Comparing visual acuity, range of vision and spectacle independence in the extended range of vision and monofocal intraocular lens.

IMPORTANCE: This study is the first to compare the extended range of vision (ERV) intraocular lens (IOL) targeted at micro-monovision to a monofocal targeted at binocular emmetropia. BACKGROUND: Compares visual acuity, range of vision and spectacle independence in monofocal and ERV IOLs. DESIGN: Assessor-blinded retrospective cohort study. PARTICIPANTS: Eighty-eight participants (176 eyes) with bilateral IOL implants at 5+ month postoperative review. METHODS: Regression analyses (general estimating equations and multiple linear regression) tested associations between IOL type (ZA9002 Tecnis 3-piece or Tecnis ZCT monofocal; and Tecnis Symfony ERV IOL) and visual acuity, adjusting for key confounders including residual astigmatism. MAIN OUTCOME MEASURES: Monocular and binocular visual acuity measured with and without distance refractive correction at distance (3.00 m), intermediate (1.00 and 0.63 m) and near (0.40 m) (logMAR units); near vision reading test used British 'N' notation; self-reported spectacle independence. RESULTS: There was no significant difference between ERV and monofocal groups in uncorrected binocular visual acuity at distance (P = 0.595). Binocular uncorrected visual acuity at intermediate (0.63 m: monofocal 0.24, ERV 0.09, P < 0.001) and near (0.40 m: monofocal 0.42, ERV 0.18, P < 0.001) were significantly better in the ERV group. Binocular uncorrected near vision: all the ERV group read N8 or better, compared to 36% in the monofocal group (P < 0.001); 93% of the ERV group reported spectacle independence at near compared to 33% in the monofocal group (P < 0.001). CONCLUSIONS AND RELEVANCE: The ERV IOL, targeted to achieve micro-monovision, demonstrated superior range of visual acuity and spectacle independence compared to the monofocal targeted to achieve emmetropia.

Effects of Contact Lens Wear on Biometry Measurements for Intraocular Lens Calculations.

OBJECTIVES: To determine the effects of contact lens (CL) wear on biometry measurements for cataract surgery and whether a CL hiatus can reduce the prediction error of intraocular lens (IOL) calculations. METHODS: Retrospective, interventional case series of eyes that received repeat biometry measurements for IOL calculations after discontinuing hard or soft CLs for at least 14 days. PRIMARY OUTCOME MEASURES: intersession change in axial length, average keratometry, astigmatism, and axis. SECONDARY OUTCOME MEASURES: change in recommended IOL power and toricity, postoperative refraction prediction error. RESULTS: Thirty-two eyes of 16 patients had a mean duration of CL wear (12 hard and 20 soft) of 39.5 years (range, 29-55 years) and mean CL hiatus duration of 25 days (range, 14-56 days). Mean absolute intersession change in axial length was 0.016 mm (range, 0-0.05 mm), average keratometry 0.31 D (range, 0.02-1.01 D), astigmatism 0.41 D (range, 0.01-1.10 D), and axis 6.3° (range, 0-28°). The IOL power predicting the lowest postoperative spherical equivalent changed for 17 of 32 eyes (by 0.5 D for 12 eyes and 1.0 D for five eyes). Recommended IOL toricity changed for nine of 14 eyes (by 0.75 D for six eyes and 1.50 D for three eyes). The median absolute prediction error of IOL calculations was 0.69 D (range, 0.19-2.93 D) before and 0.57 D (range, 0.01-2.82 D) after the CL hiatus (P=0.16). CONCLUSIONS: Contact lens wear may affect biometry measurements and subsequent IOL power and toricity selection. For some eyes, repeating biometry measurements after a CL hiatus may improve the accuracy of IOL calculations.

Short term visual outcomes of a new trifocal intraocular lens.

