Effects of Corneal Scars and Their Treatment With Rigid Contact Lenses on Quality of Vision.

OBJECTIVES: To study the effects of corneal scars and the treatment of these scars with rigid gas-permeable (RGP) contact lenses on quality of vision including straylight. Visual effects were related to scar characteristics such as size and grade. METHODS: Straylight and best-corrected visual acuity were measured in 23 patients with corneal scars during and after RGP contact lens wear. Contralateral eyes were used as controls, and age-normal values in case of bilateral scars. Straylight measurements were performed using the compensation comparison method of the Oculus C-Quant instrument. RESULTS: Scarred eye straylight values were 1.53 log(s) without contact lens and 1.60 log(s) with contact lens (P=0.043). Healthy eyes without contact lens had a mean straylight value of 1.13 log(s), corresponding to age-normal values. Contact lens wear increased straylight in healthy eyes to 1.26 log(s) (P<0.001). Visual acuity improved from 0.66 logarithm of minimal angle of resolution (logMAR) to 0.19 logMAR with contact lens wear in eyes with a corneal scar (P<0.001). CONCLUSIONS: Corneal scars can have a strong effect on quality of vision by diminishing visual acuity and increasing straylight. The increase in straylight from corneal scars on its own can lead to a serious visual handicap. Contact lens treatment did not improve straylight, but showed a slight worsening. As the recovery of visual acuity with contact lens wear far exceeded straylight increase, contact lenses remain a clinically useful treatment option in most patients with corneal scars.

Topical bevacizumab treatment in aniridia.

PURPOSE: To report the results of long-term topical treatment with bevacizumab (Avastin) 5 mg/mL eyedrops in a case of aniridia-related neovacularization of the cornea. METHODS: Interventional case report. A female patient with aniridia had a decrease in the best corrected visual acuity from 0.32 to 0.02 in the OS over the course of 4 years, secondary to central corneal neovascularization and epithelial breakdown. Vision in the OD was 0.2. In 2008, at age 28, a shared decision was made to start off-label treatment with bevacizumab eyedrops 0.5% in both eyes. After 9 years, the visual acuity in the OD remained stable, with stability of the macropannus and maintenance of central corneal clarity. In the OS, the central corneal neovascularization regressed, the epithelium regained its clarity, and after cataract surgery visual acuity was regained to 0.32. RESULTS: After 9 years of treatment with topical bevacizumab, vision acuity is comparable to the situation of 12 years previously: Visual acuity remained stable in the ODS. CONCLUSION: In a young patient with progressive corneal neovascularization secondary to aniridia, stability of central corneal neovascularization was obtained and corneal clarity was preserved by adding a daily drop of bevacizumab 5 mg/mL. No adverse events occurred. Vessel growth was inhibited, and as such, the progression of the natural history of the patient's disease was halted. More clinical study with longer follow-up is needed to investigate the applicability of treatment with topical VEGF inhibitors in aniridia.

Vernal shield ulcers treated with frequently installed topical cyclosporine 0.05% eyedrops.

PURPOSE: To report on the beneficial results of an intense regimen of 0.05% cyclosporine eye drops, eight times a day in patients with therapy resistant vernal shield ulcers. METHODS: Case cohort of four eyes of three male children with vernal keratoconjunctivitis complicated by shield ulcers, who were treated with frequent cyclosporine 0.05% eye drops and observed for up to 5 years. RESULTS: Quick resolution of the shield ulcers and complete re-epithelialization within 14-25 days was observed after adding intensive treatment with cyclosporine 0.05% to regular anti-inflammatory, histamine blocking, and surgical therapy. In one patient, additional scraping of the bottom of the ulcer was needed. CONCLUSIONS: In patients with vernal shield ulcers, frequent installation of low-concentration cyclosporine eye drops seems to have a promising therapeutical value.

A novel mutation of laminin ß2 (LAMB2) in two siblings with renal failure.

