Long-term Clinical Outcomes After Trifocal Intraocular Lens Implantation: A Retrospective Observational Study.

PURPOSE: To evaluate the long-term stability of the AcrySof IQ PanOptix TFNT00 intraocular lens (IOL) (Alcon Laboratories, Inc). METHODS: This was a retrospective review of 1,065 eyes (745 patients) who underwent implantation of a PanOptix IOL. A total of 296 eyes (mean age: 58.62 ± 5.63 years and preoperative refractive error: -0.68 ± 3.01 diopters [D]) met inclusion criteria for this study. The objective refraction, uncorrected distance and near visual acuity (UDVA and UNVA), and corrected distance visual acuity (CDVA) were evaluated at postoperative months 1, 2, 6, 12, 24, and 36. RESULTS: The refractive error was -0.20 ± 0.36 D at 1 month, -0.20 ± 0.35 D at 2 months (P = .503), -0.10 ± 0.37 D at 6 months (P < .001), -0.02 ± 0.38 D at 12 months (P < .001), 0.00 ± 0.38 D at 24 months (P < .001), and 0.03 ± 0.39 D at 36 months (P < .001). Multivariate analysis showed long-term, independent associations for young age (beta = -0.122; P = .029) and changes in mean keratometry (beta = -0.413; P < .001). A greater refractive change was associated with a greater change in UNVA (r = 0.134; P = .026) but not with UDVA (r = -0.029; P = .631) or CDVA (r = -0.010; P = .875). CONCLUSIONS: Implantation of the PanOptix IOL yields stable clinical outcomes for visual acuity and refractive error for the first 3 years. A slight hyperopic shift, causing decreased near visual acuity, is anticipated for younger patients. [J Refract Surg. 2023;39(4):236-241.].

Accuracy of Nine Formulas to Calculate the Powers of an Extended Depth-of-Focus IOL Using Two SS-OCT Biometers.

PURPOSE: To evaluate the accuracy of nine formulas to calculate the power of a new extended depth-of-focus intraocular lens (EDOF IOL), the AcrySof IQ Vivity (Alcon Laboratories, Inc), using measurements from two optical biometers, the IOLMaster 700 (Carl Zeiss Meditec AG) and Anterion (Heidelberg Engineering GmbH). METHODS: After constant optimization, the accuracy of these formulas was analyzed in 101 eyes: Barrett Universal II, EVO 2.0, Haigis, Hoffer Q, Holladay 1, Kane, Olsen, RBF 3.0, and SRK/T. Both standard and total keratometry from the IOLMaster 700 and standard keratometry from the Anterion were used for each formula. RESULTS: Constant optimization provided slightly different values for the A-constant, which ranged between 118.99 and 119.16, depending on the formula and the optical biometer. According to the heteroscedastic test, within each keratometry modality the standard deviation of the SRK/T was significantly higher compared to that of the Holladay 1, Kane, Olsen, and RBF 3.0 formulas. The SRK/T formula provided less accurate results also when the absolute prediction errors were compared by Friedman test. According to McNemar's test with Holm corrections, statistically significant differences were found within each keratometry modality between the percentage of eyes with a prediction error within ±0.25 diopters obtained with the Olsen formula compared to the Holladay 1 and Hoffer Q formulas. CONCLUSIONS: Constant optimization remains a mandatory step to achieve the best outcomes with the new EDOF IOL: the same constant should not be used for all formulas and for both optical biometers. Different statistical tests revealed that older IOL formulas have lower accuracy compared to newer formulas. [J Refract Surg. 2023;39(3):158-164.].

Analysis of uncorrected near visual acuity after extended depth-of-focus AcrySof® Vivity™ intraocular lens implantation.

