Visual Outcomes at 12 Months in Patients Following Implantation of a Diffractive Multifocal Intraocular Lens.

INTRODUCTION: The aim of this study was to assess distance, intermediate, and near visual acuity, contrast sensitivity, and patient satisfaction outcomes of a multifocal intraocular lens (IOL). METHODS: This multicenter, prospective clinical study was conducted at seven study sites in Turkey. Patients who underwent bilateral cataract removal and implantation of a diffractive, acrylic, hydrophobic, multifocal IOL (Acriva UD Reviol MFB 625; VSY Biotechnology, Istanbul, Turkey) were included. The uncorrected and best corrected distance visual acuities (UCDVA and BCDVA), uncorrected and best corrected intermediate visual acuities (UCIVA and BCIVA), and uncorrected and best corrected near visual acuities (UCNVA and BCNVA) were measured preoperatively and at postoperative 1, 6, and 12 months. Distance and near visual acuity scores (VAS) contrast sensitivities were measured at these time points. Quality of life was evaluated by visual function-14 (VF-14) questionnaire. RESULTS: Two hundred eyes of 100 patients were included. Monocular and binocular visual acuities at all distances showed improvement at postoperative 12 months compared to preoperative measurements (P < 0.001). Monocular and binocular UCIVA and binocular BCIVA at postoperative 12 months were significantly improved compared to measurements at 1 month (P < 0.001). Binocular contrast sensitivity at distance showed significant improvement from postoperative 1 month to postoperative 12 months, except for 3 cycles per degree (cpd; without glare) and 18 cpd (with glare). VAS improved from 75.96 at postoperative 1 month to 76.85 at postoperative 12 months. VF-14 score was 98.2 ± 4.6. CONCLUSION: The Acriva UD Reviol MFB 625 appears to provide a good level of distance and near visual acuity, quality of life, and patient satisfaction. Further studies with longer follow-up will provide valuable insight into the long-term stability of these visual outcomes.

Effect of apraclonidine versus dorzolamide on intraocular pressure after phacoemulsification.

BACKGROUND AND OBJECTIVE: To investigate the efficacy of 1% apraclonidine hydrochloride and 2% dorzolamide hydrochloride in controlling postoperative intraocular pressure elevation in patients undergoing phacoemulsification. PATIENTS AND METHODS: A prospective, randomized, double-blind, placebo-controlled study was conducted. Seventy-five patients were randomized to receive either 1% apraclonidine hydrochloride, 2% dorzolamide hydrochloride, or artificial tears immediately after uncomplicated phacoemulsification. Intraocular pressure was measured by Goldmann applanation tonometer 1 to 3 hours preoperatively and 24 hours and 5 days postoperatively. RESULTS: Mean intraocular pressure measured at 24 hours and 5 days after surgery was not significantly different between groups. None of the patients had an elevated intraocular pressure of 30 mm Hg or higher. No marked difference was observed in patient age, preoperative intraocular pressure, mean ultrasound time, degree of nuclear hardness, and amount of postoperative intraocular inflammation between groups. CONCLUSION: Uneventful phacoemulsification involving meticulous cortical and viscoelastic removal does not cause a significant increase in intraocular pressure 24 hours following surgery.

Short-course use of recombinant factor VIIa in a haemophilia patient with inhibitor undergoing cataract surgeries.

A 36 year-old patient with severe haemophilia A and high-titre inhibitor underwent cataract surgery under topical anaesthesia. Recombinant factor VIIa was used only three times, once before and twice following surgery. Tranexamic acid was given concomitantly. One month after the first successful procedure on the right eye, a second operation was performed on the left eye in the same manner. Both procedures were uneventful. Neither bleeding complications nor any other side effects occurred.

Cataract extraction and primary hydrophobic acrylic intraocular lens implantation in infants.

PURPOSE: We sought to report the incidence of visual axis opacification and to evaluate the complication and reoperation rates after intraocular lens implantation in infants. METHODS: Twenty-one infants (31 eyes) who had cataract extraction with primary hydrophobic acrylic IOL implantation between October 1996 and May 2002 were reviewed. Posterior capsule was left intact in 14 eyes (group A); posterior capsulorrhexis or capsulotomy with anterior vitrectomy was performed in 17 eyes (group B). Complication and reoperation rates were compared with an age-matched control group of 17 patients (33 eyes) who were left aphakic after pars plicata lensectomy. Mean follow-up period was 41 months (range, 22-75 months) in group A, 37 months (range, 10-75 months) in group B, and 52 months (range, 7-97 months) in the control group. RESULTS: Mean age of the patients was 6.8 months (range, 3-10 months) in group A, 8.9 months (range, 3-18 months) in group B, and 4.9 months (range, 1-15 months) in the control group. Visual axis opacification was significantly higher in group A (86%) when compared with group B (17.6%; P < 0.0001). No significant difference was found in terms of pupillary irregularities and peripheral anterior synechiae formation between pseudophakic and aphakic group ( P = 0.43 and P = 0.306, respectively), whereas pigment dispersion and fibrinous reaction were significantly more common in the pseudophakic group ( P = 0.002). Serious complications, such as retinal detachment, pseudophakic bullous keratopathy, and secondary glaucoma, did not develop in any eye. Reoperation rate was significantly higher in group A (78%) when compared with group B (17%) and the control group (12%; P = 0.0011 and P < 0.0001, respectively). CONCLUSIONS: Visual axis opacification requiring a reoperation was significantly more common in patients with an intact posterior capsule. To decrease the reoperation rate and maintain a clear visual axis, posterior capsulorrhexis with anterior vitrectomy should be performed. Even although early complications were quite frequent, serious late complications were not encountered in any eye. Therefore, under appropriate conditions, IOL implantation is a suitable alternative in infants.