This report describes a novel mutation of LAMB2, the gene associated with Pierson syndrome (microcoria-congenital nephrosis syndrome), in two female siblings. The c.970T>C p.(Cys324Arg) mutation in the LAMB2 gene affects one of the eight highly conserved cysteine residues within the first EGF-like module of the laminin ß2 protein. These residues form disulfide bonds in order to achieve a correct 3D structure of the protein. The reported phenotype is considered a relatively mild variant of Pierson syndrome and is associated with later-onset (18 months) therapy-resistant nephrotic syndrome leading to renal failure, and ocular abnormalities consisting of high myopia, microcoria, diverse retinal abnormalities, hence a low level of visual acuity. Importantly, the reported LAMB2 mutation was associated with normal neurological development in both siblings. CONCLUSION: this report presents the variability of the renal, ocular and neurological phenotypes associated with LAMB2 mutations and underscores the importance of ophthalmologic examination in all children with unexplained renal insufficiency or nephrotic syndrome. What is known • LAMB2 mutations are associated with Pierson syndrome • Pierson syndrome is associated with congenital nephrotic syndrome, microcoria and neurological deficits What is new • A novel mutation in the LAMB2 gene in two female siblings • Genotype and clinical phenotype description of a novel LAMB2 mutation.

Mobile ultra-clean unidirectional airflow screen reduces air contamination in a simulated setting for intra-vitreal injection.

The aim of this study is to determine whether the use of a mobile ultra-clean laminar airflow screen reduces the air-borne particle counts in the setting of a simulated procedure of an intra-vitreal injection. A mobile ultra-clean unidirectional airflow (UDF) screen was tested in a simulated procedure for intra-vitreal injections in a treatment room without mechanical ventilation. One UDF was passed over the instrument tray and the surgical area. The concentration of particles was measured in the background, over the instrument table, and next to the ocular area. The degree of protection was calculated at the instrument table and at the surgical site. Use of the UDF mobile screen reduced the mean particle concentration (particles > 0.3 microns) on the instrument table by a factor of at least 100.000 (p < 0.05), and over the patient's eye by at least a factor of 436 (p < 0.05), which in clinical practice translates into significantly reduced air contamination. Mobile UDF screen reduces the mean particle concentration substantially. The mobile UDF screen may therefore allow for a safer procedural environment for ambulatory care procedures such as intra-vitreal injections in treatment rooms.

Seven-year follow-up of unilateral multifocal pseudophakia in a child.

The purpose of the study was to report the long-term outcome of unilateral implantation of a multifocal intraocular lens (IOL) in a pediatric cataract. This study was carried out at Tertiary Academic Ophthalmology Department, AMC, Amsterdam. This is a case report study of a 7-year-old child with a unilateral irradiation cataract, in whom an apodized diffractive multifocal IOL (SN6D3, Alcon) was implanted at the time of cataract surgery. During the follow-up period, visual acuity was preserved at logMAR -0.1; the child did not develop amblyopia. Binocular single vision was established. Few glistenings were seen on the IOL. The non-operated eye developed more myopia during the follow-up period than the multifocally implanted eye. Straylight was increased to log(s) 1.83. Patient and parents satisfaction were high. In selected cases, unilateral implantation of apodized diffractive multifocal IOLs leads to good long-term results in terms of visual acuity and patient satisfaction. No untoward effects were seen, including few glistenings on the IOL. Straylight is increased, but subjectively not disturbing.

LASIK flap breakthrough in Nd:YAG laser treatment of epithelial ingrowth.

PURPOSE: To present two cases with complications after Nd:YAG laser treatment of epithelial ingrowth. METHODS: Case reports. RESULTS: Dense central recurrent epithelial ingrowth was treated with a Nd:YAG laser directed at the epithelial nests in the LASIK flap interface in one case. Misalignment of the aiming beam after movement resulted in perforation of the LASIK flap, followed by renewed epithelial ingrowth through the new defect. The epithelial ingrowth receded and became more translucent as a result of the treatment, but the area of the perforation remained irregular. In another case, use of the Nd:YAG laser to treat recurrent epithelial ingrowth adjacent to the flap edge created a cavitation bubble that broke through the flap edge, creating a new epithelial channel through which ingrowth recurred. CONCLUSIONS: Surface breakthrough and renewed epithelial ingrowth is a possible complication of Nd:YAG laser treatment of epithelial ingrowth.

Indications for and outcomes of tertiary referrals in refractive surgery.

