Clinical and laboratory studies on the effects of capsular tension ring on surgical outcomes of trifocal intraocular lens implantation.

PURPOSE: To assess the influence of capsular tension ring (CTR) on surgical outcomes of trifocal intraocular lens (IOL) implantation in femtosecond laser-assisted cataract surgery. SETTING: Sugita Eye Clinic, Tokyo, and University of Tsukuba, Ibaraki, Japan. DESIGN: Prospective, randomized, paired-eye clinical study and laboratory study. METHODS: In the clinical study involving 44 eyes of 22 patients with no risk of zonular instability, 1 eye received IOL alone and the contralateral eye received IOL with CTR. Preoperative capsular bag diameter and postoperative IOL tilt/decentration were measured using anterior segment optical coherence tomography. In the laboratory study, IOL and CTR were implanted into an artificial capsular bag of 10 mm in diameter, and IOL centration was evaluated. RESULTS: Throughout the 12-month follow-up period, there was no significant difference in refractive and visual outcomes between groups. The amount of IOL decentration was significantly larger in eyes with CTR than in eyes without CTR at 12 months postoperatively (P = .037). There was a significant negative correlation between capsular bag diameter and the amount of IOL decentration in eyes with CTR (P = .038), but not in eyes without CTR (P = .873). The laboratory study indicated that interference between CTR eyelets and IOL haptics significantly increased IOL decentration (P < .001). CONCLUSIONS: The use of CTR did not affect refractive and visual outcomes of trifocal IOL implantation in eyes without the risk of zonular weakness. CTR coimplantation increased IOL decentration possibly due to the interference between CTR eyelets and IOL haptics.

Long-term outcomes of cataract surgery with toric intraocular lens implantation by the type of preoperative astigmatism.

Surgical outcomes of toric intraocular lens (IOL) implantation for 8 years after surgery were analyzed. Data were retrospectively collected in 176 eyes of 176 patients before and 1 month, 1, 3, 5, and 8 years after phacoemulsification and implantation of a toric IOL. Preoperative corneal and postoperative manifest astigmatism was analyzed by converting to power vector notations; horizontal/vertical (J0) and oblique (J45) astigmatism components. Toric IOL implantation significantly reduced pre-existing astigmatism by decreasing J0 in eyes with preoperative with-the-rule (WTR) astigmatism, increasing J0 in eyes with against-the-rule (ATR) astigmatism, and correcting J45 in eyes with oblique astigmatism. After surgery, the eyes with preoperative ATR astigmatism showed a significant ATR astigmatic shift, and J0 at 5 and 8 years was significantly smaller than that at 1 month postoperatively. Uncorrected distance visual acuity was also significantly worse at 5 and 8 years than at 1 month postoperatively. In eyes with WTR and oblique astigmatism, the effects of toric IOLs on astigmatism and visual acuity were sustained for 8 years. The long-term astigmatism-correcting effects did not differ among the models of toric IOL used in this study, SN6AT3-8 (Alcon Laboratories). In eyes with preoperative ATR astigmatism, astigmatism-correcting effects of toric IOLs decreased at 5 years and later postoperatively, indicating that overcorrection may be considered at the time of cataract surgery. In eyes with WTR and oblique astigmatism, the effects of toric IOLs were maintained throughout the 8-year follow-up period.

Effect of small-incision sutureless cataract surgery on the natural course of astigmatism over 10 to 20 years.

