Longitudinal study of intraocular lens exchange.

PURPOSE: To analyze the indications for intraocular lens (IOL) exchange, interval between the first IOL implantation and the exchange, type and mix of IOLs used, effect on vision, and frequency of complications. SETTING: Cincinnati Eye Institute-Cincinnati-Ohio-USA. METHODS: This retrospective study comprised 49 eyes of 49 adult patients who had IOL exchange between 1986 and 2002 performed by the same surgeon. The mean age was 70 years old, and 55% were women. The mean interval between surgeries was 53.8 months and the mean follow-up, 35.6 months. The patients were divided into 2 groups according to the type of IOL originally implanted: anterior chamber (AC) or posterior chamber (PC). RESULTS: There were 15 eyes with an AC IOL and 34 eyes with a PC IOL. The difference in mean age and follow-up were not statistically significant between groups. The mean interval between the primary surgery and IOL explantation was 82.3 months in the AC IOL group and 37.9 months in the PC IOL group. The main reason for IOL exchange was inflammation (53.34%) and dislocation/decentration (85.30%), respectively. The preoperative best corrected visual acuity was similar in both groups, and visual acuity was maintained or improved in 80%. Vitreous prolapse was the main intraoperative complication. CONCLUSIONS: The primary indication for IOL exchange was intraocular inflammation in patients with an AC IOL and IOL malposition in patients with a PC IOL. The results confirm the safety and positive visual outcome in this complex group of patients.

Visual performance of AcrySof ReSTOR apodized diffractive IOL: a prospective comparative trial.

PURPOSE: Evaluate the visual performance of the AcrySof ReSTOR intraocular lens (IOL) and compare it with the monofocal SA60AT IOL. DESIGN: Prospective, nonrandomized, clinical trial. METHODS: Forty patients (80 eyes) from the Federal University of São Paulo were enrolled in two groups. Twenty-five patients were assigned to the ReSTOR group and 15 patients to the monofocal group. Inclusion criteria were corneal astigmatism <1.0 diopter, potential acuity meter >0.2 logMAR units, and no associated ocular diseases. Parameters analyzed included distance uncorrected and best-corrected visual acuity, near uncorrected and distance corrected visual acuity, intermediate visual acuity, contrast sensitivity (Pelli-Robson chart), stereopsis (Titmus test), reading speed, wavefront measurement (LADARWave aberrometer), and a quality-of-life questionnaire. main outcome measure: Distance and near uncorrected and best distance corrected visual acuity, contrast sensitivity, and reading speed. RESULTS: Distance uncorrected and best-corrected visual acuity in the ReSTOR group were not statistically different from the monofocal group (P = .66). Near uncorrected and distance corrected visual acuity were statistically better in the ReSTOR group than the monofocal group (0.16 +/- 0.13 vs 0.62 +/- 0.09, P < .001, and 0.14 +/- 0.12 vs 0.62 +/- 0.07, P < .001, respectively). The ReSTOR group demonstrated less spherical aberrations compared with the monofocal group (P < .001). Monocular photopic contrast sensitivity was statistically lower in the ReSTOR group (P < .001). Stereopsis and reading speed were not statistically different between the groups. CONCLUSION: The AcrySof ReSTOR IOL provides a satisfactory full range of vision and achieves a more satisfactory quality of life when compared with the monofocal SA60AT IOL, but with lower contrast sensitivity.

Postoperative wavefront analysis and contrast sensitivity of a multifocal apodized diffractive IOL (ReSTOR) and three monofocal IOLs.

PURPOSE: To compare visual acuity, total and high order wavefront aberrations (coma, spherical aberration, and other terms of high order aberration), and contrast sensitivity in 105 eyes implanted with 4 different types of intraocular lenses (IOLs) (1 multifocal apodized diffractive IOL and 3 monofocal IOLs). METHODS: A prospective study comparing four types of IOLs (Alcon ReSTOR [50 eyes], Alcon Acrysof MA30AC [20 eyes], Alcon Acrysof SA60AT [20 eyes], and Mediphacos Acqua IOL [15 eyes]) was carried out. All eyes were targeted for emmetropia. Complete ophthalmological examination, including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), contrast sensitivity (Pelli-Robson chart), and wavefront analysis, was performed 2 months postoperatively. RESULTS: All eyes in all groups had BSCVA > or = 20/32 postoperatively. Mean total aberration root-mean-square (RMS) values were: 0.72 +/- 0.25 microm (ReSTOR), 0.94 +/- 0.26 microm (MA30), 0.84 +/- 0.23 microm (SA60), and 2.04 +/- 0.77 microm (Acqua). Mean higher order aberration values were: 0.35 +/- 0.15 microm (ReSTOR), 0.41+/- 0.12 microm (MA30), 0.43 +/- 0.13 microm (SA60), and 0.85 +/- 0.50 microm (Acqua). The Acqua IOL showed statistically significant more total and higher order aberrations when compared with the other IOLs (P < .05). The ReSTOR IOL showed statistically significant less induction of spherical aberration when compared to the monofocal IOLs (P < .05). Mean contrast sensitivity values were: 1.64 +/- 0.08 (ReSTOR), 1.72 +/- 0.08 (MA30), 1.70 +/- 0.07 (SA60), and 1.65 +/- 0.11 (Acqua). CONCLUSIONS: Different types of IOLs resulted in measurably different postoperative higher order aberration patterns. The multifocal apodized diffractive IOL (ReSTOR) induced significantly less spherical aberration compared to the monofocal IOLs. Contrast sensitivity revealed better values with MA30 and SA60 IOLs when compared to ReSTOR. The integration of wavefront technology in evaluating pseudophakic patients represents a step towards better understanding and analyzing postoperative visual quality.

Small pupil phacoemulsification using iris sutures: a new method?

A case is presented in which an alternative surgical method for managing poorly dilating pupils preoperatively or intraoperatively was employed. The technique uses iris sutures, is simple, safe, easily reproducible, and reversible, and does not require new devices for pupil enlargement. This new surgical method is appropriate for extracapsular cataract extraction and phacoemulsification or posterior segment surgeries, and maintains pupillary appearance and function postoperatively. Although other techniques are generally available, this technique may be useful in unique situations where other pupil devices or methods are not available.