PURPOSE: To review the spectrum of disease, symptomatology, and management offered to patients referred for a second opinion after refractive surgery. METHODS: A prospective cohort study was done on all patients referred from October 1, 2006, to September 30, 2011, to a tertiary eye clinic after refractive surgery of any kind (ie, corneal laser surgery, conductive keratoplasty, radial keratotomy, phakic implants, refractive lens exchanges, or any combination thereof). Data analysis was performed on all demographic and clinical aspects of this cohort, including the initial complaint, type of referral, number of complaints, procedure previously performed, diagnosis at our center, type of advice given, and rate and type of surgical intervention. RESULTS: One hundred thirty-one eyes (69 patients) were included. Corneal refractive surgery was performed in 82% (108 eyes), and 11% (14 eyes) were seen after phakic intraocular lens (PIOL) implantation and 7% (9 eyes) after refractive lens exchange. The most common diagnoses were tear film dysfunction (30 eyes, 23%), residual refractive error (25 eyes, 19%), and cataract (20 eyes, 15%). Most patients (42 patients, 61%) were treated conservatively. In 27 patients (39%), 36 eyes (28%) were managed surgically. Severe visual loss was seen in 1 eye. CONCLUSIONS: No major problems were found in most second opinions after refractive surgery referral. Dry eyes, small residual refractive error, or higher-order aberrations were the most common complaints. Surgical intervention was needed in 36 eyes (28%), almost half of which were cataract extractions. Severe visual loss was seen in 1 eye with a PIOL. There was no incidence of severe visual loss in keratorefractive and refractive lens exchange procedures.

Intraocular pressure after descemet stripping endothelial keratoplasty (DSEK).

To assess the incidence of elevated intraocular pressure (IOP) after descemet stripping endothelial keratoplasty (DSEK). Retrospective case series. From the start of the technique in our hospital in 2003 until the middle of 2010, 73 eyes underwent DSEK, of which 66 (90.5 %) had a clear graft 1 year after surgery. IOP data pre- and postoperatively were analyzed. Follow-up was 1-5 years (mean 3.8, SD 1.3). Mean age was 71 years (SD 11, range 43-89). Three eyes (4.5 %) had a history of glaucoma before DSEK. Mean pre-operative IOP was 12.4 mmHg (SD ± 4.3). Mean IOP 1 day post-operatively was 16.4 mmHg (±9.2). Mean IOP after 1 and 6 months, and 1, 3, and 5 years were, respectively, 13.9 (±5.3), 14.7 (±5.6), 14.2 (±5.4), 13.8 (±3.7), and 12.6 (±3.5). Seventeen percent (11 eyes) had a postoperative rise in IOP which needed medical or surgical intervention: 8 % (5 eyes) had a rise in IOP 1 day after DSEK, of which 1 underwent a trabeculectomy 7 months after DSEK surgery; 6 % (4 eyes) had a rise in IOP later in the postoperative period, which could all be managed medically; and 3 % (2 eyes) had increased IOP 1 day after DSEK and later in the postoperative period, both eyes underwent a trabeculectomy 5 and 24 months, respectively, after DSEK surgery. An increase in IOP was encountered in 17 % of DSEK patients. Checking the IOP in the short and long postoperative period is necessary.

Comparison of a hydrophilic and a hydrophobic apodized diffractive multifocal intraocular lens.

UNLABELLED: To compare outcomes between a new design apodized diffractive hydrophilic multifocal intraocular lens (IOL) (Seelens MF; study group), and a well-known apodized diffractive hydrophobic multifocal IOL (SN6AD1; control group). A comparative case series comparing refractive and visual outcomes at distance and near. Patient satisfaction with a validated questionnaire, dysphotopsia and straylight measurement scores were recorded at 3 months post-operatively. The study group comprised 48 eyes and the control group 37 eyes. At 3 months post-operatively the mean uncorrected distance visual acuity (UDVA) was not statistically significant different between the study group and the control group (0.02 ± 0.07 logMAR [SD] vs 0.04 ± 0.09 logMAR). Corrected distance visual acuity (CDVA) was statistically significantly better with the study lens (-0.04 ± 0.05 logMAR vs -0.01 ± 0.04 logMAR (p < 0.019). There was no clinical or statistical significant difference at the 40 cm distance (0.09 ± 0.12 logMAR vs 0.08 ± 0.09 logMAR). The study group had statistically significant better uncorrected near acuity at 50 and 60 cm distances (p < 0.03 and p < 0.007, respectively). In terms of satisfaction the lenses performed equally. Halos were seen less often with the study lens. Straylight, as a parameter for visual quality, was significantly less with the study lens. CONCLUSION: The Seelens MF performs equally as well as the well-known SN6AD1 for UCDA and CDVA. The Seelens MF performs better at intermediate distance, and seems to allow for better depth of focus, and increased visual quality. More study is needed to corroborate the last finding.

