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Purpose: To evaluate the refractive and visual acuity outcomes when using trifocal toric intraocular lenses (IOLs), femtosecond laser assisted cataract surgery (FLACS), swept-source optical coherence tomography (SS-OCT) biometry, digital image tracking (DT) and intraoperative aberrometry (IA). Methods: This prospective, single-arm, observational study of refractive and visual outcomes included 40 eyes of 34 subjects. Preoperative biometry was performed with the Argos, FLACS and digital marking with LenSx, and IA and DT with ORA. Eyes were implanted with the Clareon PanOptix toric IOL. Study outcome measures included absolute prediction error, residual refractive astigmatism, and monocular uncorrected and distance corrected visual acuity at distance (UDVA, CDVA), intermediate (UIVA, DCIVA; 60cm), and near (UNVA, DCNVA; 40cm). Results: Mean absolute prediction error (spherical equivalent) was 0.43 ± 0.36 D, and the percentage of eyes with absolute prediction error ≤ 0.5 D was 72.5% (29/40 eyes). Mean residual astigmatism was 0.36 ± 0.65 D, and the percentage of eyes with residual astigmatism ≤ 0.5 D was 80% (32/40 eyes). Monocular UDVA, UIVA, and UNVA was 20/25 or better in 75%, 64%, and 87% of eyes respectively. Monocular CDVA, DCIVA, and DCNVA was 20/25 or better in 95%, 64%, and 87% of eyes respectively. Conclusion: The results of this study suggest that trifocal toric implantation with SS-OCT, FLACS, DT, and IA can provide excellent refractive and visual outcomes.
When the natural lens inside the eye becomes opaque (develops a cataract), it can be surgically replaced with a clear artificial intraocular lens (IOL). There are many different technologies available to the cataract surgeon in order to maximize postoperative visual outcomes with implanted IOLs. These include, modern biometers, femtosecond laser-assisted cataract surgery (FLACS), trifocal IOLs, toric IOLs, image-guided digital tracking (DT), and intraoperative aberrometry (IA). Individually, good refractive outcomes have been reported with these technologies. However, there is minimal data on outcomes using a combination of all of them. The purpose of this study was to determine the refractive and visual acuity outcomes when using modern biometers, toric IOLs, FLACS, DT, IA, and trifocal IOLs. The results of this study suggest that trifocal toric implantation with modern biometry, FLACS, DT, and IA can provide excellent refractive and visual outcomes.
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A 64-year-old man with a 2-year history of seizure disorder presented to the emergency department at an outside hospital with breakthrough seizures. What is your diagnosis?
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Purpose: This report describes the technique of utilizing a neutral density filter (NDF) during Scheimpflug imaging of a dense corneal opacity in order to increase data acquisition success and improve data reliability for densitometry analysis. Observations: A 49-year-old female with Steven-Johnson Syndrome secondary to sulfonamide use presented for routine follow up evaluation of her customized ocular surface prosthetic device (PD). Her ocular history was significant for mucous membrane grafting and limbal stem cell transplant in both eyes. The ocular surface examination of the left eye was notable for chronic dense neovascularization and scarring of the temporal and inferior cornea which extended into the visual axis. Scheimpflug imaging and densitometry analysis were performed in order to quantify the severity of the scar, however, there was significant difficulty in acquiring densitometry data. During a subsequent follow-up visit to monitor the scar, standardized room lighting and a neutral density filter were used to obtain reproducible and reliable imaging for densitometry analysis. The corneal scar was monitored over time using this standardized imaging protocol and by densitometry analysis minimal progression of the scar was evident, suggesting that recently documented significant vision loss in the left eye could not be attributed solely to changes in the scar. Conclusion and Importance: The use of a neutral density filter along with standardized ambient lighting conditions when performing Scheimpflug imaging may be necessary to reliably monitor densitometry progression of clinically severe corneal opacities.