Clinical performance and shape analysis of trifocal intraocular lenses via scanning electron microscopy.

BACKGROUND: To evaluate visual performance after implantation of the TFNT (Acrysof Panoptix, Alcon, Fort Worth, Texas, USA) and CNWT (Clareon Panoptix, Alcon, Fort Worth, Texas, USA) intraocular lens (IOL), and compare the lens shape observed by scanning electron microscope (SEM). METHODS: Eighteen patients (18 eyes) received implantation of the CNWT and Twenty patients (20 eyes) received implantation of the TFNT. Exclusion criteria were previous ocular surgeries, ocular pathologies, or corneal abnormalities. Intervention or Observational Procedure(s): Postoperative examination at 1 months including manifest refraction; evaluation of refractive error, distance-corrected visual acuity (DCVA) at 5 m, 1 m, 70 cm, 50 cm, 40 cm, and 30 cm, slit-lamp examination; defocus curve testing; contrast sensitivity (CS) was performed. The lens shape of the TFNT and the CNWT was examined under SEM. RESULTS: Mean spherical equivalent was 0.11 ± 0.41 D (CNWT group) and 0.12 ± 0.34 D (TFNT group) 1 month postoperation. DCVA and defocus curve showed no significant difference between the two groups. CS was significantly higher in CNWT group than TFNT group at spatial frequencies of 6 cycles per degree (cpd). Observation of the IOL with a scanning electron microscope (SEM) revealed that CNWT group had improved diffraction structure and edge processing accuracy compared to TFNT group. CONCLUSION: There was no significant difference between the two groups in the defocus curve and visual acuity at all distances. CS was better in the CNWT group than in the TFNT group. IOL surface features may affect CS.

Rotational stability of monofocal and diffractive multifocal toric intraocular lens with identical design and material: a propensity score based prospective comparative study.

PURPOSE: To compare the rotational stability of a monofocal and a diffractive multifocal toric intraocular lens(IOLs) with identical design and material. METHODS: This prospective study enrolled patients who underwent plate-haptic toric IOL (AT TORBI 709 M and AT LISA 909 M) implantation. Propensity score matching (PSM) was performed to balance baseline factors. Follow-up examinations were conducted at 1 h, 1 day, 3 days, 1 week, 2 weeks, 1 month, and 3 months postoperatively. A linear mixed model of repeated measures was used to investigate the changes in IOL rotation over time. A 2-week timeframe was utilized to assess differences in IOL rotation between the two groups. RESULT: After PSM, a total of 126 eyes were selected from each group for further analysis. Postoperatively, the time course of IOL rotation change in the two groups remained consistent, with the greatest rotation occurring between 1 h and 1 day postoperatively. At the 2-week postoperative mark, the monofocal toric IOL exhibited a higher degree of rotation compared to the multifocal toric IOL (5.40 ± 7.77° vs. 3.53 ± 3.54°, P = 0.015). In lens thickness(LT) ≥ 4.5 mm and white-to-white distance(WTW) ≥ 11.6 mm subgroups, the monofocal toric IOL rotated greater than the multifocal toric IOL (P = 0.026 and P = 0.011, respectively). CONCLUSION: The diffractive multifocal toric IOL exhibits superior rotational stability compared to the monofocal toric IOL, especially in subgroups LT ≥ 4.5 mm and WTW ≥ 11.6 mm. Moreover, the time course of IOL rotation change is consistent for both, with the maximum rotation occurring between 1 h and 1 day postoperatively.

The comparison of corneal higher-order aberration and surgically induced astigmatism between the clear corneal incision and the limbus tunnel incision of posterior chamber implantable collamer lens implantation.

