Visual outcomes and patient satisfaction after presbyopic lens exchange with a diffractive multifocal intraocular lens.

PURPOSE: To investigate the visual outcomes, severity of symptoms, and patient satisfaction after refractive lens exchange (RLE) with a diffractive multifocal intraocular lens (IOL). METHODS: A nonrandomized, unmasked, retrospective chart review study was performed. Patients who underwent RLE with ZMA00 (Abbott Laboratories) were identified from a hospital database. Eyes with preoperative uncorrected distance visual acuity or corrected distance visual acuity 20/20 or better were included. The study cohort comprised 45 eyes from 29 patients. Monocular uncorrected and distance-corrected visual acuity at distance, 67 cm, and 30 cm were measured 6 months postoperatively. A patient questionnaire assessing visual symptoms (halo, night glare, and starburst) and satisfaction with visual performance was administered. RESULTS: Six months postoperatively, mean uncorrected visual acuity (logMAR) was -0.10±0.13, 0.43±0.25 at 67 m (intermediate), and 0.18±0.05 at 30 m (near). Mean distance-corrected visual acuity at these distances was -0.02±0.06, 0.40±0.21, and 0.17±0.02, respectively. Twenty-seven patients completed the questionnaire. Patients reported postoperative halos (78%), night glare (26%), and starbursts (48%). All bilateral RLE patients were spectacle-free at all distances, whereas 50% of unilateral RLE patients required spectacles postoperatively. Bilateral RLE patients with habitual spectacle use preoperatively were the most satisfied with their postoperative visual performance. CONCLUSIONS: Refractive lens exchange with the ZMA00 is an option for presbyopic correction; however, significant glare, halo, and starburst issues are subjectively reported.

Correlation Between Axial Length and Anterior Chamber Depth in Normal Eyes, Long Eyes, and Extremely Long Eyes.

PURPOSE: The objective of this study was to investigate the correlation between axial length (AL) and anterior chamber depth (ACD) in normal to long eyes and in extremely long eyes. DESIGN: This was an observational cross-sectional study in a single-center, private hospital. METHODS: Axial length and ACD data were retrieved from the intraocular lens (IOL) Master database of patients who presented for IOL or phakic lens implantation. Only left eyes were included. The correlation between AL and ACD was tested with Pearson correlation coefficient in all eyes, normal to long eyes (AL < 27.5 mm), and extremely long eyes (AL ≥ 27.5 mm). P < 0.01 was statistically significant. RESULTS: The cohort was composed of 1184 eyes of 1184 Chinese patients. The mean age was 65.8 ± 13.3 years (range, 19-98 years). The mean AL and ACD were 24.73 ± 2.48 mm (range, 20.51-36.20 mm) and 3.09 ± 0.44 mm (range, 1.95-4.68 mm), respectively. Pearson correlation coefficients in all eyes, normal to long eyes (1026 eyes, 87%), and extremely long eyes (158 eyes, 13%) were 0.56 (P < 0.001), 0.59 (P < 0.001), and -0.15 (P = 0.67), respectively. CONCLUSIONS: There was a statistically significant positive correlation between AL and ACD in normal and long eyes but not in extremely long eyes. No correlation between AL and ACD in extremely long eyes requires newer-generation IOL formulas (ACD included) to increase the accuracy of IOL implantation.

Conductive keratoplasty to treat hyperopic overcorrection after LASIK for myopia.

PURPOSE: to investigate the refractive outcomes and stability of conductive keratoplasty (CK) for retreatment of myopic LASIK overcorrection. METHODS: seven eyes (six patients) that were overcorrected after myopic LASIK by +1.00 to +2.75 diopters (D) manifest refraction spherical equivalent (MRSE) were retreated using CK. All eyes had insufficient stromal thickness for LASIK retreatment. LightTouch CK was performed at least 1 year after LASIK. Either 8 or 16 spots were applied at 7- and/or 8-mm zones on the cornea. Uncorrected distance visual acuity, manifest refraction, corrected distance visual acuity (CDVA), and postoperative complications were analyzed. RESULTS: mean MRSE after CK at last follow-up was +0.38 ± 0.52 D (range: -0.38 to +1.13 D). The change in MRSE ranged from -0.63 to -2.38 D. Mean MRSE after CK changed from -0.60 ± 2.07 D (range: -3.38 to +1.50 D) at 1 week to +0.45 ± 0.69 D (range: -0.38 to +1.38 D) at 12 months. Two eyes experienced an initial overcorrection of -2.75 D and -3.38 D, respectively, at 1 week after CK. Cylinder ≤0.75 D was induced in four eyes, whereas one eye had a 0.75-D reduction in cylinder. All eyes had CDVA of logMAR 0.10 or better. Two eyes lost one line of CDVA and no eyes lost more than one line. CONCLUSIONS: lighttouch CK retreatment for over-corrected myopic LASIK can reduce the hyperopia but produces minimal change in cylinder, and may be appropriate for eyes with insufficient stromal tissue for repeated excimer laser surgery. Early regression occurs commonly.