Performance of Extended Depth of Focus Intraocular Lens in Eyes with Preexisting Retinal Disease.

INTRODUCTION: Extended depth of focus (EDOF) intraocular lens (IOL) offers improved near and intermediate vision, aiming to reduce spectacle dependence in cataract patients. This research aimed to evaluate the performance of EDOF IOL in patients with retinal pathologies following cataract surgery. METHODS: The medical charts of thirty-three eyes with retinal pathologies and 100 healthy eyes that underwent cataract extraction with implantation of an EDOF IOL and had at least 3 weeks of postoperative follow-up were retrospectively included. Patients' overall satisfaction, spectacle dependence, visual perception, and side effects were evaluated with a self-reported questionnaire. RESULTS: Mean uncorrected visual acuities (LogMAR) were significantly better in the healthy eyes compared with the eyes with retinal pathologies: 0.05 and 0.10, p = 0.011 (distance), 0.06 and 0.16, p = 0.001 (intermediate), and 0.20 and 0.28, p = 0.026 (near), respectively. No or rare use of spectacles for any distance was reported by 71% and 38% of patients, respectively (p = 0.004). Haloes/glare were reported by 17% and 23%, respectively (p = 0.556); only in 7% and 4% it was clinically disturbing (p > 0.999). The same IOL would be chosen again in 77% and 73% of patients, respectively, (p = 0.550). CONCLUSION: Patients with retinal pathologies who were implanted with an EDOF IOL demonstrated excellent distant uncorrected visual results with reasonable intermediate and near uncorrected visual results alongside high satisfaction; however, results were inferior to those of the control healthy eyes.

Hydrodissection and femtosecond laser assisted surgery in posterior polar cataract.

PURPOSE: To present our clinical experience using femtosecond laser-assisted cataract surgery (FLACS) and cortical cleavage hydrodissection in eyes with posterior polar cataract. METHODS: Medical records of consecutive10 eyes of 6 patients with clinical diagnosis of posterior polar cataract (PPC), were retrospectively reviewed. All surgeries were done by using femtosecond laser-assisted cataract surgery. In all cases careful hydrodissection was done to separate the lens material from the posterior capsule. RESULTS: There were 3 males and 3 females, ages 39-73 years (average 52.5 years), two of them were implanted with toric lenses. In all eyes hydrodissection was successfully performed and the lens material was separated from the lens capsule. The posterior capsule remained intact during nucleus removal in all cases. In one eye the posterior capsule broke during cortical cleaning and the tear was converted to posterior capsulorhexis (PCCC). No postoperative complications were recorded during follow-up in all eyes. CONCLUSIONS: Hydrodissection can be safely performed in combination (but not exclusively) with FLACS, in eyes with posterior polar cataract with no evidence of a preexisting posterior capsule rent. Hydrodissection is regarded by most surgeons as contraindicated in these eyes however apparently it is more gentile to the capsule than any other surgical maneuver and allows clean and efficient separation of the lens material from the thinned posterior capsule. Femtosecond laser capsulotomy and lens fragmentation is effective and may further assist surgery by pneumo-separation of the lens material. Anterior chamber maintainer may further aid to the stability of the chamber and safety of surgery.

Iris color as a predictive factor for intraoperative floppy iris syndrome.

PURPOSE: To assess the influence of iris color on the predisposition for intraoperative floppy iris syndrome (IFIS) during cataract surgery. METHODS: Medical records of patients who underwent cataract surgery in two medical centers between July 2019 and February 2020 were reviewed. Patients younger than 50 years, with preexisting ocular conditions affecting pupillary size or anterior chamber depth (ACD), and combined procedures were excluded. The remaining patients were questioned via telephone regarding their iris color. The association of IFIS occurrence and severity with iris color was tested using univariant and multivariant analyses. RESULTS: Overall, 155 eyes of 155 patients were included, 74 with documented IFIS and 81 without. The mean age was 74.03 ± 7.09 years, and 35.5% were female. The most common iris color among study eyes was brown (110/155, 70.97%), followed by blue (25/155, 16.13%) and green (20/155, 12.90%). Compared to brown-colored eyes, blue irises exhibited a 4.50-fold risk for IFIS (OR = 4.50, 95% CI: 1.73-11.70, p = 0.002), and green irises 7.00-fold risk (OR = 7.00, 95% CI: 2.19-22.39, p = 0.001). After adjusting for possible confounders, the results remained statistically significant (p < 0.01). Light-colored irises tended to exhibit a more severe IFIS compared to the brown iris group (p < 0.001). IFIS bilaterality was also affected by iris color (p < 0.001), with a 10.43-fold risk for fellow eye IFIS in the green iris group compared to eyes with brown irises (OR = 10.43, 95% CI: 3.35-32.54, p < 0.001). CONCLUSIONS: Light iris color was associated with a significantly increased risk of IFIS occurrence, severity, and bilaterality on univariate and multivariate analysis in this study.

