL (Seelens MF; Hanita Lenses, Hanita, Israel) and a hydrophobic multifocal IOL (SN6AD1; Alcon Laboratories, Inc., Fort Worth, TX). METHODS: In a prospective cohort study, routinely obtained straylight measurements (C-Quant; Oculus Optikgeräte, Wetzlar, Germany) 3 months after standard phacoemulsification for either cataract or refractive lens procedures were compared. Patients were implanted with either the SeeLens MF IOL or the SN6AD1 IOL. Postoperative straylight values, visual acuity, and refractive outcomes were compared. RESULTS: The SeeLens MF IOL was implanted in 84 eyes and the SN6AD1 IOL in 79 eyes. The difference in straylight was 0.08 (P = .01), with the SeeLens MF IOL having less straylight. Postoperative CDVA was logMAR -0.03 ± 0.06 in the SeeLens MF group, and logMAR -0.02 ± 0.08 in the SN6AD1 group. Mean postoperative refraction was +0.01 ± 0.43 and +0.06 ± 0.35 D, respectively. CONCLUSIONS: The Seelens MF IOL showed a stray-light of log(s) 0.08 lower than the SN6AD1 IOL. In terms of spherical equivalent and visual acuity the lenses performed equally. More study will aid in understanding the causes and clinical impact of this difference.

Autorefraction versus subjective refraction in a radially asymmetric multifocal intraocular lens.

PURPOSE: To evaluate whether the automated refraction (AR) correlates with subjective manifest (MR) refraction in eyes implanted with radially asymmetric multifocal intraocular lens (IOLs). METHODS: This retrospective study evaluated 52 eyes (52 patients) implanted with a radially asymmetric multifocal IOL (LS-312 MF30, Oculentis, Germany). At 3 months postoperatively, the AR and MR values were compared to determine the correlation between the sphere (S), the spherical equivalent (SE) and the astigmatic components J0 and J45. RESULTS: The difference of mean spherical measurement was +0.98D ± 0.62, with the AR measuring more myopic. The difference of the mean spherical equivalent was +1.11D ± 0.57, again with AR being more myopic. Both these differences were statistically significant (p < 0.001). The astigmatic components showed less differences, with the mean difference of the J0 being -0.09D ± 0.43, and the J45 of +0.04D ± 0.47, which were both not statistically significant (p = 0.123 and p = 0.531, respectively). Correlation analysis of the refractive parameters showed r(2) = 0.067, r(2) = 0.078, r(2) = 0.018 and r(2) = 0.015, respectively, all of which point to a low correlation between the AR and the MR. CONCLUSION: Autorefraction shows poor correlation to manifest subjective refraction with these radially asymmetric multifocal IOLs. The autorefraction systematically underestimates the spherical and spherical equivalent power, while the correlation between the astigmatic components was also low. Autorefraction seems not a valid starting point for manifest subjective refraction with these types of lenses, unless a corrective factor of about +1 dioptre is used.

Straylight before and after phacoemulsification in eyes with preoperative corrected distance visual acuity better than 0.1 logMAR.

PURPOSE: To report the outcomes of changes in straylight before and after phacoemulsification in eyes with preoperative corrected distance visual acuity (CDVA) better than 0.1 logMAR. SETTING: Private refractive surgery clinic, Driebergen, the Netherlands. DESIGN: Cohort study. METHODS: Standard phacoemulsification with implantation of a monofocal or multifocal intraocular lens (IOL) was performed. Preoperative and 3-month postoperative straylight values, CDVA, and refractive error were compared. RESULTS: The study enrolled 160 eyes (89 patients). The mean CDVA was 0.02 ± 0.05 logMAR (range -0.1 to 0.1 logMAR) preoperatively and 0.00 ± 0.04 logMAR (range -0.1 to 0.2 logMAR) postoperatively. The mean preoperative straylight was 1.21 ± 0.20 log(s) (range 0.80 to 1.74 log[s]) and 1.11 ± 1.16 log(s) (range 0.76 to 1.63 log[s]), respectively; the improvement was statistically significant. There was a correlation between high preoperative straylight values and postoperative improvement in straylight values. CONCLUSIONS: In eyes with relatively good CDVA of 0.1 logMAR or better (decimal 0.8 or better; Snellen 20/25 or better), straylight improved by 0.10 log(s) after cataract surgery. A subgroup of 44 eyes had an improvement of more than 0.20 log(s), which is comparable to a 2-line improvement on the vision chart.

