A comparison of mesopic visual acuity and objective visual quality following cataract surgery with hydrophobic acrylic intraocular lenses.

PURPOSE: To evaluate mesopic visual acuity and visual quality as measured by objective scatter index (OSI) in pseudophakic eyes with long-term follow-up after implantation of hydrophobic acrylic lenses made from two different lens materials. SETTING: This study was carried out in a private clinic. DESIGN: This study was an observational cohort study. METHODS: This pilot study included 181 eyes of 136 patients who had undergone cataract surgery with implantation of monofocal hydrophobic acrylic intraocular lenses (IOLs), either Alcon AcrySof (82 eyes) or Abbott Medical Optics' Tecnis (99 eyes). The monocular corrected distance visual acuity (CDVA) of the subjects was recorded under mesopic room illumination and OSI was measured by an optical quality analysis system using double-pass wavefront method. RESULTS: Mean follow-up duration was 60.07±18.82 months. Eyes implanted with Tecnis IOLs had statistically significantly better mesopic CDVA (0.08±0.08) compared to those implanted with AcrySof IOLs (0.11±0.07) (P=0.020). Mesopic CDVA of 20/25 or better was found in 79.8% of eyes in the Tecnis group compared to 62.2% of eyes in AcrySof group. Similarly, OSI was also found to be statistically significantly better for Tecnis IOLs compared to AcrySof IOL group (mean OSI, Tecnis: 1.65±0.92, AcrySof: 2.01±1.36; P=0.033). When glaucomatous eyes were excluded, OSI was still significantly better (P=0.028) in the Tecnis IOL group. CONCLUSION: The eyes implanted with Tecnis IOLs showed better long-term optical performance in terms of both OSI and mesopic visual acuity in comparison to those with AcrySof IOLs.

A review of preoperative manoeuvres for prophylaxis of endophthalmitis in intraocular surgery: topical application of antibiotics, disinfectants, or both?

PURPOSE OF REVIEW: Postoperative endophthalmitis is an ophthalmic surgeon's most feared complication, as it portends a high probability of visual loss. The purpose of this article is to review the literature on the subject of preoperative measures used for prevention of postoperative endophthalmitis and to determine the effectiveness of these measures. RECENT FINDINGS: The present reviewed literature regarding topical prophylaxis of endophthalmitis in cataract surgery. SUMMARY: There is strong evidence for the use of povidone-iodine preoperatively for prophylaxis of postoperative endophthalmitis in ocular surgery; the evidence for topical antibiotics is not as compelling.

Decreased visual acuity resulting from glistening and sub-surface nano-glistening formation in intraocular lenses: A retrospective analysis of 5 cases.

BACKGROUND: To report on five patients with decreased visual acuity due to glistening and severe sub-surface nano-glistening (SSNG) formation within their intraocular lenses (IOLs). DESIGN: Case reports and analysis of extracted IOLs. PARTICIPANTS AND SAMPLES: We report improved visual acuity when IOLs with severe glistening and SSNG were exchanged for clear IOLs in five patients. METHODS: Case reports. MAIN OUTCOME MEASURES: The main outcome measure was visual acuity. The secondary outcome measure was light transmission. Explanted IOLs were subjected to investigation. Pre- and postoperative slit lamp images of the anterior eye and microscopic images of the extracted IOLs were taken and compared. Light transmission of the IOL was measured using a double beam type spectrophotometer. An integrated value of the percentage light transmittance in the visible light spectrum was calculated. RESULTS: We report on five patients whose visual acuity improved when IOLs were exchanged because of severe glistening and SSNG. All of the affected IOLs were MA60BM (Alcon, Forth Wroth Texas, USA) and the original implantation had occurred over a range of 6-15 years prior to the IOL exchange. Light transmission was decreased in all affected lenses compared to a similar control IOL. CONCLUSIONS: Although only a few reports of cases in which glistening and SSNG have progressed to the level of decreased visual function have been published, the likelihood is that this phenomena will increase as the severity and incidence of these inclusions have been shown to increase with time. Appropriate evaluations of visual function in such patients are needed and consideration should be given to IOL exchange in symptomatic patients.

A pilot study to determine if intraocular lens choice at the time of cataract surgery has an impact on patient-reported driving habits.

PURPOSE: To determine if intraocular lens (IOL) choice at the time of cataract surgery affects driving habits. MATERIALS AND METHODS: Pseudophakes who were 28-35 months postbilateral cataract surgery with one of two contemporary one-piece hydrophobic acrylic IOLs (SN60WF or ZCB00) were asked to complete the Driving Habits Questionnaire, a validated instrument for determining self-reported driving status, frequency, and difficulty. To determine if there were any differences in driving habits between the two groups, t-tests and χ (2) tests were used. RESULTS: Of 90 respondents, 72 (40 SN60WF and 32 ZCB00) were still active drivers. The SN60WF-implanted subjects were less likely to drive at the same speed or faster than the general flow of traffic, less likely to rate their quality of driving as average/above average, less likely to have traveled beyond their immediate neighborhood, less likely to drive at night, more likely to have moderate-to-severe difficulty driving at night, and more likely to have self-reported road traffic accidents. The differences did not reach statistical significance. CONCLUSION: Changes in patients' driving habits 2-3 years after cataract surgery may be associated with the type of IOL implanted. A larger study, powered to demonstrate statistical significance, is needed to verify the trends identified in this pilot study and discover possible contributing factors.