Preoperative atropine and non-steroidal anti-inflammatory drugs for the prevention of intraoperative floppy iris syndrome.

PURPOSE: To examine the efficacy of preoperative administration of topical atropine 1% and non-steroidal anti-inflammatory drugs (NSAIDs) for prevention of intraoperative floppy iris syndrome (IFIS). METHODS: In this retrospective cohort study, patients who underwent cataract surgery by phacoemulsification between July 2019 and February 2020 in two hospitals were included. Both hospitals are located in central Israel, have similar patient demographics and employ similar surgical techniques. They, however, differ in policy of IFIS prevention. In Meir Medical Center no preventive medications are given pre-operatively, while in Shamir Medical Center patients at-risk for IFIS receive topical atropine 1% once daily and non-steroidal anti-inflammatory drugs (NSAIDs) thrice daily for 3 days preoperatively. RESULTS: Overall, 207 eyes of 207 patients with history of alpha-antagonist use were included. Mean age was 74.9 ± 7.8 years and 82.1% (n = 170) were male. Among patients from the pretreating center 86.8% (n = 92/106) were pre-treated with either NSAIDs or atropine preoperatively, while in the non-pretreating center no treatment was prescribed (n = 0/101). IFIS rate among the non-pretreating center was 29.7% (n = 30/101) compared to 15.1% (n = 16/106) in the pretreating center (p = 0.012). When strictly comparing treated to untreated patients, the treated group had an IFIS rate of 12.0% compared to 30.4% among untreated (p = 0.001). Adjusted for age and gender results remain consistent (odds ratio 0.329 for treated patients, 95% confidence interval: 0.150-0.720; p = 0.005). CONCLUSIONS: IFIS rates were significantly lower in the pretreating center compared to the non-pretreating center. When comparing strictly treated to untreated patients, differences were even more pronounced.

Trans-optic suture fixation of malpositioned intraocular lenses.

PURPOSE: To report a technique for fixating posterior chamber intraocular lenses (PCIOLs) to the sclera by passing sutures through the lens material. METHODS: Cases in which PCIOLs were fixated to the sclera using trans-optic sutures were included in this series. Intra and post-operative complications were recorded, and lens position was assessed using slit-lamp examination. RESULTS: Fourteen cases were included in this series. In nine cases, the procedure was performed using 9-0 polypropylene in pseudophakic eyes to correct subluxation, centration, tilt or to replace a broken haptic. In five cases, this technique was used for primary PCIOL fixation using a flanged 6-0 polypropylene suture in aphakic eyes. In all cases, the lenses remained centered and stable at the end of follow-up, and no post-operative complications occurred. CONCLUSION: Trans-optic suturing is a safe and effective alternative method for fixation of IOLs in a variety of pseudophakic and aphakic clinical scenarios.

Pars plana vitrectomy for posteriorly dislocated intraocular lenses: risk factors and surgical approach.

