[Clinical Comparison of a Trifocal and a Trifocal-Toric Intraocular Lens Based on the Same Diffractive Platform]. / Klinischer Vergleich einer trifokalen und einer trifokal-torischen Intraokularlinse auf gleicher diffraktiver Plattform.

Purpose To evaluate and compare the visual performance of a trifocal and a trifocal-toric intraocular lens (IOL) based on the same diffractive platform. Methods Prospective non-randomized comparative study enrolling 142 eyes of 77 patients (age 40-73 years) undergoing uneventful phacoemulsification lens surgery. Two groups were differentiated according to the implanted IOL: trifocal group, 98 eyes (50 patients) implanted with the trifocal diffractive IOL AT LISA tri 839MP (Carl Zeiss Meditec), and trifocal-toric group, 44 eyes (27 patients) implanted with the trifocal-toric diffractive IOL AT LISA trifocal-toric 939MP (Carl Zeiss Meditec). Visual and refractive changes were evaluated 3 months postoperatively. Results No significant differences between groups were found in postoperative refraction (p ≥ 0.144), monocular and binocular uncorrected intermediate visual acuity (UIVA; p = 0.519 and 0.398, respectively) and binocular uncorrected near visual acuity (UNVA; p = 0.073). In contrast, significantly better monocular and binocular uncorrected distance visual acuity (UDVA; p ≤ 0.002), as well as monocular UNVA (p = 0.005), were found in the trifocal group. A postoperative spherical equivalent within ± 1.00 D was found in 98 % and 100 % of eyes in the trifocal and trifocal-toric groups, respectively. Postoperative binocular UDVA, UIVA and UNVA of 20/30 or better were found in 100, 95 and 100 % of eyes, and in 96.3, 95.8 and 90.9 % of eyes in the trifocal and trifocal-toric groups, respectively. Conclusions The evaluated trifocal and trifocal-toric IOLs both provide a successful restoration of the visual function after cataract surgery, with good levels of refractive precision, as well as UIVA and UNVA.

[Impact of Different Percent Tissue Altered Values on Visual Outcome after Refractive Small Incision Lenticule Extraction (ReLEx SMILE)]. / Auswirkung verschiedener Percent-Tissue-altered-Werte auf das Behandlungsergebnis bei refraktiver Small Incision Lenticule Extraction (ReLEx SMILE).

Purpose To compare the visual outcomes after ReLEx SMILE treatment of eyes with low and high PTA values (PTA: percent tissue altered) within a follow-up period of up to 3 years and to assess whether a high PTA value might contribute to the development of keratectasia, as is the case for LASIK. Methods This retrospective analysis comprises results from 313 eyes (189 patients) with a PTA value of less than 40 % and of 373 eyes (213 patients) with a PTA value of at least 40 %. Preoperatively and up to 3 years after SMILE surgery, refraction values, monocular corrected (CDVA) and uncorrected distant visual acuity (UDVA) and wavefront data were evaluated. Results One to 3 years after surgery, the group with PTA < 40 % (PTA ≥ 40 %) had a loss of two Snellen lines in 1.1 % (0.0 %) of the cases. Loss of one line occurred in 1.1 % (3.6 %) of the eyes, whereas 97.7 % (96.4 %) remained unchanged or gained lines. With respect to predictability of the spherical equivalent, 92.0 % (78.6 %) of the eyes were within ± 0.5D and 97.7 % (92.9 %) were within ± 1.0D. The group with high PTA values displayed a slightly but significantly greater undercorrection of about 0,25D. 74.4 % (71.8 %) achieved UDVA of at least 20/20 and 96.5 % (87.1 %) achieved at least 20/25. The mean UDVA was - 0.03 ± 0.10logMAR (0.01 ± 0.12logMAR) and its mean difference to the preoperative CDVA was 0.00 ± 0.09logMAR (0.03 ± 0.12logMAR). Conclusion ReLEx SMILE is a safe and effective corneal refractive treatment, even for PTA values of 40 % and more. Eyes with high PTA values did not display any evidence of keratectasia development within the 3-year follow-up of this study.

[Functional Results 3 Months after Implantation of an "Extended Range of Vision" Intraocular Lens]. / Funktionelle Ergebnisse 3 Monate nach Implantation einer "Extended-Range-of-Vision"-Intraokularlinse.

