Transitional conic toric intraocular lens evaluation after femtosecond laser-assisted cataract surgery using intraoperative aberrometry.

PURPOSE: To assess refractive and visual outcomes following phacoemulsification with femtosecond laser-assisted cataract surgery (FLACS) using intraoperative aberrometry and implantation of a toric intraocular lens (IOL) in eyes with different degrees of astigmatism. METHODS: One hundred two eyes of 70 patients who underwent implantation of the transitional toric 565 Precizon IOL (Ophtec BV) were enrolled. FLACS, capsular tension ring insertion, and intraoperative aberrometry were performed. Main outcome measures were refractive error, uncorrected- and corrected distance snellen decimal visual acuity values (UDVA and CDVA, respectively), and IOL rotation. Specifically, a vector analysis was carried out with J0 and J45 evaluation. Eyes were evaluated 1-year after surgery. RESULTS: Overall, 94.12% (96 eyes) and 100% (102 eyes) of the eyes showed a spherical equivalent (SE) within ± 0.50D and ± 1.00D, respectively. The mean SE and refractive cylinder were - 0.06 ± 0.29D and - 0.23 ± 0.37D, respectively. Vector analysis revealed that 100% of the eyes were within ± 0.50D for the J0 and J45 cylindrical components. The mean toric axis rotation was 1.10 ± 1.71° (from 0° to 5°), 77% (79 eyes), and 100% (102 eyes) of the eyes showed UDVA and CDVA of 20/25, respectively. The postoperative mean values of monocular UDVA and CDVA were 0.88 ± 0.17 and 0.96 ± 0.07 (about 20/20), respectively. No patient required IOL realignment during the postoperative follow-up. CONCLUSIONS: The present study suggests that the use of the Precizon IOL after FLACS, using intraoperative aberrometry in patients with different amounts of astigmatism, provides good visual acuity, accurate refractive outcomes, and excellent rotational stability.

Agreement of white-to-white measurements with swept-source OCT, Scheimpflug and color LED devices.

PURPOSE: To assess the interchangeability of different devices for measuring white-to-white (WTW) distance. METHODS: WTW distance was measured in 53 eyes of 53 patients using Anterion swept-source optical coherence topographer (SS-OCT), IOLMaster 700 SS-OCT, Pentacam HR Scheimpflug and Cassini color LED. Statistical analysis was done by means of the Friedman test and the post hoc Tukey test. The Bland-Altman analysis was applied to carry out pairwise comparisons with the average difference, 95% confidence interval of the average difference and limits of agreement 95% (LoA). RESULTS: WTW values obtained by the Anterion, IOLMaster 700, Pentacam HR and Cassini were: 11.84 ± 0.41 mm, 11.96 ± 0.41 mm, 11.68 ± 0.38 mm and 12.65 ± 0.52 mm, respectively. Statistically significant differences were found in all pairwise comparison (p < 0.001). The lowest mean difference was found between the Anterion and IOLMaster 700 (- 0.11 mm) and the highest between the Pentacam HR and Cassini (- 0.96 mm). The widest LoA ranges were those that compared any device with the Cassini. LoA ranges when the other three devices were compared among them were similar: Anterion versus IOLMaster 700, Anterion versus Pentacam HR and IOLMaster versus Pentacam HR (about 0.2 mm). CONCLUSIONS: Our results show that there were statistically significant differences in WTW measurement among the four devices, but under a clinical point of view, we believe that Anterion and IOLMaster 700 may be considered interchangeable and so Anterion and Pentacam HR, however, IOLMaster 700 and Pentacam HR may not and neither is Cassini with any of the other three devices.

Clinical Outcomes of a Toric Enhanced Depth-of-Focus Intraocular Lens Based on the Combination of 4th- and 6th-Order Spherical Aberration.