PURPOSE: To present updated risk factors, anatomical and visual outcomes and a surgical approach to posteriorly dislocated intraocular lenses (IOL). METHODS: A retrospective case series review of patients presenting with posteriorly dislocated IOL to the vitreous was performed. All cases were managed surgically with pars plana vitrectomy (PPV) followed by IOL repositioning and refixation or IOL exchange. Clinical characteristics, risk factors for IOL dislocation, visual outcomes and intraoperative and postoperative complications were investigated. RESULTS: Forty patients with posteriorly dislocated IOL underwent 3-port PPV and lens retrieval at an average of 6.5 years after cataract surgery. The main causes of IOL dislocation were previous PPV, myopia, pseudoexfoliation syndrome, ocular trauma and recurrent intravitreal injections. The existing IOL was repositioned and secured in 90% of the cases. Visual acuity improved in 34 patients, maintained in 5 and deteriorated in 1. All IOLs were central and stable at final follow-up. CONCLUSION: Posterior intraocular lens dislocation is becoming more prevalent. The main underlying causes found in this series were previous vitrectomy, myopia and recurrent intra-vitreal substance injections. Visual acuity improved in most cases after lens repositioning; however visual outcome is often limited due to associated ocular co-morbidities despite adequate lens position. Despite complete lack of zonular support, a posteriorly dislocated IOL can often be preserved by repositioning and fixation of the lens in the posterior chamber. Pathologies primarily associated with this type of lens malposition include history of vitrectomy, high myopia and multiple intravitreal substance injections.

[NEW LENSES IN MODERN CATARACT SURGERY].

INTRODUCTION: During cataract surgery the natural opaque crystalline lens is replaced by an artificial intraocular lens that compensates for the optical loss following lens removal. The conventional intraocular lens is mono-focal and necessarily requires spectacle correction for the clear vision at various foci in the same eye. In recent years a variety of intraocular lenses were developed including multifocal (bifocal and trifocal), "toric" lenses to correct corneal astigmatism, lenses with extended depth of focus and their combinations. Modern cataract surgery not only enables the correction of quality of vision but also enhances quality of life and eliminates spectacle dependence following surgery at all distances; far, intermediate and near.

Characteristics of orbital lymphoma: a clinicopathological study of 26 cases.

OBJECTIVE: Evaluation of the medical data of patients with orbital and adnexal lymphoma. DESIGN: Cohort study of all cases diagnosed with orbital or adnexal lymphoma at Meir Medical Center between 1993 and 2007. PARTICIPANTS: Twenty-six patients, with intraorbital or subconjunctival masses with orbital involvement, were examined and followed up between 1 and 8 years. MATERIALS AND METHODS: Examined data included: clinical presentation, age, gender, imaging, tumor location, surgical management, and pathological diagnosis. RESULTS: Presenting signs and symptoms included proptosis, eyelid lesions, tearing, chemosis, decreased visual acuity, ptosis, pain, squint, and optic nerve compression. In five cases, lymphoma was misdiagnosed on neuroimaging. Bone changes were seen in four patients. All cases were B cell lymphomas; with the majority (22 cases) of small B cell type; consisting of primary extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue and two cases of small cell lymphoma. One small cell lymphomas was of follicular type on a background of CLL, and the other was CLL/SLL type. Fourteen cases were primary orbital disease, and 12 cases were systemic disease. Macroscopic appearance of lymphoma at open biopsy was characteristic in most cases. Flow cytometry phenotyping gave rapid reliable diagnosis of the disease. CONCLUSIONS: Epiphora or chemosis in the presence of an orbital mass should alert the ophthalmologist to suspect lymphoma. Lymphoma may be easily misinterpreted on neuroimaging for other diseases. Bone changes seen on CT are more common than is generally perceived. Macroscopic appearance at open biopsy was characteristic.

Wound temperature profiles of coaxial mini-incision versus sleeveless microincision phacoemulsification.

BACKGROUND: Temperature profiles at the corneal wound of coaxial mini-incision (2.4 mm) cataract surgery and sleeveless microincision (1.1 mm) cataract surgery were compared. DESIGN: Prospective, controlled, paired-eye clinical trial conducted in a tertiary care hospital. PARTICIPANTS: Twenty patients with mild-to-moderate bilateral nuclear sclerotic cataract. METHODS: Twenty patients underwent bilateral cataract surgery within a 1-month period. One eye was operated on by conventional coaxial mini-incision (2.4 mm) phacoemulsification. The second eye underwent microincision surgery by using a naked phacoemulsification tip and a specialized 19-gauge anterior chamber maintainer as the sole fluid source (three-port microincision cataract surgery technique). Patients had moderate bilateral cataracts with no other anterior segment pathology. Temperature at the corneal wound was constantly recorded by using infrared thermal imaging. MAIN OUTCOME MEASURES: Temperatures at the corneal wound. RESULTS: Mean temperatures at the corneal surgical wound were not significantly different between the coaxial and sleeveless groups (31.1 °C ± 2.3 vs. 31.0 °C ± 2. 0; P = 0.89). There was also no difference in maximum temperatures reached during phaco-emulsification. Temperatures did not rise above 40 °C during any surgery, and there were no corneal burns. Final visual acuity and intraoperative and postoperative complication rates were similar between the two groups. CONCLUSIONS: The temperature profile at the surgical wound using a microincisional sleeveless phacoemulsification technique is comparable with that of the conventional coaxial mini-incision method.