BACKGROUND: This study aimed to compare the corneal high-order aberrations and surgically induced astigmatism between the clear corneal incision and limbus tunnel incision for posterior chamber implantable collamer lens (ICL/TICL) implantation. METHODS: A total of 127 eyes from 73 myopic patients underwent ICL V4c implantation, with 70 eyes receiving clear corneal incisions and 57 eyes receiving limbus tunnel incisions. The anterior and back corneal surfaces were measured and the Root Mean Square of all activated aberrations (TRMS) was calculated, including higher-order aberration (HOA RMS), spherical aberration Z40, coma coefficients (Coma RMS) Z3-1 Z31, and surgically induced astigmatism (SIA). The measurements were taken preoperatively and postoperatively at 1 day, 1 week, and 1, 3, and 6 months. In this study, the corneal higher-order aberration was estimated as the Zernike coefficient calculated up to 5th order. The measurements were taken at a maximum diameter of 6.5 mm using Pentacam. RESULTS: One week after the operation, the corneal back Z31 of the clear corneal incision group was 0.06 ± 0.06, while the limbus tunnel incision group showed a measurement of 0.05 ± 0.06 (p = 0.031). The corneal back Z40 of the clear corneal incision group was -0.02 ± 0.25, compared to -0.04 ± 0.21 in the limbus tunnel incision group (p = 0.01). One month after the operation, the corneal back SIA of the clear corneal incision group was 0.11 ± 0.11, compared to 0.08 ± 0.11of the limbus tunnel incision group (p = 0.013), the corneal total SIA of the clear corneal incision group was 0.33 ± 0.30, compared to 0.15 ± 0.16 in the limbus tunnel incision group (p = 0.004); the clear corneal incision group exhibited higher levels of back astigmatism and total SIA than the limbus tunnel incision in the post-operation one month period. During the 6- month post-operative follow-up period, no significant difference in Z31, Z40, and other HOA RMS data was observed between the two groups. The total SIA of the corneal incision group and the limbus tunnel incision group were 0.24 ± 0.14 and 0.33 ± 0.32, respectively (p = 0.393), showing no significant difference between the two groups 6 months after the operation. CONCLUSION: Our data showed no significant difference in the high-order aberration and SIA between clear corneal incision and limbus tunnel incision up to 6 months after ICL-V4c implantation.

Longitudinal evaluation of trifocal and extended depth of focus lenses implantation using standard automated perimetry parameters.

PURPOSE: To evaluate reliability and global indices parameters from standard automated perimetry (SAP) in normal eyes undergoing phacoemulsification cataract surgery with implantation of trifocal or extended depth of focus intraocular lens (IOL). METHODS: Prospective study to evaluate the effect of trifocal IOL AcrySof IQ PanOptix® and extended depth of focus intraocular lens (EDOF) Tecnis Symfony® IOL implantation on visual field parameters. Patients underwent SAP pre- and postoperatively. Reliability indices (false negative rate-FN, false positive rate-FP), global indices (foveal sensitivity threshold, visual field index-VFI, standard pattern deviation-PSD, mean deviation MD) and test duration were analyzed. RESULTS: A total of 23 eyes from 13 patients were in the trifocal IOL group and a total of 22 eyes from 14 patients were in the EDOF group. The following results were obtained by analyzing pre- and postoperative SAP of EDOF IOL: the rate of change of FN was 1.95/1.41% (p = 0.61); FP 1.64/1.27 (p = 0.60); MD - 1.60/- 1.08 dB (p = 0.15); foveal sensitivity was 34.5/33.9 dB (p = 0.41); VFI 98.5/98.4% (p > 0.99); PSD 1.85/1.86 (p = 0.07); and for test duration 305.81/298.36 s (p = 0.35); all respectively. Analysis of pre- and postoperative parameters of trifocal IOL were the rates of change of FN 1.22/1.83% (p = 0.29); FP 1.65/1.48% (p = 0.95); MD - 1.55/- 1.37 dB (p = 0.19); foveal sensitivity 33.9/34.9 dB (p = 0.47); VFI 98.6/98.3% (p = 0.62); PSD 1.58/2.05 (p = 0.02); and test duration 297.17/298.57 s (p = 0.87); all respectively. CONCLUSION: We identified a change in the PSD parameters in the trifocal IOL group. No other significant changes were identified in SAP parameters after implantation of trifocal AcrySof IQ PanOptix® and EDOF Tecnis Symfony® IOL. Longitudinal evaluation showed no changes in SAP after Trifocal and EDOF IOL implantation in normal subjects.

[Current possibilities of laser surgery on anterior eye segment]. / Sovremennye vozmozhnosti lazernogo vozdeistviya na struktury perednego segmenta glaza.

The article summarizes the experience of recent years in the development and implementation of novel original laser technologies used in surgery of the anterior segment of the eye. The presented technology of laser activation of scleral hydropermeability (LASH) in glaucoma is based on the effect of enhanced transscleral filtration and has been shown as effective and safe, which was confirmed by the results of a comprehensive clinical and experimental study. Development of another technique was associated with the need to improve the safety of laser interventions in anterior capsule contraction syndrome in pseudophakia, and resulted in a proposition to change the configuration of the anterior lens capsule incision from the usual linear-radial to T-shaped laser anterior capsulorhexis. The proposed technology of laser photomydriasis based on near-infrared radiation of the diode laser (0.810 µm) has shown its effectiveness and gentle nature (absence of atrophy of the iris stroma and post-burn pigmentation) in ectopias and pupil deformity.

