Bilateral Implantation of Multifocal Intraocular Lenses: 10-Year Follow-Up.

PURPOSE: To evaluate and compare the long-term results after bilateral implantation of different multifocal intraocular lenses (MIOLs). METHODS: This retrospective comparative study included 42 patients who underwent cataract surgery with bilateral MIOL implantation. Patients were divided into 5 groups: Group 1 received a refractive ReZoom NGX1 IOL (AMO), Group 2 a diffractive Acrysof ReSTOR SA60D3 IOL (Alcon), and Group 3 a diffractive Tecnis ZM900 IOL (AMO). Group 4 and Group 5 were implanted using the mix and match approach with refractive ReZoom-diffractive ReSTOR IOL and refractive ReZoom-diffractive Tecnis ZM900 IOL, respectively. Primary outcome measures were distance, near, and intermediate distance visual acuity measured 6 months (T0) and 10 years (T1) after surgery. Secondary outcomes were defocus curves, contrast sensitivity, patients' satisfaction, and spectacle independence. RESULTS: All patients achieved best-corrected distance visual acuity (BCDVA) greater than 0.11 logMAR and uncorrected distance visual acuity (UCDVA) greater than 0.14 logMAR at both time points. A decrease in contrast sensitivity was evident, particularly at high spatial frequencies; at T1, Group 4 reported statistically higher values than Group 2 at 12 cycles/degree and 18 cycles/degree and statistically higher values than Group 3 at 18 cycles/degree. Great overall satisfaction was reported even in the presence of dysphotopsia. Tecnis ZM900 IOL showed the lowest incidence of posterior capsular opacification. CONCLUSION: MIOLs could provide adequate functional vision and patient satisfaction, despite the incidence of side effects, in carefully selected patients desiring spectacle independence.

Optical coherence tomography measurements with the LENTIS Mplus multifocal intraocular lens.

BACKGROUND: To investigate optical coherence tomography (OCT) measurements following implantation of the LENTIS Mplus multifocal IOL, compared with a control group. METHODS: OCT scans were performed on 50 eyes with the Topcon 3D OCT-1000 in two groups of patients. The first group consisted of patients following implantation of the LENTIS Mplus, and a second group of age-matched control eyes following implantation of a monofocal aspheric IOL. Macular thickness and macular volume values were compared between groups and assessment for any onscreen visible artifacts. RESULTS: OCT scans were successfully performed in all 50 eyes with no visible artifacts in either group during scan acquisitions. There were no statistically significant differences (p > 0.05) in any measured or calculated macular thickness or volume values between the two groups. CONCLUSIONS: OCT measurements with the Topcon 3D OCT-1000 is possible and free from visible artifacts in eyes which have had the LENTIS Mplus multifocal IOL implanted. Macular thickness and volume values were similar to those of an age-matched control group of monofocal aspheric IOLs.

Macular star secondary to nasal branch retinal vein occlusion.

An 83-year-old woman affected by nasal branch retinal vein occlusion with macular star underwent treatment with intravitreal triamcinolone acetonide injection followed by laser treatment addressed to the leaking vascular lesions. Visual acuity improved from 20/200 to 20/40 with a remarkable reduction of the macular exudates and resolution of dye leakage on fluorescein angiography over a 2-year follow-up. Nasal branch retinal vein occlusion may rarely occur with macular edema and macular star. Intravitreal triamcinolone acetonide injection and laser treatment of the leaking vascular lesions can result in visual function improvement over a 2-year follow-up.

Scanning laser polarimetry - a review.

Glaucoma is a leading cause of irreversible blindness worldwide. Retinal ganglion cells and their axons represent the selective target of the disease. When visual function is still intact on standard automated perimetry and optic disc appearance is suspicious, an early diagnosis may be supported by the identification of a retinal nerve fibre layer (RNFL) defect in the peripapillary area. At present days, computer-based, real-time imaging of the peripapillary RNFL is available through instruments of easy use and with high levels of accuracy and reproducibility. Scanning laser polarimetry is performed by a confocal scanning laser ophthalmoscope with an integrated polarimeter (GDx-VCC). There is a considerable amount of scientific evidence about the role of this imaging technique for glaucoma diagnosis. The aim of this review is to describe the principles of operation, the examination procedure, the clinical role, the results of main diagnostic studies and the future development of the software for the scanning laser polarimetry.