PURPOSE: To assess the visual and refractive outcomes of patients implanted with a toric extended depth-of-focus (EDOF) intraocular lens (IOL) following cataract surgery. METHODS: A total of 44 eyes implanted with the EDOF LuxSmart toric IOL were evaluated 4 to 6 months postoperatively. The main outcomes measurements evaluated were refractive error, rotational stability, distance, intermediate, and near visual acuities, defocus curve, photopic and mesopic contrast sensitivity, wavefront aberrations, and modulation transfer function, and the Catquest-9SF-questionnaire. RESULTS: The mean postoperative spherical equivalent and cylinder were -0.02 ± 0.26 and -0.17 ± 0.29 diopters (D), respectively. A total of 90.45% and 100% of the eyes had a postoperative spherical equivalent within ±0.50 and ±1.00 D, respectively (this being 93.18% and 100% for the refractive cylinder). The mean rotational stability was 0.61 ± 1.61 degrees. The mean binocular corrected distance visual acuity (CDVA), corrected distance intermediate visual acuity (CDIVA), and corrected distance near visual acuity (CDNVA) were -0.02 ± 0.06, 0.07 ± 0.08, and 0.26 ± 0.09 logMAR, respectively. The CDVA was 20/25 or better in 95.45% of patients, CDIVA was 20/25 or better in 72.73%, and CDNVA was 20/40 or better in 72.73%. The defocus curve showed good visual acuity at distance and intermediate vergences. The contrast sensitivity and optical quality outcomes were good with mean higher order, spherical, and coma aberration values of 0.161 ± 0.155, -0.019 ± 0.048, and 0.080 ± 0.065 µm, respectively. A total of 90.9% of patients were either fairly satisfied or very satisfied with their vision after the surgery, and 77.7% of patients reported no difficulties when reading text in newspapers. CONCLUSIONS: Implantation of the toric pure refractive EDOF technology IOL provides good refractive, optical, and visual quality at different distances, with high levels of patient satisfaction being reported. [J Refract Surg. 2024;40(6):e398-e406.].

Clinical Performance of an Omnidirectional Aberration-Free Trifocal Toric Intraocular Lens.

Purpose: To assess the refractive and visual outcomes at different distances following cataract surgery with implantation of an omnidirectional aberration-free diffractive trifocal toric intraocular lens (IOL). Methods: A total of 24 patients who underwent bilateral implantation with the TrivaT-aAY IOL were analyzed at 3-4 months post-surgery. Refractive error, monocular and binocular uncorrected and corrected-distance visual acuity (UDVA, CDVA), uncorrected and corrected-distance intermediate visual acuity (UIVA, CDIVA) at 60 cm, uncorrected and corrected-distance near visual acuity (UNVA, CDNVA) at 40 cm, monocular and binocular defocus curve and rotational stability were measured. Patients also completed the Catquest-9SF questionnaire at the last postoperative visit. Results: The postoperative mean values of binocular logMAR CDVA, CDIVA and CDNVA were -0.06±0.06, 0.05±0.07 and 0.07±0.08, respectively. One hundred percent of patients showed a cumulative binocular CDVA ≥20/25, and 95.83% of patients showed a cumulative binocular CDIVA and CDNVA ≥20/32. The mean postoperative spherical equivalent was 0.07±0.26D and 100% and 97.92% eyes were within ±1.00D and ±0.50D, respectively. The mean postoperative refractive cylinder was -0.22±0.29D and 100% and 89.58% eyes showed a value ≤1.00D and ≤0.50D, respectively. The defocus curves showed a wide range of useful vision, with visual acuity values >0.2 logMAR. Mean absolute IOL rotation was 2.19±2.17 degrees and all eyes had a rotation <10 degrees. For the questionnaire, 95.83% of patients reported being quite satisfied to very satisfied with their vision and about 79.17% did not report any difficulty with their vision in their everyday life. Between 83.33% and 95.83% of patients reported no difficulty performing different tasks. No intra- and postoperative complications were reported during the follow-up. Conclusion: Our study shows that the TrivaT-aAY IOL provides good visual acuities at all distances and refractive outcomes with excellent rotational stability and with high satisfaction among our patients after its implantation.

Surgical Efficiency Comparison Between Two Phacoemulsification Systems.

Purpose: To assess the surgical efficiency in cataract surgery comparing two phacoemulsification systems. Methods: Prospective, consecutive-comparative study in a two-site private practice. Three hundred and one eyes undergoing standard or femtosecond laser-assisted (FLACS) cataract surgery with either the R-Evo Smart (BVI, Waltham, USA) and/or the Centurion Vision System (Alcon, Fort Worth, USA). Preoperative eye characteristics (degree of cataract using the lens opacities classification system LOCS III grading) and intraoperative outcomes (total ultrasound time and total estimated fluid aspirated/drainage bag weighting) were registered in all cases. Results: One hundred and fifty-five eyes undergone cataract surgery with the R-Evo Smart and 146 eyes with the Centurion Vision System phacoemulsification systems. Mean cataract grade was 3.07 ± 0.78 and 2.96 ± 0.85 for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.12). Mean total ultrasound time was 18.99 ± 12.85 and 40.24 ± 21.91 seconds for the R-Evo Smart and Centurion Vision System groups, respectively (p < 0.01). Mean total estimated fluid aspirated/drainage bag weighting was 53.00 ± 14.56 g and 54.33 ± 14.88 cc for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.21). Considering non-FLACS surgery (98 eyes with the R-Evo Smart and 63 eyes with the Centurion Vision System), mean cataract grade was 2.95 ± 0.74 and 2.97 ± 0.91 for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.44). Mean total ultrasound time was 19.96 ± 11.20 and 42.84 ± 28.35 seconds for the R-Evo Smart and Centurion Vision System groups, respectively (p < 0.01). Mean total estimated fluid aspirated/drainage bag weighting was 55.95 ± 14.76 g and 55.97 ± 13.62 cc for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.49). No adverse events were found in the two groups of eyes. Conclusion: The objective measurement of surgical efficiency through total ultrasound time during lens removal and fluid consumption during both lens removal and irrigation/aspiration proved R-Evo Smart to be an efficient phacoemulsification platform, in comparison with the current standard of care Centurion Vision System.