PURPOSE: To retrospectively assess astigmatic changes over 10 years and 20 years after small-incision cataract surgery. SETTING: 5 ophthalmic surgical sites in Japan. DESIGN: Retrospective case series. METHODS: Data were collected from patients who had undergone phacoemulsification and implantation of an intraocular lens through a 2.2 to 2.4 mm incision. Preoperative corneal and postoperative manifest astigmatism were converted to power vector notations: horizontal/vertical (J 0 ) and oblique (J 45 ) astigmatism components. RESULTS: 422 eyes of 422 patients were followed for 10 years, and data preoperatively and at 1 month and at 1 year, 3 years, 5 years, 8 years, and 10 years postoperatively were analyzed. The mean J 0 decreased significantly ( P < .001, repeated measures analysis of variance) with an against-the-rule (ATR) shift of 0.363 ± 0.433 diopter (D) over 10 years, but the mean J 45 did not change significantly ( P = .150). Double-angle plot analyses also showed similar ATR shifts in all astigmatism groups. In the subgroup analysis conducted in 34 patients who were followed for 20 years, J 0 declined significantly ( P < .001) by 0.649 ± 0.576 D, whereas J 45 did not ( P = .516). The postoperative changes in J 0 and J 45 were not significantly different between eyes with preoperative with-the-rule, ATR, or oblique astigmatism. CONCLUSIONS: Postoperative astigmatism continued to shift toward ATR during the follow-up period of 20 years after small-incision cataract surgery, which seems to reflect the natural course of corneal astigmatic changes that commonly occur with aging. ATR astigmatic shifts were similar in both pattern and magnitude regardless of the type of preoperative astigmatism.

Comparison of incidence of repositioning surgery to correct misalignment with three toric intraocular lenses.

PURPOSE: To compare the incidence of re-orientating surgery to improve misalignment of three models of acrylic toric intraocular lenses: AcrySof toric intraocular lens (Alcon Laboratories, Inc.), TECNIS toric intraocular lens (Johnson & Johnson Vision, Inc.) and HOYA 355 toric intraocular lens (HOYA). METHODS: In this retrospective, multicenter case series, medical charts were reviewed for collecting data on realignment surgery of toric intraocular lenses at 10 ophthalmic surgical sites in Japan. RESULTS: Over all, intraocular lens repositioning surgery was conducted in 89 of 9430 eyes (0.944%) at an average of 10.5 ± 9.7 days after the initial cataract surgery. The incidence was 0.213% (11/5155), 1.797% (62/3451) and 1.942% (16/824) with AcrySof, TECNIS and HOYA toric intraocular lenses, respectively. The incidence was significantly lower with AcrySof than with other two brands of toric intraocular lenses (p < 0.0001). In those eyes which underwent reorientation surgery, the amount of misalignment was 26.4 ± 21.9°, 29.7 ± 15.4° and 28.1 ± 20.7° with AcrySof, TECNIS and HOYA toric intraocular lenses, respectively; there was no significant difference among groups (p = 0.821). The repositioning surgery significantly reduced misalignment in all three groups. CONCLUSION: The rotational stability was considerably different among toric intraocular lenses of different manufacturers. The incidence of repositioning surgery was significantly lower with AcrySof than with TECNIS and HOYA toric intraocular lenses.

Influence of surface light scattering and glistenings of intraocular lenses on visual function 15 to 20 years after surgery.

PURPOSE: To assess the long-term influence of surface light scattering and glistenings of hydrophobic acrylic (Acrysof), silicone, and poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) on visual function. SETTING: Eleven surgical sites, Japan. DESIGN: Retrospective case series. METHODS: Patients who had cataract surgery with implantation of a hydrophobic acrylic, silicone, or PMMA IOL from 1994 to 2000 were examined. Silicone and PMMA IOLs were not restricted to specific manufacturers or models. Patients were included if their corrected distance visual acuity (CDVA) within 3 months postoperatively (baseline CDVA) was 20/25 or better. The CDVA, contrast sensitivity, degree of surface light scattering measured with Pentacam densitometry, and glistening grades were recorded at the patient's latest visit. RESULTS: Of the eyes, 31 had a hydrophobic acrylic IOL, 37 a silicone IOL, and 30 a PMMA IOL. Surface light scattering and glistenings were significantly greater with the hydrophobic acrylic IOL than with silicone and PMMA IOLs (P < .0001). The CDVA at the latest visit as well as the changes in CDVA from the baseline to the latest visit did not differ between the IOLs and was unaffected by surface light scattering and glistenings, as was the contrast sensitivity. CONCLUSIONS: The hydrophobic acrylic IOL was associated with a significantly greater level of surface light scattering and glistenings than the silicone IOLs and PMMA IOLs 15 to 20 years postoperatively. However, the optical phenomena within the optics of the hydrophobic acrylic IOL did not influence the patients' visual function.

