ABSTRACT
INDICATIONS: The operation is carried out to exchange previously implanted intraocular lenses (IOL) because of deviation from the target refraction with aniseikonia and anisometropia, in cases of contact lens intolerance, dissatisfaction with the IOL due to side effects and particularly problems with multifocal lenses. OBJECTIVE AND PRINCIPLES: The aim of this surgical approach is to retain the original implantation site of the exchange lens and capsular bag integrity with maximum sparing of the zonular fibers and secondary IOL implantation with stable positioning for fine adjustment of residual refractive errors. OPERATIVE TECHNIQUE: Using a non-astigmatic approach the primary IOL is first mobilized and removed. A light-adjustable IOL is then implanted in the capsular bag and residual refractive errors in the visual axis are adjusted using profiled UV light. The surgical technique is demonstrated in detail with the help of a video of the operation, which is available online. RESULTS: Residual postoperative deviations from the target refraction of sphere and cylinder up to 2 diopters can be precisely adjusted noninvasively. Individual alterations of asphericity can provide stable distance visual acuity while enhancing near and intermediate visual acuity.
Subject(s)
Device Removal/methods , Lens Implantation, Intraocular/methods , Lenses, Intraocular , Monitoring, Intraoperative/methods , Device Removal/instrumentation , Humans , Lens Implantation, Intraocular/instrumentation , Monitoring, Intraoperative/instrumentation , Treatment OutcomeSubject(s)
Artificial Lens Implant Migration/etiology , Cataract Extraction/adverse effects , Hyphema/etiology , Lens Implantation, Intraocular/adverse effects , Vitreous Hemorrhage/etiology , Artificial Lens Implant Migration/diagnosis , Artificial Lens Implant Migration/surgery , Female , Follow-Up Studies , Humans , Hyphema/diagnosis , Hyphema/surgery , Macular Edema/diagnosis , Macular Edema/etiology , Middle Aged , Ophthalmoscopy , Recurrence , Reoperation , Retinal Detachment/diagnosis , Retinal Detachment/etiology , Retinal Detachment/surgery , Tomography, Optical Coherence , Visual Acuity , Vitrectomy , Vitreous Hemorrhage/diagnosis , Vitreous Hemorrhage/surgeryABSTRACT
The intraocular correction of aphakia in the anterior chamber currently consists of two options: an angle supported intraocular lens (IOL, Kelman Multiflex) and an iris fixated IOL (Artisan/Verisyse). The angle supported IOL is fixated with four haptic points in the anterior chamber and the iris fixated IOL is enclavated to the anterior iris surface. Acceptable results of both IOLs are reported in the literature; however both IOLs show some long-term complications in some eyes. Alternatives to these anterior chamber IOLs to correct aphakia are the retropupillary fixated Artisan and sclera fixated IOLs.