BACKGROUND: Today, patients often expect to achieve spectacle independance after cataract surgery. New trifocal intraocular lenses have been developed to try and fullfill this demand. The purpose of this study is to report the short-term visual outcomes of a new trifocal intraocular lens (AcrySof PanOptix™). METHODS: Consecutive adult patients undergoing cataract surgery with bilateral implantation of the study intraocular lens in a private practice clinic were considered for inclusion. Exclusion criteria were the presence of other ocular pathologies or preoperative astigmatism >1.5 diopters (D). Patients with intraoperative complications were excluded from analysis. One month after surgery patients underwent: monocular defocus curve; monocular and binocular uncorrected visual acuity in photopic and mesopic conditions, for far (4 m), intermediate (60 cm) and near (33 cm) distances and binocular contrast sensitivity. Patients completed a visual satisfaction questionnaire between 9 and 12 months after surgery. RESULTS: One hundred and sixteen eyes of fifty-eight patients receiving bilateral implantation of the study intraocular lens were analysed. Mean binocular uncorrected visual acuity in photopic conditions was 0.03 LogMAR for far, 0.12 for intermediate and 0.02 for near distances. All patients achieved a binocular uncorrected visual acuity better than 0.3 LogMAR (20/40 Snellen equivalent) for distance and near vision and 94.8% of patients for intermediate vision. Mesopic binocular uncorrected visual acuity values were similar to photopic values. The monocular defocus curves showed that the best visual acuity was reached at a vergence of 0.00D. Visual acuity dropped slightly at -1.00D and peaked again at -2.00D. Visual acuities better than 0.2 LogMAR were maintained between -2.50D and +0.50D. Contrast sensitivity was high and similar in photopic and mesopic conditions. As regards patient-evaluated outcomes, only 2 patients (3.4%) were fairly dissatisfied with their sight after surgery. Three patients (5.1%) reported the need for spectacle correction for certain activities. All other patients (94.8%) reported never using spectacle correction. CONCLUSIONS: The PanOptix trifocal IOL provides good short-term visual outcomes, with good intermediate performance and excellent patient-reported satisfaction. The similar values achieved in mesopic and photopic conditions in binocular uncorrected visual acuity and contrast sensitivity suggest low pupillary dependence for light distribution. TRIAL REGISTRATION NUMBER: ISRCTN60143265 , retrospectively registered on the 24th of April 2017.

Chromatic aberration and spectral dependency of extended-range-of-vision intraocular lens technology.

This study compared the optical quality and chromatic performance of refractive-diffractive intraocular lenses (IOLs) that are designed to extend the range of vision of pseudophakic patients and alter chromatic aberration. Five IOLs were evaluated, Tecnis Synergy and Triumf POD L GF, both intended to compensate for eye's chromatism, as well as Acriva Trinova Pro C-a lens that increases chromatic aberration, and AT Lisa Tri and AcrySof IQ PanOptix. An optical setup composed of a corneal model inducing monochromatic and chromatic aberrations and incorporating various spectral conditions was employed. The two chromatic-aberration correcting IOLs demonstrated the lowest far-focus dispersion, but it was negative only, with the Synergy indicating its ability to reduce eye's chromatic aberration. Although the Trinova increased far-point chromatism, it was close to the level of the PanOptix, but higher than that of the AT Lisa. All the studied models demonstrated varying optical quality in response to light color. Still, the strongest spectral dependency was associated with achromatizing technology. Therefore, chromatic aberration and wavelength dependency should be considered in IOL optimization and predicting visual function, particularly in non-white spectral conditions.

Pseudophakic cystoid macular edema.

PURPOSE OF REVIEW: Pseudophakic cystoid macular edema (PCME) is a common cause of visual impairment after cataract surgery. This article systematically reviews and discusses the epidemiology, risk factors, diagnosis, and treatment of PCME, with a focus on advances in the past 1-2 years. RECENT FINDINGS: The incidence of PCME has declined with the advent of modern surgical techniques. Optical coherence tomography (OCT) has become an important adjunct to biomicroscopy and fluorescein angiography. PCME prophylaxis with topical nonsteroidal anti-inflammatory drugs remains unproven because long-term visual outcomes and comparative effectiveness studies are lacking. Chronic, refractory CME remains a therapeutic challenge, but investigational therapies with potential include corticosteroid intravitreal injections and implants, and intravitreal anti-vascular endothelial growth factor treatments. Few studies have assessed surgical options. SUMMARY: There is currently a lack of well designed randomized clinical trials to guide the treatment of PCME.