RECOGNITION VERSUS RESOLUTION CHARTS FOR DEFOCUS CURVE DETERMINATION IN TRIFOCAL INTRAOCULAR LENSES.

PURPOSE: To determine the impact of optotype choice on the determination of defocus curve in cataract patients implanted with presbyopia-correcting intraocular lens (IOL). SETTING: Oftalvist Alicante, Alicante, Spain. DESIGN: Observational case-control study. METHODS: Patients implanted with Asqelio Trifocal IOL (AST Products, Inc., Billerica, MA, USA) participated in this study. Uncorrected and distance corrected visual acuity and subjective refraction were determined. Monocular defocus curves were obtained 6 months after surgery with the CTS system using either ETDRS or Landolt C charts under photopic conditions (85 cd/m2), and range of vergence from +2.00D to -5.00D in 0.50D steps. RESULTS: A total of 49 patients were enrolled in the study, 24 in the EDTRS group (7 male, 17 female) and 25 in the Landolt C group (5 male, 20 female). Non-significant differences were found between patients conforming both groups, except for preoperative intraocular pressure and white-to-white distance. All patients were within ±1.00D from intended refraction after surgery. 75% of patients in the EDTRS group and 84% in the Landolt C group were within ±0.50D. Average difference between the groups across vergences provided by the defocus curve was 0.12±0.05 logMAR units, significant for all vergences (p<0.05). Differences in VA were significant for distance, intermediate and near between both groups, except for uncorrected distance VA. CONCLUSION: Defocus curves created using Landolt C charts yield significantly lower through-focus outcomes than those created with standard EDTRS charts. This should be taken into account when comparing the performance of presbyopia-correcting systems accross studies where recognition charts might have been used due to patient characteristics.

Clinical Results of a Monofocal Aspheric Bitoric Intraocular Lens with Plate Haptics in Hyperopic Eyes.

Purpose: To assess the refractive and visual outcomes of hyperopic and astigmatic eyes implanted with a monofocal, aspheric, bitoric intraocular lens (IOL) with plate haptics following cataract surgery. Methods: The study evaluated 51 eyes implanted with the AT TORBI 709M IOL (Carl Zeiss Meditec AG, Jena, Germany) during a follow-up of 12-months. Refractive error, rotational stability, monocular uncorrected distance visual acuity (UDVA), monocular corrected distance visual acuity (CDVA), and contrast sensitivity were analyzed at 1-, 6-, and 12-months post-surgery. Results: At 12 months, the cumulative CDVA was 20/25 in 94.12% of eyes and 20/32 or better in 98.04%. The UDVA was the same as, or better than, the CDVA in 88.24% of eyes. The mean logMAR UDVA and CDVA values were 0.06 ± 0.11 and 0.00 ± 0.08, respectively. In addition, 92.16% of eyes were within ±0.50 D and 98.04% were within ±1.00 D of a spherical equivalent, and 86.27% of eyes had refractive astigmatism ≤0.50D and 100% were ≤1.00D. The mean spherical equivalent was 0.21 ± 0.31D and the mean refractive cylinder 0.34 ± 0.27D. The IOL rotation was 1.18 ± 1.35 degrees and all eyes had a rotation ≤5 degrees. The log contrast sensitivity functions were good and similar for all spatial frequencies during follow-up. Conclusion: Our results demonstrate that implantation of the AT TORBI 709M IOL in hyperopic and astigmatic eyes is effective and safe. The visual and refractive outcomes were good, showing excellent rotational stability.

Visual and Refractive Outcomes After Bi-aspheric Trifocal Toric Diffractive Intraocular Lens Implantation.

