Vector Analysis, Rotational Stability, and Visual Outcome After Implantation of a New Aspheric Toric IOL.

PURPOSE: To evaluate vector analysis, rotational stability, and refractive and visual outcome of a new toric intraocular lens (IOL) for correction of preexisting corneal astigmatism during routine cataract surgery. METHODS: In this prospective, interventional case series, 30 toric, aspheric Bi-Flex T toric IOLs (Medicontur Medical Engineering Ltd., Inc., Zsámbék, Hungary) were implanted in 20 consecutive patients with topographic corneal astigmatism between 1.50 and 4.00 diopters (D) and evaluated within the first year after implantation. Appropriate IOL-toric alignment was facilitated by combined imaging/eye tracking technology. Postoperative evaluation included refraction and uncorrected and corrected distance visual acuities (UDVA, CDVA). For each visit, photodocumentation in retroillumination was performed to evaluate toric alignment and potential toric IOL rotation. Vector analysis of refractive astigmatism was performed using the Alpins method. RESULTS: At 12 months postoperatively, a reduction of the refractive astigmatism from 1.93±0.90 D (range: 0.50 to 4.00 D) to 0.28±0.61 D (range: 0.00 to 1.50 D) could be found, with patients achieving a mean UDVA of 0.06±0.16 logMAR (range: -0.18 to 0.40 logMAR; Snellen 20/20). Intraoperative to 12-month postoperative comparison of IOL axis alignment showed low levels of rotation (0.2°±2.41°; range: +4° to -5°). Vector analysis showed target induced astigmatism of 0.60 D @180°, surgically induced astigmatism of 0.80 D @177°, correction index of 1.02±0.25, and a difference vector of 0.30 D @82°. CONCLUSIONS: Implantation of the new Bi-Flex T IOL was a safe, stable, and effective method to correct preexisting regular corneal astigmatism during cataract surgery.

Prospective Randomized Intraindividual Comparison of Posterior Capsule Opacification After Implantation of an IOL With and Without Heparin Surface Modification.

PURPOSE: To compare posterior capsule opacification (PCO) of a hydrophobic acrylic heparin surface modified intraocular lens (HSM-IOL) and an uncoated IOL (UC-IOL) 1 year after implantation. METHODS: One hundred two eyes of 51 patients underwent routine phacoemulsification with randomized implantation of a HSM-IOL in one eye (the HSM-IOL group) and a UC-IOL in the fellow eye (the UC-IOL group). Morphologic PCO evaluation was performed comparing digital photographs in retroillumination using the Evaluation of Posterior Capsule Opacification (EPCO) system, grading the density of the opacification from 0 to 4 (0 = none, 1 = minimal, 2 = mild, 3 = moderate, and 4 = severe). Distance visual acuities, subjective manifest refraction, pupil size, straylight measurements, flare in the anterior chamber using a laser flare meter, and contrast sensitivity were also evaluated. RESULTS: The mean total EPCO score was slightly higher in the HSM-IOL group (0.50 ± 0.45) compared to the UC-IOL group (0.45 ± 0.46), but did not reach statistical significance. No statistically significant differences were found in the other main outcome parameters (straylight measurement, distance visual acuities, flare in the anterior chamber, and mesopic and photopic contrast sensitivity) when comparing both IOLs. CONCLUSION: Although the HSM-IOL showed decreased flare 1 day postoperatively, no statistically significant differences regarding PCO were found 1 year postoperatively.

Central and peripheral corneal iron deposits after implantation of a small-aperture corneal inlay for correction of presbyopia.