Pseudophakic cystoid macular edema.

Cataract surgery is an efficient procedure, and is generally associated with good visual results. Nevertheless, cystoid macular edema (CME) may develop, and this can result in suboptimal postoperative vision. Many factors are considered to contribute to its development, and although the treatment options depend upon the underlying cause of CME, the usual therapeutic approach for prophylaxis and treatment of CME is directed towards blocking the inflammatory mediators. This article provides a review of possible risk factors, pathogeneses, incidence rates, and methods of diagnosis, as well as the current guidelines for managing CME.

[Pseudophakic cystoid macular oedema]. / Das pseudophakiebedingte zystoide Makulaödem.

Pseudophakic cystoid macular oedema is still a relevant clinical disease entity although major progress in modern cataract surgery has been made within the last decades. The relevance is attributed to the large number of cases that are performed each year. Even after uneventful surgery, a pseudophakic cystoid macular oedema can develop and may lead to severe and lasting visual impairments. In respect to the pathophysiology, four consecutive steps have to be considered: (i) surgical procedure-related induction and release of various inflammation mediators into the anterior chamber; (ii) removal of the physiological lens barrier between the anterior and posterior segments of the eye, leading consecutively to an increase in diffusion rate in either direction; (iii) local action of the inflammation mediators towards the macular area; and (iv) increased vitreoretinal traction due to the anteriorly oriented drive of the vitreous. To prevent the development of a pseudophakic cystoid macular oedema, systemic and ocular pathologies should be treated consequently prior to surgery. Furthermore, an individual risk profile of each patient needs to be evaluated to define the best pre- and postsurgical medical treatment. A less traumatic surgical approach can help to prevent macular oedema development additionally. The diagnosis is made by performing biomicroscopy, fluorescence angiography and optical coherence tomography as well as by evaluating the patients' major complaints. Standard operation procedures or recommended guidelines by the specialised eye associations to prevent and treat pseudophakic cystoid macular oedema are not available up to date. A synopsis of recommendations in the literature suggests a step-wise treatment regimen, including topical medical treatment on the one hand and a surgical approach on the other hand as well as a combination of both, if needed. Topical medical treatment options include the use of non-steroidal, corticosteroid and/or carbonic anhydrase inhibitor eye drops. Surgical interventions include pars plana vitrectomy.

Twenty-three-gauge pars plana vitrectomy, Densiron-68, and 360° endolaser versus combined 20-gauge pars plana vitrectomy, scleral buckle, and SF6 for pseudophakic retinal detachment with inferior retinal breaks.