PURPOSE: To assess clinical outcomes after cataract surgery with bilateral implantation of a new bi-aspheric diffractive intraocular lens (IOL). METHODS: Thirty patients underwent bilateral implantation of the Asqelio Trifocal Toric IOL (AST Products, Inc) and were evaluated 3 months postoperatively. Main outcomes included refractive error, photopic monocular and binocular uncorrected and corrected distance (UDVA, CDVA), intermediate (UIVA, CDIVA) at 60 cm, and near (UNVA, CDNVA) at 40 cm visual acuities. Mesopic monocular and binocular CDNVA were also measured. Defocus curves, binocular contrast sensitivity under photopic and mesopic conditions with and without glare and rotational stability were determined. Patients completed Catquest-9SF and visual symptoms questionnaires. RESULTS: Average values of binocular photopic CDVA, CDIVA, and CDNVA, and mesopic CDNVA were -0.04 ± 0.06, 0.02 ± 0.08, 0.02 ± 0.07, and 0.22 ± 0.11 logMAR, respectively. All patients achieved cumulative CDVA ⩾ 20/25, and CDIVA and CDNVA of 20/32 or better. Binocular depth of focus was approximately 3.25 diopters (D). Mean postoperative spherical equivalent was -0.08 ± 0.26 D, with 95% of eyes within ±0.50 D. Mean postoperative refractive cylinder was -0.22 ± 0.27 D, with 91.67% of eyes within 0.50 D or less, respectively. IOL rotation averaged 0.25 ± 0.65 degrees, all eyes having rotation of less than 5 degrees. Contrast sensitivity was within or above normal levels under photopic and mesopic conditions, with or without glare, except for 12 cpd under mesopic conditions with glare. Questionnaire responses indicated 96.67% of patients were satisfied or very satisfied with postoperative vision, and 80.00% to 96.67% reported no difficulty in different daily activities. CONCLUSIONS: The Asqelio Trifocal Toric IOL demonstrated favorable outcomes, providing excellent visual performance at all distances, precise refractive results, and remarkable rotational stability. Patients reported high satisfaction levels and minimal difficulty in daily activities. [J Refract Surg. 2024;40(6):e407-e419.].

Clinical Outcomes of a Bi-Aspheric Trifocal Diffractive Intraocular Lens.

Purpose: To assess refractive and visual outcomes post-cataract surgery with bilateral implantation of a bi-aspheric diffractive trifocal intraocular lens (IOL). Methods: A total of 24 patients who underwent bilateral implantation with the Asqelio Trifocal IOL TFLIO130C were evaluated at the 6 months postoperative mark. Key outcome measures included refractive error, photopic monocular and binocular uncorrected and corrected distance visual acuity (UDVA, CDVA), uncorrected and corrected intermediate visual acuity (UIVA, CDIVA) at 60 cm, and uncorrected and corrected near visual acuity (UNVA, CDNVA) at 40 cm. Additionally, monocular and binocular CDNVA were assessed under mesopic conditions. Monocular and binocular defocus curves, and binocular contrast sensitivity under photopic and mesopic conditions, with and without glare, were measured. Catquest-9SF and visual symptoms questionnaires were also administered. Results: Postoperative average values of binocular logMAR photopic CDVA, photopic CDIVA, photopic CDNVA and mesopic CDNVA were -0.01±0.06, 0.03±0.09, 0.02±0.05 and 0.19±0.13, respectively. About 100% of patients showed cumulative CDVA and CDNVA ≥20/25, and CDIVA ≥20/32. The average absolute depth-of-focus was about 4.50D. The average postoperative spherical equivalent was 0.05±0.30D and 100% and 93.75% eyes were within ±1.00D and ±0.50D, respectively. Contrast sensitivity was either within or above normal levels under both photopic and mesopic conditions, both with and without glare, except for 12 cpd under mesopic conditions with glare where the mean falls just below the normal range. Questionnaires revealed that 87.5% of patients were either satisfied or very satisfied with their vision after the surgery, and higher percentages for no difficulty in performing different activities, ranging from 70.83% to 95.83%, were reported. Conclusion: This study demonstrates that the bi-aspheric diffractive trifocal IOL yields very good visual performance across distances, fostering high satisfaction levels and minimal difficulties in daily activities.

Non-diffractive, toric, extended depth-of-focus intraocular lenses in eyes with low corneal astigmatism.

