Multifocal and Accommodating Intraocular Lenses for the Treatment of Presbyopia: A Report by the American Academy of Ophthalmology.

PURPOSE: To review the published literature assessing the efficacy and safety of presbyopia-correcting intraocular lenses (IOLs) for the treatment of presbyopia after cataract removal. METHODS: Literature searches were undertaken in January 2018 and September 2020 in the PubMed, Medline, and Cochrane Library databases. This yielded 761 articles, of which 34 met the criteria for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist. Thirteen studies were rated level I and 21 studies were rated level II. RESULTS: Presbyopia-correcting lenses were effective at improving distance and near visual acuity after cataract surgery. Near acuity at different focal lengths was related directly to the effective add power of multifocal and extended depth-of-focus (EDOF) IOLs. Most multifocal and EDOF lenses that were compared with a control monofocal lens demonstrated that patient-reported spectacle independence was superior to the monofocal lens. All patients who had multifocal and EDOF lenses implanted showed decreased contrast sensitivity and reported more visual phenomena as compared with control participants who received monofocal lenses. CONCLUSIONS: Presbyopia-correcting lenses improve uncorrected near and distance visual acuity and decrease spectacle dependence after cataract surgery. Mesopic contrast sensitivity is decreased compared with monofocal lenses, and patient-reported visual phenomena are more likely in patients receiving multifocal or EDOF lenses.

Risk for microbial keratitis: Comparative metaanalysis of contact lens wearers and post-laser in situ keratomileusis patients.

PURPOSE: To compare the risk for microbial keratitis in contact lens wearers stratified by wear schedule with the risk after laser in situ keratomileusis (LASIK). SETTING: Hamilton Eye Institute and Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee, USA. DESIGN: Comparative metaanalysis and literature review. METHODS: An extensive literature search was performed in the PubMed database between December 2014 and July 2015. This was followed by a metaanalysis using a mixed-effects modeling approach. RESULTS: After 1 year of daily soft contact lens wear, there were fewer microbial keratitis cases than after LASIK, or approximately 2 cases fewer cases per 10 000 (P = .0609). If LASIK were assumed to have essentially a 1-time risk for microbial keratitis, 5 years of extrapolation would yield 11 more cases per 10 000 with daily soft contact lens wear than with LASIK, or approximately 3 times as many cases (P < .0001). The extended use of soft contact lenses led to 12 more cases at 1 year than LASIK, or approximately 3 times as many cases (P < .0001), and 81 more cases at 5 years (P < .0001). When incorporating an estimated 10% retreatment rate for LASIK, these results changed very little. CONCLUSIONS: Microbial keratitis is a relatively rare complication associated with contact lens use and LASIK postoperatively. The risk for microbial keratitis was similar between patients using contact lenses for 1 year compared with LASIK. Over time, the risk for microbial keratitis was higher for contact lens use than for LASIK, specifically with extended-wear lenses.

Continuous Curvilinear Capsulorhexis Performed With the VERUS Ophthalmic Caliper.

PURPOSE: To compare size, circularity, and centration outcomes of continuous curvilinear capsulorhexis (CCC) performed with or without assistance from the VERUS ophthalmic caliper (Mile High Ophthalmics, Denver, CO). METHODS: This was a multicenter retrospective consecutive case controlled series review. RESULTS: Data from 40 consecutive cases using the VERUS device for CCC were compared to 40 consecutive cases with standard manual CCC. VERUS-assisted CCC size, circularity, and centration were closer to target compared to that of manual only procedures (P < .05). The average time from initiation to completion of the capsulotomy was shorter with manual (40 ± 11 seconds) compared to VERUS-assisted (71 ± 13 seconds) cases (P < .0001). CONCLUSIONS: The VERUS ophthalmic caliper is effective at improving size, circularity, and centration of the CCC in a time-efficient manner when compared to manual procedures performed without VERUS guidance. [J Refract Surg. 2016;32(10):654-658.].

Localized opacification of hydrophilic acrylic intraocular lenses after procedures using intracameral injection of air or gas.

PURPOSE: To describe clinical and laboratory findings in a series of cases of intraocular lens (IOL) opacification after procedures involving intracameral injections of air or gas. SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN: Experimental study. METHODS: Seven hydrophilic acrylic IOLs explanted after Descemet-stripping endothelial keratoplasty (DSEK) or Descemet-stripping automated endothelial keratoplasty (DSAEK) because of a localized central optic opacification associated with decrease in visual acuity and complaints of foggy vision were analyzed. The explanted IOLs were sent to our laboratory in the dry state or in fixative by the explanting surgeons. They underwent pathological and histochemical evaluation (alizarin red and von Kossa method). Light scattering measurements were also performed on the surface of 1 explant using Scheimpflug photography. A questionnaire was sent to the surgeons to obtain information pertinent to each case. RESULTS: The 7 explanted IOLs were represented by 6 hydrophilic acrylic designs from 5 manufacturers. Gross and light microscopy showed that granular deposits were densely distributed in an overall round pattern within the margins of the capsulorhexis or the pupil on the anterior surface/subsurface of the IOLs. The granules stained positive for calcium (alizarin red and von Kossa method). Light scattering on the anterior optic surface was very high (228 versus 13 computer-compatible tapes on a control IOL). CONCLUSIONS: A localized pattern of calcification was seen on the anterior surface/subsurface of various hydrophilic acrylic IOLs. Surgeons should be aware of this phenomenon following DSEK/DSAEK procedures in pseudophakic patients with hydrophilic acrylic IOLs. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Descemet-stripping automated endothelial keratoplasty donor tissue preparation using the double-pass microkeratome technique.