Functional visual acuity after implantation of diffractive extended depth-of-focus intraocular lenses using an echelett optics.

BACKGROUND: The prospective comparative case series aimed to evaluate all-distance visual acuity, contrast sensitivity, and functional visual acuity (FVA) of eyes with diffractive extended depth-of-focus (EDOF) intraocular lenses (IOLs) using an echelett optics and monofocal IOLs with the same platform. METHODS: Diffractive EDOF and monofocal IOLs were implanted in 27 eyes of 27 patients each. At 3 months after implantation, all-distance visual acuities at distances of 0.3, 0.5, 0.7, 1, 2, 3, and 5 m were measured under distance-corrected. Static visual function was also examined using photopic contrast sensitivity and area under the logarithmic contrast sensitivity function (AULCSF). Dynamic visual function was examined with FVA, and mean FVA value, visual maintenance ratio (VMR), mean response time, and number of blinks were evaluated. These outcomes were compared between the two IOLs. RESULTS: The mean distance-corrected visual acuities were better at distances of 0.7 m or nearer in eyes with EDOF IOLs. There was no difference in the contrast sensitivities (P > 0.22). In the FVA results, no difference was found in mean FVA and VMR (P > 0.68). CONCLUSION: The static and dynamic evaluations of postoperative visual functions demonstrated that the visual function of eyes with EDOF IOLs under photopic and distance-corrected conditions was comparable to eyes with monofocal IOLs.

Clinical outcome comparison: bilateral trifocal vs. mix-match extended depth of focus and trifocal intraocular lenses.

PURPOSE: To analyze the visual outcomes, contrast sensitivity (CS), and patient satisfaction differences between the bilateral implantation of a trifocal intraocular lens (IOL) and the mix-match implantation of an extended-depth-of-focus (EDOF) IOL and a diffractive trifocal IOL. METHODS: A total of 20 patients who underwent bilateral implantation of AT LISA tri 839MP (Group 1) and 20 patients who had a mix-match implantation of AT LARA 829MP in the dominant eye and AT LISA tri 839MP in the nondominant eye (Group 2) were evaluated. Uncorrected distance (4 m), intermediate (60 cm and 80 cm), and near (40 cm) visual acuity, as well as CS, defocus curve, and responses to the patient questionnaires, were evaluated. RESULTS: Eighty eyes of 40 patients were included. Uncorrected distance and near visual outcomes were similar between the groups (p > 0.05). Group 2 showed significantly better intermediate visual outcomes at 60 cm and 80 cm than Group 1 (p < 0.05). Group 2 showed significantly better CS outcomes (photopic and mesopic) than Group 1 (p < 0.05). There was no significant difference between the groups regarding defocus curves from + 0.00 D to - 2.00 D, but a significant difference was shown from - 2.00 D to - 4.00 D. Patients' satisfaction was significantly higher in Group 2 for driving at night (p < 0.05). CONCLUSIONS: Both groups showed an effective visual performance. Group 2 exhibited better photopic and mesopic CS. The combination of EDOF and trifocal IOL seems to be a good option with a comfortable vision at all distances and less adverse visual phenomena.

Comparison between bilateral implantation of a trifocal intraocular lens (Alcon Acrysof IQ® PanOptix) and extended depth of focus lens (Tecnis® Symfony® ZXR00 lens).

PURPOSE: To compare the visual performance outcomes following bilateral cataract surgery using trifocal intraocular lens (Alcon Acrysof IQ® PanOptix) and extended depth of focus lens (Tecnis® Symfony® ZXR00 lens). METHODS: In this prospective, non-randomized, comparative trial, a total of 40 subjects (80 eyes) were divided into two different groups and submitted to bilateral cataract surgery and implantation of the two different IOLs, Alcon Acrysof IQ® PanOptix® TNFT00 in group A and Tecnis® Symfony® ZXR00 lens (Johnson & Johnson Vision) in group B, was assessed. The uncorrected and corrected near (33 cm), intermediate (60 cm), and far (4 m) binocular visual acuity was measured, and visual binocular defocus curves were also measured in the photopic condition with a long-distance visual acuity and the qualitative visual function was assessed by NEI VFQ-25. RESULTS: Group A comprised 20 patients; 11 women (55%) and 9 men (45%) with a mean age of 62.1 ± 5.4. In group B 20 patients were recruited; 12 women (60%) and 8 men (40%) with a mean age of 63.2 ± 6.1. The postoperatively calculated mean sphere was + 0.35 ± 0.12 D and - 0.14 ± 0.13 D in groups A and B, respectively. The postoperative uncorrected distance visual acuity (UDVA) as well as uncorrected intermediate visual acuity (UIVA) were statistically equal in both groups (P = 0.12, P = 0.17); meanwhile, the postoperative uncorrected near visual acuity (UNVA) was significantly better in patients with PanOptix IOL implantation (P = 0.01) compared to the binocular defocus curve; the results of the PanOptix group were better than the Symfony group in intermediate and near distance (P = 0.089, P = 0.001) and according to the VFQ-25 questionnaire, then ear vision score as well as sum score turned out to be significantly higher in groups A than B (P = 0.001 and P = 0.015, respectively). CONCLUSION: Both strategies were able to provide good vision for far, intermediate and near distances.