Impact of intraocular lens material and design on light scatter: In vitro study.

PURPOSE: To determine the typical in vitro straylight levels for intraocular lenses (IOLs) of different materials and designs. SETTING: Abbott Medical Optics, Inc., Groningen, the Netherlands. DESIGN: Experimental study. METHODS: Two optical bench setups were used to determine baseline straylight levels of IOLs placed in a saline-filled cuvette: one for forward scatter positions between 0.6 and 3.0 degrees and one for positions up to 22.0 degrees. Line-spread functions were measured using the small-angle setup, and scattered light intensity was measured using the wide-angle setup. From these measurements, the angular dependent straylight parameter was calculated. Ten IOLs of different materials (hydrophobic and hydrophilic) and designs (monofocal or diffractive multifocal and spheric or aspheric) were studied, and their measured straylight levels were compared with the levels in a 20-year-old and a 70-year-old healthy noncataractous human crystalline lens. RESULTS: Irrespective of the material or design, monofocal IOLs had straylight levels below or close to those of a 20-year-old human crystalline lens. Diffractive multifocal IOLs had straylight levels higher than those of monofocal IOLs but less than those of a 70-year-old human crystalline lens. With increasing angle, hydrophobic IOLs showed a gradual decrease in straylight level. After an initial decrease, hydrophilic IOLs showed an increase in straylight level for larger angles. CONCLUSIONS: The baseline straylight levels of IOLs were design and material dependent (hydrophobic < hydrophilic; monofocal < diffractive multifocal). Most monofocal IOLs had straylight levels below the levels in a 20-year-old human crystalline lens.

Microincisions in cataract surgery.

UNLABELLED: Improvements in phacoemulsification technology and instrumentation and intraocular lens materials and design have enabled cataract surgery to be performed through incisions smaller than 2.0 mm in external width. This evolution has occurred over time, with new challenges arising at each step of the decrease in incision size. This article reviews the current trend of using increasingly smaller incisions to perform phacoemulsification. Specifically, each facet of phacoemulsification is briefly reviewed from a historical context and then evaluated predominantly from a current perspective to better understand the development of the microincision in cataract surgery. The goal is to help the operating surgeon recognize the potential benefits as well as the potential weaknesses of the smaller incision. FINANCIAL DISCLOSURES: Proprietary or commercial disclosures are listed after the references.

Modification of externalized haptic support of glued intraocular lens technique.

The original technique for scleral fixation of an intraocular lens using fibrin glue requires an assistant to grasp and hold an externalized haptic with forceps. We present a modification of the technique in which the externalized haptic is maintained by a silicone "tire" without the aid of an assistant.

Comparison of visual results with accommodating intraocular lenses versus mini-monovision with a monofocal intraocular lens.

PURPOSE: To compare near vision and quality of vision after controlling for pseudoaccommodation in patients with single-optic accommodating intraocular lenses (IOLs) or monofocal IOLs targeted for mini-monovision. SETTING: Clinical practice. DESIGN: Prospective randomized controlled clinical trial. METHODS: Patients were randomized to bilateral implantation of the Crystalens HD silicone accommodating IOL, the Tetraflex acrylic accommodating IOL, or the Tecnis 1-piece monofocal (nonaccommodating) control IOL. The target refraction for the control group was mini-monovision (-0.25 diopter [D] and -0.75 D). In the accommodating IOL groups, manufacturer recommendations were followed; that is, a target refraction of mini-monovision (-0.25 D and -0.75 D) in the acrylic accommodating group and +0.25 D in the silicone accommodating group. Pupil size and anterior corneal spherical aberration were measured preoperatively. Main outcome measures were binocular target refraction corrected near vision and contrast sensitivity 3 months postoperatively. RESULTS: There were no statistically significant differences between the 3 groups in age, photopic or mesopic pupil size, anterior corneal spherical aberration, corneal astigmatism, or the power of the IOLs implanted. Binocular distance visual acuity at 4 m was 20/20(-) in all groups, intermediate vision was approximately 20/25, and near vision was 20/40 to 20/50. There were no statistically significant differences between the 3 groups in visual acuity or contrast sensitivity. CONCLUSION: Single-optic accommodating IOLs did not offer a significant advantage in near visual acuity over mini-monovision with a monofocal (nonaccommodating) IOL.