BACKGROUND: To assess clinical outcomes after implanting toric, extended-depth-of-focus intraocular lenses (IOLs) to correct low corneal astigmatism in eyes with cataracts. METHODS: 47 eyes were implanted with the AcrySof IQ Vivity Toric DFT215 IOL. Main outcome measures were refractive error, monocular uncorrected and corrected distance (UDVA/CDVA), uncorrected and distance-corrected intermediate (UIVA/DCIVA), and uncorrected near and distance-corrected near (UNVA/DCNVA) visual acuities, monocular defocus curve, rotational stability, and IOLSAT and QUVID questionnaires. Patients were assessed at 3 months postsurgery. RESULTS: All eyes had a postoperative spherical equivalent (SE) within ± 0.50 D and 97.87% (n = 46) had a refractive cylinder ≤ 0.50 D. The mean SE and refractive cylinder were - 0.10 ± 0.17 D and - 0.16 ± 0.24 D, respectively. The CDVA was ≥ 20/25 and ≥ 20/32 in 95.74% (n = 45) and 97.87% (n = 46) of eyes, respectively. The DCIVA was ≥ 20/32 in 85.11% (n = 40) of eyes and the DCNVA was ≥ 20/40 in 74.47% (n = 35). The mean values of CDVA, DCIVA, and DCNVA were - 0.02 ± 0.08, 0.14 ± 0.09, and 0.23 ± 0.12 logMAR, respectively. The defocus curve revealed good visual acuity at far and intermediate distances with a depth-of-focus of about 1.75 D. IOL rotation was 0.74 ± 1.13 degrees and all eyes had a rotation of less than 5 degrees. Patients reported either good or very good postoperative vision without eyeglasses under bright-light-conditions at distance (87.80%, 36/41) and intermediate distance (92.68%, 38/41). Between about 63.83%-72.34% (30-34) of patients reported no starburst, halos, or glare, or if experienced, were not bothersome. CONCLUSIONS: The Vivity toric IOL implanted in eyes with low-astigmatism provides accurate refractive outcomes, good visual acuity at different distances and excellent rotational stability. Trial Registration The study was registered with the German Clinical Trials Register (DRKS00030579).

Corneal erosion and Kindler syndrome.

PURPOSE: To describe a very common corneal pathology in a patient with Kindler syndrome. CASE REPORT: We report the case of a 21-year-old woman, who presented to the Ophthalmology Department as an emergency presentation because of ocular pain in the left eye that radiated to other areas of the face and neck. After an exhaustive clinical interview, it was determined that the patient had a rare disease (Kindler syndrome). Ophthalmologic examination revealed corneal erosion on the left eye. No other significant conditions were found. After the application of conventional treatment, the corneal integrity was completely restored. CONCLUSIONS: We describe a very rare syndrome. Although conventional treatment restored corneal integrity, it is important to remember that ocular signs and symptoms are often associated with systemic pathologies.

Clinical outcomes of trifocal toric intraocular lenses.

The purpose of this report is to summarize the visual and refractive outcomes of patients with trifocal toric intraocular lens (IOL) implants. A peer-reviewed literature search in different databases was carried out to identify clinical publications reporting outcomes of patients with this type of implant. The analysis considered information on the sample of eyes, type and power of the trifocal toric IOLs, biometric preoperative data, postoperative refraction, rotational stability, visual acuity at different distances and other analyses undertaken, such as contrast sensitivity or quality of vision questionnaires. 20 clinical studies, encompassing a total of 1404 eyes implanted with three commercially available trifocal toric IOLs, were included in this review. The analysis assessed the outcomes reported for the AT LISA tri toric 939MP IOL, involving 3 articles and 313 eyes; the FineVision toric POD FT IOL, with 7 articles studying 370 eyes, and the AcrySof IQ PanOptix toric IOL, involving 11 articles and 721 eyes. Our assessment of the outcomes of the various studies indicates that the efficacy of the refractive correction (both sphere and cylinder) and visual acuity at different distances was similar between the IOL models. The same was found for the patients' quality of vision and satisfaction levels, in addition to photic phenomena reported. The outcomes summarized in this report lead us to conclude that the use of trifocal toric IOLs allows complete visual restoration over a wide range of distances.

Axial length acquisition success rates and agreement of four optical biometers and one ultrasound biometer in eyes with dense cataracts.

