[Bioptics with multifocal lenses and Lasek]. / Bioptics mit Multifokallinsen und Lasek.

PURPOSE: Good functional results with multifocal lenses need exact postoperative emmetropia. Therefore, it seems reasonable to perform additional refractive surgery to correct minimal spherical or cylindrical postoperative ametropia (bioptics). But concerns could arise about additional photoptic phenomena or loss of contrast. The literature contains only a few reports about bioptics after multifocal lens implantation. METHOD: In eight eyes of seven patients, laser subepithelial keratomileusis (Lasek) was done after multifocal lens implantation. Pre-Lasek and 6 months postoperatively, we performed the following examinations in addition to visual acuity: contrast sensitivity (Pelli-Robson charts), low-contrast visual acuity (Humphrey AR 570), glare visual acuity (Humphrey AR 570), and night-driving ability (Mesoptometer II, Oculus). RESULTS: Preoperative contrast sensitivity was 1.2-1.65; postoperatively it was 1.35-1.65. Low-contrast visual acuity measured 50-70% preoperatively and 57-70% postoperatively. Glare visual acuity measured 12.5-50% preoperatively and 28.5-57% postoperatively. Mesoptometer measurements did not change after Lasek; they revealed night-driving ability under strict criteria for four patients. CONCLUSIONS: Bioptics as a combination of multifocal lens implantation and Lasek does not cause a functional decline in low-contrast or glare visual acuity, but it minimizes postoperative ametropia. It seems superior to exclusive multifocal lens implantation.

[A new toric diffractive multifocal lens for refractive surgery]. / Neue torische diffraktive Multifokallinse in der refraktiven Chirurgie.

BACKGROUND: Up to now only a combination of lens and corneal surgery in the sense of bioptics could be used in refractive surgery for correcting high myopia, hyperopia or presbyopia in combination with astigmatisms. Since the summer of 2007 the first model of a toric diffractive bifocal intraocular lens is available for correcting combined refractive errors. The first results on 10 eyes from 6 patients are presented in this article. METHOD: Refractive lens exchange with implantation of a toric diffractive multifocal lens (Acri.LISA toric, Zeiss/(*)Acritec) was performed on 10 eyes from 6 patients (age 25-57 years old). Preoperatively best corrected visual acuity varied between 0.5 and 1.0 in patients with astigmatisms between 1.5 and 5.75 dpt in combination with hyperopia (one patient) or myopia. RESULTS: Postoperatively uncorrected visual acuity varied between 0.5 and 1.25 and best corrected visual acuity between 0.8 and 1.25. Postoperative refraction as spherical equivalent was 0 to +1.0 dpt with postoperative astigmatisms between 0 and 1.0 dpt. Rotational stability was found in all eyes, early postoperatively and also after 1 year. Patient satisfaction was very high. CONCLUSIONS: The new toric multifocal lens is a new option in refractive surgery. The first results are very promising but further results and a comparison to the bioptics procedure have to be awaited.

[Monocentric two-year results after phakic posterior chamber lens (PRL) implantation in myopic patients]. / Monozentrische Ergebnisse zwei Jahre nach Implantation einer phaken Hinterkammerlinse (PRL) zur Myopie-Korrektur.

PURPOSE: Some refractive procedures such as PRK or LASIK are limited by factors, including high myopia, hyperopia, or a thin cornea. For these cases, phakic intraocular lenses have been developed. Previous models have been associated with various complications, however. In order to minimize risks involved, a new phakic posterior chamber lens (PRL, IOLTECH) has been developed. Recent data suggest a considerably lower complication rate. Our two-year results are presented. MATERIAL AND METHODS: The implanted lens (PRL) is a very thin foldable lens made of highly refractive silicone. The design allows floating of the lens and avoids contact to the natural lens. It is not fixed in the ciliary sulcus. Up to now, we have implanted this lens into 56 myopic eyes of 31 patients. Preoperative refraction was within a range of -8.5 to -21.25 D (spherical equivalent = S.E). Best corrected preoperative visual acuity was between 0.3 and 1.0. Postoperative follow-up was up to 3.5 years. In this study 44 eyes with at least 2 years follow-up were included. RESULTS: Postoperative refraction was + 0.25 to - 1.0 D (SE, one patient with intended postoperative myopia). Far visual acuity without correction was 0.4 to 1.25, far visual acuity with best correction was 0.6 to 1.25. Two cataract formations were observed, one lens had to be removed due to repeated decentration. CONCLUSIONS: The PRL lens seems to be a promising choice for refractive surgery in myopic patients unfit for corneal surgery, although more results, especially long-term follow-ups are needed.