PURPOSE: Evaluation of the visual and refractive results 3 months after implantation of a diffractive extended range of vision (ERV) intraocular lens (IOL) during cataract surgery. METHODS: In a prospective multicentre study, patients with a calculated postoperative corneal astigmatism of ≤ 1.5 D received a diffractive ERV IOL (TECNIS Symfony, model ZXR00, Abbott Medical Optics, USA) during cataract surgery. After 3 months, the monocular and binocular corrected and uncorrected far, intermediate and near visual acuity, as well as refraction, were evaluated. RESULTS: 18 patients (36 eyes) with a mean age of 63.34 ± 4.6 years underwent bilateral cataract surgery. After 3 months, the binocular uncorrected distance visual acuity (UDVA) of logMAR was - 0.05 ± 0.11 and the corrected distance visual acuity (CDVA) of logMAR - 0.14 ± 0.05. Binocular uncorrected intermediate (UIVA) and near visual acuity (UNVA) were logMAR - 0.09 ± 0.02 and 0.19 ± 0.09, respectively. A target refraction of ± 0.75 D was reached by 89 % of the patients. CONCLUSION: Implantation of an extended range of vision intraocular lens offers an effective way for visual rehabilitation at far and intermediate distances. Near vision is still in a functional range.

[Functional Results One Year after Implantation of a Bitoric, Trifocal Intraocular Lens]. / Funktionelle Ergebnisse 1 Jahr nach Implantation einer bitorischen, trifokalen Intraokularlinse.

PURPOSE: An evaluation of the visual and refractive results was undertaken one year after implantation of a trifocal diffractive toric intraocular lens (IOL) during cataract surgery. METHODS: In a prospective study patients with a calculated postoperative corneal astigmatism of ≥ 0.75 D received a diffractive trifocal toric IOL (AT LISA tri toric 939MP, Carl Zeiss Meditech, Jena, Germany) during cataract surgery. One year postoperatively the near, intermediate and distance visual acuity, corrected and uncorrected vision as well as refraction were evaluated. RESULTS: 20 patients (40 eyes) with a median age of 59 ± 11 years of which 15 were female underwent bilateral cataract surgery. One year postoperatively a binocular uncorrected distance visual acuity (UDVA) of 0.10 logMAR ± 0.11 and a corrected distance visual acuity (CDVA) of 0.00 logMAR ± 0.08 could be found. Binocular intermediate visual acuity (UIVA) and near visual acuity (UNVA) were 0.00 logMAR ± 0.05 and 0.09 logMAR ± 0.07, respectively. 100 % of patients were between ± 1.0 D from target refraction. Even 1 year after surgery no patient had an IOL rotation greater than 5°. CONCLUSION: The implantation of a trifocal toric intraocular lens offers an effective way for visual rehabilitation in near, intermediate and far distances with a good rotational stability of the IOL platform.

[Functional results with two multifocal intraocular lenses with different near addition]. / Funktionelle Ergebnisse zweier Multifokallinsen mit unterschiedlicher Nahaddition.

BACKGROUND: The reduction of the near addition of multifocal intraocular lenses from +4 D to +3 D should improve the visual function in the intermediate distance. The ReSTOR +3 D is a multifocal lens with a near addition of 3 D. PATIENTS AND METHODS: In a prospective study the new ReSTOR +3 D was compared to the former ReSTOR platform with 4 D near addition. A total of 40 patients received 1 of these 2 multifocal lenses bilaterally in both eyes after uneventful phacoemulsification in otherwise sound cataract eyes (20 patients ReSTOR +3 D, 20 patients ReSTOR + 4D). After 3 months the following parameters were assessed: uncorrected and corrected distance visual acuity, near vision at different distances, contrast sensitivity, defocus curve and anterior and posterior segments. The functional tests were performed monocularly and binocularly. RESULTS: Uncorrected binocular distance visual acuity (decimal) was 0.93 (logMAR 0.03 ± 0.12) in the ReSTOR +3 D group and 1.05 (-0.02 ± 0.1) in the ReSTOR +4 D group. In the intermediate distance the ReSTOR +3 D performed slightly better at 40 cm (0.68 versus 0.56) (logMAR 0.17 ± 0.14 versus 0.24 ± 0.18). The difference was significant (p<0.01) at 70 cm (0.69 versus 0.43) (logMAR 0.16 ± 0.27 vs 0.37 ± 0.2). The superior performance of the ReSTOR +3 D in the intermediate distance was also clearly visible in the defocus curves. All functional tests revealed significantly better results when performed binocularly. CONCLUSION: The ReSTOR +3 D multifocal intraocular lens performed significantly better in the intermediate distance compared to the ReSTOR +4 D. The other functional tests showed excellent and equal results with both lenses. The reduction of near addition does not increase dysphotopsia, particularly halos. Complaints of unsatisfactory vision in the intermediate distance were reported only by patients with the ReSTOR +4 D. The new ReSTOR +3 D is likely to improve the acceptance of multifocal intraocular lenses.

