Spherical aberration and contrast sensitivity in eyes implanted with aspheric and spherical intraocular lenses: a comparative study.

PURPOSE: To determine whether implantation of an intraocular lens (IOL) with a modified anterior aspheric surface results in reduced spherical aberration and improved contrast sensitivity after cataract surgery. DESIGN: Prospective, comparative, interventional case series. METHODS: In an intraindividual randomized prospective study of 25 patients with bilateral cataract, an IOL with a modified anterior surface (Tecnis Z9001; Advanced Medical Optics, Santa Ana, California, USA; group 1) was compared with biconvex lens with spherical surfaces (ClariFlex; Advanced Medical Optics; group 2). Ocular aberrations for a 5.0-mm pupil and 6.0-mm pupil were measured with Hartmann-Shack aberrometer. Quality of vision was measured by visual acuity and contrast sensitivity under mesopic and photopic conditions. All patients were followed up for three months. RESULTS: No statistically significant difference in postoperative uncorrected and best-corrected distance vision acuity after a follow-up of three months existed between the groups. Postoperative contrast sensitivity testing revealed significant differences between the groups under photopic and mesopic conditions. These differences reached statistical significance under photopic conditions at three spatial frequencies and under mesopic conditions at all spatial frequencies. When analyzing higher-order aberrations, the difference between the groups was statistically significant at the 5.00-mm and 6.00-mm pupil diameters, with the group 1 inducing less higher-order aberration and also less spherical aberration compared with group 2. CONCLUSIONS: Results show the Tecnis Z9001 IOL with a modified anterior aspheric surface induced significantly less higher-order aberration and spherical aberration compared with the ClariFlex IOL. Contrast sensitivity revealed better values under photopic and mesopic conditions with the Tecnis Z9001 IOL.

Primary piggyback implantation using the ReSTOR intraocular lens: case series.

PURPOSE: To assess the postoperative outcomes of piggyback implantation using the AcrySof ReSTOR intraocular lens (IOL) (model SA60D3, Alcon Surgical Laboratories). SETTING: Hospital Oftalmológico de Brasília, Brasília, Brazil. METHODS: Thirteen eyes of 7 patients who had phacoemulsification with piggyback IOL implantation were analyzed prospectively. In all cases, a ReSTOR IOL was implanted in the capsular bag and a second silicone IOL was implanted in the ciliary sulcus. Information collected included uncorrected visual acuity (UCVA) at near and distance, best corrected visual acuity (BCVA), and spherical equivalent (SE) before and after surgery. RESULTS: The patients were followed for 12 months. The mean distance UCVA was 0.25 (20/80) preoperatively and 0.88 (20/23) at the last follow-up (1 year), which was significantly better than before surgery (P<.05). The mean SE was +4.25 diopters (D) +/- 1.5 (SD) preoperatively and +0.15 +/- 0.44 D (range -0.50 to +0.75 D) at 1 year, which was significantly better than preoperatively (P<.05). No patient lost lines of BCVA after surgery. At the last follow-up, all eyes had a near UCVA of J1 and none required spectacles for near or distance vision. CONCLUSION: Piggyback implantation using the ReSTOR IOL appeared to be a safe and efficient procedure providing high-quality visual acuity for near and distance vision in selected patients.

Primary piggyback implantation using the Tecnis ZM900 multifocal intraocular lens: case series.

PURPOSE: To assess the postoperative outcomes of primary piggyback implantation using the Tecnis ZM900 multifocal intraocular lens (IOL) (Advanced Medical Optics). SETTING: Hospital Oftalmológico de Brasília, Brasília, Brazil. METHODS: Patients who had phacoemulsification with primary piggyback IOL implantation were analyzed prospectively. In all cases, a Tecnis ZM900 multifocal IOL was implanted in the capsular bag and a second silicone IOL was implanted in the ciliary sulcus. Information collected included near and distance uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and the spherical equivalent (SE) before and after the surgery. RESULTS: Twenty eyes of 12 patients were included in the study. They were followed for 6 months. The mean preoperative distance UCVA was 20/400. At the last follow-up (6 months), the mean distance UCVA was 20/29, significantly better than before referral (P<.001). The mean preoperative SE was +6.35 diopters (D) +/- 2.25 (SD). Six months after surgery, the mean SE was -0.25 +/- 0.40 D (range -1.00 to +0.50 D), significantly better than before referral (P<.001). No patient lost lines of BCVA after surgery. At the last follow-up, 90% of the eyes achieved a near UCVA of J1 and 83.3% of patients were spectacle independent for near and distance vision. A second refractive procedure was performed in 2 eyes. CONCLUSIONS: Primary piggyback implantation using the Tecnis ZM900 multifocal IOL was a simple, safe, and accurate option for patients with high hyperopia who wanted to reduce their dependency on spectacles.