PURPOSE: To describe central and peripheral corneal iron deposition after implantation of the AcuFocus corneal inlay (ACI 7000, AcuFocus Inc) for the surgical correction of presbyopia. METHODS: Patients who underwent inlay implantation between September 2006 and May 2007 and displaying corneal iron deposits were enrolled in the study. RESULTS: Eighteen (56%) eyes of 32 patients developed corneal iron deposition within 36 months after corneal inlay implantation. One (5.5%) eye had a central spot-like iron deposition only, 10 (55.5%) eyes had formation of deposits in a half-moon shape in the inferior cornea parallel to the outer margin of the inlay or a complete circular ring formation, and 7 (39%) eyes demonstrated deposits in both areas. The median interval between implantation and diagnosis of corneal iron deposition was 18 ± 9 months. CONCLUSIONS: Corneal iron deposition can develop in different shapes after implantation of the small-aperture ACI 7000. Alterations in tear film thickness, its composition, and corneal epithelial basal cell storage, resulting from changes in corneal topography, may be contributing factors for these specific iron depositions.

Device for improving quantification of reading acuity and reading speed.

PURPOSE: To present a new device, the Salzburg Reading Desk (SRD), for the standardized testing of reading acuity and reading speed at a subjectively convenient reading distance (best distance). METHODS: First, in a systematic experimental setup, testing for validity and reliability was performed at 450 simulated reading distances (90 different test situations, each repeated 5 times) between 16 and 70 cm. The distance read-outs by the SRD software were correlated to the distances measured with a meter ruler. Second, reading distance and reading speed of 27 naturally emmetropic and presbyopic patients were evaluated using the log-scaled Radner Reading Charts implemented in the SRD. RESULTS: In the experimental setup, an overall mean difference of the SRD distance read-out-compared to a standard distance measurement with a meter ruler-of 0.08±0.13 cm was observed. In the presbyopic patients, overall mean reading distance was 49.74±4.43 cm. Patients were able to read with their own subjectively convenient reading distance. A constant mean reading speed of sentences with bigger typeface (between 152.4±22.6 words/minute [wpm] and 157.3±15.8 wpm) was found, but reading speed gradually diminished over time when reading sentences with smaller typeface. CONCLUSIONS: The SRD seems to be a valid and reliable device for testing reading acuity at the best reading distance in an experimental setup as well as in clinical use in presbyopic patients. The SRD may be used whenever a detailed comparison of different methods for correcting presbyopia is required.

Refractive surgical correction of presbyopia with the AcuFocus small aperture corneal inlay: two-year follow-up.

PURPOSE: To evaluate the safety and efficacy of the AcuFocus Corneal Inlay 7000 (ACI 7000) implanted in emmetropic presbyopic patients for the improvement of near and intermediate vision over 2-year follow-up. METHODS: This prospective, non-randomized, non-comparative study included 32 naturally emmetropic presbyopic patients. The intracorneal inlay was implanted in the non-dominant eye over the pupil by creating a superior-hinged flap with the IntraLase 60-kHz femtosecond laser (Abbott Medical Optics). Inlay centration was over the line of sight. Minimum postoperative follow-up was 24 months. RESULTS: After mean follow-up of 24.2±0.8 months (range: 24 to 26 months), 96.9% of patients read J3 or better in the implanted eye. Mean binocular uncorrected near visual acuity improved from J6 preoperatively to J1 after 24 months. Mean binocular uncorrected intermediate visual acuity (UIVA) was 20/20 at 1 month and remained 20/20 throughout 24-month follow-up, with 71.9% of eyes reaching UIVA of 20/20 or better. At 24 months, mean uncorrected distance visual acuity was 20/20 in the implanted eye and 20/16 binocularly. No inlay was explanted during the study. Two decentered inlays were recentered after 6 months because of in-sufficient increase in near and intermediate visual acuity. Both patients' near and intermediate visual acuity improved significantly after recentration. CONCLUSIONS: The ACI 7000 seems to provide a safe and effective treatment for presbyopia over follow-up of 2 years.

Comparison of short-term refractive surgery outcomes after wavefront-guided versus non-wavefront-guided LASIK.