['I don't want readers': options for treatment of presbyopia]. / 'Ik wil geen leesbril, wat nu?'.

Presbyopia is farsightedness of old-age. Due to lenticular stiffness, decreased accommodative range, and decreased ciliary muscle function, the ability to see up close diminishes with age. Clinically this means people will need reading glasses. Cataract surgery is the most performed and successful surgery to improve patients' visual acuity. Currently there are many possibilities of solving presbyopia during cataract surgery. This can be achieved by using premium implant lenses, which are lenses that have more than one focus, enabling freedom from spectacles postoperatively. These premium lenses allow vision at the near, intermediate and distance foci, decreasing dependence on optical aids. In this article we will explain the options, and patients' suitability for these solutions and will briefly outline the ins and outs of presbyopia correcting surgery.

New Nitinol-based Thermomechanically Adjustable IOL Technology.

PURPOSE: To evaluate the feasibility of new adjustable intraocular lens (IOL) technology. METHODS: The foldable adjustable IOL consists of a nitinol mechanism placed in a haptic-optic cradle. Heating actuators on the nitinol mechanism with a continuous green laser achieve controlled movement of the mechanism and optic. Activation occurs in controlled steps: rotation in 1-degree steps over 360 degrees, and anterior posterior movement in 0.25-diopter (D) steps with a range of +1.50 D. The IOL was tested in vitro and in vivo in a rabbit eye. Foldability and unfolding were demonstrated through a 2.6-mm cartridge. RESULTS: The adjustable lens mechanism was successfully tested in vitro and in vivo. Activation resulted in a change in optic position relative to the haptics and the capsular bag. Activation of the lever and ratchet mechanism showed radial advancement of the IOL clockwise and counterclockwise. In vivo rotatory movement was achieved after activation by the argon laser at 1 week after implantation. Anterior to posterior movement was accomplished by activating the circular spring actuator mechanism in the laboratory model. Uneventful folding and unfolding were performed. CONCLUSIONS: A new adjustable IOL with a mechanism that responds in measured steps had been shown to move as planned after activation by argon laser. This was successful in the laboratory in both radial and anterior posterior movement. The radial movement was also proven in vivo in an animal model. Further refinement of the prototype is currently being undertaken. [J Refract Surg. 2023;39(10):662-667.].

Clinical Outcomes After Bilateral Implantation of a Diffractive Trifocal Intraocular Lens: A Worldwide Pooled Analysis of Prospective Clinical Investigations.

Purpose: To investigate visual and safety outcomes of AcrySof® IQ PanOptix® (model TFNT00), a trifocal, presbyopia-correcting intraocular lens (IOL), in patients of different ethnicities across multiple countries, based on a pooled analysis of six prospective multicenter studies. Patients and Methods: This pooled analysis included adult patients from six prospective clinical studies performed across 56 centers worldwide. After cataract removal by phacoemulsification, all patients were implanted with TFNT00; follow-up duration varied from 3 to 12 months according to the studies' design. Binocular defocus curve; absolute manifest refraction spherical equivalent (MRSE); and binocular photopic uncorrected and corrected visual acuities at distance (UCDVA, BCDVA; 4-5 m), intermediate (UCIVA, DCIVA; 60-66 cm), and near (UCNVA, DCNVA; 40 cm) were measured. Results: The study included 557 patients, 547 of whom were implanted bilaterally with the TFNT00 IOL (n = 1094 eyes). Binocular visual data at 1 month and 3-6 months after implantation were available for up to 546 and 542 bilaterally implanted patients, respectively. A continuous range of 0.1 logarithm of the minimum angle of resolution (logMAR) or better vision from distance (0.00 diopter [D], 4-5 m) to near (-3.00 D; optically equivalent to 33 cm) was observed 3-6 months after TFNT00 implantation. At 3-6 months, 88.2% of first eyes achieved an MRSE ≤0.50 D and 88.7% of second eyes achieved an MRSE ≤0.50 D. Overall, 99.3%, 92.3%, and 94.6% of patients bilaterally implanted with TFNT00 achieved binocular photopic BCDVA, DCIVA, and DCNVA of 0.14 logMAR or better, respectively. Ocular adverse device effects and secondary surgical interventions (SSIs) were infrequent. Conclusion: This global pooled analysis showed that TFNT00 provided a continuous range of 0.1 logMAR (~20/25 Snellen) or better vision from distance to 33 cm, with a low incidence of ocular adverse device effects and SSIs.