A newly developed extended-depth-of-focus AcrySof® Vivity™ intraocular lens (IOL), which has a wavefront-shaped anterior surface, has shown a promising outcome in minimizing dysphotopsia, the biggest issue after diffractive type IOL implantation. On the contrary, relatively low uncorrected near visual acuity (UNVA) has been raised as a demerit of this IOL. However, there is only limited information about the UNVA after Vivity implantation. In the present study, we compared the uncorrected distant and intermediate visual acuity (UDVA and UIVA) and UNVA according to the range of refractive error (RE) from 91 eyes from 91 patients implanted with Vivity IOL. Then we assessed the biometric factors for their association with UNVA from 66 eyes with a RE within ± 0.25 D. The UDVA was worst in eyes with RE < -0.50 D (0.17 ± 0.21), which was significantly worse than in any other group (P < 0.001 for every analysis). The UIVA was worst in eyes with RE of 0.25 to 0.50 D (0.35 ± 0.07 D), which was significantly worse than in eyes with RE of -0.50 to -0.26 D (P = 0.020) and in eyes with RE of -0.25 to -0.01 D (P = 0.028). The UNVA was worst in eyes with RE of 0.25 to 0.50 D (0.40 ± 0.14 D), which was significantly worse than in eyes with RE of -0.50 to -0.26 D (P = 0.022), which suggests that the extent of monovision should be limited up to -0.50 diopter. On univariate analysis for UNVA in eyes with a RE within ± 0.25 D, the anterior chamber depth (R = 0.257; P = 0.037) and pupil size (R = 0.451; P < 0.001) had a statistically significant relation to UNVA, while multivariate analysis showed the pupil size (ß = 0.451; P < 0.001) as the sole indicator, suggesting eyes with a small pupil size might receive a UNVA benefit.

Clinical outcomes after implantation of extended depth-of-focus AcrySof® Vivity® intraocular lens in eyes with low-grade epiretinal membrane.

PURPOSE: To evaluate the clinical outcomes of extended depth-of-focus (EDoF) AcrySof® Vivity® intraocular lens in eyes with low-grade epiretinal membrane (ERM). METHODS: Forty-five eyes with low-grade ERM and history of Vivity implantation were compared with 50 age-matched controls with Vivity implantation and no ERM. Eyes with ERM showing widening of the outer nuclear layer and loss of the foveal depression, but no ectopic inner foveal layer or outer retinal defect were eligible. Corrected and uncorrected distant visual acuity (CDVA and UDVA), uncorrected intermediate and near visual acuity (UIVA and UNVA), contrast sensitivity detected by area under the log contrast sensitivity function (AULCSF), Strehl ratio, area ratio, and occurrence of dysphotopsia were compared between groups. RESULTS: UDVA and CDVA were similar between groups (UDVA: 0.01 ± 0.05 vs 0.03 ± 0.06, P = 0.154; CDVA: 0.00 ± 0.00 vs 0.00 ± 0.02, P = 0.125). UIVA and mesopic AULCSF were significantly worse in eyes with ERM compared to those with no ERM (UIVA: 0.09 ± 0.09 vs 0.14 ± 0.10, P = 0.028; mesopic AULCSF: 1.26 ± 0.15 vs 1.17 ± 0.10, P = 0.013). The occurrence of dysphotopsia was similar in both groups (glare: P = 0.465; halo: P = 0.218; starburst: P = 0.457). DISCUSSION: Eyes with low-grade ERM showed comparable outcomes to eyes without ERM after Vivity IOL implantation. Implantation of this newly developed EDoF IOL with low addition can be of benefit to eyes with low-grade, reversible ERM that is limited to the inner retina.

Accuracy of IOL Power Calculation Formulas for Quadrifocal Acrysof IQ PanOptix TFNT Implantation in Patients With Previous Corneal Refractive Surgery: Comparison of SS-OCT-Based Biometers.

PURPOSE: To evaluate the accuracy of intraocular lens (IOL) power calculation formulas from two biometers using swept-source optical coherence tomography for quadrifocal Acrysof IQ Panoptix TFNT IOL (Alcon Laboratories, Inc) implantation in patients with visually significant cataract with previous corneal refractive surgery. METHODS: This retrospective study comprised 50 eyes from 50 patients with a history of corneal refractive surgery and TFNT IOL implantation. Candidate formulas were Shammas-PL and Barrett True-K in the Argos (Movu, Inc), Barret True-K and Haigis-L in the IOLMaster 700 (Carl Zeiss Meditec AG), and Haigis using the total keratometry (TK) mode in the IOLMaster 700. The main outcome measure was the mean absolute error (MAE) detected at postoperative 6 months. The refractive accuracy was also evaluated as number and percentage of eyes within ±0.25, ±0.50, and ±0.75 diopters (D) of the prediction error. RESULTS: The uncorrected distance and near visual acuity were 0.32 ± 0.34 and 0.46 ± 0.20 logMAR at baseline, and significantly improved to 0.04 ± 0.07 and 0.03 ± 0.06 logMAR at postoperative 6 months (P < .001 for all analysis) with a mean spherical equivalent of -0.20 ± 0.39 D. The MAE was smallest for the Barrett True-K formula in the IOLMaster 700 (0.36 ± 0.26 D) and largest for the Shammas-PL formula in the Argos (0.59 ± 0.37 D). The Barrett True-K formula from both devices showed that 90% of eyes were within ±0.75 D of MAE. CONCLUSIONS: The visual and refractive outcomes of TFNT IOL implantation in patients with previous corneal refractive surgery were favorable. The Barrett True-K formula in the IOLMaster 700 showed the best refractive outcome for TFNT IOL implantation. [J Refract Surg. 2021;37(11):836-841.].