PURPOSE: To compare human donor corneal lenticule thickness, endothelial cell viability, area of cell damage, and cell counts between corneal tissue prepared with a double-pass microkeratome cut versus the standard single-pass microkeratome cut. SETTING: University of Colorado Teaching Hospital, Aurora, Colorado, USA. DESIGN: Experimental study. METHODS: Eleven matched pairs of human donor corneas unfit for transplantation were used for analysis. Tissue was prepared using a Moria CB microkeratome and artificial anterior chamber. One cornea was prepared using the standard single-pass cut; the second cornea was prepared with a double-pass technique. Visante optical coherence tomography images were obtained from each cornea, and central and peripheral thickness measurements were made. The tissue was also stained with trypan blue and alizarin red to assess tissue damage from preparation. RESULTS: The mean central thickness measurement was 92 µm ± 20 (SD) for the double-pass technique and 126 ± 34 µm for the single-pass technique. The area of cell damage after preparation was not significantly different between the 2 methods; however, there was a statistically significant increase in the ratio of nonviable to viable cells for the double-pass technique. CONCLUSION: The double-pass microkeratome technique for donor preparation resulted in a thinner lenticule than a single-pass technique and an increase in endothelial cell damage.

Emergency lateral canthotomy and cantholysis: a simple procedure to preserve vision from sight threatening orbital hemorrhage.

Retrobulbar hemorrhage is an uncommon, but potentially devastating complication associated with facial trauma. It can rapidly fill the orbit and cause an "orbital compartment syndrome" that subsequently cuts off perfusion to vital ocular structures, leading to permanent visual loss. Treatment must be initiated within a limited time in order to prevent these effects; however, specialty consultation is not always available in remote field environments. This article addresses the mechanism, diagnosis, and treatment ofretrobulbar hemorrhage via lateral canthotomy and cantholysis, and recommends that 18D medical sergeants be properly trained to evaluate and perform this sight-saving procedure in emergent settings where upper echelons of care are not immediately available.

Glistenings in the single-piece, hydrophobic, acrylic intraocular lenses.

PURPOSE: To study glistenings in single-piece AcrySof (models SA60 and SN60; Alcon, Fort Worth, Texas, USA) intraocular lenses (IOLs). DESIGN: Observational, longitudinal study. METHODS: Consecutive patients with the SA60 were examined at 12, 24, and 36 months after surgery; those with the SN60 were examined 12 months after surgery. Best-corrected logarithm of the minimum angle of resolution visual acuity, glare testing, contrast sensitivity, and wavefront analysis were performed. Any patient with pathologic features likely to impact visual quality was eliminated. All IOLs were photographed, and glistenings were analyzed for size and density by a computer program. RESULTS: All IOLs had glistenings, and neither size, density, nor severity index (size x density) correlated with acuity, glare testing, or wavefront analysis results. High spatial resolution contrast acuity (patch D) had a borderline correlation (P = .06) with severity index, as did progress over time (P = .04). CONCLUSIONS: All IOLs studied had glistenings. High spatial resolution contrast sensitivity impact and severity progression over time deserve further study.

Thermal inertia associated with ultrapulse technology in phacoemulsification.

PURPOSE: To determine whether very short pulses of ultrasound (5 to 6 milliseconds) have less heat propagation in biological tissue (thermal inertia) than traditional pulses (50 milliseconds). SETTING: Department of Ophthalmology and Visual Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah. METHODS: Thermal testing was done in balanced salt solution (BSS) and in eye-bank eyes. In the same fresh human eye-bank eye, net temperature increase after 20 seconds of ultrasound (50 milliseconds on and 50 milliseconds off) was compared with the increase after 6 milliseconds on and 12 milliseconds off with the same phacoemulsification unit. The same experiment and setting was run in BSS and the eye-bank ratios compared with the BSS ratios. Twenty runs were done at each power setting in BSS and 22 in the eye-bank eye. RESULTS: There was 10.9% less heat generated with 6-millisecond pulses of ultrasound in limbal tissue than in BSS compared with 50-millisecond pulses of ultrasound (P = .0002). CONCLUSION: Very short pulses of ultrasound (5 to 6 milliseconds) propagated less thermal energy in limbal tissue than in BSS compared with 50-millisecond ultrasound pulses.

Phacoemulsification tip vacuum pressure: Comparison of 4 devices.

PURPOSE: To determine the vacuum pressure generated by 4 phacoemulsification devices measured at the phacoemulsification tip. SETTING: University ophthalmology department. METHODS: The effective vacuum pressures generated by the Sovereign (AMO), Millennium (Bausch & Lomb), Legacy AdvanTec (Alcon Laboratories), and Infiniti (Alcon Laboratories) phacoemulsification machines were measured with a device that isolated the phacoemulsification tip in a chamber connected to a pressure gauge. The 4 machines were tested at multiple vacuum limit settings, and the values were recorded after the foot pedal was fully depressed and the pressure had stabilized. The AdvanTec and Infiniti machines were tested with and without occlusion of the Aspiration Bypass System (ABS) side port (Alcon Laboratories). The Millennium machine was tested using venturi and peristaltic pumps. RESULTS: The machines generated pressures close to the expected at maximum vacuum settings between 100 mm Hg and 500 mm Hg with few intermachine variations. There was no significant difference between pressures generated using 19- or 20-gauge tips (Millennium and Sovereign). The addition of an ABS side port decreased vacuum by a mean of 12.1% (P < .0001). CONCLUSION: Although there were some variations in vacuum pressures among phacoemulsification machines, particularly when an aspiration bypass tip was used, these discrepancies are probably not clinically significant.