BACKGROUND: To evaluate the axial length acquisition success rates and agreement between various biometric parameters obtained with different biometers in dense cataracts. METHODS: Fifty-one eyes were measured using Anterion®, Argos® and IOLMaster® 700 swept-source optical coherence tomography (SS-OCT) biometers, a Pentacam® AXL partial coherence interferometry (PCI) biometer, and an OcuScan® RxP ultrasound biometer. We measured keratometry (K1, flattest keratometry and K2, steepest keratometry), white-to-white (WTW), anterior chamber depth (ACD), lens thickness (LT) and axial length. Cataracts were classified according to the Lens Opacities Classification System III grading system, the dysfunctional lens index (DLI) and Pentacam® nucleus staging (PNS) metrics. Percentage of acquisition success rate and a Bland-Altman analysis for the agreement between biometers were calculated. RESULTS: The mean LOCS III score was 3.63 ± 0.92, the mean DLI was 2.95 ± 1.30 and the mean PNS was 2.36 ± 1.20. The acquisition success rates for the Anterion®, Argos®, IOLMaster® 700, Pentacam® AXL and OcuScan® RxP biometers were 94.12%, 100%, 98.04%, 60.78% and 100%, respectively. There were significant differences in the success rates between biometers (P = 0.014). There were statistically significant differences between biometers for all parameters evaluated (P < 0.05). The range of the limit of agreement (LoA) for all comparisons of K1 and K2 were > 1.00 D. The LoA for WTW ranged from 0.095 to 1.050 mm. The LoA for ACD and LT ranged from 0.307 to 0.114 mm and from 0.378 to 0.108 mm, respectively. The LoA for axial length ranged from 0.129 to 2.378 mm. CONCLUSIONS: Among optical biometers, those based on SS-OCT technology are more successful at measuring axial length in eyes with dense cataracts. TRIAL REGISTRATION: The study was registered with the National Institutes of Health (clinical trial identifier NCT05239715, http://www. CLINICALTRIALS: gov ).

Agreement of Corneal Diameter and Anterior Chamber Depth Measurements with the IOLMaster 500 and the IOLMaster 700 Optical Biometers in Myopic Eyes.

Purpose: To assess the agreement in automated corneal diameter (CD) and anterior chamber depth (ACD, measured from corneal epithelium to lens) distances measurements between the IOLMaster 500 and 700 optical biometers in myopic eyes. Methods: One hundred and sixteen eyes of 116 myopic patients aged between 21 to 60 years were included in this study. Measurements of CD and ACD distances were taken with each biometer for all patients in the same session. A t-test and a p-value less than 0.05 was considered statistically significant when the measurements were compared. The agreement between biometers was studied by applying a Bland-Altman analysis. Results: The mean CD values obtained using the IOLMaster 500 and 700 biometers were 12.26±0.35 mm and 12.13±0.34 mm, respectively. The mean ACD distance values were 3.61±0.29 mm and 3.62±0.31, for the IOLMaster 500 and 700 biometers, respectively. There were statistically significant differences between the two devices only for CD measurements (p<0.001), but not for ACD measurements (p=0.26). The limits of agreement obtained were wide in both types of measurements, being 0.422 mm for the CD distance and 0.389 mm for the ACD distance. Conclusion: There were statistically significant differences between the IOLMaster 500 and 700 biometers regarding CD but not in ACD measurements in healthy myopic eyes. These differences could be clinically significant in some cases. According to these results, medical judgement should be used to assess whether the two devices could be used interchangeably for CD and ACD measurements during the clinical practice.

Visual and Refractive Outcomes of a Trifocal Toric Intraocular Lens Implanted in Eyes With High Corneal Astigmatism.

PURPOSE: To analyze the refractive and visual outcomes following cataract surgery and implantation of a trifocal toric intraocular lens (IOL) in eyes with high degrees of corneal astigmatism. METHODS: A total of 29 eyes from 21 patients who underwent implantation of a trifocal toric IOL (FineVision PODFT; PhysIOL) were evaluated in this study. Phacoemulsification with femto-second laser and intraoperative aberrometry were performed in all cases. All IOLs used exhibited a cylinder power of 3.75 diopters (D) or greater. The main outcome measures were refractive error and corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA) values. Eyes were evaluated during a follow-up period of 5 years. RESULTS: A total of 96.30%, 100%, 95.83%, and 89.47% of eyes were within ±1.00 D at 1, 2, 3, and 5 years postoperatively, respectively. Furthermore, 92.31%, 86.36%, 82.61%, and 84.21% of eyes showed a refractive cylinder value of ±1.00 D at 1, 2, 3, and 5 years postoperatively, respectively. During the entire follow-up period, between 81.48% and 91.30% of eyes showed a CDVA of 20/25 or better. The mean monocular Snellen decimal CDVA values were 0.90 ± 0.12, 0.90 ± 0.11, 0.91 ± 0.11, and 0.90 ± 0.12 at 1, 2, 3, and 5 years postoperatively, respectively. No significant rotation was reported in any eye during follow-up. CONCLUSIONS: The current study suggests that use of this trifocal toric IOL in eyes with high amounts of corneal astigmatism provides accurate refractive outcomes with good distance visual acuity. [J Refract Surg. 2023;39(4):229-234.].

Contrast Sensitivity and Patient Reported Outcomes After Bilateral Implantation of a Bi-Aspheric Hydrophobic Trifocal Diffractive Intraocular Lens.