Subject(s)
Anterior Chamber/surgery , Aphakia, Postcataract/surgery , Iris/surgery , Lens Implantation, Intraocular/instrumentation , Lens Implantation, Intraocular/methods , Lenses, Intraocular , Suture Anchors , Humans , Reoperation/instrumentation , Reoperation/methodsABSTRACT
BACKGROUND: This study was designed to evaluate the effectiveness and safety of femtosecond laser-assisted lens surgery depending on interface design and laser pulse energy settings. METHODS: In this non-randomized, consecutive case series200 eyes underwent femtosecond laser-assisted (LenSx, Alcon) lens surgery between November 2012 and June 2013. Group 1 consisted of 85 eyes with 60 cataracts and 25 refractive lens exchanges (RLE) which were treated with a curved direct contact interface, and group 2 consisting of 115 eyes with 72 cataracts and 43 RLEs treated with a modified interface using an additional soft contact lens (SoftFit™, Alcon) between the corneal surface and the interface. The degree of opacity of the lens in cataract eyes was measured with a Scheimpflug camera. Afterwards, phacoemulsification was performed with intraocular lens (IOL) implantation in all eyes. Primary endpoints were the effective phacoemulsification time (EPT), the average laser treatment time and the occurrence of intraoperative complications. RESULTS: The mean EPT in group 1 was 1.62 ± 1.12 s (cataract 1.94 ± 1.31 s, RLE 1.29 ± 1.01 s) and in group 2 the mean EPT was 1.66 ± 0.92 s (cataract 1.98 ± 1.28 s, RLE 1.33 ± 1.22 s, p = 0.32 between groups). The laser treatment lasted on average 48.90 ± 2.45 s (group 1) and 49.70 ± 2.87 s (group 2) with an average lens fragmentation thickness of 3401.48 ± 401.12 µm (all groups). In four cases of group 1, a second applanation of the interface was necessary. Furthermore, one anterior capsule tear, 39 cases of intraoperative wrinkling of the corneal surface and 21 cases in which the corneal incision had to be opened manually were documented in group 1. In group 2 no second applanation of the interface, no anterior capsule tears and no corneal wrinkling but 9 cases with a manual opening of corneal incisions were documented (p < 0.01 between groups). CONCLUSION: The minor intraoperative complications of the femtosecond laser technique investigated could be significantly reduced using an optimized interface and reduced laser pulse energy.
Subject(s)
Cataract Extraction/instrumentation , Laser Therapy/instrumentation , Lens, Crystalline/surgery , Phacoemulsification/instrumentation , Posterior Capsulotomy/instrumentation , Cataract Extraction/adverse effects , Cataract Extraction/methods , Equipment Design , Equipment Failure Analysis , Female , Humans , Laser Therapy/adverse effects , Laser Therapy/methods , Male , Middle Aged , Phacoemulsification/adverse effects , Phacoemulsification/methods , Pilot Projects , Posterior Capsulotomy/adverse effects , Posterior Capsulotomy/methods , Treatment OutcomeABSTRACT
The femtosecond laser technology continues its progress in ophthalmology and now also plays an increasingly important role in lens surgery. Using this technology it is possible to create corneal sections and to perform capsulorhexis and lens fragmentation. There are currently four instruments on the market with more to follow. The individual benefits and also critical issues are presented and the results of current studies are discussed.
Subject(s)
Laser Therapy/instrumentation , Refractive Surgical Procedures/instrumentation , Equipment Design , Equipment Failure Analysis , Technology Assessment, BiomedicalABSTRACT
The light-adjustable intraocular lens offers the possibility to correct postoperative residual refractive errors in a non-invasive way. After implantation and healing, a fine-tuning of the refractive power can be performed using ultraviolet light based on the individual requirements of each patient. Up to 2 diopters in sphere, as well as cylinder, can be adjusted in one step. This technology received CE market approval in 2007. This review article summarises published prospective studies on clinical evaluations of the effectiveness, safety and long-term refractive stability of this innovative technique. Moreover, a critical statement about limitations and perspectives will be given and future options will be discussed. For safety reasons, following application of the UV-light during refractive adjustments, examinations of endothelial cell count changes and measurements of corneal thickness have been monitored for 12 months following treatment. Further studies have been performed to evaluate the refractive stability over an 18-month period with a patient population that included average as well as biometrically short and long eyes. An analysis of postoperative refractive data led to optimised constants for preoperative IOL power calculation enabling the surgeon to further enhance visual outcomes with the IOL by using additional nomograms for customised correction of presbyopia, multifocality and increasing depth of focus with individual corrections of asphericity.