Decision taking in corneal refractive surgery.

A 27-year-old woman who wants to get rid of contact lenses and spectacles was seen at our clinic. She had strabismus surgery as a child and was patched for the right eye but now shows mild nondisturbing exophoria. Infrequently, she likes to box in the sports school. Her corrected distance visual acuity at presentation in the right eye was 20/16 with -3.75 -0.75 × 50 and in the left eye 20/16 with -3.75 -1.25 × 142. Her cycloplegic refraction in the right eye was -3.75 -0.75 × 44 and in the left eye was -3.25 -1.25 × 147. The left eye is the dominant eye. The tear break-up time was 8 seconds in both eyes, and the Schirmer tear test was 7 to 10 mm in right and left eyes, respectively. Pupil sizes under mesopic conditions were 6.62 mm and 6.68 mm. The anterior chamber depth (ACD) (measured from the epithelium) in the right eye was 3.89 mm and in the left eye was 3.87 mm. The corneal thickness was 503 µm and 493 µm of the right and left eye, respectively. Corneal endothelial cell density was on average 2700 cells/mm2 for both eyes. Slitlamp biomicroscopy showed clear corneas and a normal flat iris configuration. Supplemental Figures 1 to 4 (available at http://links.lww.com/JRS/A818, http://links.lww.com/JRS/A819, http://links.lww.com/JRS/A820, and http://links.lww.com/JRS/A821) show the corneal topography and Belin-Ambrósio deviation (BAD) maps at presentation of the right eye and left eye, respectively. Would you consider this patient a candidate for corneal refractive surgery (eg, laser-assisted subepithelial keratectomy, laser in situ keratomileusis [LASIK], or small-incision lenticule extraction [SMILE] procedure)? Has your opinion changed given the recent opinion of the U.S. Food and Drug Administration (FDA) regarding LASIK?1 The patient herself is slightly favoring an implantation of a phakic intraocular lens (pIOL), as she prefers something reversible. Would you implant a pIOL, and which type of IOL, for this level of myopia? What is your diagnosis or are additional diagnostic methodologies needed to establish a diagnosis? What is your treatment advice for this patient? REFERENCES 1. U.S. Food and Drug Administration, HHS. Laser-assisted in situ keratomileusis (LASIK) lasers-patient labeling recommendations; draft guidance for industry and food and drug administration staff; availability. July 28, 2022, Federal Register; 87 FR 45334. Available at: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/laser-assisted-situ-keratomileusis-lasik-lasers-patient-labeling-recommendations Accessed January 25, 2023.

Effect of Nd:YAG laser capsulotomy on refraction in multifocal apodized diffractive pseudophakia.

PURPOSE: To evaluate the effect on refraction of neodymium:YAG (Nd:YAG) laser posterior capsulotomy for posterior capsule opacification (PCO), and to evaluate the correlation between automated and subjective refraction in multifocal apodized diffractive pseudophakia. METHODS: A retrospective study of 75 pseudophakic eyes (50 patients) with multifocal apodized diffractive pseudophakia, treated for PCO with Nd:YAG laser posterior capsulotomy, was performed. Pre- and postintervention values of refractive and visual parameters were compared. The outcomes of autorefraction and subjective refraction were also compared. RESULTS: Uncorrected and corrected distance visual acuity improved significantly after Nd:YAG capsulotomy (P<.001). No significant changes were noted in defocus equivalent, astigmatic power vectors J(0) and J(45), and overall blurring strength in subjective refraction and autorefraction. Spherical equivalent changed significantly in autorefraction (P=.008), but not in subjective refraction. Autorefraction and subjective refraction were highly correlated in spherical equivalent, defocus equivalent, and blurring strength (r(2)>0.59). In approximately 7% of eyes, a change of more than 0.50 diopters in spherical equivalent in subjective refraction occurred. CONCLUSIONS: In most cases, Nd:YAG laser capsulotomy in patients with multifocal pseudophakia did not result in a change in refraction. However, 7% of eyes experienced a significant change in subjective refraction. Autorefraction correlated well with subjective refraction in apodized diffractive multifocal IOLs.

Measured Corneal Astigmatism Versus Pseudophakic Predicted Refractive Astigmatism in Cataract Surgery Candidates.