[Clinical results of the aspheric intraocular lens FY-60AD (Hoya) with particular respect to decentration and tilt]. / Klinische Ergebnisse unter besonderer Berücksichtigung von Dezentrierung und Verkippung der asphärischen Intraokularlinse FY-60AD.

BACKGROUND: Aspheric intraocular lenses (IOLs) aim to improve visual function and particularly contrast vision by neutralizing spherical aberration. One drawback of such IOLs is the enhanced sensitivity to decentration and tilt, which can deteriorate image quality. METHODS: A total of 30 patients who received bilateral phacoemulsification before implantation of the aspheric lens FY-60AD (Hoya) were included in a prospective study. In 25 of the patients (50 eyes) the following parameters could be assessed 3 months after surgery: visual acuity, refraction, contrast sensitivity, pupil size, wavefront errors and decentration and tilt using a newly developed device. RESULTS: The functional results were very satisfying and comparable to results gained with other aspheric IOLs. The mean refraction was sph + 0.1 D (±0.7 D) and cyl 0.6 D (±0.8 D). The spherical equivalent was −0.2 D (±0.6 D). Wavefront measurements revealed a good compensation of the corneal spherical aberration but vertical and horizontal coma also showed opposing values in the cornea and IOL. The assessment of the lens position using the Purkinje meter demonstrated uncritical amounts of decentration and tilt. The mean amount of decentration was 0.2 mm±0.2 mm in the horizontal and vertical directions. The mean amount of tilt was 4.0±2.1° in horizontal and 3.0±2.5° in vertical directions. CONCLUSIONS: In a normal dioptric power range the aspheric IOL FY-60AD compensates the corneal spherical aberration very well with only minimal decentration. The slight tilt is symmetrical in both eyes and corresponds to the position of the crystalline lens in young eyes. This may contribute to our findings of compensated corneal coma.

[Functional vision training after MIOL implantation]. / Funktionstraining nach MIOL-Implantation.

In a prospective and intraindividually comparative study, we investigated visual performance after implantation of two multifocal intraocular lenses. Eight patients received the ReSTOR (Alcon) bilaterally, and eight patients received the Tecnis ZM900 (AMO). The nondominant eye of each patient was trained based on the concept of perceptual learning using orientation discrimination of near-vertical bars. The fellow eye served as a control. After 3 h of training distributed over 2 weeks, the mean improvement of orientation discrimination in the trained eyes was 44%, which was significantly higher compared with the control eyes (9%). Moreover, contrast sensitivity and near vision under different contrast levels showed a significant benefit of training. These results support the concept of improving visual function by training after multifocal lens implantation. The superior function of the trained eyes was still present at the 6-month follow-up.

[The aspheric blue light filter IOL AcrySof IQ compared to the AcrySof SA60AT : influence of IOL power, pupil diameter, and corneal asphericity on postoperative spherical aberration]. / Die asphärische Blaulichtfilter-IOL AcrySof IQ im Vergleich mit der AcrySof SA60AT : Abhängigkeit der postoperativen sphärischen Aberration von IOL-Brechkraft, Pupillenweite und Asphärizität der Hornhaut.

BACKGROUND: The aspheric optic design of intraocular lenses (IOL) aims to minimize postoperative ocular spherical aberration (SA). The effect of a standardized IOL asphericity depends on IOL power, pupil diameter, and corneal asphericity. The impact of these factors was investigated in a comparative study. MATERIAL AND METHODS: In a prospective study, 70 eyes with the aspheric blue light filter IOL AcrySof IQ (Alcon) were compared to 36 eyes with the conventional AcrySof SA60AT (Alcon). Six weeks after uneventful phacoemulsification the following parameters were assessed: visual acuity, higher order aberrations, pupil diameter, and corneal asphericity. RESULTS: The comparison of 42 eyes in a normal dioptric range with the IQ IOL (22.4+/-2.0 D) to 20 eyes with the control lens of similar IOL power (22.0+/-2.7 D) showed no different visual outcome. For a 5-mm pupil SA was calculated at 0.04 (+/-0.05) microm for the IQ IOL and 0.20 (+/-0.06) microm for the AcrySof SA60AT. Also for a 4-mm pupil SA was significantly lower in eyes with the IQ lens. A separate evaluation of 28 eyes which needed very high or low IOL power revealed a similar postoperative SA for the IQ IOL. The greatest difference of SA between the two IOLs was found in hyperopic eyes with higher IOL power. The corneal asphericity (Q value) showed significant correlation to postoperative ocular SA. CONCLUSIONS: The aspheric AcrySof IQ reduces postoperative SA significantly compared to a conventional IOL even with smaller pupils and independent of IOL power. The assessment of corneal asphericity enables an individual estimation of postoperative SA.