Subject(s)
Lenses, Intraocular/trends , Ophthalmologic Surgical Procedures/adverse effects , Refractive Errors/etiology , Refractive Surgical Procedures/instrumentation , Refractometry/instrumentation , Equipment Failure Analysis , Humans , Prosthesis Design/trendsABSTRACT
PURPOSE: The aim of this study was a prospective evaluation of new algorithms for the treatment of presbyopia using a light-adjustable intraocular lens (LAL). PATIENTS AND METHODS: A total of 15 patients scheduled for routine cataract surgery were included in the study. Following cataract removal a LAL (CalhounVision, Pasadena, CA) was implanted. At approximately 2 weeks after implantation the IOL was adjusted to correct any residual refractive error (sphere and cylinder) followed by the creation of a customized near add (CNA) that was based on the individual patient pupil size in one eye. The fellow eye was corrected for emmetropia. A final lock-in treatment was then performed. RESULTS: There were no complications observed during the surgery or power adjustments. All patients demonstrated an improvement in near vision (0.97 ± 0.18) and distance vision (0.78 ± 0.18) with good intermediate vision (0.92 ± 0.12) months after the final lock-in. CONCLUSION: This preliminary study showed that the creation of a CNA based on the individual patient's pupil size, provided patients with a good range of near, intermediate and distance vision following implantation of the LAL.
Subject(s)
Algorithms , Cataract Extraction/instrumentation , Cataract Extraction/methods , Lenses, Intraocular , Presbyopia/rehabilitation , Therapy, Computer-Assisted/methods , Aged , Female , Humans , Lens Implantation, Intraocular/methods , Lighting/methods , Male , Middle Aged , Pilot Projects , Treatment OutcomeABSTRACT
PURPOSE: The aim of this study was to determine whether residual spherical and cylindrical errors could be corrected postoperatively in a non-invasive manner using ultraviolet irradiation in patients with axial hyperopia undergoing cataract surgery and implantation of a light-adjustable lens, silicone intraocular lens (LAL) (Calhoun Vision, Pasadena, CA). METHODS: In a prospective, non-randomised clinical trial at Center for Vision Science, Ruhr University Eye Clinic, Bochum, Germany, 15 eyes of 15 patients with axial hyperopia (less than 22.2 mm) were studied. The manifest refraction, uncorrected visual acuity (UCVA), and best spectacle-corrected visual acuity (BSCVA) were determined with a follow-up time of six months to determine the achieved refractive corrections and their stability. RESULTS: The adjustment and lock-in procedures were well tolerated by patients. Preoperative refraction was in mean + 2.56 D as spherical equivalent, postoperative before adjustment + 1.01 D, one month after lock-in procedure + 0.03 D, after 3 months + 0.12 D and after 6 months 0.0 D (± 0.21 D). 6 months after lock-in all patients reached an uncorrected visual acuity of 20/30 or better, 10 of 15 patients reached 20/25 and 1 patient 20/20. The data demonstrate the stability of the achieved refractive change after the adjustment and lock-in procedures. CONCLUSION: Postoperative refractive errors were successfully corrected with precision and significant improvement in UCVA and without compromising BSCVA using the light adjustable intraocular lens technology. Our data demonstrate the stability of the achieved refractive change after the adjustment and lock-in procedures. The light-adjustable lens is a promising technology with the potential to eliminate postoperative refractive surprises of up to 2 diopters of refractive and cylindrical error following cataract surgery.
Subject(s)
Hyperopia/surgery , Lens Implantation, Intraocular/methods , Lenses, Intraocular , Aged , Aged, 80 and over , Axial Length, Eye , Eyeglasses , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prosthesis Design , Refraction, Ocular , Visual AcuityABSTRACT
Despite improvements in preoperative lens power calculations many patients are in need of spectacle correction to achieve emmetropia and/or optimal distance vision after cataract surgery. A method to adjust residual spherical and astigmatic errors postoperatively in a predictable and non-invasive way is the implantation of the light-adjustable lens (LAL). Selective irradiation of the LAL with UV light (365 nm) using a digital light delivery device enables a customized light pattern for each patient which produces modifications in the lens curvature and lens power by polymerization of silicon monomers in the lens matrix. In Europe this therapeutic option is currently only available in Spain and Germany, therefore, the number of patients treated is limited. In the future this technique will be available for correction of higher order aberrations and to design individual multifocality.