In-the-bag decentration of a hydrophilic radially asymmetric multifocal intraocular lens secondary to capsule contraction.

We report a case of in-the-bag decentration and tilt of a hydrophilic rotationally asymmetric multifocal intraocular lens (IOL) of the M Plus type secondary to capsule contraction. After uneventful surgery and follow-up for 3 months, progressive decentering and tilting of the IOL secondary to capsule contraction and capsulorhexis phimosis was noticed. A surgical procedure was necessary to restore correct centration of the IOL. The uncorrected distance and near visual acuities were restored to logMAR 0. Hydrophilic multifocal IOLs of this specific design may be sensitive to postoperative decentration. Capsular tension rings may alleviate the problem in a secondary repair procedure. The softness of the C-loop haptics of this IOL type may also play a role in the decentration.

Comparison of a hydrophilic and a hydrophobic apodized diffractive multifocal intraocular lens.

UNLABELLED: To compare outcomes between a new design apodized diffractive hydrophilic multifocal intraocular lens (IOL) (Seelens MF; study group), and a well-known apodized diffractive hydrophobic multifocal IOL (SN6AD1; control group). A comparative case series comparing refractive and visual outcomes at distance and near. Patient satisfaction with a validated questionnaire, dysphotopsia and straylight measurement scores were recorded at 3 months post-operatively. The study group comprised 48 eyes and the control group 37 eyes. At 3 months post-operatively the mean uncorrected distance visual acuity (UDVA) was not statistically significant different between the study group and the control group (0.02 ± 0.07 logMAR [SD] vs 0.04 ± 0.09 logMAR). Corrected distance visual acuity (CDVA) was statistically significantly better with the study lens (-0.04 ± 0.05 logMAR vs -0.01 ± 0.04 logMAR (p < 0.019). There was no clinical or statistical significant difference at the 40 cm distance (0.09 ± 0.12 logMAR vs 0.08 ± 0.09 logMAR). The study group had statistically significant better uncorrected near acuity at 50 and 60 cm distances (p < 0.03 and p < 0.007, respectively). In terms of satisfaction the lenses performed equally. Halos were seen less often with the study lens. Straylight, as a parameter for visual quality, was significantly less with the study lens. CONCLUSION: The Seelens MF performs equally as well as the well-known SN6AD1 for UCDA and CDVA. The Seelens MF performs better at intermediate distance, and seems to allow for better depth of focus, and increased visual quality. More study is needed to corroborate the last finding.

Effect of Nd:YAG laser capsulotomy on refraction in multifocal apodized diffractive pseudophakia.

PURPOSE: To evaluate the effect on refraction of neodymium:YAG (Nd:YAG) laser posterior capsulotomy for posterior capsule opacification (PCO), and to evaluate the correlation between automated and subjective refraction in multifocal apodized diffractive pseudophakia. METHODS: A retrospective study of 75 pseudophakic eyes (50 patients) with multifocal apodized diffractive pseudophakia, treated for PCO with Nd:YAG laser posterior capsulotomy, was performed. Pre- and postintervention values of refractive and visual parameters were compared. The outcomes of autorefraction and subjective refraction were also compared. RESULTS: Uncorrected and corrected distance visual acuity improved significantly after Nd:YAG capsulotomy (P<.001). No significant changes were noted in defocus equivalent, astigmatic power vectors J(0) and J(45), and overall blurring strength in subjective refraction and autorefraction. Spherical equivalent changed significantly in autorefraction (P=.008), but not in subjective refraction. Autorefraction and subjective refraction were highly correlated in spherical equivalent, defocus equivalent, and blurring strength (r(2)>0.59). In approximately 7% of eyes, a change of more than 0.50 diopters in spherical equivalent in subjective refraction occurred. CONCLUSIONS: In most cases, Nd:YAG laser capsulotomy in patients with multifocal pseudophakia did not result in a change in refraction. However, 7% of eyes experienced a significant change in subjective refraction. Autorefraction correlated well with subjective refraction in apodized diffractive multifocal IOLs.