Visual results and complications of posterior chamber intraocular lens implantation after capsular tear during phacoemulsification.

BACKGROUND AND OBJECTIVE: To determine the visual outcome and complications of posterior chamber intraocular lens implantation after capsular tear in patients undergoing phacoemulsification at Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey. PATIENTS AND METHODS: The medical records of patients who underwent phacoemulsification surgery for senile cataract from January 1, 1996, to December 31, 1998, were reviewed. Patient inclusion criteria were implantation of a posterior chamber intraocular lens after phacoemulsification, being operated on by one of two surgeons, and a follow-up of at least 1 year. There were 58 eyes in the group with capsular tear and 159 eyes in the group with intact capsule. RESULTS: A final visual acuity of 0.8 or more was more common in eyes with uncomplicated phacoemulsification surgery (chi-square = 16.25, P = .03). Refraction stabilized most commonly at 2 to 6 months postoperatively in patients with capsular tear and 1 to 21 days postoperatively in patients with uncomplicated phacoemulsification (chi-square = 22.61, P < .001). Complications such as retinal detachment (odds ratio = 11.70, P < .05), cystoid macular edema (odds ratio = 26.33, P < .01), increased intraocular pressure (odds ratio = 14.54, P < .05), and decentration of the intraocular lens (odds ratio = 32.79, P = .001) were more frequently observed in eyes with capsular tear. CONCLUSIONS: It takes longer for the refraction to stabilize in eyes with posterior chamber intraocular lens implantation after capsular tear during phacoemulsification. Complications such as retinal detachment, cystoid macular edema, increased intraocular pressure, and decentration of the intraocular lens are more common in these patients, and therefore they should be observed for a longer period of time.

Holmium laser thermal keratoplasty for hyperopia in eyes overcorrected with laser in situ keratomileusis for myopia.

PURPOSE: To assess the efficacy and safety of holmium laser thermal keratoplasty (Ho:LTK) for hyperopia in eyes overcorrected after laser in situ keratomileusis (LASIK) for myopia. METHODS: We performed a prospective evaluation of Ho:LTK in eyes with secondary hyperopia from +1.00 to +5.50 D after LASIK. Thirty-seven eyes of 23 patients received one concentric 8-spot application at the 6-mm-diameter zone. Mean patient age was 41.3 +/- 13.0 years (range 20 to 68 yr). Mean corneal thickness was 455.86 +/- 31.20 microm (range 373 to 506 microm). RESULTS: Mean spherical equivalent refraction changed from +2.30 +/- 1.08 D to +0.45 +/- 1.00 D at 12 months after Ho:LTK. Thirty-one eyes (84%) were within +/- 1.00 D of emmetropia and 25 eyes (68%) were within +/- 0.50 D at 1 year. Mean change in refraction was 1.84 +/- 0.92 D. No eye lost 2 lines of best spectacle-corrected visual acuity. CONCLUSIONS: Ho:LTK is a suitable alternative for correcting secondary hyperopia resulting from LASIK for myopia. Parameter adjustments may be necessary for improving the results.

Pseudo-accommodation with intraocular lenses implanted in the bag.

PURPOSE: To evaluate the accommodation potential in eyes after intraocular lens in-the-bag implantation. METHODS: Fifty-one consecutive patients were included in the study. Group 1 included 26 eyes that had phacoemulsification with continuous curvilinear capsulorhexis and in-the-bag implanted foldable IOL. Twenty-five eyes in Group 2 had capsulotomy with extracapsular cataract extraction and were implanted with polymethylmethacrylate IOL. Time elapsed from surgery was at least 6 months. There was no significant difference for age or gender between groups (P > .05). We measured accommodation amplitude and depth of the anterior chamber at distance and near fixation with an ultrasonic biometry device. The results were compared using the unpaired Student t-test. RESULTS: The anterior chamber depths while fixating at a distant object were not significantly different between groups (P>.05), however, at near the difference was statistically significant (P=.008). The change in depths between far and near fixation was significantly different (P=.002) and was more pronounced in the the capsulorhexis group (P < .001). The accommodation amplitudes in this group were significantly greater than in the capsulotomy group (P = .025). CONCLUSION: Patients who had uncomplicated small incision phacoemulsification surgery with continuous curvilinear capsulorhexis and in-the-bag implanted lens seemed to preserve some pseudo-accommodation after surgery.