Modified corneal incisions in intraoperative floppy iris syndrome (IFIS)-prone patients.

BACKGROUND: We aimed to report a simple technique that involves modified anterior (to the limbus) elongated corneal incisions in order to reduce the incidence and severity of intraoperative floppy iris syndrome (IFIS) and related complications. METHODS: This was a retrospective study of phacoemulsification cataract surgeries performed by a single surgeon on patients receiving tamsulosin or alfuzosin between 1 January 2009 and 31 July 2012 at Meir Medical Center, Kfar-Sava, Israel. We recorded preoperative gender, age, α-antagonist medication, coexisting pseudoexfoliation (PXF), and intraoperative use of ophthalmic viscosurgical devices (OVDs), pupil size, complications, IFIS grading and the need for additional operative strategies to manage IFIS. Elongated corneal incisions were performed approximately 1 mm anterior to the limbus. RESULTS: Ninety-three eyes of 81 men were included. Mean age was 76.5 years (range 55 to 96 years). Forty-seven eyes (40 patients) had documented use of alfuzosin and 45 eyes (40 patients) of tamsulosin. One patient received both. The overall rate of IFIS was 22.6 % (n = 21). Eyes of patients who were treated with alfuzosin had a milder grading (p < 0.001) and an overall lower percentage of IFIS compared to tamsulosin (4.26 % versus 42.22 % respectively, p < 0.001). No additional strategies were used to manage IFIS during surgery. No intraoperative complications occurred. CONCLUSION: Anterior elongated incisions are simple and efficient in preventing IFIS, exempting the surgeon from the use of additional expensive devices or materials in most cases. They do not limit the surgeon to one strategy, and therefore, if necessary, another may be applied at any given time.

Ocular Paintball Injuries.

UNLABELLED: Background: One of the most alarming ocular injury trends in recent years has been the proliferation of paintball guns and the proportional increase in the number of ocular eye injuries caused by paintballs. OBJECTIVES: To describe five cases of paintball eye injuries that resulted in loss of functional vision in four of them. METHODS: We conducted a retrospective review of the clinical course in five patients with paintball eye injuries treated in the ophthalmology departments of two medical centers. RESULTS: Five young males were evaluated for paintball injuries caused by blunt trauma. There was one case of full-thickness laceration (globe rupture). Four patients required one to five surgical interventions: three of these involved the removal of traumatic cataract including two eyes with significant zonular dehiscence treated by lens capsule conservation using anchoring devices, one retinal surgery and two glaucoma filtration surgeries. However, final visual outcome was not favorable due to irreversible retinal damage. CONCLUSIONS: Paintball trauma often results in significant ocular injury and loss of functional vision despite successful surgical intervention. Most injuries occur in under-supervised settings and are easily preventable. Improved safety measures, strict regulation enforcement and appropriate public education could prevent such serious damage.

Surgically induced astigmatism assessment: comparison between three corneal measuring devices.

PURPOSE: To compare the findings of three corneal measuring devices for calculating surgically induced astigmatism (SIA) during cataract extraction. METHODS: Patients' records were retrospectively reviewed to identify patients who had corneal astigmatism measurements before and at least 1 month after cataract surgery through 2.4-mm corneal incisions by all three tested devices (Lenstar LS900, Haag-Streit, Koeniz, Switzerland; IOLMaster 500, Carl Zeiss Meditec, Dublin, CA; and Atlas topographer, Carl Zeiss Meditec). Vector analysis was used to calculate the SIA for each measuring device. RESULTS: Seventy eyes of 49 patients were included. All three measuring devices had similar SIA results: the median SIAs were 0.45 diopters (D) for the Lenstar, 0.41 D for the IOLMaster, and 0.47 D for the Atlas topographer (P = .884). CONCLUSIONS: The three evaluated anterior corneal measuring devices produced similar results in measuring SIA. [J Refract Surg. 2015;31(4):244-247.].