Comparison of a new-generation sectorial addition multifocal intraocular lens and a diffractive apodized multifocal intraocular lens.

PURPOSE: To compare visual, refractive, and satisfactory outcomes between a new-generation sectorial addition multifocal intraocular lens (IOL) (Lentis Mplus LS-312; study group) and a diffractive apodized multifocal IOL (Restor SN6AD1; control group). SETTING: Private practice, Driebergen, and Department of Ophthalmology, Academic Medical Center, Amsterdam, The Netherlands. DESIGN: Comparative case series. METHODS: Refractive and visual outcomes at near and distance, patient satisfaction, and dysphotopsia scores were recorded 3, 6, and 12 months postoperatively. RESULTS: The study group comprised 90 eyes and the control group, 143 eyes. Three months postoperatively, the mean uncorrected distance visual acuity (UDVA) was not statistically significantly different between the study group and the control group (0.04 ± 0.15 logMAR [SD] versus 0.06 ± 0.25 logMAR). The control group had significantly better uncorrected near visual acuity than the study group at 30 cm (0.05 ± 0.14 logMAR versus 0.15 ± 0.08 logMAR) and 40 cm (0.05 ± 0.14 versus 0.16 ± 0.21) (P<.01 and P<.03, respectively). Patients in the control group were more satisfied with their vision (P<.001). Dissatisfaction was related to younger age at surgery and male sex (P<.0001 and P<.033 respectively). Dysphotopsia occurred in approximately 18% of cases in both groups. CONCLUSIONS: The new sectorial addition multifocal IOL performed comparably to the diffractive apodized multifocal IOL in terms of UDVA and the presence of dysphotopsia. The diffractive apodized multifocal IOL performed better at 30 cm and 40 cm reading distances and had higher patient satisfaction.

Straylight before and after hyperopic laser in situ keratomileusis or laser-assisted subepithelial keratectomy.

PURPOSE: To compare straylight values before and 3 months after hyperopic laser in situ keratomileusis (LASIK) or laser-assisted subepithelial keratectomy (LASEK) and determine the cause of any change. SETTING: Private refractive surgery clinic, Driebergen, The Netherlands. DESIGN: Comparative case series. METHODS: Straylight (by definition the measure for glare disability) was measured preoperatively and postoperatively with a C-Quant straylight meter and recorded as log(s). The main outcome measures were the difference between postoperative and preoperative straylight values. RESULTS: The mean increase in straylight from preoperatively to postoperatively was 0.051 log(s) ± 0.158 (SD) in the LASIK group (39 eyes) and 0.031 ± 0.146 log(s) in the LASEK group (26 eyes). Although neither change was statistically significant, it was clinically significant in some cases. Haze or interface debris was seen in some eyes with increased straylight. The mean postoperative spherical equivalent refraction was -0.05 ± 0.27 diopter. CONCLUSIONS: Although straylight increased slightly after hyperopic LASIK and LASEK, the increase was not statistically significant. Some eyes with increased straylight had haze or interface debris. The cause of the increased straylight could not be determined in some cases.

Straylight measurements in laser in situ keratomileusis and laser-assisted subepithelial keratectomy for myopia.

