Impact of posterior vitreous detachment on visual acuity after the implantation of a diffractive multifocal intraocular lens.

PURPOSE: To investigate the effect of posterior vitreous detachment (PVD) on visual acuity (VA) after implantation of a diffractive multifocal intraocular lens (mIOL). SETTING: Eye Clinic, Okayama, Japan. DESIGN: Retrospective case series. METHODS: This study evaluated 475 eyes of 475 patients who underwent cataract surgery with a TECNIS Multifocal ZLB00 lens implant between November 2017 and October 2019. Patient eyes were classified into the complete PVD group (PVD group) or the control group with no PVD/partial PVD (non-PVD group) and divided into 3 age categories: 65 to 69, 70 to 74, and 75 to 79 years. The postoperative VA of the PVD and non-PVD groups was compared between and within groups by age. RESULTS: Distance-corrected near VA (DCNVA) was significantly worse in the PVD group than in the non-PVD group in all age categories ( P ≤ .029). In the PVD group, both corrected distance VA (CDVA) and DCNVA were significantly worse in the 75 to 79 years age group than in the 65 to 69 and 70 to 74 years age groups ( P ≤ .034). CDVA and DCNVA in the non-PVD group did not differ significantly between age categories. CONCLUSIONS: The results of this study suggest that complete PVD worsens near VA in eyes with a diffractive mIOL. Furthermore, eyes with complete PVD may show an age-related decline in both CDVA and DCNVA. In particular, eyes ≥75 years of age with complete PVD have a poor visual prognosis and should be given careful consideration when deciding whether to implant a diffractive mIOL.

Preoperative Factors Affecting Visual Acuity Following the Implantation of Diffractive Multifocal Intraocular Lenses.

PURPOSE: To investigate the preoperative factors affecting visual acuity after the implantation of a diffractive multifocal intraocular lens. METHODS: This study evaluated 774 eyes of 774 patients who underwent cataract surgery with TECNIS Multifocal ZLB00 lens (Johnson & Johnson Surgical Vision) implantation. Anterior segment optical coherence tomography (CASIA2; Tomey Corporation) was performed as a part of the preoperative eye examination. Sex, age, axial length, and CASIA2 parameters, such as crystalline lens diameter and lens tilt relative to the corneal topographic axis, were investigated. The eyes considered were classified into good (20/20 or better) or poor (worse than 20/20) far vision groups based on corrected distance visual acuity, and good (20/25 or better) or poor (worse than 20/25) near vision groups based on distance-corrected near visual acuity, respectively. Preoperative characteristics of both groups were compared to determine factors affecting postoperative visual acuity. RESULTS: Multivariate logistic regression analysis revealed that older age (P < .001), a short axial length (P = .010), and a large lens tilt (P < .001) were associated with poor near vision. There was no significant difference between the two far vision groups. There was a significant negative correlation between lens tilt and axial length (r = -0.513, P < .001). CONCLUSIONS: The results of this study suggest that age, axial length, and lens tilt to the corneal topographic axis may predict poor visual acuity after the implantation of a diffractive multifocal intraocular lens. Eyes with a short axial length tended to have a large degree of lens tilt and should be considered particularly carefully. [J Refract Surg. 2021;37(10):674-679.].

Cases of replacing diffractive bifocal intraocular lens with extended depth of focus intraocular lens due to waxy vision.