Retinal nerve fibre layer of perimetrically unaffected eyes of glaucoma patients: an optical coherence tomography study.

PURPOSE: The aim of this study is to evaluate whether optical coherence tomography (StratusOCT) may detect early changes in perimetrically unaffected (PU) fellow eyes of glaucomatous patients by assessing retinal nerve fibre layer (RNFL) thickness parameters. METHODS: Thirty-seven glaucomatous patients with unilateral field loss and 34 age-matched controls were recruited. In glaucoma patients, PU and perimetrically affected fellow eyes were analysed separately. For each group, mean values (+/-SD) of RNFL thickness parameters were calculated and comparisons between fellow eyes of glaucoma patients and between healthy and PU eyes of glaucoma patients conducted with paired t-test and Mann-Whitney U-test, respectively. Proportion of clock-hour sectors flagged with probability <5% or <1% was collected and differences between healthy and PU eyes were evaluated on Fisher exact test. RESULTS: Global (Average Thickness) and sectoral parameters (Inferior and Nasal Average), Maximum thickness-minimum thickness (Max-min), as well as 2-o'clock (nasal side) and 6-o'clock sectors resulted significantly thinner in PU eyes than in control group. Proportion of eyes with clock-hour position flagged with probability <5% or <1% was not significantly different between healthy and PU eyes. CONCLUSION: Despite a standard automated perimetry within normal limits, the StratusOCT detected both localized and diffuse RNFL thinning in PU eyes of glaucoma patients. These eyes should be considered at risk of developing functional damage over time and consequently require thorough monitoring for detecting any sign of progression.

Verteporfin photodynamic therapy for anterior segment neovascularization secondary to ischaemic central retinal vein occlusion.

PURPOSE: To evaluate the efficacy of photodynamic therapy (PDT) with verteporfin for anterior segment neovascularizations (ASNVs) in patients affected by ischaemic form of central retinal vein occlusion (CRVO). METHODS: Prospective non-comparative case series including 10 consecutive patients (10 eyes) affected by ischaemic CRVO. Main outcome measure was the obliteration of ASNV. RESULTS: One month after PDT, biomicroscopic examination showed partial obliteration of iris new vessels and complete closure of angle neovascularization. Iris fluorescein angiography performed 1 week after treatment showed partial closure of the iris new vessels with no evidence of leakage in the late phases. During the subsequent examinations, a partial reopening of the iris and angle new vessels in association with dye leakage on fluorescein angiography was evident. In any case, the fluorescein leakage turned out to be still reduced with respect to the baseline aspects. CONCLUSIONS: Our results show that PDT with verteporfin can partially obliterate ASNVs in eyes affected by ischaemic CRVO preventing from the evolution towards advanced stages of neovascular glaucoma, but is not effective in cases with complete angle synechial closure.

Panretinal photocoagulation and photodynamic therapy for anterior segment neovascularization secondary to ischemic central retinal vein occlusion.

BACKGROUND AND OBJECTIVE: To compare the effects of panretinal photocoagulation (PRP) and photodynamic therapy (PDT) for anterior segment neovascularization secondary to ischemic central retinal vein occlusion (CRVO). PATIENTS AND METHODS: Fifty-seven eyes were randomized to receive standard PRP (19 eyes), selective PRP (20 eyes), or PDT (17 eyes). Selective PRP was performed only when iris neovascularization and/or angle neovascularization showed progression on weekly follow-up. Primary outcome measures were the extension of anterior segment neovascularization and the rate of neovascular glaucoma development. Secondary outcome measures included visual acuity results. RESULTS: After 12 months of follow-up, iris neovascularization extension was 0.52, 2.55, and 2.27 in the PRP, selective PRP, and PDT groups, respectively. Anterior segment neovascularization extension was 0.57, 1.50, and 1.27 in the PRP, selective PRP, and PDT groups, respectively. Both showed a statistically significant difference in the PRP group. The rate of neovascular glaucoma development was similar in the three groups. CONCLUSIONS: Although PRP was better at determining iris neovascularization and anterior segment neovascularization regression, the similar rate of neovascular glaucoma development found in the three groups indicates that anterior segment neovascularization secondary to ischemic CRVO can also be safely managed using selective PRP or PDT.

