Comparing the contrast sensitivity of a modified prolate anterior surface IOL and of two spherical IOLs.

PURPOSE: To compare the contrast sensitivity of an intraocular lens (IOL) with a modified prolate anterior surface (Tecnis Z9000, Pfizer), with 2 standard spherical IOLs (Sensar AR40e Opti-Edge IOL, AMO and AcrySof Natural SN60AT IOL, Alcon). METHODS: In this prospective study, 98 eyes of 71 patients received 1 of 3 IOLs at random. After 6 months, best corrected visual acuity, pupil size and contrast sensitivity under mesopic and photopic conditions were measured. RESULTS: No statistically significant differences in preoperative and postoperative refractive error and best corrected visual acuity existed between the groups. When comparing the Tecnis IOL with the AR40e IOL, contrast sensitivity testing showed significantly better results in the Tecnis group at 3 and 12 cpd in photopic conditions; at 3, 12 and 18 cpd in photopic with glare; at 3, 12 and 18 cpd in mesopic and at 12 and 18 cpd in mesopic with glare. The Tecnis IOL provided significantly better contrast sensitivity at almost all spatial frequencies in any lighting condition in comparison with the SN60AT IOL. CONCLUSION: Implantation of a modified prolate IOL may improve quality of vision as demonstrated by our clinical results of contrast sensitivity testing. In this study, we found a better performance of the Tecnis IOL under both photopic and mesopic conditions, compared to the results of the AR40e and the SN60AT IOL.

Neodymium: YAG capsulotomy rates after phacoemulsification with hydrophobic and hydrophilic acrylic intraocular lenses.

PURPOSE: To retrospectively evaluate the incidence of neodymium: YAG (ND:YAG) laser capsulotomies for posterior capsule opacification (PCO) seen with hydrophobic and hydrophilic acrylic intraocular lens implants 18 months after surgery. METHODS: One hundred and five eyes that had phacoemulsification with a continuous curvilinear capsulorhexis and implantation of either a hydrophobic or a hydrophilic acrylic posterior chamber IOL were evaluated in order to assess the incidence of PCO. Fifty-six eyes received a hydrophobic IOL (Acrysof-Alcon) and forty-nine eyes received a hydrophilic IOL (Galand-Visional). A standardized surgical protocol was performed by a single surgeon. All surgical complications were excluded and all patients had standardized postoperative medication and follow-up. RESULTS: With an average follow-up of 18 months in both groups, the incidence of posterior Nd:YAG laser capsulotomy for PCO was 8.9% in the hydrophobic group and 24.4% in the hydrophilic group, respectively (p = 0.03). CONCLUSION: Intraocular lenses made from hydrophobic acrylic material are associated with a significantly reduced rate of Nd:YAG laser capsulotomies as compared with intraocular lenses made from hydrophilic acrylic material.

Topical anesthesia without intracameral lidocaine in cataract surgery.

PURPOSE: To evaluate the efficacy of topical anesthesia with oxybuprocaïne 0.4% without intracameral lidocaïne as an alternative to peribulbar or retrobulbar anesthesia in cataract surgery. METHODS: Fifty-eight patients (eighty-two eyes) were included in this study. All patients received topical anesthesia with oxybuprocaïne 0.4%. No intracameral lidocaïne was used at the start of the intervention. Seventy-five per cent of patients received oral sedation with lorazepam 2.5 mg. All surgery was done using a superior corneal incision and phacoemulsification followed by a foldable IOL implantation. Subjective pain was assessed at 4 intervals during surgery using a 4-point pain scale. All patients were evaluated for intraoperative eye motility and blepharospasm. Patient and surgeon satisfaction was measured with a 4-point satisfaction scale. RESULTS: 15% of patients experienced mild pain during phaco and 43% had mild pain during corneal suturing. No patient had severe pain during the operation. In 4% of patients, intracameral lidocaïne was used to relieve pain. The surgeon and patient satisfaction was high. No eye movements or blepharospasm were recorded in 75% and 62% of cases respectively. No serious complications occurred. CONCLUSION: Topical anesthesia is a safe and effective alternative to peribulbar and retrobulbar anesthesia in corneal cataract surgery for the experienced surgeon.

Trabeculectomy: a retrospective long-term follow-up study.

The results of the surgical procedure of trabeculectomy as performed in our hospital on 100 eyes (67 patients) are presented. At the end of the follow-up period, with a range of 1 to 5 years and a mean follow-up of 36 months, there was an overall success rate of 68%. Criteria for success included no further visual field loss or disc damage, and no glaucomatous etiology for a decrease in visual acuity. Only in half of failure cases an IOP of more than 20 mmHg was recorded at least once during the follow-up period. Hyphaema, resolving most of the time in less than 7 days, was the most frequent postoperative complication (66%), followed by hypotomia (29%). Progression of lensopacities occurred in 22% of eyes.