PURPOSE: To investigate the postoperative course of patients who explanted a diffractive bifocal intraocular lens (IOL) due to waxy vision and implanted with an extended depth of focus IOL. METHODS: This study evaluated 29 eyes of 25 patients who underwent diffractive bifocal IOL explantation followed by TECNIS Symfony® implantation because of dissatisfaction due to waxy vision at the Takabatake West Eye Clinic between January 2018 and November 2019. The indication criteria for this surgery were patients with uncorrected distance visual acuity of 0.05 logMAR or better, without eye diseases that may affect visual function, and no dissatisfactions about photic phenomena. We investigated patient demographics, uncorrected and corrected visual acuity, manifest refraction, contrast sensitivity, subjective symptoms, time to IOL explantation, explanted IOL type, and spectacle independence. RESULTS: The time to the IOL exchange after the initial IOL implantation was 55.3 ± 50.4 days (range: 14-196 days). The logMAR corrected distance visual acuity before and after IOL exchange were -0.13 ± 0.06 and -0.14 ± 0.06, respectively (p = 0.273). After IOL exchange surgery, the area under log contrast sensitivity function increased significantly from 1.07 ± 0.12 to 1.21 ± 0.12 (p < 0.001), and the waxy vision symptoms improved. The spectacle independence rate at the last visit was 88.0%. CONCLUSION: For patients who complain of waxy vision despite good visual acuity after diffractive bifocal IOL implantation, exchange to extended depth of focus IOL was considered one of the useful surgical options.

Influence of extended depth of focus intraocular lenses on visual field sensitivity.

PURPOSE: To investigate the influence of EDOF IOLs, TECNIS Symfony® (Johnson & Johnson Surgical Vision, Inc.), on visual field sensitivity and to compare the IOLs with other kinds of IOLs. METHODS: The subjects included the normal fellow eyes of patients who underwent the Humphrey Field Analyzer (HFA) 30-2 with Swedish Interactive Threshold Algorithm Fast within 6 months after cataract due to glaucoma or suspected glaucoma. Each parameter of HFA was compared among eyes implanted with TENIS Symfony® (EDOF group), diffractive bifocal IOLs (bifocal group), and monofocal IOLs (monofocal group). RESULTS: The total of 76 eyes, including 24 eyes in the EDOF group, 26 eyes in the bifocal group, and 26 eyes in the monofocal group, were included in this study. Mean deviation (MD) of HFA was -0.24±0.58 dB in the EDOF group, -1.38±0.58 dB in the bifocal group, and 0.02±0.44 dB in the monofocal group. Foveal threshold (FT) of HFA was 35.8±1.6 dB in the EDOF group, 33.6±1.7 dB in the bifocal group, and 36.6±1.4 dB in the monofocal group. In both MD and FT, there was significant difference between the bifocal group and the others (p<0.001). There was no difference between the EDOF group and the monofocal group. Moreover, there was no significant difference between the three groups about pattern standard deviation (PSD) of HFA. CONCLUSION: TECNIS Symfony® may have little influence on visual field sensitivity, whereas diffractive bifocal IOLs decrease visual field sensitivity.

Multiple sclerosis-like disease secondary to alpha interferon.

PURPOSE: To describe bilateral optic neuritis that occurred as an adverse effect of recombinant and natural interferon alpha administration. METHODS: Report of two cases. Case 1, a 62-year-old woman, developed bilateral optic neuritis with decreased sensation of vibration and increased deep tendon reflex in the lower extremities after a seven-month use of recombinant interferon alpha-2a for chronic active hepatitis C. Case 2, a 29-year-old woman, developed bilateral optic neuritis combined with numbness of the lower extremities as well as bowel and bladder dysfunction after a 22-month use of recombinant interferon alpha-2b for chronic myelogenous leukemia. After a two-month interruption of interferon administration, natural interferon alpha was given but followed by another episode of the same neurological manifestations. RESULTS: In both cases, magnetic resonance imaging demonstrated multiple small high-intensity areas in the cerebral white matter and spinal cord, while cerebrospinal fluid examination disclosed mononuclear cell increase and protein elevation including myelin basic protein, all of which simulated the features of multiple sclerosis. The two patients underwent several courses of pulse corticosteroid therapy, each course consisting of three days of methylprednisolone 1000 mg daily, resulting in visual recovery to some extent. CONCLUSIONS: Optic neuritis in combination with other neurological signs, simulating multiple sclerosis, should be included in the list of adverse effects of recombinant and natural interferon alpha administration.