Internal limiting membrane removal during macular hole surgery: results of a multicenter retrospective study.

PURPOSE: To evaluate the effect of internal limiting membrane (ILM) peeling and other variables in hole closure and functional success rate after idiopathic macular hole surgery. DESIGN: Retrospective, multicenter, observational study. METHODS: The records of 1627 patients operated on for idiopathic macular hole were collected retrospectively from 28 surgeons. All patients underwent a single pars plana vitrectomy and were divided into 2 groups: with and without ILM peeling. Preoperative, intraoperative, and postoperative variables were evaluated. RESULTS: The overall rate of macular hole closure was 94.1% in the ILM peeling group and 89.0% in the no ILM peeling group (P<0.001). The probability of achieving hole closure after surgery is 2.59 times higher if the ILM is peeled (95% confidence interval [CI], 1.71-3.92; P<0.001), 3.12 times higher for holes lasting less than 6 months (95% CI, 1.70-5.71; P<0.001), 4.94 (95% CI, 2.39-10.20) for stage 2 holes, and 2.34 (95% CI, 1.55-3.53) for stage 3 holes than that of patients with a stage 4 hole (P<0.001). CONCLUSIONS: Internal limiting membrane peeling seems to improve hole closure for stage 3 and 4 holes and for long-lasting holes. Higher-stage macular holes and longer duration of symptoms are risk factors for surgical failure. In patients obtaining hole closure, there is no difference in functional results between pseudophakic peeled and not peeled patients, whereas in phakic patients, a better functional result in not peeled patients was seen.

Subthreshold grid laser treatment of macular edema secondary to branch retinal vein occlusion with micropulse infrared (810 nanometer) diode laser.

PURPOSE: To compare the effectiveness of subthreshold grid laser treatment (SGLT) with an infrared micropulse diode laser with that of threshold grid laser treatment (TGLT) for macular edema secondary to branch retinal vein occlusion (BRVO). DESIGN: Randomized clinical trial. PARTICIPANTS: Thirty-six patients (36 eyes) were randomized either to infrared SGLT (17 eyes) or to krypton TGLT (19 eyes). METHODS: Complete ophthalmic examinations, including determination of visual acuity (VA) with Early Treatment Diabetic Retinopathy Study charts, optical coherence tomography (OCT), and fluorescein angiography, were performed at the time of the study entry and at 6-month intervals, with a planned follow-up of 24 months. MAIN OUTCOME MEASURES: Primary: decrease in mean foveal thickness (FT) on OCT. Secondary: changes of the total macular volume (TMV) over the follow-up, proportion of eyes that gained at least 10 letters (approximately > or =2 lines of VA gain) at the 12- and 24-month examinations, and timing of macular edema resolution. RESULTS: Changes in mean FT and TMV from the initial values were statistically significant for TGLT from the 6-month examination (P<0.001) and for SGLT from the 12-month examination (P<0.001). After 1 year, there was no difference in mean FT and TMV between the 2 groups. At the 12-month examination, 10 patients of the SGLT group (59%) and 11 of the TGLT group (58%) gained at least 10 letters (2 lines) in VA. At the 24-month examination, this gain was achieved by 11 patients (65%) of the SGLT group and 11 (58%) of the TGLT group. Moreover, at the 24-month examination 59% and 26% gained 3 lines in the SGLT and TGLT groups, respectively. CONCLUSIONS: Resolution of macular edema and VA improvement are similar to those obtained with conventional TGLT, but SGLT is not associated with biomicroscopic and angiographic signs. A multicenter randomized clinical trial would be needed to ascertain the real efficacy and the most appropriate settings of SGLT for macular edema secondary to BRVO.