[Risk factors and prognosis of the development of pseudophakic myopia in children]. / Faktory riska i prognoz razvitiya psevdofakicheskoi miopii u detei.

Recent studies indicate the prevalence of myopic refraction in children with pseudophakia, which significantly reduces the functional results of treatment and may be an indication for replacing the intraocular lens (IOL). Therefore, studies conducted to achieve the target refraction in children with pseudophakia are relevant. PURPOSE: To determine the risk factors for the prognosis of myopic refraction in children after extraction of congenital cataract and IOL implantation. MATERIAL AND METHODS: The study presents the results of refraction examination in 69 (110 eyes) children aged 1 to 12 years 36 months after extraction of congenital cataract with implantation of soft IOL. RESULTS: The obtained data of anamnesis, results of ophthalmological, echobiometric, clinical and laboratory studies were subjected to statistical processing assessing the significance of differences in outcomes depending on the impact of possible risk factors for the development of pseudophakic myopia; a regression logistic model and a ROC-curve were constructed. CONCLUSION: According to the authors, reliable risk factors for the development of pseudophakic myopia in children can be such indicators as axial eye length at the time of IOL implantation exceeding the age norm by more than 0.2 mm; the child from the first pregnancy; the AL/CR ratio of ≥3.0; myopia on the paired eye; strabismus of more than 4 prism diopters; hereditary load; tension of eye's fibrous capsule: pressure of ≤180 mm Hg at the time of IOL implantation. The presented reliable factors, as well as a combination of less significant signs (the child being outside for less than 1 hour per day, intermarriage of the patient's parents, near-sight visual loads of more than 3 hours per day, the blood Ca level of less than 1.8 mmol/L) can be used for prognosis of the development of pseudophakic myopia and to help make adjustments in the management tactics for patients to achieve target refraction.

Clinical outcomes after mix-and-match implantation of diffractive multifocal intraocular lenses with + 2.75 and + 4.00 diopter add powers.

BACKGROUND: To evaluate the clinical outcomes of bilateral mix-and-match implantation of diffractive multifocal intraocular lenses (IOLs) with different add powers. METHODS: We retrospectively reviewed the medical records of 18 patients who underwent bilateral mix-and-match implantation of diffractive multifocal IOLs with different add powers. Multifocal IOLs with add powers of + 2.75 diopters (D) and + 4.00 D were implanted into the patients' dominant and nondominant eyes, respectively. At 1 and 3-month postoperatively, monocular and binocular visual acuity was measured using logMAR charts and manifest refraction was performed. Specifically, logMAR charts were used to measure uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), and corrected distance visual acuity (CDVA). Defocus curves, contrast sensitivity, and patient satisfaction were assessed at 3-month postoperatively. RESULTS: Binocular logMAR measurements (mean ± standard deviation) at 3-month postoperatively were 0.01 ± 0.04 (UDVA), 0.16 ± 0.05 (UIVA), and 0.11 ± 0.07 (UNVA). Postoperative spherical equivalent was - 0.43 ± 0.35 D and - 0.39 ± 0.21 D in the dominant and nondominant eyes, respectively. Defocus curves showed significant differences between - 1.50 and - 4.00 D among binocular, dominant, and nondominant eye measurements, except between - 2.50 and - 3.00 D. Eyes implanted with + 2.75 and + 4.00 D IOLs showed good contrast sensitivity under photopic and mesopic conditions. Over 80% of patients reported high satisfaction with their near vision. CONCLUSIONS: Bilateral mix-and-match implantation of diffractive multifocal IOLs with add powers of + 2.75 D and + 4.00 D showed good near, intermediate, and far vision.

Visual Function after Implantation of a Presbyopia-Correcting Trifocal Intraocular Lens.