PURPOSE: To evaluate and compare visual and refractive outcomes after laser-assisted in situ keratomileusis (LASIK) surgery for the correction of myopia or myopic astigmatism using 3 different treatment protocols. METHODS: We included 736 eyes of 369 patients (age 18-62 years) divided into 3 groups: 235 eyes of 118 patients (MEL80 group) undergoing LASIK using optimized aspheric ablation profiles (MEL80 excimer laser; Carl Zeiss Meditec), 248 eyes of 124 patients (Wavescan group) undergoing wavefront-guided (WFG) LASIK (STAR S4IR excimer laser + Wavescan aberrometer; Abbott Medical Optics), and 253 eyes of 127 patients (iDesign group) undergoing WFG LASIK (STAR S4IR excimer laser + iDesign system; Abbott Medical Optics). Visual and refractive outcomes were evaluated 2 months after surgery. RESULTS: A total of 91% (215/235), 95% (237/248), and 99% (251/253) of eyes achieved a postoperative uncorrected distance visual acuity of 0.0 logMAR (≈20/20) in the MEL80, Wavescan, and iDesign groups, respectively. Postoperative spherical equivalent (SE) was within ±0.5 D in 95% (223/235), 98% (242/248), and 100% (253/253) of eyes in these same 3 groups, respectively. Likewise, manifest cylinder was below 0.50 D in 95% (223/235), 97% (241/248), and 100% (253/253) of eyes. Significant differences in postoperative SE and cylinder were found between the MEL80 and iDesign groups (p<0.05). CONCLUSIONS: All evaluated LASIK treatment protocols are predictable and effective for the correction of myopia. The treatment planned with a high resolution aberrometer obtained the best postoperative refractive outcomes.

Visual, aberrometric, photic phenomena, and patient satisfaction after myopic wavefront-guided LASIK using a high-resolution aberrometer.

PURPOSE: The purpose of this study was to evaluate the visual, refractive, and aberrometric outcomes as well as the level of patient satisfaction and photic phenomena after myopic laser in situ keratomileusis (LASIK) surgery using wavefront-guided (WFG) ablations based on measurements obtained with a high-resolution aberrometer. PATIENTS AND METHODS: This study was a prospective analysis including 253 eyes of 127 patients (aged between 19 years and 54 years) undergoing WFG LASIK using the STAR S4 IR Excimer Laser System combined with the iDesign System and iFS Femtosecond Laser. Visual, refractive, and aberrometric outcomes during a 2-month follow-up as well as patient satisfaction and photic phenomena were evaluated by means of a questionnaire. RESULTS: A total of 85% (215/253) and 99% (251/253) of eyes achieved a postoperative (Postop) uncorrected distance visual acuity of 20/16 and 20/20, respectively, and all eyes achieved an uncorrected distance visual acuity of 20/25. Postop spherical equivalent values were within ±0.25 D and ±0.50 D in 97% and 100% of eyes, respectively. Likewise, manifest cylinder was <0.25 D in 97% (245/253) of eyes. A statistically significant reduction was found in the total root mean square (P<0.001) and in the level of primary spherical aberration (P=0.001). Postop difficulties related to vision were graded as minimal, with low levels of photic phenomena and high levels of patient satisfaction. The level of difficulty to perform daily activities and the level of glare perceived by patients while driving car were significantly decreased (P<0.001). CONCLUSION: WFG LASIK surgery using the technology evaluated is predictable and effective for the correction of myopia and leads to high levels of patient satisfaction.

Reliability and reproducibility of the German version of the European Society of Cataract and Refractive Surgeons reading charts.

