Comparison of clinical performance and subjective outcomes between two diffractive trifocal intraocular lenses (IOLs) and one monofocal IOL in bilateral cataract surgery.

BACKGROUND: To compare clinical outcomes and subjective experience after bilateral implantation of two diffractive trifocal and one monofocal intraocular lenses (IOLs). METHODS: Fourty-eight patients received bilateral implantation of the RayOne Trifocal IOL (Rayner), the AcrySof IQ PanOptix IOL (Alcon), or the AcrySof IQ SN60WF IOL (Alcon). At 1-month, 3-month, and 12-month follow-up visits, the tested outcomes were monocular and binocular uncorrected and corrected distance, intermediate at 70 cm, and near at 30 cm visual acuities, subjective refractive outcomes, defocus curves, contrast sensitivity and ocular aberrometry. Subjective patient satisfaction in terms of visual disturbance and spectacle independence was also evaluated. RESULTS: Each group comprised 32 eyes (16 patients). Refractive outcomes of RayOne and PanOptix IOLs were comparable. Both trifocal IOLs demonstrated superior visual acuity to the AcrySof monofocal IOL at near and intermediate ranges and along the defocus curves at all points other than at 0.0 D. The patient satisfaction results were comparable between the RayOne and PanOptix trifocal IOL groups. CONCLUSIONS: Both trifocals performed similarly providing good visual outcomes at all distances, demonstrating superior visual acuity compared to the monofocal IOL. Patients implanted with these trifocal IOLs reported similar levels of quality of vision and satisfaction. The RayOne trifocal and PanOptix IOLs are a valuable alternative for patients wishing to seek spectacle independence and low visual disturbances when undergoing cataract surgery.

An ultra-low-molecular-weight heparin, fondaparinux, to treat retinal vein occlusion.

Retinal vein occlusions may decrease visual acuity. There is no known therapy to treat ocular thrombosis. The authors used fondaparinux, an ultra-low-molecular-weight heparin, to treat 13 consecutive cases of recent-onset retinal vein occlusions. Two patients with renal insufficiency were not included. Eight central retinal vein occlusions and 5 branch retinal vein occlusions in 13 patients were treated with subcutaneous fondaparinux 2.5 mg once a day. The patients were seen every 2 weeks. Macular edema was treated with intravitreal injections of anti-vascular endothelial growth factor or steroids. Two patients elected to discontinue treatment. Of the remaining 11, 9 occlusions resolved in 1.5 to 13.5 months with rapid resolution of retinal edema and hemorrhage as soon as the occlusions resolved. One patient had a retinal vein that was still occluded after 8 months of therapy and 1 had retinal vein occlusion that partially resolved after 15 months of treatment. Of the 9 eyes with occlusions that resolved, visual acuity improved in 7. In 2, visual acuity decreased due to macular ischemia. Occlusion recurred in 1 2.5 months after the suspension of initial treatment. This patient is again being treated with fondaparinux 2.5 mg. No hemorrhaging occurred. Fondaparinux 2.5 mg can be given subcutaneously once a day to patients with recent-onset retinal vein occlusions without renal insufficiency. An occlusion may take a number of months to resolve. Once the vein occlusion has resolved, retinal edema and hemorrhage rapidly resolve and vision improves. Macular edema should be treated while waiting for the vein occlusion to resolve.