Higher-order aberrations after implantation of iris-fixated rigid or foldable phakic intraocular lenses.

PURPOSE: To evaluate higher-order aberrations (HOAs) after implantation of Artiflex phakic intraocular lenses (pIOLs). SETTING: Department of Ophthalmology, Academic Hospital Maastricht, Maastricht, The Netherlands. METHODS: This retrospective comparative case series comprised 27 eyes (14 patients) that had Artiflex pIOL implantation and 22 eyes (13 patients) that had Artisan pIOL implantation. Refractive data, pupil size, IOL decentration, and HOA values were recorded and compared. Laboratory analysis was performed. Follow-up was 1 year. RESULTS: In the Artiflex group, the mean spherical equivalent (SE) changed from -9.95 diopters (D) +/- 1.43 (SD) (range -6.75 to -12.13 D) to -0.30 +/- 0.53 D (range -1.94 to 0.56 D). Postoperatively, trefoil-y increased (increase factor 1.73) and spherical aberration decreased (increase factor 0.55). The mean pIOL decentration was 0.24 +/- 0.12 mm; 96.3% were decentered 0.5 mm or less. There was a significant correlation between pIOL decentration and postoperative spherical aberration and coma-y. In the Artisan group, the mean SE changed from -9.90 +/- 2.74 D (range -4.00 to -14.50 D) to -0.20 +/- 0.42 D (range -0.75 to 0.50 D). Postoperatively, trefoil-y and spherical aberration increased (increase factors 3.32 and 6.84, respectively). Laboratory analysis confirmed the negative and positive spherical aberration profile of the Artiflex pIOL and Artisan pIOL, respectively. CONCLUSIONS: Artiflex pIOL implantation decreased spherical aberration, while Artisan pIOL implantation increased spherical aberration. Trefoil-y increased in both groups. These changes might be explained by incision size differences in relation to trefoil and differences in optic design in relation to spherical aberration.

Artisan iris-fixated toric phakic and aphakic intraocular lens implantation for the correction of astigmatic refractive error after radial keratotomy.

We report 2 patients who had radial keratotomy (RK) to correct myopia. The first patient developed a postoperative hyperopic shift and cataract. Nine years post RK, she had intracapsular cataract extraction and implantation of an Artisan aphakic intraocular lens (IOL). Twenty years post RK, hyperopia and astigmatism progressed to +7.0 -5.75 x 100 with a best corrected visual acuity (BCVA) of 20/20. Due to contact lens intolerance, the Artisan aphakic IOL was exchanged for an Artisan toric aphakic IOL. Three months later, the BCVA was 20/20 with +1.0 -0.50 x 130. The second patient demonstrated residual myopic astigmatism 6 years after bilateral RK and had become contact-lens intolerant. An Artisan toric phakic IOL was implanted in both eyes. Four months later, the BCVA was 20/25 with a refraction of +0.25 -1.0 x 135 and 20/20 with a refraction of -1.0 x 40. Both patients were satisfied with the visual outcomes.

Functional outcome and patient satisfaction after Artisan phakic intraocular lens implantation for the correction of myopia.

PURPOSE: To determine patient satisfaction after Artisan phakic intraocular lens (PIOL) implantation to correct myopia. DESIGN: Non-comparative prospective case series. METHODS: One hundred twenty eyes of 60 patients who had undergone Artisan PIOL implantation to correct myopia were analyzed. A validated questionnaire that consisted of 66 satisfaction items were self-administered by patients 12 months after surgery. Clinical parameters (PIOL decentration, the difference between pupil size and PIOL optical zone, and optical aberrations) were measured. Main outcome measures of satisfaction scale scores (global satisfaction, quality of uncorrected and corrected vision, night vision, glare, day and night driving) were analyzed. Correlations with clinical parameters were obtained. RESULTS: After surgery, 98.3% of patients were satisfied, and 73.3% of patients considered their night vision to be the same or better; 44.1% of patients reported more bothersome glare. The night vision score correlated with spheric aberration (r = -0.303; P = .020). The glare score correlated with the difference between scotopic pupil size and PIOL optical zone (r = -0.280; P = .030) and vertical coma (r = -0.337; P = .009). The night driving score correlated with postoperative spheric equivalent (r = 0.375; P = .009), total root mean square aberrations (r = -0.337; P = .017), higher order root mean square aberrations (r = -0.313; P = .027), and vertical coma (r = -0.297; P = .036). CONCLUSION: Overall satisfaction after Artisan PIOL implantation for myopia is excellent. The quality of night vision and night driving were related to scotopic pupil size, individual higher order aberrations, and residual refractive error.

Recurrent intraocular inflammation after implantation of the Artiflex phakic intraocular lens for the correction of high myopia.