PURPOSE: To create a validated, standardized, logarithmic European Society of Cataract and Refractive Surgeons (ESCRS) reading chart in German and to use this reading chart as a template for comparable reading charts in other languages. SETTING: Hanusch Hospital, Vienna, and Department of Ophthalmology, Paracelsus Medical University, Salzburg, Austria. DESIGN: Prospective multicenter validation study. METHODS: Thirty-nine short standardized German sentences were developed and tested on healthy volunteers and pseudophakic patients. On the first visit, corrected distance visual acuity was assessed in each eye using autorefraction (KR8000) and subjective refraction using Early Treatment Diabetic Retinopathy Study charts at 4 m. Reading speed, when reading the new ESCRS reading charts, was tested under photopic conditions (85 to 100 candelas/m(2)) and high contrast (≥95% Michelson contrast). RESULTS: The study assessed 120 subjects. Sixty subjects were young healthy volunteers and 60 were pseudophakic patients. Reliability of the sentences was tested using Cronbach's α and was found to be high (α = 0.994). Furthermore, reproducibility was high in most cases and the absolute mean difference between the first measurement and second measurement for all sentences was 0.56 seconds ± 0.07 (SD) (range 0.43 to 0.72 seconds). CONCLUSION: The German version of the ESCRS reading charts, a standardized logarithmic and validated reading test, was reliable in healthy volunteers as well as in pseudophakic patients. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Randomized controlled clinical trial to evaluate different intraocular lenses for the surgical compensation of low to moderate-to-high regular corneal astigmatism during cataract surgery.

PURPOSE: To evaluate vector analysis, rotational stability, and visual outcomes after implantation of toric IOLs with low (<2.25 diopter [D]) toric values (Acrysof IQ SN6AT3 or SN6AT4) and moderate-to-high toric (3.00 D to 6.00 D) values (Acrysof IQ SN6AT5, SN6AT6, SN6AT7, SN6AT8, or SN6AT9) versus after implantation of a nontoric IOL (Acrysof SN60WF) in eyes with regular topographic corneal astigmatism. SETTING: Department of Ophthalmology, Paracelsus Medical University Salzburg, Salzburg, Austria. DESIGN: Randomized controlled clinical trial. METHODS: The study included eyes of patients undergoing phacoemulsification and IOL implantation. Patients were randomized into 3 groups to bilaterally receive the nontoric IOL, the low toric IOL, or the moderate-to-high toric IOL. Over a 6-week follow-up period, rotational stability and astigmatic changes were evaluated in the 2 toric IOL groups using the Alpins vector method. RESULTS: The study included 78 eyes of 39 patients. Postoperatively mean refractive astigmatism decreased significantly from 1.45 D ± 1.18 (SD) to 0.36 ± 0.44 D in the low toric group and from 1.92 ± 1.09 D to 0.31 ± 0.46 D in the moderate-to-high toric group. There was no significant difference between mean difference vectors in the low toric IOL group and the moderate-to-high toric IOL group. A significant difference in the correction index was detected, revealing overcorrection with low toric IOLs (1.03 ± 0.12 D) and undercorrection with moderate-to-high toric IOLs (0.95 ± 0.12 D). CONCLUSIONS: Implantation of low toric IOLs and medium-to-high toric IOLs in patients with low to moderate-to-high corneal astigmatism was shown to be effective in correcting regular corneal astigmatism. Undercorrection in the moderate-to-high group could be related to misalignment. FINANCIAL DISCLOSURE: This research project was financially supported by the Fuchs Foundation for the Promotion of Research in Ophthalmology, Salzburg, Austria. Alcon Inc. financially supports the Fuchs-Foundation as the clinical research center of the Department of Ophthalmology of the Paracelsus Medical University Salzburg, Salzburg, Austria (Grant Number 2010-37). No author has a financial or proprietary interest in any material or method mentioned.

Long-term outcomes after monocular corneal inlay implantation for the surgical compensation of presbyopia.