Purpose: To assess contrast sensitivity and patient reported outcomes after uncomplicated cataract surgery with a new bi-aspheric diffractive trifocal intraocular lens (IOL) implantation. Methods: Twenty-five patients who underwent bilateral implantation with the Asqelio Trifocal TFLIO130C IOL (AST Products Inc., Billerica, MA, USA) were analyzed at 6 months post-surgery. Binocular contrast sensitivity with and without glare was measured under photopic conditions (85 cd/m2) and mesopic conditions (3 cd/m2). Patients were asked to complete the Catquest-9SF patient outcomes questionnaire and a visual symptoms questionnaire. Results: Photopic contrast sensitivity values were either within or above normal levels without glare; when glare was induced, the mean sensitivity values dropped just below normal range. Mesopic contrast sensitivity values were above or within normal range both with and without glare, except for 12 cpd with glare, where the mean fell just below the normal range. Differences in binocular contrast sensitivity threshold values with and without glare were significant for all spatial frequencies tested under both photopic and mesopic conditions (p<0.05). The Catquest-9SF questionnaire outcomes showed that 88% of patients were either satisfied or very satisfied with their sight after the surgery, and in all cases, the results indicated no difficulty in performing different daily activities. The visual symptoms questionnaire indicated no relevant visual symptoms regarding frequency, intensity, or bothersomeness after implantation of the trifocal IOL. Conclusion: This novel bi-aspheric diffractive trifocal IOL provides good contrast sensitivity outcomes under bright and dim lighting conditions. Patients were satisfied with the surgery, with no relevant visual symptoms.

Clinical Performance of a New Trifocal IOL with a 7.0 mm Optical Zone.

Purpose: To evaluate the refractive and visual outcomes following cataract surgery and implantation of a diffractive trifocal intraocular lens (IOL) with a 7.0 mm optical zone. Methods: A total of 23 patients who underwent bilateral implantation with the Triva-aXAY IOL were analyzed at 6 months post-surgery. The main outcome measures were refractive error, monocular and binocular uncorrected and corrected-distance visual acuity (UDVA, CDVA), uncorrected and corrected-distance intermediate visual acuity (UIVA, CDIVA) at 60 cm, uncorrected and corrected-distance near visual acuity (UNVA, CDNVA) at 40 cm, and binocular defocus curve. Patients also completed the Catquest-9SF questionnaire. Results: All eyes were within ±1.00D, and 91.30% of eyes within ±0.50D, with a mean postoperative spherical equivalent of -0.14±0.29D. Similarly, 95.65% of patients showed a binocular UDVA ≥20/25, compared to 100% for CDVA, and the mean binocular UDVA and CDVA were 0.02±0.06 and 0.00±0.05 logMAR, respectively. At intermediate vision, 65.22% of patients showed a binocular UIVA ≥20/25, compared to 86.96% for CDIVA, and the mean binocular UIVA and CDIVA were 0.07±0.06 and 0.06±0.06 logMAR, respectively. At near, 95.65% of patients showed a binocular UNVA and CDNVA ≥20/25, with a mean binocular UDNVA and CDNVA of 0.04±0.07 and 0.02±0.05 logMAR, respectively. Finally, 95.65% of patients reported being quite satisfied to very satisfied with their vision and about 74% did not report any difficulty with their vision in their everyday life. Between 65.22% and 100% of patients reported no difficulty performing different tasks. Conclusion: Our study shows good visual and refractive outcomes with high satisfaction in patients implanted with the Triva-aXAY IOL with a 7.0 mm optical zone.

Visual Performance at Different Distances After Implantation of an Isofocal Optic Design Intraocular Lens.

PURPOSE: To evaluate refractive and visual outcomes at different distances after implantation of an isofocal optic design intraocular lens (IOL) following cataract surgery. METHODS: This multicentric, retrospective/prospective, open-label, observational study considered 183 eyes of 109 patients who were implanted with the ISOPURE 123 (PhysIOL) IOL. The main outcome measures were refractive error and monocular and binocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), and distance-corrected intermediate visual acuity (DCIVA) at 66 and 80 cm, uncorrected near visual acuity (UNVA), and distance-corrected near visual acuity (DCNVA) at 40 cm. Binocular visual acuity at different vergences (defocus curve) was also measured. Patients were evaluated at least 120 days postoperatively. RESULTS: A total of 95.7% of the eyes were within ±1.00 diopter (D) and 73.2% of the eyes were within ±0.50 D; the mean postoperative spherical equivalent was -0.12 ± 0.42 D. There were 90.54% and 98.57% of patients presenting a cumulative binocular UDVA and CDVA value of 20/25 or better, respectively; 80.65% and 50.0% of patients presented a binocular DCIVA value of 20/25 or better at 80 and 66 cm, respectively; and 41.94% of patients presented a binocular DCNVA value of 20/40 or better. The through-focus curve showed good visual acuity at far and intermediate distances with a depth of focus value of 1.50 D. No adverse events were reported. CONCLUSIONS: The current study shows that this isofocal optic design IOL provides excellent visual performance for far vision and functional intermediate vision with an extended range of vision. This lens is an effective option for providing functional intermediate vision and correcting aphakia. [J Refract Surg. 2023;39(3):150-157.].