We describe a 54-year old man who developed a severe cell deposition 1 week after implantation of a foldable Artiflex phakic intraocular lens (pIOL) (Ophtec B.V.) with a silicone optic and poly(methyl methacrylate) (PMMA) haptics in the left eye for the correction of high myopia. Nine months after implantation, many cell deposits remained visible on the posterior surface of the IOL, causing severe glare, especially during daylight conditions. We explanted the Artiflex pIOL and exchanged it for a PMMA Artisan pIOL. One month after the exchange, the uncorrected visual acuity was 20/20 and the patient's glare complaints had disappeared. Slitlamp examination showed no signs of inflammation in the anterior segment or cell deposits on the PMMA Artisan pIOL. Scanning electron microscopy demonstrated multiple cell deposits on the explanted Artiflex pIOL.

Evaluation of pupil dynamics after implantation of artisan phakic intraocular lenses.

PURPOSE: To compare pre- and postoperative horizontal and vertical pupil diameters after horizontal Artisan phakic intraocular lens (PIOL) (Ophtec BV, Groningen, The Netherlands) implantation for correction of myopia. METHODS: The pre- and postoperative scotopic pupil diameters measured by the Colvard pupillometer (Oasis Medical, Glendora, Calif) were compared in 71 eyes after Artisan PIOL implantation (Artisan Colvard group). Analysis of pupil shape (vertical vs horizontal diameter, V/H ratio) after horizontal Artisan PIOL implantation was performed with the Procyon pupillometer (Procyon Instruments Ltd, London, United Kingdom) in 121 eyes (Artisan Procyon group) under scotopic, mesopic-low, and mesopic-high conditions and compared to an age- and refraction-matched control group of 121 eyes of refractive surgery candidates (Procyon control group). RESULTS: After horizontal Artisan PIOL implantation, the mean horizontal pupil diameter decreased from 6.231 +/- 0.70 mm preoperatively to 5.34 +/- 0.68 mm postoperatively in the Artisan Colvard group (P < .01). The mean horizontal scotopic diameter was 5.60 +/- 0.66 mm, the mesopic-low diameter was 4.94 +/- 0.71 mm, and the mesopic-high diameter was 3.98 +/- 0.54 mm for the Artisan Procyon group. The mean horizontal scotopic diameter was 6.29 +/- 0.91 mm, the mesopic-low diameter was 5.40 +/- 0.96 mm, and the mesopic-high diameter was 4.16 +/- 0.80 mm in the Procyon control group. A significant increase was noted in V/H ratio under scotopic, mesopic-low, and mesopic-high conditions from 1.02, 1.02, and 1.01, respectively, in the Procyon control group to 1.17, 1.12, and 1.06, respectively, in the Artisan Procyon group (P < .01). CONCLUSIONS: Horizontal pupil size was significantly decreased after horizontal Artisan PIOL implantation and might be attributed to a mechanical restriction of the iris in the horizontal meridian.

Functional outcomes and patient satisfaction after laser in situ keratomileusis for correction of myopia.

PURPOSE: To determine subjective patient satisfaction and self-perceived quality of vision after laser in situ keratomileusis (LASIK) to correct myopia and myopic astigmatism. SETTING: Department of Ophthalmology, Academic Hospital Maastricht, Maastricht, The Netherlands. METHODS: A validated questionnaire consisting of 66 items was self-administered by 142 consecutive patients. Seven scales covering a specific aspect of quality of vision were formulated. Aspects included global satisfaction, quality of uncorrected and corrected vision, quality of night vision, glare, daytime driving, and night driving. Main outcome measures were responses to individual questions and scale scores, and correlations with clinical parameters including refractive outcome, uncorrected visual acuity, best corrected visual acuity, ablation depth, and scotopic pupil-optical zone disparity were obtained. RESULTS: The mean score for the overall satisfaction was 4.1 +/- 0.71 (SD) (scale 0 to 5.0). A total of 92.2% of patients were satisfied or very satisfied with their surgery, 93.6% considered their main goal of surgery achieved, and 92.3% would choose to have LASIK surgery again. Satisfaction with uncorrected vision was 3.03 +/- 0.71. The mean score for glare was 3.0 +/- 0.9. At night, glare from lights was believed to be more important than before surgery by 47.2%. Glare from oncoming car headlights after surgery was reported by 58.4% and was believed to be more bothersome for night driving than before surgery by 52.8%. Night driving was rated more difficult than before surgery by 39.4%, whereas 59.3% had less difficulty driving at night. There was a significant correlation between the uncorrected vision score and the postoperative spherical equivalent (r = 0.245) and postoperative astigmatism (r = 0.265). There was no correlation between the glare or night vision scores and the degree of correction, the amount of ablation depth, or the disparity between the scotopic pupil and the optical zone. CONCLUSIONS: Self-perceived uncorrected vision after LASIK surgery for the correction of myopia and myopic astigmatism appears to be very good and is related to the postoperative residual error. Although the majority of patients postoperatively experienced glare, particularly with driving at night, this was not related to the pupil-optical zone disparity or degree of correction.