The effect of ethanol extract of Glycyrrhiza uralensis on the voltage-gated sodium channel subtype 1.4.

To investigate the inhibitory effect of Glycyrrhiza uralensis (G. uralensis) and its monomeric compounds on Nav1.4 voltage-gated sodium channels (VGSCs) and analyze the relationship between the content of its marker compounds and the inhibitory rate. Based on this study, we found that 4 mg/ml ethanol extract of G. uralensis at 30%, 50%, 70% and 90% (v/v) exhibited 77.00 ± 0.03%, 34.75 ± 0.09%, 100.00 ± 0.01% and 2.00 ± 0.01% inhibitory rates on INav1.4 respectively, and 8 mg/ml ethanol extract of G. uralensis at 30%, 50%, 70% and 90% (v/v) exhibited 99.00 ± 0.01%, 97.10 ± 0.02%, 100.00 ± 0.01% and 17.00 ± 0.04% inhibitory rates on INav1.4 respectively. Isoliquiritigenin, echinatin, liquiritin and glycyrrhizic acid exhibited higher inhibitory rates of 39.98 ± 4.55%, 33.20 ± 1.61%, 22.62 ± 0.30% and 20.54 ± 4.82% respectively. However, liquiritigenin, formononetin, neoisoliquiritin and glycyrrhetinic acid exhibited lower inhibitory rates of less than 20%. Further, liquiritin apioside, isoliquiritin and neoliquiritin exhibited almost no effect on INav1.4. These findings showed that glycyrrhizic acid reached a maximum concentration of 49.15 µg/ml, while echinatin had the lowest concentration. The ethanol extract of G. uralensis has significant inhibitory effects on Nav1.4 VGSCs. This may be an important mechanism in the treatment of gastrocnemius spasm and could guide further research regarding material basis and mechanism of the treatment of gastrocnemius spasm with peony and licorice decoction.

Incidence and Outcomes of Repositioning Surgery to Correct Misalignment of Toric Intraocular Lenses.

PURPOSE: To analyze the incidence and appropriate timing of repositioning surgery to correct misalignment of acrylic foldable toric intraocular lenses (IOLs). DESIGN: Retrospective, multicenter case series. PARTICIPANTS: Patients who had undergone phacoemulsification and implantation of toric IOL at 8 surgical sites. METHODS: Patient charts were reviewed to collect data on repositioning surgery of toric IOLs. MAIN OUTCOME MEASURES: Incidence, timing, and outcomes of repositioning surgery. RESULTS: Among 6431 eyes implanted with toric IOLs, 42 eyes (0.653%) of 42 patients underwent repositioning surgery at an average of 9.9±7.5 days (range, 0-30 days) after IOL implantation. The repositioning surgery significantly reduced misalignment from 32.9°±15.7° to 8.8°±9.7° (P < 0.001), which was measured at 7.6±5.0 weeks postoperatively. Refractive cylinder was significantly reduced from 2.4±1.1 diopters (D) to 1.1±0.8 D (P < 0.001). There was a significant negative correlation between the interval from cataract surgery to repositioning procedure and the degree of residual misalignment (r = -0.439, P < 0.001). The residual misalignment was 13.1°±13.5° when the repositioning surgery was performed within 6 days after cataract surgery, whereas the residual misalignment was 6.3°±5.9° when the IOL was repositioned 7 days or later (P < 0.001). In 2 eyes that were treated within 24 hours after cataract surgery, the IOL re-rotated significantly, and additional surgical intervention was required. CONCLUSIONS: Toric IOLs were repositioned in 0.653% of cases. A relationship was found between the timing of repositioning surgery and surgical outcome. These data suggest that repositioning surgery should be performed 1 week after IOL implantation.