Accuracy of predicted refraction with multifocal intraocular lenses using two biometry measurement devices and multiple intraocular lens power calculation formulas.

BACKGROUND: To evaluate the accuracy of predicted refraction using multifocal intraocular lenses (IOLs) with power calculation based on two biometric devices and multiple IOL power calculation formulas. DESIGN: A retrospective study conducted in a private practice ophthalmology clinic. PARTICIPANTS: Seventy-three eyes of 48 patients were evaluated. METHODS: Consecutive cases of eyes that had undergone successful cataract surgery with an implantation of a multifocal IOL (SN6AD1, Alcon Laboratories, Inc., Fort Worth, TX, USA) by a single surgeon were enrolled. Patients were meticulously screened for suitability for a multifocal IOL implantation according to our clinic guidelines. Two biometric measurement devices (IOLMaster-500 [Carl Zeiss Meditec AG, Jena, Germany] and Lenstar-LS900 [Haag-Streit AG, Koeniz, Switzerland]) were used under strict validation criteria to evaluate the predicted refraction errors for the Holladay 1, SRK/T, Hoffer Q, Haigis, Holladay 2, Barrett Universal II and Olsen formulas. MAIN OUTCOME MEASURES: Predicted refractive sphere equivalent (RSE) errors. RESULTS: The measurements obtained from the two biometric devices were highly correlated. The standard deviation of the error in predicted RSE and the median absolute error were similar for the IOLMaster and the Lenstar devices using all formulas, ranging from 0.27 dioptres (D) to 0.31D and from 0.15D to 0.21D, respectively. A high percentage of eyes had an error in predicted RSE within ±0.5D from target refraction, ranging from 86.3% to 93.2%. CONCLUSIONS: High accuracy can be achieved in multifocal IOL power calculations by appropriate patient selection, precise biometry and appropriate IOL calculation formulas.

Establishment of a Registry to Monitor Trends in Cataract Surgical Procedures and Outcomes in Israel, 1990-2014.

BACKGROUND: Cataract extraction is the most commonly performed ophthalmic surgical procedure. There is no registry for documenting cataract surgical procedures and the overall risk of its complications overtime in Israel. OBJECTIVES: To present trends in the number and type of selected parameters associated with cataract surgical procedures in Israel between 1990 and 2014. METHODS: Questionnaires had been sent annually to all surgical centers in which cataract surgery was performed in Israel during the study period. The trends that were investigated included annual rates, surgical sites, surgical techniques, use of an intraocular lens (IOL), and type and rates of postoperative endophthalmitis (POE). RESULTS: A total of 812,112 cataract surgical procedures were reported during the 25 year study period. Responses to the questionnaire increased from 75% in 1990 to 100% in 2006 onwards. The annual number of reported cataract surgical procedures increased from 16,841 (3.5 per 1000) in 1990 to 57,419 in 2014 (6.9 per 1000), representing an increase of 197%. There was a shift from performing the surgery in the public health system to private medical centers. The surgical technique changed from predominantly manual extracapsular cataract extraction (56% in 1999) to predominantly phacoemulsification (98.7% in 2014). POE rates decreased from 0.25% in 2002 to 0.028% in 2014. CONCLUSIONS: There was a continuous increase in the rate of surgical cataract procedures, and more were performed in private medical facilities. There was also a major shift towards advanced cataract procedures and a decreased rate of POE.

[UPDATE ON CATARACT EXTRACTION SURGERY AND INTRA-OCULAR LENS IMPLANTATION].

Cataract extraction and intra-ocular lens (IOL) implantation is one of the most prevalent surgical interventions worldwide. In Israel more than 50,000 procedures were performed in 2013. The progress in cataract surgery is dual, including the surgical technique of the crystalline lens removal along with developments in IOL structure and optic characteristics. This review focuses on new techniques in cataract surgery and modern types of IOLs for implantation.

Gonioscopy-assisted transluminal trabeculotomy (GATT) with scleral or iris fixation for subluxated intraocular lenses and glaucoma.