Visual and Refractive Outcomes After Bilateral Implantation of a Biconvex Aspheric Toric Monofocal Intraocular with a Double C-Loop Haptic Design.

Purpose: To show the visual and refractive outcomes in cataract patients with corneal astigmatism when bilaterally implanted with a biconvex aspheric toric monofocal intraocular lens (IOL) with a double C-loop haptic-design. Methods: Forty-seven cataract patients (94 eyes) with corneal astigmatism (≥0.75D) were implanted with the monofocal PODEYE toric IOL and assessed for 4-6 months post-surgery. Measurements included monocular and binocular uncorrected-distance visual acuity (UDVA) and corrected-distance visual acuity (CDVA), under both photopic and mesopic lighting conditions. Refraction, photopic and mesopic contrast sensitivity (with and without glare), and rotational stability were also recorded at the last postoperative visit. Results: At 4-6 months, 78.2% and 98.9% of eyes were within ±0.50D and ±1.00D of the target refraction, respectively. The mean spherical equivalent and refractive cylinder values were 0.09±0.35D and -0.36±0.35D, respectively. 76.5% and 98.8% of eyes presented a postoperative refractive cylinder of ≤0.50D and ≤1.00D, respectively. 91.5% and 100% of patients had a binocular UDVA and CDVA of ≥20/25, respectively. The mean binocular UDVA and CDVA were 0.02±0.08 and -0.02±0.07 logMAR, respectively. Under mesopic conditions, 78.7% and 83.0% of patients presented a binocular UDVA and CDVA ≥20/32, respectively. The mean binocular UDVA and CDVA were 0.15±0.11 and 0.12±0.11 logMAR, respectively. The patients showed good contrast sensitivity under photopic and mesopic conditions. The mean absolute IOL rotation was 1.22±2.21 degrees with 97.87% of eyes having a rotation of <10 degrees. Conclusion: This study shows good visual and refractive outcomes for the PODEYE toric IOL when implanted bilaterally in cataract patients with corneal astigmatism.

Efficacy and Safety of the Preserflo Microshunt With Mitomycin C for the Treatment of Open Angle Glaucoma.

PRCIS: The Preserflo Microshunt (PSM) is a safe and effective glaucoma microfiltering implant that significantly reduces the intraocular pressure (IOP), either alone or in combination with phacoemulsification, during the first year after surgery. PURPOSE: The purpose of this study was to assess the safety and efficacy of the PSM for the treatment of open angle glaucoma with 0.2 mg/mL mitomycin C, either alone or in combination with cataract surgery. METHODS: A retrospective, open-label study of 64 eyes with primary open angle glaucoma that underwent PSM implantation and were followed up for at least 9 months. Success was defined as IOP 6-17 mm Hg and a reduction of at least 20%, complete without hypotensive medication, and qualified with medication. Safety was assessed by the incidence of adverse events. Secondary endpoints included mean hypotensive medications, visual acuity, and incidence of needling and surgical revision. RESULTS: A total of 51 eyes underwent PSM alone and 13 underwent PSM+phacoemulsification. In the overall population of the study, the mean IOP was significantly reduced from 22.03±0.7 mm Hg at baseline to 12.7±0.4 mm Hg at the final visit, P <0.0001 (mean follow-up: 11±1.4 mo). The IOP was significantly reduced in both groups ( P <0.0001). Ocular hypotensive medication was reduced significantly from 2.7±0.7 to 0.2±0.5 ( P <0.0001). No significant differences were found in IOP-lowering medication between groups (PSM alone, 0.2±0.08; PSM+phacoemulsification, 0.1±0.1; P =0.2). At the final visit, 70.3% were considered as complete success and 12.5% as qualified success. The most common adverse event was clinical hypotony (7.8%) followed by hyphema (4.7%), and anterior chamber reformation (1.6%). Overall, 1.6% required needling and 15.6% surgical revision to restore the flow. CONCLUSION: Glaucoma surgery with the PSM and mitomycin C was efficacious and safe in the short term, either alone or in combination with cataract surgery, and may be considered a surgical option for lowering IOP in primary open angle glaucoma.