PURPOSE: To evaluate distance, intermediate, and near visual performance in patients implanted with a trifocal aspheric presbyopia-correcting intraocular lens (IOL). METHODS: Forty patients were bilaterally implanted with the AcrySofIQ PanOptix IOL after femtosecond laser-assisted lens surgery. Binocular best corrected distance visual acuity (CDVA) (4 m), best distance-corrected near visual acuity (DCNVA) (40 and 30 cm), best corrected distance intermediate visual acuity (DCIVA) (70, 60, and 50 cm), binocular distance contrast sensitivity under photopic conditions (85 cd/m2), and defocus curves were evaluated at 6-months. RESULTS: Six months postoperatively, the mean binocular Snellen decimal CDVA and DCNVA were 0.94 ± 0.10 (ranging from 0.70 to 1.25) and 0.85 ± 0.13 (ranging from 0.63 to 1.00), respectively. At a distance, all patients showed a cumulative binocular distance-corrected visual acuity of 0.8 or better, and about 80% (n = 31) of the patients had a value of 1.0 (20/20). At near and intermediate distances, all patients showed a cumulative distance-corrected visual acuity of 0.5 (20/40) or better at 30, 40, 50, 60, and 70 cm. Specifically, 50 cm showed the highest percentage of patients with larger values of visual acuity (60% [n = 26] with 20/20). Defocus curve showed a wide range of useful vision with two peaks of best visual acuity at distance and at 50 cm, and the binocular distance contrast sensitivity was within normal limits. CONCLUSIONS: The outcomes of the present study show that the visual performance obtained with bilateral implantation of the trifocal aspheric AcrySofIQ PanOptix IOL is good at far, intermediate, and near distances.

Comparative Evaluation of Visual Outcomes After Bilateral Implantation of a Diffractive Trifocal Intraocular Lens and an Extended Depth of Focus Intraocular Lens.

OBJECTIVES: To compare visual outcomes and clinical performance of diffractive trifocal and extended depth of focus (EDOF) intraocular lenses (IOLs). METHODS: This prospective, consecutive, nonrandomized, comparative study of 6-month duration included assessment of 160 eyes of 80 patients (40 patients in each group). The patients had bilateral cataract surgery with implantation of a trifocal (FineVision Micro F; PhysIOL SA, Liège, Belgium) or EDOF IOL (TECNIS Symfony; Abbott Medical Optics, Inc., Abbott Park, IL) in both eyes. Ophthalmological evaluation included measurement of monocular uncorrected distance visual acuity (UDVA) and corrected distance VA (CDVA), uncorrected intermediate VA (UIVA) and distance-corrected intermediate VA (DCIVA), uncorrected near VA (UNVA) and distance-corrected near VA (DCNVA). Analysis of point-spread function and modulation transfer function was also performed postoperatively, and quality of vision and spectacle-dependence questionnaires were assessed. RESULTS: There was no statistically significant difference between groups in monocular UDVA (P=0.65), CDVA (P=0.82), and binocular UDVA (P=0.81). The monocular UIVA, monocular DCIVA, and binocular UIVA were also comparable among the two groups (P=0.70, 0.74, and 0.81, respectively). Monocular UNVA, DCNVA, and binocular UNVA were statistically and significantly better for the trifocal group than for the EDOF (P=0.01, P=0.009, and P=0.001, respectively). There were no differences in visual symptoms and quality among groups. CONCLUSIONS: Trifocal IOL had a clear advantage over EDOF IOLs in near VA, while both IOLs showed excellent performance in distance and intermediate VA. Both IOLs provided high percentage of spectacle independence and patient satisfaction with minimal level of disturbing photic phenomena.

Comparison of visual outcomes after implantation of AtLisa tri 839 MP and Symfony intraocular lenses.