PURPOSE: To compare standard and total corneal astigmatism measurements to the predicted pseudophakic (nontoric) refractive astigmatism in candidates for cataract surgery. DESIGN: A retrospective, cross-sectional study. METHODS: A single-center analysis of consecutive eyes measured with a swept-source optical coherence tomography biometer at a large tertiary medical center between February 2018 and June 2020. Corneal astigmatism was calculated based on standard keratometry astigmatism (KA), total corneal astigmatism (TCA), and predicted refractive astigmatism (PRA) for a monofocal nontoric intraocular lens (IOL) implantation calculated by the Barrett toric calculator using the predicted posterior corneal astigmatism (PRA(Predicted-PCA)) and the measured posterior corneal astigmatism (PRA(Measured-PCA)) options. Separate analyses were performed for each eye. SETTING: Ophthalmology Department, Shaare Zedek Medical Center, Jerusalem, Israel. RESULTS: In total, 8152 eyes of 5320 patients (4221 right eyes [OD] and 3931 left eyes [OS], mean age 70.6±12.2 years, 54.2% females) were included in the study. The mean vector values (centroid) for KA, TCA, PRA(Predicted-PCA), and PRA(Measured-PCA) were 0.07 diopters [D] at 19.5°, 0.27 D at 7.5°, 0.44 D at 2.9°, and 0.43 D at 179.3°, respectively (P < .01), for OD and 0.02 D at 150.3°, 0.23 D at 169.7°, 0.40 D at 179.4°, and 0.42 D at 169.5°, respectively (P < .01), for OS. More than 73% of eyes had a PRA >0.5 D. CONCLUSIONS: Standard and total corneal astigmatism measurements differ significantly from the PRA by the Barrett toric calculator. The PRA, rather than the KA or TCA, should be used as the reference guide for astigmatism correction with toric IOL implantation.

Visual and satisfaction results with implantation of the trifocal Panoptix® intraocular lens in cataract surgery.

PURPOSE: To assess visual results (including the Lapid-Kushlin defocus coefficient), and satisfaction, following the implantation of PanOptix® a trifocal intraocular lens. METHODS: Observational, retrospective cohort study. 130 eyes of 65 subjects with bilateral implantation were included. Binocular uncorrected visual acuities [distance (Binocular UDVA), intermediate (Binocular UIVA) and near (Binocular UNVA)] were measured. Also, the manifest refraction, binocular defocus curve and binocular contrast sensitivity were determined. The Lapid-Kushlin defocus coefficient, a new single numerical parameter based on the area under the curve of the defocus curve, was calculated. The validated Spanish CATQUEST-9SF satisfaction survey was applied. RESULTS: Postoperative visual acuity ranges were: binocular UDVA 0.18 to 0.0 LogMAR, binocular UIVA 0.30 to 0.0 LogMAR and Binocular UNVA 0.18 to 0.0 LogMAR. The levels of contrast sensitivity both in bright light conditions (with and without glare) and low light conditions with glare, remained within the limits of normality. Under scotopic conditions without glare values below normality were found at lower spatial frequencies. The binocular defocus curve showed a plateau without a clearly evident peak. The Lapid-Kushlin defocus coefficient was 0.199. Two patients (3.1%) needed glasses after the procedure for near and intermediate vision. No patient manifested great visual difficulties or was dissatisfied with the results. CONCLUSIONS: The trifocal platform showed very good results in this series of patients. 96.9% of the patients achieved independence of the glasses and expressed a high degree of satisfaction. The Lapid-Kushlin defocus coefficient was better than those calculated from literature, for other multifocal intraocular lenses.

New methodology for measuring intraocular lens performance using acuity reserve.