PURPOSE: To compare the anatomical and functional outcomes of 23-gauge pars plana vitrectomy (PPV) with Densiron-68 tamponade and 360° endolaser versus 20-gauge PPV with encircling scleral buckling (ESB) and an SF6 gas tamponade for the repair of primary pseudophakic retinal detachment with inferior retinal breaks. METHODS: Prospective, randomized, comparative, interventional study. Eighty-two eyes of 82 consecutive patients were randomly assigned to 1 of the 2 treatment groups: 23-gauge PPV/Densiron-68 (44 eyes, 54%) or 20-gauge PPV/ESB/SF6 (20%) (38 eyes, 46%). The inclusion criterion was the presence of primary pseudophakic retinal detachment with at least 1 retinal break between the 4- and 8-o'clock positions. The study protocol involved a minimum of 7 visits: baseline, day of surgery, 1 week, and 1, 3, 6, and 9 months postoperation. Densiron-68 removal was performed within 12 weeks of the initial surgery. Two surgical procedures were required in the Densiron group to remove the oil. RESULTS: After the primary procedure, the retina was reattached in 90% (40 of 44) of cases in the 23-gauge PPV/Densiron group and in 92% (35 of 38) of cases in the 20-gauge PPV/ESB/SF6 group (P = 0.2, Fisher's exact test). After resolution of redetachments, final anatomical success rate rose to 97% (43 of 44) in the 23-gauge PPV/Densiron group and 94% (36 of 38) in the 20-gauge PPV/SB/SF6 group (P = 0.32, Fisher's exact test). Mean final best-corrected visual acuity (logarithm of the minimum angle of resolution) was 0.40 in the 23-gauge PPV/Densiron group and 0.48 in the 20-gauge PPV/ESB/SF6 group (P = 0.31, t-test). Operative time was significantly less in the 23-gauge PPV/Densiron group (P = 0.002, t-test). No statistically significant difference in the complication rate between the two groups was recorded. CONCLUSION: Twenty-three-gauge PPV combined with Densiron-68 and 360° endolaser and 20-gauge PPV combined with ESB/SF6 seemed to have similar efficacy in the repair of primary pseudophakic retinal detachment. Supplementary scleral buckling can be avoided using a Densiron-68 tamponade for retinal detachment with inferior retinal breaks.

Update on pediatric cataract surgery and intraocular lens implantation.

PURPOSE OF REVIEW: Cataract surgery is the most commonly performed intraocular surgery in the pediatric population worldwide. Although the basic surgical techniques have not significantly changed over the last several years, there are many related issues under continual debate and research. These include use of local perioperative anesthesia, capsular management, type and power of intraocular lenses (IOLs), sutured IOLs, and risk of subsequent glaucoma. This review will primarily focus on postsurgical outcomes and IOL-related controversies. RECENT FINDINGS: The just completed Infant Aphakia Treatment Study aims to answer questions regarding visual outcomes with primary IOL implantation versus contact lens use in children less than 7 months old with a unilateral congenital cataract. But correct IOL selection is controversial as recent studies highlight difficulties with biometry measurement and IOL calculations in the entire pediatric population. We also discuss the risk of late suture breakage and dislocation with sutured IOLs and the risks of aphakic glaucoma. SUMMARY: Worldwide experiences with pediatric cataract surgery and IOL implantation are constantly evolving. Expectations of good outcomes by the patients, families, and surgeons are also increasing therefore continued efforts to improve techniques and formulas specific to the pediatric population are critical.

One-year clinical evaluation of rotationally asymmetric multifocal intraocular lens with +1.5 diopters near addition.

We conducted a one-year prospective, multicenter study to assess clinical outcomes after implantation of segmented, rotationally asymmetric multifocal intraocular lenses (IOLs) with +1.5 diopters (D) near addition. In this phase III clinical trial, 120 eyes of 65 patients undergoing phacoemulsification and implantation of Lentis Comfort LS-313 MF15 (Oculentis GmbH) were included. The ophthalmological examinations were performed before and 1 day, 1 week, 1, 3, 6, 9, and 12 months after surgery. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuity at 70 cm, and uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity at 30 cm were measured. A defocus curve was obtained and patients were asked about the severity of photic phenomena. Postoperative distance and intermediate visual acuity was excellent, with UDVA, CDVA, UIVA, and DCIVA of approximately 20/20, 20/16, 20/25, 20/25 were attained, respectively. The level of near visual acuity was lower; UNVA and DCNVA remained at around 20/60 and 20/70, respectively. The defocus curve indicated that postoperative uncorrected visual acuity of 20/25 and 20/40 was obtained at as close as 67 cm and 50 cm, respectively. Contrast sensitivity was within the normal range, with a minimal level of subjective symptoms and high patient satisfaction. The rotationally asymmetric multifocal IOLs with +1.5 D near addition provided excellent distance and intermediate vision, but near vision was not enough for reading small prints. Contrast sensitivity was high, with very low incidences of photic phenomena and a high level of patient satisfaction.