PURPOSE: To compare visual outcomes after implantation of AtLisa tri 839 MP and Symfony intraocular lenses (IOLs). METHODS: All subjects underwent sequential bilateral cataract extraction with AtLisa tri 839 MP or Symfony IOL implantation. The design is prospective case series. Each group consists of 20 patients (40 eyes). At 1 year postoperatively, the following parameters were analysed: binocular uncorrected visual acuity (log MAR): for distance (UDVA) at 4 m, for intermediate distances (UIVA) at 60, 70, 80 cm and for near (UNVA) at 40 cm, defocus curve, mesopic and photopic contrast sensitivities (CSs), spectacle independence, visual function test questionnaire modified VFQ-25), photopic phenomena and postoperative complications. RESULTS: In the AtLisa tri 839 MP group, the mean binocular UNVA and UIVA were significantly better than in the Symfony group (UNVA: - 0.01 ± 0.04 vs. 0.21 ± 0.15; p = 0.000; 60 cm UIVA: - 0.01 ± 0.04 vs. 0.09 ± 0.09, p = 0.001; 70 cm UIVA - 0.05 ± 0.06 vs. 0.11 ± 0.08, p = 0.002; 80 cm UIVA - 0.01 ± 0.06 vs. 0.15 ± 0.08, p = 0.019). There were no significant between-group differences in the mean binocular UDVA and CS, with one exception: the mean binocular distance CS (18 cpd) under mesopic conditions was significantly better in the Symfony group than in the AtLisa tri 839 MP group (1.39 ± 0.22 vs. 1.17 ± 0.27; p = 0.015). The defocus curve analysis revealed significant between-group differences at vergences of 2.0 to - 4.0 D (p < 0.05), except for 2.0, 1.0, 0 and - 1.5. All subjects in AtLisa tri 839 MP group and 18 subjects (90%) in Symfony group were spectacle independent. Patients from both groups highly rated their overall vision quality in the VFQ-25 (1.67 ± 0.47 vs. 1.85 ± 0.5 in the Symfony and AtLisa tri 839 MP group, respectively, p = NS). The scores for daytime driving (1.00 ± 0.00 vs. 1.21 ± 0.36; p = 0.002), night driving (1.57 ± 0.55 vs. 2.13 ± 1.15; p = 0.027) and difficult situation driving (1.14 ± 0.31 vs. 1.53 ± 0.56; p = 0.049) were significantly better in the AtLisa tri 839 MP group than in the Symfony group. The incidence and perception level of halo and glare were significantly reduced (p = 0.00) in the Symfony group as compared to the AtLisa tri 839 MP group. The postoperative course was uneventful in all subjects. CONCLUSIONS: Visual outcomes achieved with both IOLs are comparable. In both groups, 90% of patients achieved spectacle independence. Whereas the AtLisa tri 839 MP IOL implantation was associated with slightly better intermediate distance VA and significantly better near VA, photic phenomena were less perceived by patients with Symfony IOLs.

Postoperative Endothelial Cell Density Is Associated with Late Endothelial Graft Failure after Descemet Stripping Automated Endothelial Keratoplasty.

PURPOSE: To determine whether preoperative endothelial cell density (ECD) and postoperative ECD after Descemet stripping automated endothelial keratoplasty (DSAEK) are associated with late endothelial graft failure (LEGF) in the Cornea Preservation Time Study (CPTS). DESIGN: Cohort study within a multicenter, randomized clinical trial. PARTICIPANTS: A total of 1007 individuals (1223 study eyes), mean age 70 years, undergoing DSAEK for Fuchs' dystrophy (94% of eyes) or pseudophakic or aphakic corneal edema (PACE) (6% of eyes) and followed for up to 5 years. METHODS: Central ECD was determined by a central image analysis reading center. Preoperative ECD was determined for 1209 eyes that did not fail and 14 eyes that experienced LEGF. The ECD at 6 and 12 months after DSAEK, the change in ECD from preoperative to 6 and 12 months, surgeon-reported operative complications, and postoperative graft dislocation were investigated for an association with LEGFs unrelated to other postoperative events. Univariable and multivariable Cox proportional hazards regression models were used to assess associations. MAIN OUTCOME MEASURES: Late endothelial graft failure and its associations with pre- and postoperative ECD and operative complications. RESULTS: The cumulative probability of LEGF was 1.3% (95% confidence interval [CI], 0.8%-2.4%). Median (interquartile range [IQR]) preoperative ECDs were similar for eyes with LEGF (2523; 2367-3161) cells/mm2) and eyes without failure (2727; 2508-2973) cells/mm2) (P = 0.34). The ECD at 6 months was associated with LEGF (P < 0.001) in time-to-event analyses, whereas preoperative ECD was not (P = 0.55). The cumulative incidence (95% CI) of LEGF was 6.5% (3.0%, 14.0%) for 97 grafts with a 6-month ECD less than 1200 cells/mm2, 0.3% (0.0%, 2.4%) for 310 grafts with a 6-month ECD between 1200 and 2000 cells/mm2, and 0.6% (0.1%, 2.7%) for 589 grafts with a 6-month ECD greater than 2000 cells/mm2. In multivariable analyses, ECD at 6 months and operative complications were both associated with LEGF (P = 0.002 and P = 0.01, respectively), whereas graft dislocation was not (P = 0.61). CONCLUSIONS: In eyes undergoing DSAEK, preoperative ECD is unrelated to LEGF, whereas lower ECD at 6 months is associated with LEGF. Early endothelial cell loss after DSAEK and intraoperative complications should be minimized to improve graft survival.