PURPOSE: To evaluate long-term outcomes of small-aperture corneal inlay implantation for the surgical compensation of presbyopia. SETTING: Paracelsus Medical University, Salzburg, Austria. DESIGN: Prospective interventional cohort study. METHODS: Monocular implantation of a Kamra small-aperture inlay (model ACI7000) (1.6 mm central aperture) was performed in emmetropic presbyopic eyes. The preoperative and postoperative parameters included monocular and binocular uncorrected (UDVA) and corrected (CDVA) distance visual acuities, uncorrected intermediate visual acuity (UIVA), and uncorrected (UNVA) and corrected (CNVA) near visual acuities; refraction; patient satisfaction; and complications. RESULTS: From September 4, 2006, to May 21, 2007, a small-aperture inlay (1.6 mm central aperture) was implanted in 32 emmetropic presbyopic eyes. The mean binocular uncorrected visual acuities improved as follows: UNVA from Jaeger (J) 6 ± 1.2 lines (∼20/50) to J2 ± 1.8 lines (∼20/25) (P < .001) and UIVA from 0.2 logMAR ± 1.3 lines (∼20/32) to 0.1 logMAR ± 1.3 lines (∼20/25) (P = .04). The UDVA decreased from -0.2 logMAR ± 0.2 lines (∼20/12.5) to -0.1 logMAR ± 0.6 lines (∼20/16) (P < .001). At 60 months, 74.2% of patients had a UNVA of J3 (∼20/32) or better, 87.1% had a UIVA of 0.2 logMAR (∼20/32) or better, and 93.5% had a UDVA of 0.0 logMAR (∼20/20) or better. One inlay was removed after 36 months because of patient dissatisfaction with vision after a hyperopic shift in the surgical eye, with no loss of CDVA or CNVA 2 years after removal. CONCLUSION: Long-term results of monocular corneal inlay implantation indicate increased UNVA and UIVA and slightly compromised UDVA in emmetropic presbyopic eyes. FINANCIAL DISCLOSURE: Dr. Grabner was reimbursed for travel expenses from Acufocus. Dr. Riha is a consultant to Acufocus. No other author has a financial or proprietary interest in any material or method mentioned.

Vector analysis of astigmatism correction after toric intraocular lens implantation.

PURPOSE: To determine astigmatic changes by vector analysis and postoperative refractive and visual outcomes after implantation of the monofocal aspheric bitoric AT Torbi 709M toric intraocular lens (IOL). SETTING: Three centers in Salzburg, Austria, and Alicante and San Sebastián, Spain. DESIGN: Prospective interventional case series. METHODS: Preoperative and postoperative visual acuity, subjective and objective refractions, and corneal radii using a topographer were examined in all patients. All patients had postoperative examinations within the first week and at 6 to 12 weeks. Astigmatic changes were evaluated using the Alpins vector method based on 3 fundamental vectors as follows: target induced astigmatism (TIA), surgically induced astigmatism (SIA), and difference vector. The various relationships between these 3 vectors were calculated, providing an extensive description of the astigmatic correction achieved. RESULTS: Eighty-eight eyes (71 patients) were included. Postoperatively, refractive cylinder was reduced significantly (P < .001), concurrent with visual improvement. The mean magnitude of the SIA vector (2.54 diopters [D] ± 1.21 [SD]) was slightly higher than the mean magnitude of the TIA vector (2.37 ± 1.15 D) at the last follow-up. The mean difference vector was 0.46 ± 0.46 D, the mean magnitude of error was 0.16 ± 0.46 D, and the mean correction index was 1.09 ± 0.21, all indicating minimal overcorrection at 3 months that remained stable during the follow-up. CONCLUSION: Implantation of the toric IOL was safe and effective for the treatment of eyes with cataract in combination with preexisting regular corneal astigmatism over a short-term follow-up. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Visual performance after bilateral implantation of a new diffractive aspheric multifocal intraocular lens with a 3.5 D addition.