Photodynamic therapy for juxtafoveal choroidal neovascularization associated with multifocal choroiditis.

PURPOSE: Evaluation of visual acuity outcome of photodynamic therapy (PDT) with verteporfin for juxtafoveal choroidal neovascularization (CNV) secondary to multifocal choroiditis (MC). DESIGN: Open-label, prospective, interventional case series. METHODS: Seven patients (seven eyes) diagnosed with juxtafoveal CNV associated with MC at the Eye Clinic of Trieste were considered. Inclusion criteria were the presence of juxtafoveal CNV no larger than 5400 microm in greatest linear dimension and best-corrected visual acuity (BCVA) (Snellen equivalent) of approximately 20/200 or better. PDT was performed according to the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) study. The primary outcome was the variation in Early Treatment Diabetic Retinopathy Study (ETDRS) charts visual acuity. In particular, the study considered changes of at least eight letters (approximately <1.5 lines of visual acuity loss) at the 12- and 24-month examinations compared with the baseline examination. Secondary outcomes included fluorescein angiographic features such as progression and area of CNV. RESULTS: At both the 12- and 24-month examinations, three patients (43%) gained at least 1.5 lines of visual acuity, three patients (43%) did not show changes in either direction, whereas visual acuity decreased by 1.5 or more lines from baseline in one patient (14%). The median CNV area was 0.3 mm(2) at baseline and 0.24 mm(2) at the 12- and 24-month controls, respectively. CONCLUSIONS: The positive results of the present study and the absence of treatment-related side effects suggest that PDT may be considered a safe and viable therapeutic option for juxtafoveal CNV for a 24-month period. Further studies including a greater number of patients are needed to confirm these preliminary results.

Photodynamic therapy of subfoveal choroidal neovascularization secondary to reticular pattern dystrophy: three-year results of an uncontrolled, prospective case series.

PURPOSE: To investigate the effects of photodynamic therapy (PDT) on subfoveal choroidal neovascularization (CNV) secondary to reticular pattern dystrophy (RPD) of the retinal pigment epithelium. DESIGN: Open-label, prospective, interventional case series. METHODS: Thirteen eyes diagnosed with subfoveal CNV associated with RPD were considered. Complete ophthalmic examinations were performed at baseline and thereafter at three-month intervals for three years. Primary outcome measure was the number of eyes with <15 letters loss (approximately <3 lines) at 12, 24, and 36 months, compared with baseline. Secondary outcome measures included CNV progression and number of PDT sessions. RESULTS: Seven eyes showed a decrease in best-corrected visual acuity of at least three lines at three-year examination. Each eye received a median number of treatments of two, zero, and zero in years one, two, and three, respectively. CONCLUSIONS: PDT does not appear to guarantee long-term vision stabilization in RPD-related subfoveal CNV, and alternative therapies should be investigated.

Unilateral Optic Neuritis: A Rare Complication after Measles-Mumps-Rubella Vaccination in a 30-Year-Old Woman.

Purpose. To report a case of unilateral optic neuritis following Measles-Mumps-Rubella (MMR) vaccination. Methods. A 30-year-old female developed unilateral optic neuritis five days after a Measles-Mumps-Rubella (MMR) booster vaccination. The patient displayed unilateral involvement, with severe visual loss. However, visual acuity improved significantly after four days of intravenous steroid therapy with 500 mg/day of methylprednisolone. Conclusions. Optic neuritis is one of the rare complications associated with the mumps, measles, and rubella vaccine. It may be a toxic reaction to the nonviral component of the vaccine, but the exact etiology is unknown. Postvaccination neuritis is generally bilateral and usually affects children. In adults, unilateral optic neuritis is usually correlated with multiple sclerosis (MS).

The Italian Catquest-9SF cataract questionnaire: translation, validation and application.