Accuracy of Total Corneal Power Calculation for Multifocal Toric Intraocular Lens Implantation: Swept-Source OCT-Based Biometer vs Scheimpflug Tomographer.

PURPOSE: To evaluate the accuracy of total corneal power calculation from a swept-source optical coherence tomography-based biometer and a rotating Scheimpflug tomographer for the Acrysof IQ Panoptix toric TFNT intraocular lens (IOL) (Alcon Labroatories, Inc). METHODS: A retrospective study was undertaken on 145 eyes implanted with the TFNT IOL. The accuracy of total corneal power calculation from a SS-OCT-based biometer (IOLMaster 700; Carl Zeiss Meditec AG; total keratometry [TK]) and a rotating Scheimpflug tomographer (Oculus Optikgeräte GmbH; total corneal refractive power at 3 mm [TCRP3] and at 4 mm [TCRP4]) were compared. The surgically induced astigmatism vector, difference vector, angle of vector, correction index, index of success, coefficient of adjustment, and flattening index were analyzed using the VectrAK analysis program (ASSORT). RESULTS: The index of success showed a significant difference between the three methods (P = .035, analysis of variance test). The mean ± standard deviation of the index of success was the best in TK (0.43 ± 0.20), followed by TCRP4 (0.47 ± 0.24, P = .400, Bonferroni HSD test) and TCRP3 (0.50 ± 0.22, P = .030, Bonferroni HSD test). The preoperative refractive astigmatism prediction error was within ±0.50 diopters (D) in 62 eyes (42.8%) when using TCRP4 and in 66 eyes (45.5%) when using TK. CONCLUSIONS: These study results suggest that the refractive accuracy of TFNT implantation using total corneal power from TCRP4 and TK was favorable. [J Refract Surg. 2021;37(10):686-692.].

Effect of Capsular Tension Ring on Refractive Outcomes in Patients With Implantation of the Quadrifocal Acrysof PanOptix TFNT00 IOL.

PURPOSE: To evaluate the effect of a capsular tension ring (CTR) on refractive outcomes in eyes undergoing implantation of the quadrifocal Acrysof PanOptix TFNT00 intraocular lens (IOL) (Alcon Laboratories, Inc). METHODS: A retrospective case-control study was undertaken of 91 eyes implanted with the TFNT00 IOL. Of these 91 eyes, a CTR was implanted in 33 and these eyes were compared to the 58 eyes in which a CTR was not implanted. The main outcome measure was the mean absolute error (MAE) of the refractive prediction error. To evaluate the consistency of refractive outcomes, variance of MAE was measured. Using a swept-source optical coherence tomography device, postoperative aqueous depth (AQD) was measured to estimate the position of the IOL. RESULTS: Eyes with a CTR showed a significantly smaller MAE when compared with eyes without a CTR (P = .038 at 1 m, P = .003 at 2 m, and P = .001 at 6 m). There was a lower variance of MAE in the eyes implanted with a CTR, with higher precision of refraction (P = .058 at 1 m, P = .007 at 2 m, and P = .001 at 6 m). There was a significant difference in the percentage of the eyes showing more than 0.50 D from the estimated target of the Barrett Universal II formula (P = .007 at 1 m, P = .064 at 2 m, and P = .004 at 6 m, respectively). AQD was significantly shallower in eyes with a CTR than in eyes without a CTR (P = .006). CONCLUSIONS: Use of the CTR enhanced the accuracy of postoperative refractive outcomes after TFNT00 IOL implantation by preventing the posterior bowing of the optic-haptic junction. [J Refract Surg. 2021;37(3):174-179.].