Rotation of a toric intraocular lens with and without capsular tension ring: data from a multicenter non-inferiority randomized clinical trial (RCT).

BACKGROUND: Evaluation of clinical outcome in cohorts with versus without simultaneous implantation of a capsular tension ring (CTR) and a toric lens (Tecnis Toric). Main parameter was rotation referring - in contrast to misalignment - to the IOL axis change from immediately after implantation to the final postoperative position. METHODS: Lens position was measured at baseline with the patient still in recumbent position, postoperative rotation was calculated by software. Postoperative evaluation included measurement three months after surgery or prior to an indicated revision surgery. Explorative re-evaluation of the underlying RCT's intent-to-treat population was performed for the entire sample and stratified for cohorts by 95% confidence intervals for binary endpoints' incidences (primary endpoint: absolute postoperative rotation ≤5 degrees; secondary endpoints: absolute deviation between achieved cylinder and target cylinder ≤0.5 dpt, postoperative corrected distance visual acuity (CDVA) ≥ 0.8). Data exploration was based on medians and quartiles. SETTING: Outpatient study sites. DESIGN: Re-evaluation based on data from a multicenter non-inferiority randomized clinical trial (RCT). RESULTS: Sub cohorts (without CTR 89, with CTR 90 patients) did not present clinically relevant differences in preoperative characteristics: revision surgery was performed in 7 cases (3 without and 4 with CTR). Primary endpoint incidences for the total sample, without and with CTR were 90%/89%/90%; cylinder endpoint incidences were 46%/45%/46% and CDVA endpoint incidences 90%/92%/88%. Median absolute rotations were 1.74°/1.79°/1.72°, median absolute cylinder deviations 0.55/0.52/0.55 dpt and median visual acuity 1.0/1.0/1.0. CONCLUSION: No clinically relevant differences between CTR subgroups were found; a satisfying three months rotational stability was achieved. TRIAL REGISTRATION: The trial was registered retrospectively in the trial registry DRKS, trial registration number DRKS00015316 , date of registration 27. August 2018.

Correlation and predictability of ocular aberrations and the visual outcome after quadrifocal intraocular lens implantation: a retrospective longitudinal study.

BACKGROUND: To evaluate the correlating and predicting factors of visual outcome after implantation of newly developed diffractive quadrifocal intraocular lens (IOL). METHODS: A retrospective longitudinal study was conducted. Patients who underwent diffractive quadrifocal IOL implantation with a follow-up period longer than six months and records of wavefront aberrometer within one week perioperatively were enrolled. Accordingly, a total of 73 eyes from 73 patients were included. The postoperative distance and near visual acuity, ocular aberrations and postoperative symptoms were collected. The correlation and predictability between ocular aberrations and the postoperative visual outcome were evaluated. RESULTS: The corrected distance visual acuity (CDVA) one month postoperatively was significantly better than the preoperative status, and insignificant improvement was found six months postoperatively. Preoperative Tracey refraction spherical equivalent (TRSE), angle alpha, and spherical aberration (SA) were significantly correlated with postoperative CDVA and near corrected visual acuity (NCVA). For postoperative ocular aberrations, TRSE, angle alpha, and SA were significantly correlated with CDVA six months postoperatively and NCVA, while the trefoil, internal higher order aberration (HOA) and total HOA were associated with NCVA. Preoperative angle alpha could predict all postoperative visual performances, while postoperative TRSE and angle alpha could predict the CDVA six months postoperatively and NCVA. A large angle alpha is associated with visual disturbance and dissatisfaction. CONCLUSION: The angle alpha preoperatively and postoperatively was correlated with the postoperative vision and could predict visual outcome in patients who had diffractive quadrifocal IOL implanted. Furthermore, the majority of ocular aberrations were also associated with certain postoperative vision.

Outcomes of toric supplementary intraocular lenses for residual astigmatic refractive error in pseudophakic eyes.

