Medium-term visual and refractive outcomes in patients with pseudoexfoliation implanted with a toric or multifocal intraocular lens.

PURPOSE: To report medium-term visual acuity and refractive outcomes of patients with pseudoexfoliation implanted with toric or multifocal intraocular lenses (IOLs). METHODS: We retrospectively reviewed patients with pseudoexfoliation who had undergone phacoemulsification between 2016 and 2020 with at least 24 months follow-up. RESULTS: Mean follow-up was 44.17 ± 14.95 months. Toric IOLs were implanted in 48 eyes: mean uncorrected LogMAR visual acuity one month after surgery was 0.03 ± 0.09, decreasing to 0.08 ± 0.11 at the last visit (p = .01). Mean refractive cylinder was -0.12 ± 0.36 diopters one month after surgery and -0.25 ± 0.44 diopters at the last follow-up visit, p = .012. Multifocal IOLs were implanted in 42 patients: binocular uncorrected distance visual acuity was -0.02 ± 0.04 one month after surgery and 0.01 ± 0.05 at the last visit (p = .004); near acuity was 0.01 ± 0.03 and 0.04 ± 0.06 respectively (p = .001). In eyes with pseudoexfoliation, absolute spherical equivalent prediction error was 0.22 ± 0.20 diopters for toric and 0.21 ± 0.19 diopters for multifocal IOLs. One month after surgery 68.6% of eyes with toric IOLs and 74.2% of eyes with multifocal IOLs were within ±0.25 diopters of target spherical equivalent and 91.6% and 90.5% were within ±0.5 diopters, respectively. Spherical equivalent did not change significantly during follow-up for either group. CONCLUSION: Prediction error in eyes with pseudoexfoliation implanted with toric or multifocal IOLs was low and similar to values reported for normal eyes. Postoperative refractive cylinder with toric IOLs was low, with little change during follow-up. Visual function in patients receiving multifocal IOLs was excellent. Therefore, the implantation of these IOLs in eyes with pseudoexfoliation does not seem to cause medium-term problems.

Refractive outcomes of toric intraocular lens in combined trabecular micro bypass stent implantation and cataract surgery in glaucomatous eyes.

PURPOSE: To evaluate the impact of trabecular micro bypass stents (iStent Inject) on refractive outcomes with toric intraocular lens (IOL) in glaucomatous eyes. METHODS: We identified glaucomatous eyes receiving a toric IOL between October 2017 and December 2020. Eyes with iStent implantation were included in the study group and eyes undergoing isolated phacoemulsification served as controls. Corrected and uncorrected visual acuity, manifest refraction, intraocular pressure (IOP), and number of hypotensive drugs three months after surgery were evaluated. RESULTS: 26 eyes comprised the study group and 41 eyes the control group. Mean postoperative refractive cylinder was 0.26D in the control and 0.11D in the iStent group, with 63% and 85% of eyes with a cylinder of 0 and 85% and 92% of eyes with a cylinder ≤ 0.5D respectively. The mean absolute difference between target and outcome spherical equivalent was 0.26D in the control and 0.22D in the iStent group, with all eyes within 0.75D of target. LogMar uncorrected postoperative vision in eyes targeted for emmetropia was 0.04 in the control and 0.03 in the iStent group. There was a statistically significant reduction in IOP and number of hypotensive drugs in both groups, with a mean decrease in IOP of 8.6% in the control and 15.7% in the iStent group. The number of hypotensive drugs dropped from 1.63 ± 0.80 to 1.34 ± 0.91 in the control group and from 2.12 ± 0.65 to 0.44 ± 0.71 in the iStent group. CONCLUSION: Toric IOLs provide predictable refractive outcomes in glaucomatous eyes undergoing combined phacoemulsification with iStent implantation, reducing postoperative spectacle dependence.

Visual Function and Patient Satisfaction with Multifocal Intraocular Lenses in Patients with Glaucoma and Dry Age-Related Macular Degeneration.

PURPOSE: To report visual function and self-reported satisfaction of patients with glaucoma and dry age-related macular degeneration (dAMD) implanted with multifocal intraocular lenses (MIOL). METHODS: Patients with glaucoma or dAMD as well as healthy individuals implanted with MIOL were invited to participate. Explorations performed were uncorrected and corrected distance visual acuity (UDVA and CDVA), low-contrast visual acuity (LCVA), binocular contrast sensitivity, and defocus curves. Patients completed the Catquest-9 questionnaire and reported on the presence of dysphotopsias and the need for spectacles. RESULTS: 38 subjects were included: 11 in the healthy/control group and 9 each in the preperimetric glaucoma, perimetric glaucoma, and dAMD groups. Controls had statistically better monocular UDVA, CDVA, and LCVA than patients with glaucoma and dAMD, as well as better binocular acuity in the defocus curves between -2.00 D and +0.50 D. Differences between controls and patients with preperimetric glaucoma were not statistically significant. Between -3.0 D and +0.5 D, all groups except dAMD achieved acuities better than 0.2 logMAR. Patients with dAMD had worse contrast sensitivity than all others for 3 cycles per degree (cpd), and patients with glaucoma had worse values than all others for 12 cpd; other differences did not reach statistical significance. Healthy subjects and patients with preperimetric glaucoma perceived halos more often than patients with glaucoma or dAMD, while suffering less from glare. Patients with glaucoma and dAMD found more difficulties when driving at night and required spectacles for near more often than the other subjects. Patients with dAMD were less satisfied with their vision. CONCLUSIONS: MIOLs may be implanted in patients with preperimetric glaucoma with little fear of patient dissatisfaction. In glaucoma and dAMD, MIOLs might be considered with caution, after explaining the increased risk of glare and the higher need for spectacle correction for reading.