Patient outcomes following implantation with a trifocal toric IOL: twelve-month prospective multicentre study.

PURPOSE: To evaluate clinical outcomes with a premium diffractive-refractive trifocal toric intraocular lens (IOL) over a 12-month period. METHODS: Multicentre prospective clinical trial including 227 eyes of 114 patients undergoing cataract surgery with bilateral implantation of the AT LISA tri toric 939MP IOL (Carl Zeiss Meditec, Jena, Germany). One patient was implanted unilaterally. Outcome measures were: visual acuity, manifest refraction, reading performance, contrast sensitivity, defocus curve, patient satisfaction and subjective quality of vision. Alpins vector analysis was used to evaluate astigmatic changes. RESULTS: 12-month follow up results of binocular uncorrected distance, intermediate and near visual acuity were ≤0.3 logMAR in 99.0%, 98.10% and 91.40% of eyes, respectively. 79.7% of eyes had a cylinder value of ±0.50 D at 12 months post-surgery. Contrast sensitivity was in the normal range at 6 months post-surgery. The defocus curve exhibited a smooth transition between far and near foci. Vector analysis showed a mean magnitude of error of -0.16 ± 0.48 D. Mean binocular distance-corrected reading visual acuity was 0.15 ± 0.13 logRAD at 6 months postoperatively. 93.3%, 89.4% and 84.6% of patients expressed satisfaction (good or very good) with distance, intermediate and near vision, respectively, 12 months after surgery. Most (≥95%) patients felt that visual disturbances, including halos, glare, focusing difficulties and depth perception, caused little or no disturbance. CONCLUSIONS: The diffractive-refractive trifocal toric IOL, AT LISA tri toric 939MP, provides effective distance, intermediate and near visual acuity in eyes with corneal astigmatism. Patient satisfaction was high and 98.1% of patients expressed satisfaction with the IOL implanted.

Implantable Collamer Lens® for Management of Pseudophakic Ametropia in Eyes With a Spectrum of Previous Corneal Surgery.

PURPOSE: To assess the visual outcomes, predictability, and safety of the Implantable Collamer Lens (ICL) (STAAR Surgical, Inc., Monrovia, CA) for the management of residual pseudophakic refractive error. METHODS: Forty-nine pseudophakic eyes of 40 patients in which myopic, hyperopic, or toric ICLs were implanted were retrospectively analyzed. Twenty-nine eyes had been implanted with a monofocal intraocular lens (IOL) and 20 eyes had a multifocal IOL. All IOLs were implanted in the capsular bag. Of the 49 eyes included, 6 had residual refractive error after phacoemulsification without corneal pathology or surgical alteration (virgin cornea group), 12 had LASIK or photorefractive keratectomy (PRK) (excimer laser group), 8 had radial keratotomy, 5 had intrastromal corneal ring segments (ICRS) implantation, 11 had penetrating keratoplasty, and 7 had deep anterior lamellar keratoplasty (DALK). Uncorrected and corrected (CDVA) distance visual acuity and manifest refraction were evaluated. RESULTS: The efficacy/safety indices were 0.92/1.10, 0.98/1.13, 1.04/1.11, 0.90/1.13, 0.79/1.17, and 0.71/1.23 for the virgin cornea, excimer laser, radial keratotomy, ICRS, penetrating keratoplasty, and DALK groups, respectively. No eye lost one or more lines of CDVA. The virgin cornea, excimer laser, and radial keratotomy groups showed better predictability and accuracy, with 96.2% spherical equivalent within ±1.00 diopters (D). The ICRS, penetrating keratoplasty, and DALK groups demonstrated approximately 50% spherical equivalent within ±1.00 D. There were no intraoperative or postoperative complications. CONCLUSIONS: Good refractive outcomes and a strong safety record support the use of the ICL for the correction of residual refractive error in pseudophakic eyes with previous corneal surgery. [J Refract Surg. 2018;34(10):654-663.].