BACKGROUND: To validate the Catquest-9SF questionnaire in Italian, assess the change in visual disability with cataract surgery and determine the correlation between pre-operative Catquest-9SF scores and Lens Opacities Classification System (LOCS) III cataract grading. METHODS: Prospective, questionnaire validation study. The Catquest-9SF questionnaire was forward and back translated and completed by 209 Italian patients before and three months following cataract surgery. Rasch analysis was used to assess its psychometric properties. RESULTS: The Italian Catquest-9SF demonstrated ordered response categories, unidimensionality (item fit statistics range: 0.73-1.34), adequate person separation (2.04), and no differential item functioning. Mistargeting was evident with a mean difference in item difficulty and person ability of 2.04 logits but improved with inclusion of pre-operative data only. There was a statistically significant (Friedman tests, p < 0.001) median improvement in visual disability of 1.92, 3.57, 1.44 and 2.94 logits in patients undergoing first eye surgery with and without ocular comorbidity, and second eye surgery with and without ocular comorbidity respectively. There was no statistically significant difference in the improvements among the four groups (Kruskal-Wallis H test, X (2) (3) = 5.445, p = 0.142). There was no correlation between Catquest-9SF scores and nuclear opalescence (r s = 0.049, p = 0.478), nuclear colour (r s = 0.008, p = 0.909), cortical (r s = 0.066, p = 0.341), and posterior subcapsular components (r s = 0.048, p = 0.494). CONCLUSIONS: The Italian Catquest-9SF demonstrated good psychometric properties and is suitable for use in Italian speaking patients. There were similar improvements in visual disability in patients undergoing first or second eye surgery, with or without ocular comorbidity. There was no correlation between pre-operative Catquest-9SF scores and LOCS III cataract grading.

Anatomical and functional outcomes after heavy silicone oil tamponade in vitreoretinal surgery for complicated retinal detachment: a pilot study.

PURPOSE: To evaluate the effectiveness and safety of a heavy silicone oil (HSO) tamponade for complicated retinal detachment (RD) surgery. DESIGN: Prospective consecutive interventional case series study. PARTICIPANTS: The study included 26 patients with RD complicated by severe proliferative vitreoretinopathy (PVR) in the inferior quadrants. METHODS: All patients underwent pars plana vitrectomy with an internal tamponade using HSO. This tamponade was obtained by mixing 30% by volume perfluorohexyloctane and 70% by volume silicone oil, 1000 millipascal-seconds (polydimethylsiloxane 1000). MAIN OUTCOMES MEASURES: Anatomical and functional results and complications at 1 year of follow-up. RESULTS: Twenty-four of 26 patients achieved anatomical success, defined as complete retinal reattachment. Postoperative visual acuity (VA) values ranged from hand movements to 20/25, with 69.2% of patients obtaining VA better than 20/400. Postoperative complications included early postoperative ocular hypertension in 30.7% of cases, which was easily controlled. Dispersion was noted in 1 case and was not felt to be significant. A cataract requiring surgical removal developed in 2 cases, and an after cataract developed in 3 cases. CONCLUSIONS: In this pilot study, the HSO tamponade obtained by mixing 30% perfluorohexyloctane and 70% polydimethylsiloxane 1000 was associated with a high rate of anatomical success after vitrectomy in cases of RD complicated by severe PVR (greater than CP-6 and greater than CA-6 [updated Retina Society PVR classification]).

Visualization of fluid turbulence and acoustic cavitation during phacoemulsification.

PURPOSE: To describe a technique for visualizing fluid turbulence and cavitational energy created by ultrasonic phaco tips. SETTING: University Eye Clinic of Trieste, Trieste, Italy. METHODS: Generation of cavitational energy by the phaco tip was visualized using an optical test bench comprising several components. The technique uses a telescope system to expand a laser light source into a coherent, collimated beam of light with a diameter of approximately 50.0 mm. The expanded laser beam shines on the test tube containing the tip activated in a medium of water or ophthalmic viscosurgical device (OVD). Two precision optical collimators complete the optical test bench and form the system used to focus data onto a charge-coupled device television camera connected to a recorder. RESULTS: Images of irrigation, irrigation combined with aspiration, irrigation/aspiration, and phacosonication were obtained with the tip immersed in a tube containing water or OVD. CONCLUSIONS: Optical image processing enabled acoustic cavitation to be visualized during phacosonication. The system is a possible means of evaluating a single phaco apparatus power setting and comparing phaco machines and techniques.