Wavefront-guided versus standard laser in situ keratomileusis to correct low to moderate myopia.

To evaluate the 6-month refractive outcomes of wavefront-guided laser in situ keratomileusis (LASIK) (Zyoptix, Bausch & Lomb) versus standard LASIK (PlanoScan, Bausch & Lomb). Department of Ophthalmology, University Hospital Maastricht, Maastricht, The Netherlands. In a prospective randomized study, 12 patients with myopia had Zyoptix wavefront-guided LASIK in 1 eye and PlanoScan LASIK in the contralateral eye. The safety, efficacy, predictability, stability, optical zone size, and ablation depth were evaluated. The mean preoperative spherical equivalent (SE) of the subjective manifest refraction was -3.88 diopters (D) +/- 1.92 (SD) (Zyoptix) and -4.35 +/- 2.11 D (PlanoScan). Six months postoperatively, 8% of PlanoScan patients and 16% of Zyoptix patients gained at least 2 lines of best corrected visual acuity; the safety index was 1.12 in the Zyoptix group and 1.08 in the PlanoScan group. An SE of +/-1.00 D and +/-0.50 D was achieved by 100% and 92%, respectively, in both groups. There were 2 undercorrections in the Zyoptix group and 1 undercorrection in the PlanoScan group. In the Zyoptix group, 100% had a UCVA of 20/40 and 67% of 20/20 and in the PlanoScan group, 100% and 83%, respectively. The efficacy index was 0.87 and 0.93 in the Zyoptix group and PlanoScan group, respectively. The mean optical zone 6 months postoperatively was 6.16 +/- 0.34 mm in the PlanoScan group and 6.23 +/- 0.41 mm in the Zyoptix group (P =.67). The ablation depth per diopter of defocus equivalent was 13.5 +/- 4.6 microm/D and 8.6 +/- 4.4 microm/D, respectively (P =.01).An excellent safety index was achieved with the Zyoptix and PlanoScan treatments. The efficacy index was marginally lower for Zyoptix treatments as a result of 2 undercorrections. The ablation depth in the Zyoptix group per diopter of defocus equivalent was significantly lower than in the PlanoScan group. Further refinements in defining the ablation algorithms may increase the efficacy index.

Postoperative management and follow-up after corneal flap loss following laser in situ keratomileusis.

We present 3 cases of flap loss within 2 weeks of unilateral laser in situ keratomileusis. In all patients, spontaneous regeneration of the epithelial layer, covering the ablated stroma, was expected. In 2 patients, the best spectacle-corrected visual acuity recovered to 20/25 within 6 months and in 1 patient, a contact lens was fitted 6 months after the accident, restoring visual acuity to 20/25. The 6-month follow-up and the contact lens fitting technique are described.

Recovery of the visual acuity in a family with Reis-Bückler dystrophy.

BACKGROUND: The hereditary Reis-Bückler dystrophy is one of the anterior localised corneal dystrophies with superficial reticulated opacities, sometimes in combination with recurrent attacks of corneal erosion. Phototherapeutic keratectomy (PTK) is now the first method to consider for managing this disease when intervention is required. METHODS: We treated six eyes of four related patients with Reis-Bückler dystrophy, who had a demonstrable reduction in visual acuity due to corneal opacities within their virgin corneas (three eyes), penetrating (one eye) or lamellar (two eyes) grafts. We present the results of change in visual acuity and best corrected spherical spectacle and contact lens refraction at 1 year following surgery. In one case, we had to fit a rigid contact lens to correct the hyperopic shift which caused anisometropia. RESULTS: The mean spherical refractive change 1 year after PTK surgery was 0.33+/-S.D., 1.8D. A hyperopic shift was observed in four eyes. Visual acuity remained stable in all patients 1 year after surgery. The central corneal area remained clear, and mean best spectacle corrected visual acuity improved from +0.8 logMAR before PTK to +0.15 logMAR after 1 year. There was no significant change (P>0.8) between the mean 1 year best spectacle corrected visual acuity (+0.125 log MAR +/- S.D. 0.15) and the best contact lens corrected visual acuity (+0.108 log MAR +/- S.D. 0.16). After fitting a contact lens in one patient to correct anisometropia, the hyperopic shift did not change significantly during 12 months of follow-up. It was not necessary to adjust the lens parameters. One patient required cataract surgery. CONCLUSION: PTK corneal surgery is the treatment of first choice when intervention is required in patients with Reis-Bückler dystrophy because it is safe and much less invasive than lamellar or penetrating keratoplasty. Contact lens fitting following PTK has not changed corneal shape.