PURPOSE: To evaluate visual performance after implantation of a new diffractive aspheric multifocal intraocular lens (MIOL) with a +3.50 D addition power. METHODS: A total of 24 cataract patients were bilaterally implanted with the Diffractiva-aA MIOL in 2 ophthalmologic centers and followed for 6 months. Postoperative evaluations included visual acuities (VA) at various distances, defocus testing, contrast sensitivity (CS) measurements, and patient satisfaction questionnaire. RESULTS: Six months postoperatively, binocular uncorrected VA (mean ± SD; logMAR) was 0.00 ± 0.05 (≈ 20/20) for distance, 0.06 ± 0.13 (≈ 20/23) for intermediate (1 m), and 0.00 ± 0.05 (≈ 20/20) for near (40 cm). All patients achieved uncorrected VA of 20/25 or better for distance and near, and 20/40 or better at 1 m. Monocular and binocular defocus curves showed 2 peaks of maximum VA at the distance focus (0.0 D) and the near focus (-2.5 D) and a good range of intermediate vision with the lowest mean acuity being at -1.5 D defocus. Photopic and mesopic CS were within the standard normal range. The majority of patients (n = 22; 91.7%) were spectacle independent; 8.3% (n = 2) reported wearing glasses occasionally for very small print (1 patient) or for watching television (1 patient). Overall, all patients were "very satisfied" (n = 22; 91.7%) or "satisfied" (n = 2; 8.3%) with the procedure. CONCLUSIONS: The new Diffractiva-aA MIOL provided a full range of vision from near to far generating highly satisfied, spectacle independent patients with only minimal visual disturbances at night.

Evaluation of an electronic reading desk to measure reading acuity in pseudophakic patients.

PURPOSE: To compare a new electronic reading desk (Salzburg-Advanced) with conventional measurements of reading acuity. SETTING: Vienna Institute for Research in Ocular Surgery, Hanusch Hospital, Vienna, Austria. DESIGN: Evaluation of diagnostic test. METHODS: In study 1, the electronic reading desk was compared with the same version of a printed reading chart. All patients were measured twice with autorefraction (Topcon KR8800) and subjective refraction. In study 2, patients were measured once. In addition, electronic reading desk measurements were obtained under different contrast and luminance levels. RESULTS: Study 1 evaluated 100 eyes of 50 pseudophakic patients. Differences between the electronic reading desk and the printed version were small and not significant for reading speed (131.1 words per minute [wpm]±28.7 [SD] versus 134.9±20.7 wpm), reading distance (44.7±14.4 cm versus 39.6±7.6 cm), and smallest possible read print size (1.95±0.58 mm versus 2.02±0.70 mm), respectively. Study 2 evaluated 40 eyes of 20 pseudophakic patients. Reading acuity and the smallest possible read print size decreased with lower contrast and reduced luminance, whereas reading distance and reading speed did not change significantly. CONCLUSIONS: Measurements performed with the electronic reading desk can be used interchangeably with those performed using a printed chart. The opportunity to preset standardized luminance and contrast settings could be useful for measurements in clinical trials. FINANCIAL DISCLOSURES: Drs. Dexl and Grabner have a proprietary interest in the Salzburg Reading Desk technology as patent assignees. No other author has a financial or proprietary interest in any material or method mentioned.

Reliability of automatic biometric iris recognition after phacoemulsification or drug-induced pupil dilation.

PURPOSE: To investigate the reliability of a biometric iris recognition system for personal authentication after cataract surgery or iatrogenic pupil dilation. METHODS: This was a prospective, nonrandomized, single-center, cohort study for evaluating the performance of an iris recognition system 2-24 hours after phacoemulsification and intraocular lens implantation (group 1) and before and after iatrogenic pupil dilation (group 2). RESULTS: Of the 173 eyes that could be enrolled before cataract surgery, 164 (94.8%) were easily recognized postoperatively, whereas in 9 (5.2%) this was not possible. However, these 9 eyes could be reenrolled and afterwards recognized successfully. In group 2, of a total of 184 eyes that were enrolled in miosis, a total of 22 (11.9%) could not be recognized in mydriasis and therefore needed reenrollment. No single case of false-positive acceptance occurred in either group. CONCLUSIONS: The results of this trial indicate that standard cataract surgery seems not to be a limiting factor for iris recognition in the large majority of cases. Some patients (5.2% in this study) might need "reenrollment" after cataract surgery. Iris recognition was primarily successful in eyes with medically dilated pupils in nearly 9 out of 10 eyes. No single case of false-positive acceptance occurred in either group in this trial. It seems therefore that iris recognition is a valid biometric method in the majority of cases after cataract surgery or after pupil dilation.

Intraindividual aqueous flare comparison after implantation of hydrophobic intraocular lenses with or without a heparin-coated surface.