PURPOSE: To compare straylight values before and 3 months after laser in situ keratomileusis (LASIK) and laser-assisted subepithelial keratectomy (LASEK) and to analyze the causes of any change. SETTING: Private refractive surgery clinic, Driebergen, The Netherlands. METHODS: Straylight was measured before and after LASIK or LASEK with a C-Quant straylight meter; values were recorded as the straylight parameter log(s). Main outcome measures were the difference between postoperative and preoperative straylight values and factors causing a difference between the values. RESULTS: The study evaluated 102 eyes having LASIK and 137 eyes having LASEK. On average, there was significant improvement in straylight values postoperatively in both groups. The mean decrease was -0.016 log(s) in the LASIK group and -0.026 log(s) in the LASEK group. Nonparametric testing (sign test) showed that the improvement in straylight was statistically significant in more than 50% of eyes in both groups. Straylight improved in 62 eyes in the LASIK group (P<.001) and 78 eyes in the LASEK group (P<.02) and deteriorated in 35 eyes and 58 eyes, respectively. There was an increase in straylight in 17 eyes (7.1%). Clinical correlations were found in some eyes that had increased postoperative straylight values. CONCLUSION: On average, straylight values 3 months after LASIK and LASEK were slightly decreased from baseline values.

Straylight measurements before and after removal of epithelial ingrowth.

In 3 eyes with epithelial ingrowth after laser in situ keratomileusis, straylight was measured before and after the ingrowth was removed. In 2 eyes of 1 patient, epithelial ingrowth reached the pupillary axis. Straylight decreased (improved) significantly after ingrowth removal: a 3.6-fold decrease in the right eye and a 10-fold decrease in the left eye. The uncorrected distance visual acuity (UDVA) improved from 0.25 (20/80) in both eyes to 1.0 (20/20) and 0.8 (20/25), respectively. In 1 eye of another patient, from which epithelial ingrowth was removed to prevent flap melting and distortion, the pupillary opening was not obscured and no significant change in straylight was found. The UDVA improved from 0.32 (20/60) to 1.0 (20/20) after the ingrowth was removed. An increase in straylight can be a significant complication of epithelial ingrowth. After the interlamellar space is cleared, the improvement in straylight is several factors larger than the gain in UDVA.

Advanced personalized nomogram for myopic laser surgery: first 100 eyes.

PURPOSE: To report the results in the first 100 eyes treated for myopia using a new advanced nomogram. SETTING: Private refractive surgery clinic. METHODS: This prospective interventional case series comprised 58 patients (100 eyes) consecutively treated for myopia with laser in situ keratomileusis (LASIK) or laser-assisted subepithelial keratectomy (LASEK) performed by the same surgeon. All treatments used a new nomogram for the Zyoptix 217 Z100 excimer laser. Postoperative mean sphere, cylinder, and spherical equivalent (SE) refraction were evaluated 3 months postoperatively. Safety, efficacy, and predictability were also evaluated. RESULTS: In the LASIK group (34 eyes), the mean postoperative sphere was +0.18 diopters (D) +/- 0.47 (SD), the mean postoperative cylinder was -0.10 +/- 0.23 D, and the mean postoperative SE was 0.04 +/- 0.36 D. In the LASEK group (64 eyes), the respective means were 0.10 +/- 0.22 D, -0.05 +/- 0.13 D, and +0.03 +/- 0.16 D. Hyperopic overcorrection (> or = +1.00 D) occurred in 4.1% of patients. Ninety-five percent of eyes in the LASIK group and 97% of eyes in the LASIK group had an uncorrected visual acuity of 1.0 (20/20) or better. Patient satisfaction was slightly higher than that of other laser refractive surgery patients at the clinic. CONCLUSIONS: The use of the advanced nomogram increased treatment accuracy in terms of UCVA and postoperative mean refraction and reduced the rate of hyperopic overcorrection over that in earlier studies. The need for enhancement procedures was reduced, and patient satisfaction was high.