[Posterior capsule opacification in pseudophakic eyes--etiopathogenesis, clinical picture, possibilities of prevention and therapy]. / Zmetnienie torebki tylnej soczewki w oczach pseudofakijnych--etiopatogeneza, obraz kliniczny, profilaktyka i leczenie.

Posterior capsule opacification (PCO) is a late complication after the cataract surgery, currently occurring most often. The epithelial cells which migrate to the surface of the posterior capsule participate in the mechanism of PCO formation. Clinical opacification of the posterior capsule appears as the foggy form, creasing, pearl mass and fibrosis. PCO can be cured by laser or surgical capsulotomy. The factors influencing a size and intensity of PCO are as follows: age of patient, other diseases, method of surgery and type of the implanted artificial intraocular lens. Prevention against PCO during surgery should include accurate hydrodissection, removing of cortical mass, polishing of the capsule and intracapsular fixation of the lens. It is necessary to carry out further studies on possibilities of PCO prevention.

Multifocal intraocular lenses: An overview.

Multifocal intraocular lenses are increasingly used in the management of pseudophakic presbyopia. After multifocal intraocular lens implantation, most patients do not need spectacles or contact lenses and are pleased with the result. Complications, however, may affect the patient's quality of life and level of satisfaction. Common problems with multifocal lenses are blurred vision and photic phenomena associated with residual ametropia, posterior capsule opacification, large pupil size, wavefront anomalies, dry eye, and lens decentration. The main reasons for these are failure to neuroadapt, lens dislocation, residual refractive error, and lens opacification. To avoid patient dissatisfaction after multifocal intraocular lens implantation, it is important to consider preoperatively the patient's lifestyle; perform an exhaustive examination including biometry, topography, and pupil reactivity; and explain the visual expectations and possible postoperative complications.

Management of subluxated capsular bag-fixated intraocular lenses using a capsular anchor.

UNLABELLED: We describe the use of the capsular anchor (AssiAnchor) to manage a subluxated intraocular lens (IOL) in the capsular bag. The anchor comprises 2 prongs that hold the anterior lens capsule and a central rod that is sutured to the scleral wall, enabling centration of the IOL-capsular bag complex. Six pseudophakic patients presenting with subluxated posterior chamber IOLs in the capsular bag were operated on using the device. The anchor was used successfully in all cases, although in 2 cases only 1 prong was placed under the capsulorhexis edge. In 1 eye, 2 anchors were used 1 month apart following repeated traumatic zonular injury. The capsular bag holding the IOL remained centered and stable throughout the follow-up period. The anchoring device, which was originally designed to preserve the lens capsule and stabilize subluxated crystalline lenses, can also be used to treat subluxation of a capsular bag-fixated IOL. FINANCIAL DISCLOSURE: Dr. Assia is the inventor of the AssiAnchor, has a licensed patent of the anchor, and is consultant to Hanita Lenses. Dr. Lapid-Gortzak is a consultant to and speaker for Alcon Surgical, Inc., Hanita Lenses, Orca Surgical, and Sanoculis Ltd.; a speaker for Santen; and a consultant to Icon. Drs. Ton and Naftali have no financial or proprietary interest in any material or method mentioned.

Positional accommodative intraocular lens power error induced by the estimation of the corneal power and the effective lens position.