Ocular aberrations and contrast sensitivity after cataract surgery with AcrySof IQ intraocular lens implantation Clinical comparative study.

PURPOSE: To determine whether implantation of an intraocular lens (IOL) with a modified posterior aspherical surface (AcrySof IQ, Alcon Surgical Laboratories) results in reduced ocular aberrations (spherical aberration) and improved contrast sensitivity after cataract surgery. SETTING: Brasilia Ophthalmologic Hospital, Brasilia, and Sao Geraldo Eye Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil. METHODS: In an intraindividual randomized prospective study of 25 patients with bilateral cataract, an IOL with a modified posterior surface (AcrySof IQ) was compared with a biconvex IOL with spherical surfaces (AcrySof Natural, Alcon). Ocular aberrations with a 5.0 mm and 6.0 mm pupil were measured with a Hartmann-Shack aberrometer. Quality of vision was measured by visual acuity and contrast sensitivity under mesopic and photopic conditions. All patients were followed for 3 months. RESULTS: There were no statistically significant differences between eyes in postoperative uncorrected and best corrected distance visual acuities after a follow-up of 1 month and 3 months. Postoperatively, there was a statistically significant between-group difference in contrast sensitivity under photopic conditions without glare at 18 cycles per degree (cpd) (P = .04) and under mesopic conditions without glare at all spatial frequencies (3 cpd, 6 cpd, 12 cpd, and 18 cpd; P = .03, P = .009, P = .003, and P = .003, respectively) and with glare at 3 cpd and 6 cpd (P = .001 and P = .02, respectively). The difference in higher-order aberration (HOA) values between groups was statistically significant with a 5.0 mm and 6.0 mm pupil, with the AcrySof IQ IOL inducing less HOA than the AcrySof Natural IOL. Eyes with an AcrySof IQ IOL also had statistically significant less spherical aberration than eyes with an AcrySof Natural IOL with both pupil diameters (P<.001). CONCLUSIONS: The AcrySof IQ IOL with a modified posterior surface induced significantly less HOA and spherical aberration than the AcrySof Natural IOL. Contrast sensitivity was better under mesopic conditions with the AcrySof IQ IOL.

[Preliminary results of Artisan phakic intraocular lens implantation to correct myopia]. / Resultados preliminares do implante de lente intra-ocular fácica Artisan para correção de miopia.

PURPOSE: To observe the preliminary results based on the efficacy, stability and safety of Artisan anterior chamber intra-ocular lens for the correction of myopia in the first 6 months. METHODS: A retrospective study of 18 patients (34 eyes) that received the implantation of Artisan anterior chamber intraocular lens for the correction of myopia was conducted. Best visual preoperative acuity, best visual postoperative acuity, dynamic preoperative and postoperative refraction, loss and improvement of lines of vision and complications were evaluated. RESULTS: Eighteen patients (34 eyes) were included in this study. Fourteen patients were females (77.8%) and 4 were males. The mean age was 30 years (SD +/- 7.3), range from 21 to 46 years. They were followed up for an average of 8.5 months (SD +/- 3.6). The mean endothelial cell loss was 4.75% at 6 months follow-up. The average preoperative uncorrected visual acuity was 0.02 (20/800) range from 0.01 to 0.13. The average preoperative spherical equivalent was -13.25 D, range from -5.75 D to -19,75 D. On the last follow-up, uncorrected visual acuity was 0.64 (20/32), range from 0.33 to 1.00; the average spherical equivalent was -1.18 D (DP +/- 0.92) range from +0.25 to -3.0. Complications were observed in 1 case (3.4%) of our study, in one patient who had a dislocation of the lens after an ocular trauma. CONCLUSION: The use of Artisan anterior chamber intraocular lens in phakic eyes for the correction of myopia was safe, effective and predictable. However, a larger prospective study with a higher number of cases and longer follow-up is necessary to determine long-term safety of the lens.

[Performance evaluation of NeoSoniX technology in cataract surgery]. / Avaliação do desempenho da tecnologia NeoSoniX em cirurgias de catarata.