Scanning laser polarimetry of nerve fiber layer thickness in normal eyes after cataract phacoemulsification and foldable intraocular lens implantation.

PURPOSE: To assess the effect of cataract phacoemulsification and intraocular lens (IOL) implantation on retinal nerve fiber layer (RNFL) thickness using scanning laser polarimetry (SLP). SETTING: Eye Clinic, Trieste University, Italy. METHODS: Forty-eight eyes were evaluated prospectively the day before and 30 days after cataract phacoemulsification and foldable IOL implantation. In each eye, lens opacity grading according to the Lens Opacities Classification System III (LOCS III), and axial length (AL) measurements were performed. Retinal nerve fiber layer thickness was quantified at baseline by means of SLP and anterior segment birefringence compensation was evaluated acquiring macular retardation map (MRM). Acrylic and silicone IOLs were implanted randomly. After surgery, RNFL thickness was reevaluated, and MRM was reacquired. Macular retardation map pattern variations regarding baseline profile were classified into 3 groups: no variation, bow-tie profile enhancement, or attenuation. Distribution of IOL power, AL, and cataract type in the 3 groups was assessed, as were presurgery and postsurgery SLP parameters with mean values (+/-SD) compared by paired t test. RESULTS: Twenty-two eyes (Group 1, 45.8%) showed no MRM variation, 14 (Group 2, 29.2%) an enhancement, and 12 (Group 3, 25%) an attenuation. In Group 1, no significant RNFL thickness variation occurred. In Group 2, variation 10% to 15% was measured, whereas thickening a 8% to 15% thinning appeared in Group 3. Variations occurred irrespective of IOL material, AL, or cataract type. CONCLUSIONS: Cataract surgery with IOL implantation was associated with an MRM profile change and RNFL thickness variations in 54.2% of eyes. Variations are probably related to opacified lens removal. A new baseline SLP reading is mandatory after cataract surgery.

Tissue reaction to hydrophilic intraocular lenses.

The implant of intraocular lenses (IOLs) following cataract surgery induces a foreign body reaction to the IOL and a lens epithelial cell reaction. The host response to the IOL is mainly influenced by biomaterial properties. With the increasing use of phacoemulsification and small incision cataract surgery, there is growing interest in the use of foldable IOLs made of different materials. Hydrophilic acrylic IOLs include a wide group of foldable biomaterials different in terms of water content. These lenses have been reported to show a good biocompatibility after implantation. Nevertheless, tissue reaction to the implant of hydrophilic lenses is variable and not directly related to the hydrophilicity of their surface. A different adsorption of proteins on the IOL optic surface might be responsible for the different cellular reaction and lens epithelial cell response. Other properties besides hydrophilicity should be taken into account to classify IOL biomaterials.

Analysis of the optical quality of intraocular lenses.

PURPOSE: To evaluate the optical quality of different intraocular lenses (IOLs). METHODS: An optical test bench and suitable software were used to assist in analysis of the optical Fourier transform (OFT) of a test image and to determine the quality of the lens in terms of spatial frequency response. The OFT was automatically converted, by means of an optical-electronic calibration procedure, into a modulation transfer function (MTF) for each lens. The passband value calculated by computer analysis of the MTF is an objective index of the lens quality. Three randomly acquired samples of 24 different models of foldable IOLs were compared. Statistical analysis was performed with two-way and one-way ANOVA for repeated measurements and with the Ryan-Einot-Gabriel-Welsch multiple F test. RESULTS: The method was demonstrated to be precise and accurate. A large range of passband values was found. Statistically significant differences between the mean passband values for different lenses were found. The lowest passband value (125.60 line pairs [lp]/mm) was measured for the IOL (Lenstec LH3000; Lenstec, Inc., St. Petersburg, FL) and the highest (191.48 lp/mm) for the Acrysof SA30AL (Alcon, Fort Worth, TX). CONCLUSIONS: Different IOLs can transmit different spectra of spatial frequencies. The best frequency response was provided by acrylic IOLs, particularly those with an asymmetrically biconvex profile. This could be due to a reduction of optical degradation provided by this type of profile. A lens with a higher frequency response should determine a better quality of vision once implanted and the frequency response should therefore be considered when choosing the intraocular lens model.

