Outcomes of a Refractive Segmented Bifocal Intraocular Lens with a Lower Near Addition.

Purpose: To evaluate clinical and subjective outcomes of a segmented bifocal IOL with a 2.0 D near addition. Patients and Methods: Retrospective analyses of patients who had undergone refractive lens exchange with bilateral implantation of the SBL-2 IOL (Lenstec, Inc., Christ Church, Barbados) were performed. The number of patients included in the study was 389 (778 eyes). Refractive, visual and patient-reported outcomes were presented for the last available visit (mean follow-up 2.05 ± 1.33 months). Results: The percentage of eyes within ±0.50D and ±1.00D of emmetropia was 82.5% (642/778) and 97.8% (761/778), respectively. The mean uncorrected intermediate visual acuity (66 cm) of the last available visit was 0.08 ± 0.15 logMAR monocularly and 0.04 ± 0.14 logMAR binocularly. The mean monocular and binocular uncorrected near visual acuity (40 cm) were 0.30 ± 0.15 logMAR and 0.24 ± 0.14 logMAR, respectively. Of all patients, 97.2% (378/389) claimed never to use any correction for distance vision, while 93.1% (362/389) of patients did not require any correction for near vision. The mean scores for visual phenomena (on the scale from 1 - no difficulty to 7 - severe difficulty) were 1.8 ± 1.3, 1.7 ± 1.2, 1.7 ± 1.2 and 1.6 ± 1.2 for glare, halo, starburst, and ghosting/double vision, respectively. Conclusion: Despite the lower near addition of SBL-2 segmented bifocal IOL, patients achieved reasonable rates of spectacle independence and a low incidence of visual phenomena.

Outcomes and Adverse Events of Sub-Tenon's Anesthesia with the Use of a Flexible Cannula in 35,850 Refractive Lens Exchange/Cataract Procedures.

PURPOSE: To describe our technique of sub-Tenon's anesthesia and report adverse events and patient comfort. SETTING: Optical Express, United Kingdom. DESIGN: Retrospective case series. METHODS: The outcomes of 35,850 intraocular procedures (phacoemulsification and implantation of an intraocular lens) were retrospectively reviewed and the incidence of adverse events related to sub-Tenon's anesthesia was calculated. On the first postoperative day, patients were asked to complete a questionnaire enquiring about their comfort during and after the procedure. The anesthetic solution consisted of a combination of Lidocaine and Hyaluronidase, which was administered into sub-Tenon's space with a single-use sterile polyurethane 22G x 1" (0.9 x 25 mm) cannula. Mild conscious sedation (midazolam) was used during anesthetic and surgical procedure. RESULTS: No significant adverse events that would affect the posterior segment of the eye or result in vision loss were recorded. Subconjunctival haemorrhage related to sub-Tenon's anesthesia was noted in 4.3% of eyes. Five minutes after the administration of sub-Tenon's block, 80.6% of eyes had no chemosis, 14.8% had chemosis that affected only 1 quadrant of the eye and 4.5% of eyes had chemosis affecting 2 or more quadrants of the eye. Other adverse events included 14 cases of cyst/granuloma formation in the area of sub-Tenon's incision and 7 eyes required suturing of the conjunctival cut. Of all patients, 93.2% experienced no or only mild discomfort during or after surgical procedure. CONCLUSION: Sub-Tenon's anesthesia with the use of a flexible cannula is a safe option for ophthalmic anesthesia. No sight-threatening adverse events occurred.

Visual acuity improvement in adult amblyopic eyes with an iris-fixated phakic intraocular lens: long-term results.

PURPOSE: To evaluate the effect of implantation of iris-fixated phakic intraocular lenses (pIOLs) (Artisan) in adult amblyopic eyes. SETTING: Optical Express, London, United Kingdom. DESIGN: Retrospective case series. METHODS: The study analyzed data from 5 years of follow-up of amblyopic eyes that were implanted with iris-fixated pIOLs and had a preoperative corrected distance visual acuity (CDVA) of 6/15 or worse. Visual acuity, refraction, endothelial cell count, and complications were assessed. RESULTS: Data for 103 eyes were analyzed as 2 groups. Group 1 comprised 82 eyes with myopia or myopic astigmatism, and Group 2 contained 21 eyes with hyperopia or hyperopic astigmatism. The mean preoperative sphere in Group 1 was -13.42 diopters (D) ± 5.62 (SD) with a mean cylinder of -2.35 ± 1.75 D. In Group 2, the mean sphere and cylinder were +6.77 ± 1.91 D and -2.63 ± 2.43 D, respectively. The mean CDVA improved from 0.51 ± 0.15 logMAR to 0.34 ± 0.16 logMAR (P<.001) in Group 1 and from 0.54 ± 0.17 logMAR to 0.46 ± 0.14 logMAR in Group 2 (P<.005). The safety index was 1.48 in Group 1 and 1.19 in Group 2. The efficacy index was 1.21 in Group 1 and 1.00 in Group 2. The mean gain in CDVA was statistically significantly greater in Group 1 (0.17 ± 0.14 logMAR) than in Group 2 (0.08 ± 0.11 logMAR). Two or more lines of CDVA were gained by 48.8% of eyes in Group 1 and by 19.0% of eyes in Group 2. CONCLUSION: The iris-fixated pIOL was a safe and effective option for improving visual acuity in adult amblyopic eyes. FINANCIAL DISCLOSURE: Dr. Schallhorn is a consultant to Abbott Medical Optics, Inc. No other author has a financial or proprietary interest in any material or method mentioned.

Visual outcomes and patient satisfaction in 9366 eyes using a refractive segmented multifocal intraocular lens.

PURPOSE: To report the effectiveness, patient satisfaction, and complication rate with a zonal refractive intraocular lens (IOL) in a high volume of patients. SETTING: Private clinic, London, United Kingdom. DESIGN: Case series. METHODS: Retrospective data of patients with binocular Lentis Mplus IOLs were analyzed. The main outcome measures were uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), corrected distance visual acuity, manifest refraction, patient satisfaction, and complications. One-month, 3-month, and 6-month data were analyzed. RESULTS: The study comprised 9366 eyes of 4683 patients. The mean spherical equivalent changed from +1.73 diopters (D) ± 3.37 (SD) preoperatively to -0.02 ± 0.60 D at 3 months and +0.03 ± 0.60 D at 6 months. Ninety-five percent of patients achieved a binocular UDVA of 6/7.5 (0.1 logMAR) or better 3 months postoperatively. The mean binocular UNVA was 0.155 ± 0.144 logMAR and 0.159 ± 0.143 logMAR at 3 months and 6 months, respectively. Severe dysphotopsia requiring an IOL exchange occurred in 55 eyes. Patient satisfaction was high, with 97.5% of patients willing to recommend the procedure. CONCLUSIONS: The zonal refractive IOL provided excellent distance and near visual acuity. The postoperative complication rate was clinically acceptable, and patient satisfaction high. FINANCIAL DISCLOSURE: Dr. Schallhorn is a consultant to Abbott Medical Optics, Inc. No author has a financial or proprietary interest in any material or method mentioned.

Ask the experts.

Reducing NHS staff to save money is simplistic, and underestimates the purpose and complexity of the NHS.