Visual performance and patient satisfaction after implantation of extended range-of-vision IOLs: bilateral implantation vs 2 different mix-and-match approaches.

PURPOSE: To compare the visual outcomes and patient satisfaction after bilateral implantation of an extended range-of-vision intraocular lens (ERoV IOL) (Tecnis Symfony) vs 2 different mix-and-match approaches combining the ERoV IOL with bifocal IOLs. SETTING: Glory Seoul Eye Clinic, Seoul, South Korea. DESIGN: Prospective observational nonrandomized comparative study. METHODS: Patients undergoing cataract surgery were distributed into 3 groups based on their lifestyle and near visual demands: bilateral Symfony IOL, mix-and-match Symfony IOL with bifocal +3.25 diopters (D) IOL, and Symfony IOL with bifocal +4.0 D IOL. Binocular uncorrected visual acuity for distance, intermediate, and near, manifest refraction, defocus curve, contrast sensitivity, and subjective visual perception and satisfaction (photic phenomena, spectacle independence, and patient satisfaction) were evaluated at 1 week, 1 month, and 3 months postoperatively. RESULTS: The study comprised 103 people (206 eyes). There were no significant differences for uncorrected visual acuity between groups for distance, intermediate, and near vision (P > .05). Contrast sensitivity under low and high luminance conditions was not different between groups (P > .05). Influence of glare on image perception was found to reduce contrast sensitivity more in the bilateral group for smaller target sizes (P < .05). Patients implanted bilaterally with Symfony IOLs reported photic phenomena more frequently than those implanted with the mix-and-match combinations. CONCLUSIONS: All combinations evaluated provided good visual outcomes for distance, intermediate, and near. The lower incidence of photic phenomena reported by patients, and the lower reduction on contrast sensitivity for low illumination levels with the presence of glare, suggest that mix-and-match approaches might be a better option compared with bilateral implantation of ERoV IOLs.

Comparison of refractive changes after deep anterior lamellar keratoplasty and penetrating keratoplasty for keratoconus.

PURPOSE: To compare refractive changes occurring after deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PKP) in patients with keratoconus. METHODS: We retrospectively reviewed the medical records of 57 patients with keratoconus who received DALK (19 eyes of 19 patients) or PKP (38 eyes of 38 patients) before and after surgery between January 1996 and January 2008, in an effort to evaluate the surgical results and clinical courses. The principal outcome measures were as follows: preoperative and postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), manifest refraction, and corneal topography including anterior chamber depth (ACD). RESULTS: We noted no significant difference between the DALK and PKP groups in terms of postoperative UCVA, BCVA, astigmatism, or donor-recipient graft size disparities. For the PKP and DALK groups, the mean postoperative spheres were -1.64 D and -4.29 D at 6 months (P = 0.01) and -2.73 D and -4.22 D at 12 months, respectively (P = 0.04). Postoperative mean central corneal powers (3.0/5.0 mm zone) were 45.01/45.03 D and 46.94/47.84 D, respectively (P = 0.04 and P = 0.02). ACD after surgery was 3.25 and 3.37 mm at the final follow-up, respectively (P = 0.02). CONCLUSIONS: Although DALK is a safe alternative in cases of keratoconus, the DALK group evidenced significantly higher myopia than did the PKP group, which was related to steeper central corneal power and deeper ACD.

Myeloma of the eyelid: a rare necrotizing lesion.

A 77-year-old man was referred to the authors with an impression of recurrent chalazion of the left lower eyelid. He had suffered from multiple myeloma and had undergone chemotherapy for 11 months. A 2.0 x 0.8 cm, firm, tender, oval-shaped, ulcerated mass with an accompanying black crust on its surface, and erythematous swelling around it was observed. Evaluation of an eyelid biopsy specimen revealed neoplastic plasma cells with eccentric nuclei and monoclonality for lambda light chain, which the authors report as the first case of metastatic multiple myeloma presenting as a rare necrotizing eyelid lesion.

Radial extension of capsulorhexis in true exfoliation patient: a potentially hazardous complication.

A 77-year-old woman presented with decreased visual acuity due to cataracts. True exfoliation of the lens capsule was detected in both eyes, and phacoemulsification cataract surgery with intraocular lens implantation was performed in the right eye. Before the continuous curvilinear capsulorhexis was started, indocyanine green dye was introduced into the anterior chamber; when the forceps was used during the capsulorhexis, the superficial layer of the lens capsule separated from the deep layer and induced an impending radial extension. We believe this is the first such case to be reported.

Retinal breaks associated with the induction of posterior vitreous detachment.

PURPOSE: To evaluate the correlation between the incidence of vitrectomy-related retinal breaks and the induction of a posterior vitreous detachment (PVD). DESIGN: Retrospective, nonrandomized comparative study. METHODS: Three hundred and eleven eyes of 311 patients who underwent pars plana vitrectomy for the treatment of epiretinal membrane (ERM) or macular hole (MH) were reviewed. We identified the incidence of retinal breaks, the number of eyes requiring induction of PVD during operation, and the possible associated factors for retinal break in the 2 groups. RESULTS: The incidence of retinal breaks related to the operation was 6.9% (12/174 eyes) in the ERM group and 14.6% (20/137 eyes) in the MH group (P = .02). Induction of PVD was carried out in 28 eyes (16.0%) of the ERM group and in 105 eyes (76.6%) of the MH group (P = .01). Intraoperative or postoperative retinal breaks, or both, in the ERM group were detected in 9 (32.1%) of 28 eyes with induction of PVD and in 3 (2.1%) of 146 eyes without induction of PVD (P = .006). A similar trend also was observed in the MH group; retinal breaks related to the operation were detected in 19 (12.7%) of 105 eyes with induction of PVD and in 1 (3.1%) of the 32 eyes without induction of PVD (P = .008). CONCLUSIONS: Induction of PVD during vitrectomy results in a significantly higher incidence of intraoperative or postoperative retinal breaks, or both. Caution should be exercised after the induction of PVD to identify all retinal breaks so they can be treated.

Clinical outcomes of surgical techniques in congenital cataracts.

PURPOSE: To investigate the general clinical features of congenital cataracts and to determine their relationship to visual prognosis and surgical complications according to age at operation and surgical procedure adopted. METHOD: We retrospectively evaluated 92 eyes in 61 patients with congenital cataracts who underwent cataract surgery between January 1996 and December 2006. The demographic data, surgical technique, post-operative complications, and final visual prognosis were evaluated. RESULTS: The average age at surgery was 3.17 years (range 1 month to 11 years), and the mean follow-up was 40.02 months (range 6 to 46 months). Of the 56 eyes that could be checked for visual acuity after cataract extraction, 29 (51.7%) had a BCVA of > or = 0.5 at last visit. Unilateral congenital cataracts (p=0.025) and congenital cataracts with strabismus (p=0.019) showed significantly poorer visual outcomes. Patients with nystagmus also experienced a poor visual outcome; 6 patients (67%) had a BCVA of <0.1. Posterior cataracts had the worst visual prognosis (p=0.004). No statistically significant differences in posterior capsular opacity (p=0.901) or synechia formation (p=0.449) were observed between surgical techniques, but children younger than one year showed a higher tendency for PCO and synechia formation. CONCLUSIONS: Anterior vitrectomy did not reduce postoperative complications. Higher rates of complications (PCO, posterior synechia) developed in children younger than one year of age.