PURPOSE: The techniques and results of cataract surgery have improved dramatically with technological advancements. One of the reasons for this improvement would be the reduced use of ultrasound with the new phacoemulsification devices. The objective of this study is to confirm the theoretical advantage of the NeoSoniX handpiece. METHODS: The authors compared the results of the parameters recorded by the Legacy phacoemulsification system during 300 cataract surgeries performed with the use of the conventional ultrasound handpiece and 100 performed with the innovative Neosonix. All surgeries were performed by the same senior surgeon, using the same surgical technique. The choice of handpiece was random. The handpieces were compared considering cataract grade of hardness, in relation to parameters of ultrasound time, amount of balanced saline solution, and percentage of average power used during surgery. RESULTS: The analysis performed retrospectively on a chronological series of cases showed that the time of ultrasound used with the NeoSoniX handpiece was inferior to that with the conventional handpiece, for any cataract grade of hardness (p<0.000001). The volume of balanced saline solution used during surgical procedures was smaller, favoring the NeoSoniX technology (p<0.000001). In relation to the percentage of ultrasound energy used with the different technologies, an inferior value was found in the group who underwent surgery with the use of the NeoSoniX handpiece (p<0.000001). CONCLUSIONS: Based on the information provided by these surgeries, we may claim that there was a significant superiority when using the NeoSoniX handpiece in comparison to the conventional Legacy machine handpiece in cataract surgeries, regardless of cataract grade.

Ferrara intracorneal ring implantation and cataract surgery for the correction of pellucid marginal corneal degeneration.

We report a case of Ferrara intracorneal ring (Mediphacos) implantation and cataract surgery for the correction of pellucid marginal corneal degeneration. Preoperatively, the patient's uncorrected visual acuity (UCVA) was 0.05 in the right eye and 0.10 in the left eye. The best spectacle-corrected visual acuity (BSCVA) was 0.50 with -2.00 -11.25 x 80 in the right eye and 0.60 with -2.00 -5.50 x 95 in the left eye. One month postoperatively, the UCVA was 0.50 in the right eye and 0.30 in the left eye. The BSCVA was 0.80 with -1.00 in the right eye and 0.60 with -0.75 -1.25 x 160 in the left eye. Ferrara intrastromal rings and cataract surgery resulted in a more regular corneal shape with a reduction in astigmatism for good visual recovery.

[Deep anterior lamellar keratoplasty by big-bubble technique]. / Ceratoplastia lamelar anterior profunda pela técnica da "big-bubble".

PURPOSE: To evaluate the efficacy, safety, and complications related to the deep anterior lamellar keratoplasty (DALK) using the big-bubble technique. METHODS: A prospective study of patients submitted to DALK using the big-bubble technique was conducted. After the procedure, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), spherical equivalent (SE), corneal topography, endothelial cell density, and intraoperative and postoperative complications were evaluated. RESULTS: Fifty-nine eyes of 55 patients were included in this study. Mean follow-up period was 16 ± 7.4 months. Baseline mean UCVA (logMAR) and BCVA was 1.60 ± 0.33 and 1.00 ± 0.43, respectively. After 12 months, the mean UCVA and BCVA improved to 0.86 ± 0.39 and 0.17 ± 0.14, respectively. Mean SE improved from -8.21 ± 3.91 to -1.82 ± 3.62 at 12 months. Mean topographic astigmatism improved from -7.9 ± 3.7 to -2.21 ± 1.7 at 12 months. Mean preoperative endothelial cell density was 2,377.98 ± 263.56 cells/mm², after 12 months of surgery the mean endothelial cell density reduced to 1,851.32 ± 397.61 cells/mm². Intraoperative microperfuration occurred in 6 cases (10.2%). One patient developed stromal rejection, and one patient developed fixed dilated pupil (Urrets-Zavalia Syndrome) after the procedure. CONCLUSION: Nevertheless, deep anterior lamellar keratoplasty is more technically challenging, yet rewarding choice of surgery for keratoplasty patients who have a healthy endothelial cell count. ClinicalTrials.gov Identifier: NCT00887900.

Evaluation of balance and fear of falling in elderly individuals before and after senile cataract surgery / Avaliação do equilíbrio e do medo de quedas em homens e mulheres idosos antes e após a cirurgia de catarata senil

Abstract Introduction: During aging there is a close relationship between visual deficits, imbalance and falls, and eye surgery can be an efficient treatment option for elderly persons. Objective: Evaluate the influence of visual conditions on patients suffering from senile cataract with increasing imbalance. Method: A descriptive and analytical study using a quantitative longitudinal cohort technique was conducted. The study included 30 individuals who were evaluated before and 30 and 60 days after surgery. The Mini Mental State Examination (MMSE), Berg Balance Scale (BBS), Short Physical Performance Battery (SPPB), International Falls Efficacy Scale adapted for Brazil (FES-I) and a medical history questionnaire were used to collect data. Statistical analysis involved the Chi-squared, Student's t and Mann-Whitney tests. Values of p<0.05 were considered significant. Results: The SPPB found that of 15 elderly women, 13 (87%) achieved moderate performance of the lower limbs while the performance of two (13%) remained poor, after 60 postoperative days. The FES-I revealed that three (20%) elderly persons were mildly worried about falls 60 days post-surgery. Of the 15 elderly male subjects evaluated by BBS, before and at 30 and 60 days after surgery, one (7%), managed to maintain some balance but needed assistance; while 14 (93%) maintained good balance. The SPPB found that the performance of five elderly persons (33%) was moderate and that of nine (67%) was good. Conclusion: Senile cataract surgery had positive preventative effects on lower limb performance, balance and fear of falling among the elderly studied, preventing the falls and fractures that are common during aging.