PURPOSE: To evaluate rotational stability and visual and refractive outcomes of supplementary toric IOLs (Sulcoflex Toric 653T, Rayner Intraocular Lenses Ltd) for residual astigmatic refractive error in pseudophakic eyes. METHODS: A retrospective interventional case series was conducted in a single surgeon practice. Charts of patients who had Sulcoflex Toric supplementary IOLs inserted between June 2009 and September 2015 were reviewed. Outcomes were compared between eyes with and without prior corneal transplant. Patients with at least 3-months follow-up were included. RESULTS: In 51 eyes, mean UDVA improved from 20/86 to 20/43 (p = 0.002), though UDVA was better in eyes without corneal grafts (20/31) than eyes with (20/62). The proportion of eyes achieving 20/20 UDVA was 43%, 61% and 17% overall, in eyes with prior graft and in eyes with no prior graft, respectively. Sixty-four percentage achieved a spherical equivalent of within 0.5D of target (84% no graft, 34% prior graft). Fifty-three percentage of eyes achieved a cylinder of within 0.5D of target (no graft: 73%, prior graft: 0%). Mean lens rotation was 8.23° on day 1, and mean maximal rotation during follow-up was 17.63°. Sixty-two percentage of IOLs required repositioning. Of those that required repositioning, this was conducted a mean of 2.3 times. The mean final IOL rotation (following repositioning if required) was 6.17°. CONCLUSION: Sulcoflex Toric supplementary IOLs result in good visual and refractive outcomes in eyes with no prior corneal graft. However, outcomes are sub-optimal in eyes with prior corneal transplantation, and the majority of lenses require repositioning.

Comparative analysis of visual outcomes, reading skills, contrast sensitivity, and patient satisfaction with two models of trifocal diffractive intraocular lenses and an extended range of vision intraocular lens.

PURPOSE: To compare visual and contrast sensitivity (CS) outcomes, reading skills, and spectacle independence in patients implanted with two models of trifocal intraocular lenses (IOLs) or an extended range of vision (ERV) IOL. METHODS: This non-randomized prospective series of cases included 120 eyes of 60 patients undergoing cataract surgery with bilateral implantation of three different IOLs: the ERV IOL Tecnis Symfony (40 eyes) (Abbott Medical Optics), the trifocal IOLs PanOptix IQ (40 eyes) (Alcon), and AT LISA tri 839MP (40 eyes) (Carl Zeiss Meditec). Visual results, photopic and mesopic CS, binocular reading skills (MNREAD charts), and patient satisfaction were evaluated 3 months after surgery. RESULTS: There was no statistically significant difference between groups regarding uncorrected and corrected distance visual acuity. The Tecnis Symfony IOL showed better mesopic intermediate visual outcomes than the two trifocal IOLs (p < 0.05 vs AT LISA). Under photopic conditions, AT LISA tri 839MP and PanOptix IQ showed better near visual outcomes compared with the ERV IOL (p < 0.05 to p < 0.001). The Tecnis Symfony IOL provided significantly better photopic and mesopic CS outcomes than the other IOL models (p < 0.001). Reading skills were not significantly different between the three IOL models (p > 0.05). Less patients implanted with the two trifocal IOLs required a near addition than patients with the ERV IOL. CONCLUSIONS: All the tested IOLs provided good visual outcome, reading performance, and spectacle independence after cataract surgery. While trifocal IOLs gave better near visual acuity results, the ERV IOL provided better contrast sensitivity.

Vitrectomy with and without encircling band for pseudophakic retinal detachment with inferior breaks: VIPER Study Report No. 3.

PURPOSE: To test if an encircling band improves outcomes in vitrectomy for pseudophakic retinal detachment (PRD) with inferior or with multiple (4 or more) breaks. METHODS: Subgroup analysis of a prospective randomized controlled multicenter trial in patients with uncomplicated PRD assigned either to 20 G vitrectomy plus encircling band (group E1), or 20 G vitrectomy without any buckle (group C), or 23/25 G vitrectomy without any buckle (group E2). The primary endpoint was defined as no indication for any retina reattaching procedure during the review period of 6 months. One hundred out of 257 patients were identified with inferior breaks and 63 patients had 4 or more breaks. RESULTS: In patients with retinal breaks between 5:00 and 7:00, treatment was successful in 77.4% (24/31, treatment arm E1) versus 57.1% (16/28, treatment arm C) (p = 0.301, odds ratio (OR) 1.83, 95% confidence interval (CI) 0.48 to 7.17). In patients with multiple breaks, success rates were 68.2% (15/22, E1) versus. 72.4% (21/29, C, p = 0.46, OR 0.52, CI 0.08-3.65). CONCLUSION: Combining an encircling band with vitrectomy in patients with pseudophakic retinal detachment and inferior or multiple breaks does not significantly improve primary anatomical success in comparison to treatment with 20 G or 23/25 G vitrectomy alone.