Photodynamic therapy with verteporfin for subfoveal choroidal neovascularization associated with multifocal choroiditis.

PURPOSE: Evaluation of visual acuity outcomes of photodynamic therapy with verteporfin for subfoveal choroidal neovascularization (CNV) secondary to multifocal choroiditis. DESIGN: Open-label, prospective, interventional case series. METHODS: Thirteen patients (13 eyes) diagnosed with subfoveal CNV associated with multifocal choroiditis at the Eye Clinics of Trieste and Udine were considered for the study. Inclusion criteria were the presence of subfoveal CNV no larger than 5,400 microm in greatest linear dimension and best-corrected visual acuity, Snellen equivalent, of approximately 20/400 or better. The primary outcome was the number of eyes that had fewer than 8 letters lost (less than approximately 1.5 lines) at the 12-month examination compared with the baseline examination. Secondary outcomes included fluorescein angiographic features such as progression and CNV size. RESULTS: Baseline and final best-corrected visual acuity were 0.52 logarithm of the minimal angle of resolution (20/62(-2) Snellen equivalent) and 0.55 logarithm of the minimal angle of resolution (20/62(-2) Snellen equivalent), respectively. By the 12-month visit, one patient (7.7%) had gained at least 1.5 lines, two patients (15.4%) had lost 1.5 or more lines, and no patient lost 3 or more lines of visual acuity, whereas 10 patients (84.6%) showed less than 1.5-line change. Mean CNV area was 0,69 mm(2) and 0.63 mm(2) at baseline and at the 12-month visit, respectively. By the month 12 examination, patients had received an average of 1.7 treatments. CONCLUSIONS: Photodynamic therapy may be considered a viable therapeutic option for subfoveal CNV associated with multifocal choroiditis at least for a 1-year period. Further studies with longer follow-up are needed to confirm these results.

Long-term endothelial changes after implantation of anterior chamber intraocular lenses in cataract surgery.

PURPOSE: To determine and quantify corneal endothelial damage after primary or secondary implantation of anterior chamber intraocular lenses (AC IOLs). SETTING: Eye Clinic, University of Trieste, Trieste, Italy. METHODS: This retrospective study comprised 125 patients who had implantation of an AC IOL from January 1987 to December 1998. The mean follow-up was 5.2 years. The IOLs were the Domilens Chiron Vision Z (n = 52), the Iolab U85J (n = 38), and the AMO AC51B (n = 35). The Konan specular microscope was used to perform full morphometric analysis of the corneal endothelium. The values obtained were compared with those in fellow eyes, which were phakic or pseudophakic with a posterior chamber IOL (PC IOL). Two years later, 63 patients (mean follow-up 2.1 years) had another morphometric analysis and the values obtained were compared with those in the same eye at the previous examination. The Student t test for unpaired groups was used to compare the results at a 5% significance level. RESULTS: The mean endothelial cell density (ECD) was significantly lower in eyes with primary or secondary AC IOL implantation than in unoperated phakic eyes (P<.01). Patients who had primary AC IOL implantation in 1 eye and PC IOL implantation in the fellow eye had a difference in ECD that was not statistically significant. The endothelial cell difference was significantly greater in aphakic patients who had a secondary AC IOL implantation (P<.05). The ECD ranged from 1015 to 2980 cells/mm(2). The endothelium in the various groups showed no significant changes in the coefficient of variation (CV) in cell size. The ECD and endothelial CV in the same eyes at the second examination were not significantly different from the values 2 years previously. CONCLUSIONS: Anterior chamber IOL implantation did not appear to alter corneal endothelial function. Results indicate that the endothelial cell loss was related to surgical trauma rather than the presence of an IOL in the anterior chamber.