PURPOSE: To evaluate the predictability of the refractive correction achieved with a positional accommodating intraocular lenses (IOL) and to develop a potential optimization of it by minimizing the error associated with the keratometric estimation of the corneal power and by developing a predictive formula for the effective lens position (ELP). MATERIALS AND METHODS: Clinical data from 25 eyes of 14 patients (age range, 52-77 years) and undergoing cataract surgery with implantation of the accommodating IOL Crystalens HD (Bausch and Lomb) were retrospectively reviewed. In all cases, the calculation of an adjusted IOL power (P(IOLadj)) based on Gaussian optics considering the residual refractive error was done using a variable keratometric index value (n(kadj)) for corneal power estimation with and without using an estimation algorithm for ELP obtained by multiple regression analysis (ELP(adj)). P(IOLadj) was compared to the real IOL power implanted (P(IOLReal), calculated with the SRK-T formula) and also to the values estimated by the Haigis, HofferQ, and Holladay I formulas. RESULTS: No statistically significant differences were found between P(IOLReal) and P(IOLadj) when ELP(adj) was used (P = 0.10), with a range of agreement between calculations of 1.23 D. In contrast, P(IOLReal) was significantly higher when compared to P(IOLadj) without using ELP(adj) and also compared to the values estimated by the other formulas. CONCLUSIONS: Predictable refractive outcomes can be obtained with the accommodating IOL Crystalens HD using a variable keratometric index for corneal power estimation and by estimating ELP with an algorithm dependent on anatomical factors and age.

Comparison of conventional versus crossed monovision in pseudophakia.

AIMS: To compare the visual performances and patient satisfactions of conventional monovision, which corrects the dominant eye for distance vision, and crossed monovision, which corrects the non-dominant eye for distance vision in patients with pseudophakia. METHODS: This prospective randomised study was conducted in 59 patients who underwent implantation of different targets of monofocal intraocular lens for each eye at Konkuk University Medical Center between November 2009 and August 2012. The following were examined before bilateral cataract surgery and 2 months after the surgery: refractive error, binocular uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), best corrected visual acuity (BCVA) and stereopsis. Questionnaires to evaluate postoperative spectacle dependence and patient satisfaction were completed by all patients. RESULTS: The conventional monovision group and the crossed monovision group were composed of 28 and 31 patients, respectively. There were no significant differences in postoperative UCDVA, UCNVA, BCVA and stereopsis between the two groups. In addition, patient satisfaction with near and distant vision and spectacle dependence were not significantly different in the two groups. CONCLUSIONS: The clinical results of the crossed monovision were not significantly different from the results of conventional monovision. Therefore, crossed monovision can also be a valuable option for correcting postoperative presbyopia in patients considering bilateral cataract surgery. TRIAL REGISTRATION NUMBER: KCT0001065.

Intraocular lenses in children: changes in axial length, corneal curvature, and refraction.

AIM: To assess changes in axial length, corneal curvature, and refraction in paediatric pseudophakia. METHODS: 35 eyes of 24 patients with congenital or developmental lens opacities underwent extracapsular cataract extraction and posterior chamber intraocular lens implantation. Serial measurements were made of axial length, corneal curvature, objective refraction, and visual acuity. RESULTS: For patients with congenital cataracts (onset < 1 year age) the mean age at surgery was 24 weeks. Over the mean follow up period of 2.7 years, the mean increase in axial length of 3.41 mm was not significantly different from the value of an expected mean growth of 3.44 mm (paired t test, p = 0.97) after correction for gestational age. In the developmental cataract group (onset > 1 year of age) the mean age at surgery was 6.4 years with a mean follow up of 2.86 years. This group showed a mean growth in axial length of 0.36 mm that was not significantly different from an expected value of 0.47 mm (paired t test, p = 0.63). The mean preoperative keratometry was 47.78 D in the congenital group and 44.35 D in the developmental group. At final follow up the mean keratometry in the congenital group was 46.15 D and in the developmental group it was 43.63 D. In eyes followed for at least 2 years, there was an observed myopic shift by 24 months postoperatively of 3.26 D in the congenital cases (n = 10) and 0.96 D in the developmental cases (n = 18). CONCLUSION: The pattern of axial elongation and corneal flattening was similar in the congenital and developmental groups to that observed in normal eyes. No significant retardation or acceleration of axial growth was found in the eyes implanted with IOLs compared with normal eyes. A myopic shift was seen particularly in eyes operated on at 4-8 weeks of age and it is recommended that these eyes are made 6 D hypermetropic initially with the residual refractive error being corrected with spectacles.