PURPOSE: To validate a new methodology of intraocular lens (IOL) assessment using acuity reserve analysis via area under the curve (AUC) to assess intermediate vision. SETTING: Study 1 was conducted at 17 sites in Australia, Chile, and Europe. Study 2 was conducted at 15 sites in Australia, Brazil, and Europe. DESIGN: Post hoc analyses of defocus curve results from 2 clinical trials (study 1: single-arm investigation of the AcrySof IQ PanOptix Trifocal IOL [model TFNT00; Alcon Research LLC]; study 2: comparative investigation of AcrySof PanOptix Trifocal IOL vs the AT LISA Trifocal IOL [model 839MP; Carl Zeiss Meditec AG]). METHODS: Acuity reserve was calculated using AUC compared with visual demand (logMAR) at various distances. Study 1 validated the model; study 2 compared acuity reserve, for a range of defocus levels, for the 2 IOLs. RESULTS: The defocus curve (study 1 [149 patients; 298 eyes]) showed good visual acuity (ie, >20/25) at all defocus levels; the AUC estimate showed 2 lines or more of reserve at -2.50 diopters. Comparative post hoc analysis (study 2 [182 patients]) demonstrated significantly improved acuity reserve with PanOptix IOL vs AT LISA IOL at 20 to 40 days postoperatively (P < .001) and 120 to 180 days postoperatively (P < .001). CONCLUSIONS: Acuity reserve analysis using AUC represents a new methodology for comparative IOL assessment, providing additional detail beyond defocus curve analysis. This method demonstrated that the PanOptix Trifocal IOL was superior to the AT LISA Trifocal IOL (model 839MP) for visual acuity at near to intermediate distances with visual acuity reserve analysis.

Comparison of corneal surgically induced astigmatism calculations based on keratometry measurements made by 2 biometric devices.

PURPOSE: To compare calculated corneal surgically induced astigmatism (SIA) by means of anterior-based keratometry (K) and total keratometry (TK) measurements made by 2 biometric devices. SETTING: Ophthalmology Department, Shaare Zedek Medical Center, Jerusalem, Israel. DESIGN: Retrospective, consecutive case series. METHODS: The medical records of patients who had undergone cataract surgery through a 2.4 mm temporal clear corneal incision by a single surgeon between March 2018 and November 2020 were retrospectively reviewed. Patients for whom there were preoperative and postoperative K measurements assessed by 2 biometric devices, optical low-coherence reflectometry (OLCR) (Lenstar LS900, Haag-Streit, software v. eye suite i/9.1.0.0) and swept-source optical coherence tomography (SS-OCT) (IOLMaster700, Carl Zeiss Meditec AG, software v. 1.80.6.60340), were identified. Corneal SIA (mean vector value) was calculated by vector analysis for 3 groups: SS-OCT(K), SS-OCT(TK), and OLCR(K). Bivariate analyses were applied for comparisons. RESULTS: 147 eyes of 123 patients (73 right eyes and 74 left eyes) were enrolled in the study. The right eye corneal SIA values were 0.09 diopters (D) @ 136 degrees, 0.09 D @ 141 degrees, and 0.07 D @ 123 degrees for the SS-OCT(K), SS-OCT(TK), and OLCR, respectively. The corresponding left eye corneal SIA values were 0.13 D @ 120 degrees, 0.11 D @ 123 degrees, and 0.08 D @ 120 degrees. There were no statistically significant differences between the mean vector value and variance of the corneal SIA for the right (P = .78 and P = .65) and the left (P = .75 and P = .37) eyes of the 3 groups. CONCLUSIONS: Corneal SIA values were low (0.07 to 0.13 D) and similar for the SS-OCT and the OLCR biometric devices with standard K measurements. TK measurements yielded similar corneal SIA values compared with anterior corneal-based measurements.

Implantation of the Black Artisan Iris-Claw Intraocular Lens: A Case Series.

In this case series, we report the use of the black Artisan iris-claw intraocular lens (IOL) (Ophtec, The Netherlands) in 6 patients with various visually debilitating symptoms requesting occlusion of one eye. Between 2016 and 2019, 6 (5 female, 1 male) patients underwent implantation of the custom-made black Artisan iris-claw IOL after other management strategies had failed to relieve their symptoms. The black Artisan IOL is an opaque anterior chamber IOL that is fixated to the iris by enclavation. Data were obtained from the electronic patient records (Epic, Verona, WI, USA). All implantation surgeries were uneventful. In terms of outcomes, 4 patients (67%) were satisfied with the result. In 2 patients (33%), the dysphotopic symptoms were not resolved, and these patients opted for either an enucleation or an evisceration. In conclusion, a black Artisan IOL is a valuable and - if needed - reversible option in the management of patients suffering from monocular debilitating visual symptoms leading to disturbances of binocular vision. The clinical presentation leading to the implantation of a pupil-occluding IOL varies and patient satisfaction following implantation is variable. Careful preoperative evaluation of patient factors and expectations, and stepped-care management is recommended to minimize treatment failure. Pupil-occluding lens implantation is often the last step in the treatment of intractable visual complaints in eyes with complex ophthalmologic history, before evisceration or enucleation.