INTRODUCTION: This retrospective chart review aims to report a combined surgical approach of intraocular lens (IOL) fixation and gonioscopy-assisted transluminal trabeculotomy (GATT) for the treatment of subluxated IOLs and glaucoma or ocular hypertension. METHODS: Charts of patients who underwent IOL fixation combined with GATT between November 2019 and July 2023 were reviewed. The main outcome measure was surgical success, defined as a well-centered IOL and an IOP of 18 mmHg or lower and either a 30% IOP reduction or a reduction in medications as compared to baseline. Complications and the need for reoperation were recorded. RESULTS: Eleven patients who underwent GATT with IOL fixation were included. The mean age was 80.45 years (range: 73-90). IOL subluxation was associated with pseudoexfoliation in all cases. Seven patients underwent scleral fixation, and four underwent iris fixation. The mean follow-up was 15.36 (range: 2.7-26.6) months. The success rate was 72.73%. The mean baseline IOP was 20.63 ± 6.56 mmHg on 2.81 ± 1.53 medications. Four patients were on oral carbonic-anhydrase inhibitor (CAI) before surgery. The mean IOP at the end of the follow-up was 13.86 ± 3.5 mmHg on 1.36 ± 1.57 medications, and none were on oral CAIs. No intraoperative complications occurred, and transient hyphema and vitreous hemorrhage were the most common postoperative complications. All patients had a well-centered IOL. No patients needed additional surgery for IOL position or IOP control. The mean corrected distance visual acuity was 0.634 ± 0.62 logMAR at baseline and 0.36 ± 0.38 at the end of follow-up. CONCLUSIONS: GATT can be combined with IOL fixation to the sclera or iris to effectively reduce IOP and medication usage.

Preclinical safety and stability study of a next generation telescope prosthesis for end-stage macular degeneration.

BACKGROUND: To assess the surgical procedure, safety and stability of a next generation injectable telescope prosthesis in a rabbit model. METHODS: After removal of the crystalline lenses of eight New Zealand White rabbits, the next generation device was randomly implanted in one eye, and the available telescope prosthesis (Normal device) was implanted in the fellow eye. Operative parameters (incision, capsulorrhexis size and operative time), intraoperative and postoperative complications rates, endothelial cell density changes and the distance between the corneal endothelium and the telescope (central clearance distance) were measured and compared between the groups. RESULTS: Incision size and capsulorrhexis size were smaller, and operative time was shorter in the next generation group in comparison with the Normal group. No difference was found in the intraoperative and postoperative complication rates between the groups. Endothelial cell density loss observed in the next generation group was less than the loss in the Normal group, but the difference was not significant statistically. The central clearance distance was significantly larger in the next generation group in comparison with the Normal group (P = 0.001). CONCLUSIONS: The next generation telescope was implanted through a smaller incision, with a shorter surgical time and a larger central clearance distance in the rabbit eyes, in comparison with the Normal group. The next generation device may allow reduced trauma to the corneal endothelium, better control during surgery and induce less astigmatism while preserving the optical advantages of the Food and Drug Administration-approved telescope prosthesis.

Femtosecond Laser Capsulotomy in Previous Radial Keratotomy.

PURPOSE: The aim of this study was to describe clinical experience using femtosecond laser-assisted anterior capsulotomy in eyes with previous radial keratotomy. METHODS: Eyes of patients with previous radial keratotomy and cataract-related vision impairment who underwent phacoemulsification and intraocular lens implantation were retrospectively reviewed. Eyes with any vision impairment cause other than cataract or previous radial keratotomy were excluded. RESULTS: Sixteen postradial keratotomy eyes were included. In 5 patients, manual anterior capsulectomy was successfully performed. Six eyes underwent femtosecond laser capsulotomy using routine parameters (incision depth 500 µm and 4 µJ power), of which in 3 eyes capsulotomies were complete, whereas in the other 3 eyes incomplete capsulotomy was evident. In 3 patients, both incision depth and power parameters were doubled (incision depth 1000 µm and 8 µJ power), whereas in 2 patients, only the pulse energy was doubled (8 µJ power) and in all 6 cases, the capsulotomy was successfully completed. At the last follow-up, all capsulotomies were intact without radial tears, and the intraocular lenses were stable and central. CONCLUSIONS: Radial corneal scars after previous radial keratotomy may interfere with femtosecond laser-assisted anterior capsulotomy using routine parameters. Surgeons should be alert and ready to convert to manual anterior capsulectomy. Modification of the laser parameters may overcome this potential complication.