Resumo Introdução: Com o envelhecimento, existe uma relação estreita entre deficit visuais, desequilíbrios e quedas, sendo a cirurgia ocular uma alternativa eficiente para idosos. Objetivo: Avaliar a influência das condições visuais em pacientes com catarata senil em relação aos desequilíbrios corporais. Método: Estudo descritivo e analítico realizado por meio de pesquisa quantitativa de coorte longitudinal. Participaram do estudo 30 idosos, 15 homens e 15 mulheres, os quais foram avaliados antes da cirurgia de catarata, 30 e 60 dias após a intervenção. Utilizou-se para a coleta de dados, o Miniexame do Estado Mental (MEEM), a Escala de Equilíbrio de Berg (EEB), o Short Physical Performance Battery (SPPB), a Escala Internacional de Eficácia de Quedas adaptada ao Brasil (FES-I-Brasil) e questionário de anamnese. A análise estatística empregou o teste Qui-quadrado, teste t Student e teste Mann-Whitney. Foram considerados significantes valores de p<0,05. Resultados: Das 15 idosas, pelo SPPB, em 60 dias de pós-operatório, 13 (87%) conseguiram desempenho moderado e duas (13%) mantiveram baixo desempenho de membros inferiores (MMII). Pelo teste FES-I-Brasil, em 60 dias pós-cirúrgico, três (20%) idosas mantiveram leve preocupação com as quedas. Dos 15 idosos avaliados pela EEB, antes e após 30 e 60 dias de cirurgia, um (7%) conseguiu manter algum equilíbrio, mas necessitando assistência; e 14 (93%) idosos mantiveram bom equilíbrio. Pelo teste SPPB, após 60 dias de cirurgia, cinco idosos (33%) tiveram desempenho moderado e nove (67%) obtiveram bom resultado. Conclusão: A cirurgia de catarata senil possibilitou melhora no desempenho funcional de MMII, no equilíbrio e medo de quedas nos idosos investigados prevenindo caimentos e fraturas, comuns no envelhecimento.

Visual Performance of Tecnis ZM900 Diffractive Multifocal IOL after 2500 Implants: A 3-Year Followup.

Purpose. To evaluate visual performance for near, intermediate, and distant vision; complaints of photic phenomena, and patient satisfaction with the new diffractive multifocal IOL used in eyes which underwent phacoemulsification. Methods. Two thousand and five hundred consecutive eyes undergoing Tecnis ZM900 multifocal IOL implantation were included in this retrospective analysis. The minimum followup of 3 months was required after the surgery. Patients were assessed for uncorrected near visual acuity (UNVA) at a fixed distance (33 cm), uncorrected intermediate visual acuity (UIVA) at 60 cm, and uncorrected distance visual acuity (UDVA). Using a subjective questionnaire, patients satisfaction, their independence from using glasses, and the perception of glare and halo phenomena were also evaluated at the last follow-up. Results. Two thousand and five hundred eyes of 1558 patients underwent cataract surgery and Tecnis ZM900 multifocal IOL implantation. Four hundred and eighty seven patients (31.3%) were men, and 1071 (68.7%) were women. The mean age of the patients was 66.17 years. A UDVA of 20/30 or better was achieved by 85% of eyes. A UNVA of J1 was achieved by 93.7% of eyes and that of J2 or better was achieved by 98%. A UIVA of J4 or better was achieved by 65% and J5 or better was achived by more than 82.8% of the eyes in the study. Glare and halos were reported as severe by only 6.1% and 2.12% of patients, respectively. Ninety seven percent reported complete spectacle independence and 88% stated that they are totally satisfied with their quality of vision and would choose to have the same lens implanted again after the first implant. Five percent of the eyes in the study needed a second procedure (enhancement) to achieve a better visual result. No patient underwent lens exchange. Conclusion. Excellent near, intermediate, and distant vision was observed in patients implanted with the Tecnis ZM900 diffractive multifocal IOL. Spectacle independence and a minimum occurrence of photic phenomena make this IOL an excellent option in patients with cataract.