PURPOSE: To assess the efficacy of a heparin-surface-modified (HSM) hydrophobic acrylic intraocular lens (IOL) (EC-1YH PAL) and the same IOL without heparin coating (EC-1Y-PAL) by the flare and cell intensity in the anterior chamber after uneventful cataract surgery. SETTING: Department of Ophthalmology, Paracelsus Medical University Salzburg, Austria. DESIGN: Comparative case series. METHODS: Routine phacoemulsification with randomized implantation of an HSM IOL in 1 eye (HSM IOL group) and an uncoated IOL (uncoated IOL group) in the fellow eye was performed. Postoperative inflammation was assessed objectively using a laser flare-cell meter (FM-600) preoperatively as well as 1 day and 1 and 3 months postoperatively. Aqueous cells in the anterior chamber, distance visual acuities, and subjective manifest refraction were also evaluated at each visit. RESULTS: One hundred eyes (50 patients) were enrolled. In both groups, the mean flare values increased significantly from preoperatively to 1 day postoperatively (P<.001) and nearly reached preoperative values by 3 months postoperatively. One day postoperatively, the mean flare value was statistically significantly lower in the HSM IOL group (14.92 photons per millisecond [ph/ms] ± 7.47 [SD]) than in the uncoated IOL group (mean 16.73 ± 7.81 ph/ms) (P=.04); there was no statistically significant difference between groups 1 and 3 months postoperatively (both P>.58). The HSM IOL group had a greater and quicker decrease in aqueous cells, reaching statistical significance 1 month postoperatively (P=.01). CONCLUSION: The HSM IOL showed a significant lower inflammatory reaction in the early postoperative stage with a faster disappearance of inflammatory signs. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Femtosecond laser-assisted small-aperture corneal inlay implantation for corneal compensation of presbyopia: two-year follow-up.

PURPOSE: To report the 2-year postoperative safety and efficacy outcomes after monocular Kamra corneal inlay (ACI7000PDT) implantation in femtosecond laser-created corneal pockets of emmetropic presbyopic patients to improve near and intermediate vision. SETTING: University Eye Clinic, Paracelsus Medical University, Salzburg, Austria. DESIGN: Prospective interventional case series. METHODS: Patients had corneal inlay implantation in the nondominant eye. Emmetropic presbyopic patients between 45 and 60 years old with an uncorrected distance visual acuity (UDVA) of 20/20 or better in both eyes and without additional ocular pathology were eligible. Contrast sensitivity, visual field examinations, endothelial cell count (ECC), and central corneal thickness (CCT) measurements were assessed preoperatively and 12 and 24 months postoperatively. The UDVA, uncorrected intermediate visual acuity (UIVA), and near visual acuity (UNVA) were assessed preoperatively and 1 day, 1 week, and 1, 3, 6, 9, 12, 18, and 24 months postoperatively. The minimum postoperative follow-up was 24 months. RESULTS: After 24 months, the mean binocular UNVA improved from 20/50 to 20/25; 20 patients (83%) had a UNVA of 20/25 or better. The mean binocular UIVA was 20/20. The mean UDVA was 20/20 in the surgical eye and 20/16 binocularly after 24 months. Contrast sensitivity under photopic and mesopic conditions remained in the range of the normal population. No patient had detectable central visual field defect. No inlay was explanted. No inflammatory reactions were observed. The ECC and CCT remained stable. CONCLUSION: The corneal inlay implanted in femtosecond laser-created pockets was effective and safe for the corneal compensation of presbyopia in emmetropic patients after 24 months. FINANCIAL DISCLOSURE: Acufocus Inc., Irvine, California, USA, financially supports the Research Foundation for Promoting Ophthalmology, Salzburg, Austria, as the clinical research center of the University Eye Clinic (Paracelsus Medical University). Dr. Grabner received travel expenses from Acufocus, Inc. Dr. Riha currently also works as a clinical application specialist for Acufocus, Inc. No other author has a financial or proprietary interest in any material or method mentioned.