Accuracy of theoretical IOL formulas for Panoptix intraocular lens according to axial length.

The accuracy of intraocular lens (IOL) calculations is suboptimal for long or short eyes, which results in a low visual quality after multifocal IOL implantation. The purpose of the present study is to evaluate the accuracy of IOL formulas (Barrett Universal II, SRK/T, Holladay 1, Hoffer Q, and Haigis) for the Acrysof IQ Panoptix TFNT IOL (Alcon Laboratories, Inc, Fort Worth, Texas, United States) implantation based on the axial length (AXL) from a large cohort of 2018 cases and identify the factors that are associated with a high mean absolute error (MAE). The Barrett Universal II showed the lowest MAE in the normal AXL group (0.30 ± 0.23), whereas the Holladay 1 and Hoffer Q showed the lowest MAE in the short AXL group (0.32 ± 0.22 D and 0.32 ± 0.21 D, respectively). The Haigis showed the lowest MAE in the long AXL group (0.24 ± 0.19 D). The Barrett Universal II did not perform well in short AXL eyes with higher astigmatism (P = 0.013), wider white-to-white (WTW; P < 0.001), and shorter AXL (P = 0.016). Study results suggest that the Barrett Universal II performed best for the TFNT IOL in the overall study population, except for the eyes with short AXL, particularly when the eyes had higher astigmatism, wider WTW, and shorter AXL.

Ultra-Widefield Fluorescein Angiography Findings in Patients with Macular Edema Following Cataract Surgery.

Purpose: To evaluate the ultra-widefield fluorescein angiography (UWFA) findings in patients with macular edema (ME) following cataract surgery.Methods: Thirty-three eyes from patients who showed greater than a 30% increase in the central subfield thickness following cataract surgery were included. UWFA scored according to a system suggested by the Angiography Scoring for Uveitis Working Group (ASUWG). Factors associated with a high ASUWG score were evaluated.Results: Thirty-three (100.0%) of the 33 eyes showed abnormal UWFA findings, including optic disc staining (81.8%), capillary leakage (100.0%), pinpoint leakage (84.8%), peripheral retinal vascular leakage (24.2%) and retinal staining (6.1%). Multiple regression analysis reveals that following adjustment for other factors, younger age was independently associated with a higher ASUWG score (R2 = 0.476, p = .001).Conclusions: Patients with ME following cataract surgery show generalized inner and outer blood-retinal barrier breakage. Particular attention is required during cataract surgery in young patients.

Factors affecting prediction error after cataract surgery with implantation of various multifocal IOLs in patients with previous refractive laser surgery.

BACKGROUND: This study aimed to compare the clinical outcomes of implantation of various multifocal intraocular lenses (mIOLs) and the prediction accuracy of two intraocular lens (IOL) power calculation formulas for eyes that underwent previous corneal refractive surgery. METHODS: Four types of mIOLs [TECNIS Symfony (Group I), AcrySof IQ PanOptix (Group II), LENTIS Mplus (Group III), and TECNIS ZLB00 (Group IV)] were used and the IOL power was calculated with the two no-history methods, Shammas-PL and Barrett True-K. Visual acuity and refractive outcomes including manifest refraction, prediction error (PE), absolute error (AE), and median absolute error (MedAE) were evaluated at three months after the cataract surgery. RESULTS: For all groups the Barrett True-K formula produced a narrower range of PEs and lower MedAE than Shammas-PL. Eyes of lower predictive accuracy (group B, AE >0.5D) showed weak uncorrected distance visual acuity resulting from myopic refractive error and target refraction when compared to that of higher predictive accuracy (group A, AE ≤0.5 D). CONCLUSIONS: Targeting emmetropia using the Barrett True-K, which considers both anterior and posterior corneal curvature is recommended in patients undergoing mIOL implantation with prior corneal refractive surgery. Additionally, history of prior large amount of laser ablation seems to be an important factor related to low predictive accuracy.

Risk Factors for Onset or Progression of Posterior Vitreous Detachment at the Vitreomacular Interface after Cataract Surgery.