Unilateral acute iris depigmentation and transillumination after glaucoma surgery with mitomycin application and intracameral moxifloxacin.

PURPOSE: Bilateral acute iris depigmentation (BADI) and transillumination (BATI) syndromes have been linked with the use of antibiotics, especially fluoroquinolones. They are characterized by acute onset of pigment dispersion in the anterior chamber, depigmentation of the iris and pigment deposition in the angle and in the posterior surface of the cornea (BADI), with iris transillumination defects and atonic pupil with sphincter paralysis (BATI). The purpose of this paper is to report the development of clinical depigmentation and iris damage similar to BADI and BATI in patients who had undergone uneventful glaucoma surgery with intracameral moxifloxacin as prophylaxis for endophthalmitis. OBSERVATIONS: Four patients who had undergone Ex-Press implantation (cases 1 and 2) or non-penetrating deep sclerotomy (cases 3 and 4) developed asymptomatic pigment dispersion in the anterior chamber, which cleared after treatment with topical corticosteroids and NSAIDS. However, pupillary damage ensued, with mid-midriasis and pigment deposition under the filtration bleb. CONCLUSIONS AND IMPORTANCE: This is, to the best of our knowledge, the first report of acute unilateral iris depigmentation and transillumination after intracameral use of moxifloxacin. Moxifloxacin's toxic effect may have been promoted by the subconjuntival mitomycin employed to prevent scarring at the filtration bleb. Surgeons should be aware of these potential side-effects of drugs used as widely as moxifloxacin and mitomycin.

Clinical outcomes after Ex-PRESS glaucoma shunt versus non-penetrating deep sclerectomy: two-year follow-up.

PURPOSE: To compare the two-year outcomes of non-penetrating deep sclerectomy (NPDS) and Ex-PRESS glaucoma shunt. METHODS: A retrospective chart review of patients who had undergone NPDS or Ex-PRESS since 2012 was conducted. Patients were excluded if they had undergone eye surgery other than cataract extraction, were diagnosed with ocular pathology other than glaucoma or had less than two-year follow-up. Pre- and postoperative visual acuity, intraocular pressure (IOP), number of hypotensive drugs and visual fields were recorded, as well as intra- and postoperative complications. RESULTS: Thirty-nine eyes were included in the NPDS and twenty-three eyes in the Ex-PRESS group. There were no differences in baseline IOP and hypotensive drugs, IOP reduction or postoperative IOP-lowering medications between groups. Two years after surgery, IOP decrease compared to baseline was 23.5% with NPDS and 24.8% with Ex-PRESS. Qualified success (a 20% IOP reduction, with IOP ≤ 18 mmHg with or without medication) rates were similar: 53.8 and 69.6% for NPDS and Ex-PRESS. Visual fields progressed in four eyes of the NPDS (10.2%) and in three eyes (8.7%) of the Ex-PRESS group. As regards complications, early hypotony was more frequent after NPDS (9 eyes, 23.1%) than Ex-PRESS (2 eyes, 8.7%), although the difference was not statistically significant. CONCLUSIONS: Both NPDS and Ex-PRESS produce an IOP-lowering effect of approximately 25%. Success rates are similar after both procedures, and both seem to lead to a stabilization of visual loss.

Optic Nerve Head Biomechanic and IOP Changes Before and After the Injection of Aflibercept for Neovascular Age-Related Macular Degeneration.

PURPOSE: We investigated the early effects of intravitreal aflibercept injection (IAI) on optic nerve head (ONH) morphology. METHODS: All of the participants underwent applanation tonometry and enhanced depth imaging by spectral-domain optical coherence tomography immediately before injection, and within 5 and 30 minutes after IAI. Changes in the anterior lamina cribrosa surface depth, prelaminar tissue thickness (PTT), optic cup width, optic cup depth, and Bruch's membrane opening (BMO) were assessed. RESULTS: The study included 30 eyes of 30 subjects with a mean age of 77.4 ± 6.8 years (range, 65-89 years) following IAI (2 mg in 0.05 ml). Within 5 minutes after injection, the mean cup depth, mean cup width, and BMO were significantly increased (P = 0.013, P = 0.000, and P = 0.004, respectively), whereas the mean PTT was thinned (P = 0.009). These morphologic changes returned to near baseline values 30 minutes after injection. Cup widening and BMO expansion (P = 0.000; r, 0.668), as well as cup deepening and prelaminar thinning (P = 0.000; r, -0.838), were significantly correlated. The magnitude of cup deepening and prelaminar tissue thinning correlated with the IOP change in the opposite direction than expected (P = 0.039; r, -0.379 and P = 0.377; r, 0.040). CONCLUSIONS: A significant widening and deepening of the optic cup, BMO expansion, and prelaminar tissue thinning occurred following IAI for neovascular AMD. Eyes having greater optic disc cup deepening and prelaminar tissue condensation after IAI, associated with a lower IOP increase after injection, suggesting that ONH compliance might buffer the effect of additional intravitreal fluid injection on IOP values.