Clinical outcomes of presbyopia-correcting intraocular lenses in patients with Fuchs endothelial corneal dystrophy.

Fuchs endothelial corneal dystrophy (FECD) is considered a contraindication for the implantation of presbyopia-correcting IOLs, without sufficient corroborating evidence. A Retrospective, case-control study. Nineteen eyes of ten patients with grade 2-5 FECD (study group) and 57 healthy eyes of 57 patients (control group) who underwent cataract surgery with implantation of presbyopia-correcting IOLs, at the Ein-Tal Eye Center, Tel Aviv, Israel, were included. The target refraction was emmetropia for both groups. Two subgroups of IOLs were analyzed separately: extended depth of focus (EDOF), (9 eyes of FECD patients and 27 eyes of control patients) and multifocal IOLs (10 eyes of FECD patients and 30 eyes of control patients). Main outcome measures were visual acuity and refraction 6 weeks after the surgery. Secondary outcomes were patient perceptions of visual acuity, spectacle independence, photic phenomena and satisfaction scores, reported in a self-assessment questionnaire. FECD patients in the EDOF IOL subgroup had inferior uncorrected distance visual acuity (P = 0.007) and better uncorrected near visual acuity (P = 0.001) compared to the controls. They had less spectacle independence for the intermediate range (P = 0.01) and overall (P = 0.006). However, they did not have more photic phenomena. In the multifocal IOL subgroup, no significant differences were found between the FECD and the control group in visual acuity for all ranges and in spectacle independence. FECD patients had more photic phenomena than the controls (P = 0.006), but it did not interfere with daily life activities. There was no difference in post-operative mean spherical equivalent, patient reported visual perception, and general satisfaction between FECD and control patients in both groups. Our results suggest that presbyopia-correcting IOLs can be carefully considered in patients with grade 2-5 FECD, with slightly inferior results compared with healthy eyes.

Clinical Outcomes of Toric Intraocular Lenses in Patients with Fuchs Endothelial Corneal Dystrophy.

INTRODUCTION: Implantation of toric intraocular lenses (IOLs) in patients with Fuchs endothelial corneal dystrophy (FECD) is still considered relatively contraindicated, without sufficient clinical evidence. Therefore, this study was designed to evaluate the results of toric IOL implantation in patients with FECD. METHODS: A retrospective case-control study of 28 eyes of FECD patients and 84 eyes of healthy control patients who received toric IOLs during routine cataract surgery was performed. The outcome measures were uncorrected and corrected distance visual acuity, spherical equivalent, and refractive residual astigmatism. RESULTS: The mean postoperative uncorrected and corrected distance visual acuity in the FECD eyes compared to the control eyes were 0.15 ± 0.14 vs. 0.13 ± 0.17, respectively (P = 0.32), and 0.05 ± 0.08 vs. 0.06 ± 0.10, respectively (P = 0.95). The spherical equivalent in the FECD eyes compared to the control eyes was - 0.29 ± 0.43 vs. - 0.21 ± 0.50, respectively (P = 0.19). The preoperative corneal centroid astigmatism in the FECD eyes compared to the control eyes was 0.85 D@93° ± 2.42° vs. 0.23 D@68° ± 2.50°, respectively (P = 0.43), and the mean preoperative corneal astigmatism magnitude was 2.26 ± 1.1 D vs. 2.28 ± 1.03 D, respectively (P = 0.82). A trend toward higher postoperative refractive centroid astigmatism was found in the FECD eyes compared with the control eyes: 0.24 D@28° ± 0.57° vs. 0.03 D@127° ± 0.53°, respectively (P = 0.09). However, the mean refractive astigmatism magnitude was similar in FECD eyes and the healthy control eyes: 0.52 ± 0.31 D vs. 0.42 ± 0.31 D, respectively (P = 0.44) (D diopters). CONCLUSION: The postoperative refractive astigmatism (both centroid astigmatism and mean magnitude astigmatism) was no higher than 0.52 D in both groups. Therefore, FECD patients without corneal edema can be considered for toric IOLs.