Advances in lens implant technology.

Cataract surgery is one of the oldest and the most frequent outpatient clinic operations in medicine performed worldwide. The clouded human crystalline lens is replaced by an artificial intraocular lens implanted into the capsular bag. During the last six decades, cataract surgery has undergone rapid development from a traumatic, manual surgical procedure with implantation of a simple lens to a minimally invasive intervention increasingly assisted by high technology and a broad variety of implants customized for each patient's individual requirements. This review discusses the major advances in this field and focuses on the main challenge remaining - the treatment of presbyopia. The demand for correction of presbyopia is increasing, reflecting the global growth of the ageing population. Pearls and pitfalls of currently applied methods to correct presbyopia and different approaches under investigation, both in lens implant technology and in surgical technology, are discussed.

Rotational stability and visual outcome after implantation of a new toric intraocular lens for the correction of corneal astigmatism during cataract surgery.

PURPOSE: To evaluate rotational stability and the refractive and visual outcomes of a new aspheric toric intraocular lens (IOL) for correction of preexisting corneal astigmatism during routine cataract surgery. SETTING: Department of Ophthalmology, Paracelsus Medical University Salzburg, Salzburg, Austria. DESIGN: Case series. METHODS: Aspheric Bi-Flex T toric IOLs were monolaterally or bilaterally implanted after phacoemulsification in patients with topographic corneal astigmatism between 1.5 diopters (D) and 4.0 D. Preoperative IOL calculations were performed by laser interference biometry (Haigis formula). Appropriate IOL-torus alignment was facilitated by combined imaging and eye-tracking technology. Refraction and uncorrected distance (UDVA) and corrected distance visual acuities were measured 1 day, 1 week, and 1 and 3 months postoperatively. At each visit, photodocumentation in retroillumination was performed to evaluate torus position and potential toric IOL rotation. RESULTS: The mean refractive astigmatism decreased from 1.93 D ± 0.90 (SD) (range 0.5 to 4.0 D) to 0.30 ± 0.54 D (range 0.0 to 1.5 D) at 3 months. Patients achieved a mean UDVA of 0.05 ± 0.12 logMAR (range -0.18 to 0.30 logMAR [∼20/20]). Intraoperative to 3-month postoperative comparison of IOL axis alignment showed low levels of rotation (mean 2.12 ± 3.45 degrees; range -2 to +5 degrees). CONCLUSIONS: Implantation of the new aspheric toric IOL was effective, safe, and stable in correcting preexisting regular corneal astigmatism during cataract surgery. Combined imaging and eye tracking seems to be a promising technology to evaluate the correct axis for IOL torus alignment.

Profiles of intraocular pressure in human donor eyes during femtosecond laser procedures--a comparative study.

PURPOSE: To compare four different femtosecond laser devices (IntraLase FS, Zeiss VisuMAX, and Ziemer Femto LDV, and a prototype Schwind SmartTech Nanolaser) in human donor eyes with regard to their effects on IOP during femtosecond laser flap cutting. In order to get cuts parallel to the corneal surface, the cornea has to be forced into a defined shape and current femtosecond laser devices either use a flat or a curved patient interface design to achieve applanation. METHODS: IOP was measured in enucleated eyeballs (n = 46) not suitable for keratoplasty by direct cannulation of the vitreous body. A second cannula was inserted to adjust IOP to a baseline pressure of 20 mm Hg. The eyeballs were lifted by custom made supporting stands to achieve an appropriate height and put under the femto-LASIK devices. RESULTS: The flat patient interfaces gave rise to higher IOPs (IOP max = 328.3 ± 29.8, 228.8 ± 28.4, and 201.09 ± 21.4 mm Hg), whereas the curved patient interface caused lower IOPs in response to attachment and suction (IOP max = 104.9 ± 13.4 mm Hg). CONCLUSIONS: Based on previous findings of visual field defects after LASIK, and as a consequence of the present study, it seems feasible to design patient interfaces in a more physiologic manner to prevent high IOPs during refractive procedures.