[First results with a new aberration correcting bifocal intraocular lens]. / Erste Ergebnisse mit einer neuen aberrationskorrigierten intraokularen Bifokallinse.

OBJECTIVE: To investigate the functional results with a new bifocal intraocular lens. METHODS: The *Acri.LISA (*Acri.Tec) was implanted bilaterally in 20 patients after uneventful cataract surgery. The new bifocal IOL has a light distribution of 65% for distance and 35% for the near range. The diffractive optics of the lens are designed to be independent of pupil size. Smooth steps in diffractive structure should reduce glare. An aspheric design of the posterior optic surface is engineered to counteract the asphericity of the cornea (-0.26). Postoperative evaluation included 6 weeks after surgery: uncorrected (UCVA) and best corrected (BCVA) visual acuity for distance (ETDRS charts) and near (C.A.T. charts, Birkhäuser charts) monocular and binocular, defocus curve, contrast sensitivity under photopic and mesopic lighting conditions (F.A.C.T.), and subjective assessment of halos RESULTS: At the 6-week follow-up mean binocular UCVA and BCVA (LogMAR) were -0.02+/-0.10 and -0.07+/-0.09, respectively, for distance. Near UCVA (LogMAR) was 0.09+/-0.16; distance corrected near VA was 0.04+/-0.13. Visual acuity was significantly superior when tested binocularly compared to monocular testing (p<0.01). The depth of field showed an intermediate decimal VA of 0.6+/-0.21 at 70 cm and a pseudoaccommodation range of 5.5 D. Of 20 patients, 16 reported slight halos, but no patient was seriously impaired. CONCLUSIONS: The *Acri.LISA showed very good visual performance 6 weeks after bilateral surgery.

[Functional results with two multifocal intraocular lenses (MIOL). Array SA40 versus Acri.Twin]. / Funktionelle Ergebnisse nach Implantation multifokaler Intraokularlinsen (MIOL). Array SA40 versus Acri.Twin.

BACKGROUND: A multifocal intraocular lens (MIOL) with diffractive and aspherical optical design and asymmetrical light distribution (Acri. Twin, Acri.Tec) was compared to the standard MIOL, the Array SA40. PATIENTS AND METHODS: After 6 months, 16 patients with bilateral implantation of the Acri. Twin and 14 patients with bilateral Array IOL were examined to assess uncorrected and best corrected visual acuity for distance and near, contrast sensitivity under photopic and mesopic conditions, stereopsis, pupil diameter, and centration of the IOL. RESULTS: A significant difference was observed between the two MIOL in improved near visual acuity of the Acri. Twin MIOL (0.8 vs 0.4). Most of the patients described dysphotic phenomena, which were somewhat different for both MIOL, but expressed general satisfaction except for one patient. Concerning contrast sensitivity both MIOL were significantly inferior to data published for an aspherical monofocal IOL.

Effects of atropine on refractive development, dopamine release, and slow retinal potentials in the chick.

Atropine has previously been found to suppress visually induced myopia both in animals and humans. The mechanism of its action is unclear. We have studied its retinal effects in an in vitro preparation, using the retina-pigment epithelium-choroid complex of the chick eye. In vivo, deprivation myopia was induced by translucent goggles. Atropine solution was injected into the vitreous at two-day intervals. Dopamine release from the retina following atropine injection in vivo and from the in vitro retina preparation was quantified by HPLC-EC. In vitro preparations of the isolated chick retina-pigment epithelium-choroid were superfused with atropine. Light-induced potentials (local ERG), slow standing potentials from the retinal pigment epithelium/neural retina, and extracellular potassium concentrations were recorded. In line with previous findings, intravitreal injections of atropine (25 microg, 250 microg) reduced deprivation myopia in a dose-dependent manner. Atropine increased the release of the neurotransmitter dopamine into the superfusate in vitro at 100-500 microM and into the vitreous in vivo at 250 microg. Before an increase was measured in the vitreous, the retinal dopamine content was elevated. In concentrations equivalent to the intravitreal concentration to suppress myopia in vivo (200-800 microM), atropine induced spreading depression (SD) in the in vitro preparation. In contrast, muscarinic agonists, acetylcholine and pilocarpine, did not induce SD. Atropine reduced the ERG b- and d-wave, led to damped oscillations of RPE potentials, and reversed the ERG c-wave. Atropine suppressed myopia only at doses at which severe nonspecific side effects were observed in the retina. Atropine seems to intrude massively into the vital functions of the retina as indicated by the occurrence of SD. We conclude that atropine, by inducing SD, boosts neurotransmitter release from cellular stores, which may cancel out a presumed retinal signal that controls eye growth and through this, myopia.