Clinical outcome of a quadrifocal (trifocal) intraocular lens in Chinese patients: prospective, observational case series.

PURPOSE: To report the visual outcomes and quality of vision and life after bilateral implantation of a single-piece trifocal intraocular lens (IOL) in Chinese patients. SETTING: Hong Kong Sanatorium & Hospital, Hong Kong, China. DESIGN: Prospective, observational case series. METHODS: Patients with bilateral implantation of AcrySof IQ PanOptix multifocal IOL were included. Distance, intermediate (60 cm), and near (40 cm) visual acuities (VAs) and contrast sensitivity (CS), defocus curve, preoperative higher-order aberration (HOA), dysphotopsia (0 to 5), satisfaction (1 to 5), spectacle independence, and quality of life were evaluated. The association between preoperative HOA and postoperative halos was also assessed. RESULTS: 54 eyes of 27 patients were included. The mean binocular distance, intermediate, and near uncorrected VA was -0.05 ± 0.06 (20/18), 0.06 ± 0.10 (20/23), and 0.04 ± 0.05 (20/22), respectively. No eyes lost more than 1 line of vision. Binocular CS was comparable with the monocular population norm of older adults. The defocus curve demonstrated that the binocular VA of 20/25 or better was achieved at a power of -3.00 to +0.50 diopters. The mean scores for halos, glare, and starbursts were 2.4 ± 1.4, 0.2 ± 0.8, and 1.4 ± 1.4 (of 5), respectively. The mean satisfaction score was 4.3 ± 0.7 (of 5). All the patients (100%) reported total spectacle independence. The mean vision-targeted composite score of the vision-related quality-of-life questionnaire was 97.2 ± 9.7 (of 100). Preoperative HOA was not associated with postoperative halos. CONCLUSIONS: Implantation of the trifocal IOL provided satisfactory visual outcomes and quality of vision and life, which resulted in a high rate of spectacle independence.

Effect of time since primary laser-assisted in situ keratomileusis on flap relift success and epithelial ingrowth risk.

PURPOSE: To assess the association of time since primary laser-assisted in situ keratomileusis (LASIK) with flap relift success and risk for epithelial ingrowth (EI) in eyes undergoing flap relift after primary LASIK. SETTING: Hong Kong Sanatorium & Hospital, Hong Kong Special Administrative Region. DESIGN: Retrospective observational case series. METHODS: 73 eyes with flaps relifted for refractive enhancement LASIK were included. Main outcome measures included rate of relift success and EI; associations of time since primary LASIK, sex, age at relift, year of relift, and flap creation method in primary LASIK with relift success and EI. RESULTS: Of the 73 eyes included, relifting was successful in 71 eyes (97.3%). Among the successfully relifted eyes, 12 (16.9%) developed EI, of which 3 (4.2%) were clinically significant. No eyes lost more than 1 line of corrected distance visual acuity. The time since primary LASIK (up to 22 years), sex, age at relift, year of relift, and flap creation method in primary LASIK were not associated with relift success or EI. CONCLUSIONS: With the described surgical technique, flaps could be successfully relifted without much difficulty up to 22 years after primary LASIK with a low incidence of EI.

Monovision with a Bifocal Diffractive Multifocal Intraocular Lens in Presbyopic Patients: A Prospective, Observational Case Series.

PURPOSE: We report the visual outcomes and patient satisfaction after bilateral implantation of a bifocal diffractive intraocular lens with monovision. DESIGN: Prospective, observational case series. METHODS: Twenty-one subjects underwent cataract surgery or refractive lens exchange with bilateral implantation of the ZMB00 intraocular lens, with the dominant eye and nondominant eye targeted for plano and -1.25 to -1.00 diopters, respectively. Postoperative assessments included visual acuity (VA) at various distances under photopic and mesopic conditions; defocus curve, contrast sensitivity, and stereopsis; and Visual Function Questionnaire-25 and supplementary questionnaire. RESULTS: Mean binocular uncorrected VA at distance, intermediate (67 cm), and near (30 cm) were -0.03 ± 0.06, 0.12 ± 0.18, and 0.11 ± 0.05, respectively. No eyes lost >1 line of corrected distance VA. Binocular intermediate VA was significantly better in the uncorrected condition (P = .004) whereas binocular distance VA was better in the distance-corrected condition (P = .014). Near VA was similar in both conditions (P > .05). Stereoacuity and contrast sensitivity were within normal limits. All subjects had a composite score of ≥90 for vision-targeted items in the National Eye Institute Visual Function Questionnaire-25. Halos, glare, and starbursts occurred in 52%, 29%, and 24% of subjects, respectively. All subjects reported a satisfaction score of ≥3.5 of 5 and required no spectacles postoperatively. No intraocular lens exchange was required. CONCLUSIONS: Monovision with bilateral bifocal multifocal intraocular lens was safe and provided satisfactory vision at various distances, with good stereopsis and contrast sensitivity. Complete spectacle independence and high satisfaction score were achieved. In comparison with bilateral emmetropic bifocal multifocal intraocular lens, it provided better vision at intermediate and at very near distances without inducing more dysphotopsia.