Evaluation of visual outcomes and patient satisfaction after implantation of a diffractive trifocal intraocular lens.

PURPOSE: To evaluate clinical outcomes after the implantation of a diffractive trifocal intraocular lens (IOL). SETTING: Nine European ophthalmology centers. DESIGN: Prospective noncomparative interventional multicenter study. METHODS: The trifocal diffractive AT LISA tri 839MP IOL was implanted in eyes with bilateral cataract. Monocular and binocular visual performance was assessed as was the level of perceived photic phenomena, patient satisfaction, and spectacle dependence 1 month and 3 months postoperatively. RESULTS: The IOL was implanted in 208 eyes of 104 patients. The mean binocular uncorrected distance visual acuity improved from 0.44 logMAR ± 0.30 (SD) to 0.02 ± 0.10 logMAR and 0.03 ± 0.09 logMAR at 1 month and 3 months, respectively (P < .01). The mean binocular uncorrected intermediate visual acuity (80 cm) improved from 0.51 ± 0.30 logMAR to 0.09 ± 0.13 logMAR and 0.10 ± 0.15 logMAR at 1 month and 3 months, respectively (P < .01). The mean binocular uncorrected near visual acuity improved from 0.67 ± 0.31 logMAR to 0.16 ± 0.14 logMAR and 0.15 ± 0.14 logMAR, respectively (P < .01). Among the more frequently perceived photic phenomena were halos; however, approximately 75% of patients were not bothered by them. More than 90% of patients were satisfied with the outcome. Spectacle independence at all distances was higher than 90%. CONCLUSION: This IOL provided excellent visual outcomes and high refractive predictability at all distances, including intermediate, leading to high levels of patient satisfaction and spectacle independence. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Intrastromal femtosecond laser presbyopia correction: 1-year results of a multicenter study.

PURPOSE: To investigate functional outcomes of the INTRACOR femtosecond laser-based intrastromal procedure to treat presbyopia. METHODS: Sixty-three eyes from 63 presbyopic patients (median age: 54 years) with mild hyperopia were enrolled in this prospective, ethics committee-approved, multi-center, nonrandomized clinical trial. The INTRACOR procedure was performed using the Technolas femtosecond laser (Technolas Perfect Vision GmbH) in the nondominant eye. Postoperatively, follow-up was performed at 1 day, 1 week, and 1, 3, 6, and 12 months and included near and distance visual acuity tests, slit-lamp examinations, and corneal topography. RESULTS: All 63 surgeries were uneventful. Twelve months postoperatively, outcomes of 58 (92.1%) eyes were available for evaluation. Median uncorrected distance visual acuity (0.1 logMAR [range: 0.5 to 0.0 preoperatively and 0.5 to -0.1 postoperatively]) and corrected distance visual acuity (CDVA) (0.0 logMAR [range: 0.2 to -0.2 preoperatively and 0.3 to -0.1 postoperatively]) remained stable. Median spherical equivalent changed from +0.63 diopters (D) preoperatively to 0.00 D postoperatively. Median uncorrected near visual acuity increased significantly from 0.7 logMAR (range: 1.0 to 0.2) preoperatively to 0.2 logMAR (range: 0.8 to -0.1) postoperatively and eyes gained a median of 4 lines (range: 1 to 9 lines). Losses of 2 lines of CDVA were noted in 7.1% of eyes. Ring cuts were faintly visible at 12 months. CONCLUSIONS: The INTRACOR presbyopia procedure showed good and stable visual acuity outcomes over 12-month follow-up but loss of CDVA occurred in 7% of eyes. Overall patient satisfaction with the procedure was approximately 80%. Short treatment time and maintained corneal surface integrity are advantages of this procedure.

Pilot study of a new posterior chamber phakic intraocular lens (epi.lens) for high myopia.

PURPOSE: To report the first safety and efficacy results of a new posterior chamber phakic intraocular lens (PIOL) (Epi.Lens, Acri.Tec/Carl Zeiss Meditec) implanted in the ciliary sulcus to correct high myopia. METHODS: The Epi.Lens was implanted for the first time in 48 consecutive eyes of 25 patients in an ongoing two-center clinical study. Pre- and postoperative manifest refraction, uncorrected (UDVA) and corrected distance visual acuity (CDVA), intraocular pressure, slit-lamp and funduscopic examination, and ultrasound biomicroscopy were evaluated. Follow-up examinations were performed at 1, 3, 6, 12, and 24 months postoperatively. For each patient, the latest follow-up data were considered. RESULTS: The study cohort consisted of highly myopic patients with mean preoperative manifest refraction spherical equivalent of -9.90 ± 2.53 D, which was reduced to -0.26 ± 0.84 D postoperatively. Two (4.2%) eyes lost one line of CDVA postoperatively, whereas 19 (40%) met and 27 (56%) eyes exceeded preoperative CDVA values, thus improving mean CDVA from 0.83 ± 0.30 to 1.03 ± 0.26. Mean postoperative UDVA (0.85 ± 0.37) was similar to preoperative CDVA (0.83 ± 0.30). When considering all eyes with good visual potential (preoperative CDVA ≥ 1.00 [20/20] [n=25]), 20 (80%) achieved postoperative UDVA ≥ 1.00 (20/20), and 24 (96%) achieved UDVA ≥ 0.80 (20/25). One lens with a small diameter showed contact of the Epi.Lens and crystalline lens with subsequent slight anterior subcapsular cataract; however, CDVA was 1.00 (20/20) at last follow-up 2 years postoperatively. CONCLUSIONS: The results of this Epi.Lens pilot study demonstrate good safety and efficacy. The preliminary data are encouraging, and longer follow-up results are anticipated.

Modern treatment options for the therapy of keratoconus.

The following case report describes the implantation of intrastromal corneal ring segments (ICRS) and the postoperative contact lens treatment in a 42-year-old patient with bilateral advanced keratoconus. The patient had a preoperative contact lens intolerance. After femtosecond laser assisted surgery and the implantation of ICRS new custom mini-scleral contact lenses were fitted. The postoperative subjective and objective contact lens tolerance was excellent.