PURPOSE: To study the incidence and risk factors for onset or progression of posterior vitreous detachment (PVD) at the vitreomacular interface (VMI) after cataract surgery. DESIGN: Retrospective case series. PARTICIPANTS: Patients with a history of phacoemulsification from April 2018 through April 2019 at the Keye Eye Center, Seoul, Korea, and postoperative monitoring for more than 2 months. METHODS: Cox proportional hazard ratios for the onset or development of PVD after cataract surgery in the presence of selected risk factors and demographic data were calculated. To evaluate the ocular risk factors, various ocular metrics, including spherical equivalent (SE), axial length (AL), anterior chamber depth, lens thickness, central subfield thickness, PVD status at macula and optic nerve head (ONH), peripapillary retinal nerve fiber layer thickness, and ONH parameters from OCT scans, were used for the analysis. MAIN OUTCOME MEASURES: Onset or development of PVD at the VMI. RESULTS: Among 988 eyes without PVD at baseline, 174 eyes (17.6%) showed changes in the VMI. Univariate analysis showed that age, SE, AL, PVD status at macula and ONH, and average and vertical cup-to-disc ratios (CDRs) were associated significantly with PVD onset or development (P = 0.046, P = 0.004, P = 0.040, P < 0.001, P < 0.001, P = 0.008, and P = 0.042, respectively). In a multivariate analysis, PVD status at the macula and ONH and smaller CDR were associated with PVD onset or progression after cataract surgery after adjustment for age, SE, and AL (P < 0.001, P < 0.001, and P = 0.005, respectively). CONCLUSIONS: The risk of PVD onset or progression was dependent on PVD status and the CDR detected on OCT scans, not on age or AL, in a large patient cohort. Patients who show risk factors on OCT should be monitored carefully during the postoperative period.

Application of a four-flanged intrascleral fixation technique for toric and multifocal intraocular lenses.

PURPOSE: To report clinical outcomes of a four-flanged intrascleral fixation technique using toric and multifocal intraocular lens. OBSERVATIONS: We describe two cases of premium intraocular lens (IOL) implantation after which the patients fully recovered their visual function following a four-point sutureless scleral fixation technique via a 2.8-mm corneal incision. In the first case, a monofocal toric hydrophobic lens consisting of two haptic plates with four holes for suturing was fixated with 5-0 polypropylene monofilament. In the second case, a bifocal hydrophobic lens with the same haptic design was fixated. No conjunctival or scleral sutures, glue, or flap formation was required during the surgery. There were no complications related to the surgical process. CONCLUSIONS AND IMPORTANCE: A four-flanged intrascleral fixation technique may benefit patients with poor zonular support who have high expectations for postoperative visual quality.

Microcoaxial cataract surgery outcomes: comparison of 1.8 mm system and 2.2 mm system.

PURPOSE: To compare clinical outcomes of a 1.8 mm and a 2.2 mm microcoaxial cataract surgery system. SETTING: Department of Ophthalmology and Visual Science, Kangnam St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea. METHODS: In a prospective study, eyes were randomly selected to have phacoemulsification using a Stellaris system or an Intrepid Infiniti system. The initial incision size was 1.8 mm and 2.2 mm, respectively. Measured intraoperative parameters included phacoemulsification time, mean cumulative dissipated ultrasound energy (CDE), change in incision size at each step of surgery, and total volume of balanced salt solution (BSS) used. The best corrected visual acuity (BCVA), corneal astigmatism, corneal thickness, and endothelial cell count were evaluated preoperatively and postoperatively. RESULTS: The study evaluated 86 eyes of 78 patients (43 eyes in each group). There were no significant differences in postoperative BCVA, surgically induced astigmatism, or amount of BSS used between the 2 systems (P >.05). However, for high-density cataracts, the 1.8 mm group had a greater change between the initial incision size and the incision size after phacoemulsification (P = .019, nuclear opalescence [NO] NO3; P = .001, NO4), a longer phacoemulsification time (P = .013, NO3), greater mean CDE (P = .005, NO3; P = .001, NO4), and greater corneal endothelial cell loss (P = .003, NO4). CONCLUSIONS: Both systems were safe and effective in microcoaxial phacoemulsification. The 1.8 mm system performed better with cortical-type cataract and the 2.2 mm system, with high-density nuclear-type cataract.