Outcomes of iris-claw anterior chamber versus iris-fixated foldable intraocular lens in subluxated lens secondary to Marfan syndrome.

PURPOSE: To compare the outcome of phacoemulsification using 2 different iris-fixation techniques for intraocular lens (IOL) replacement, a foldable posterior chamber IOL (PCIOL; AcrySof MA60AC, Alcon Laboratories Inc, Fort Worth, TX) and an iris-claw anterior chamber IOL (ACIOL; Artisan, Ophtec BV), for treatment of subluxated lenses in patients with Marfan syndrome (MFS). DESIGN: Randomized, controlled trial. PARTICIPANTS: A total of 31 eyes of 16 patients with subluxated lenses associated with MFS and a preoperative corrected visual acuity (CVA) < or =20/40 based on the Early Treatment Diabetic Retinopathy Study chart. METHODS: Patients were enrolled and the eye with worse visual acuity was randomly assigned to 1 of 2 study arms: phacoemulsification and iris-fixated PCIOL or phacoemulsification and iris-claw ACIOL; the second eye of the same patient received the other IOL type. Preoperative and postoperative ophthalmologic examination, optical coherence tomography, and endothelial cell counts were performed. MAIN OUTCOME MEASURES: We recorded CVA results at 3, 6, and 12 months, complications, endothelial cell loss, and central retinal thickness. RESULTS: In the iris-fixated PCIOL group, CVA was significantly improved at 3 (P = 0.011; n = 16), 6 (P = 0.006; n = 16), and 12 months (P = 0.002; n = 16). In the iris-claw ACIOL group, CVA was significantly improved at 3 (P = 0.001; n=15), 6 (P = 0.001; n = 15), and 12 months (P = 0.009; n = 12). The CVA results did not differ significantly between groups. Dislocation of the IOL occurred in 3 of 16 (18.75%) eyes in the PCIOL group. Retinal detachment occurred in 3 eyes (2 in the PCIOL group and 1 in the ACIOL group) and was successfully repaired. Postoperative foveal tomograms in both groups revealed a decrease in the mean foveal thickness (MFT; < or =172 microm) in 54.16% of the patients. CONCLUSIONS: The iris-sutured PCIOL and iris-claw ACIOL produced comparable improvements in CVA at 3, 6, and 12 months postoperatively. Although IOL dislocation tended to occur more frequently in the iris-fixated PCIOL group, the difference was not significant. At 6 months postoperatively, all study patients tended to have a thinner MFT. None of the patients in either group developed cystoid macular edema.

Calculation of intraocular lens power using Orbscan II quantitative area topography after corneal refractive surgery.

PURPOSE: To present the prospective application of the Orbscan II central 2-mm total-mean corneal power obtained by quantitative area topography in intraocular lens (IOL) calculation after refractive surgery. METHODS: Calculated and achieved refraction and the difference between them were studied in 77 eyes of 61 patients with previous radial keratotomy (RK), RK and additional surgeries, myopic LASIK, myopic photorefractive keratectomy (PRK), or hyperopic LASIK who underwent phacoemulsification without complications in 3 eye centers. All IOL calculations used the average from the central 2-mm Orbscan II total-mean power of maps centered on the pupil without the use of previous refractive data. Six IOL styles implanted within the bag were used. RESULTS: Using the SRK-T formula, the overall calculated refraction was -0.64+/-0.93 diopters (D). The overall achieved spherical equivalent refraction (-0.52+/-0.79 D; range: -3.12 to 1.25 D; 95% confidence interval [CI]: -0.70/-0.34 D) was +/-0.50 D in 53% of eyes, +/-1.00 D in 78% of eyes, and +/-2.00 D in 99% of eyes. The overall difference between the calculated and achieved refraction (0.12+/-0.93 D, P=.27; range: -2.18 to 2.62 D; 95% CI: 0.09/0.33 D) was +/-0.50 D in 39% of eyes, +/-1.00 D in 77% of eyes, and +/-2.00 D in 96% of eyes. This difference was +/-1.00 D in 77% of eyes with RK (P=.70), 82% of eyes with myopic LASIK (P=.34), and 90% of eyes with myopic PRK (P=.96). In eyes with RK followed by LASIK, a trend toward undercorrection was noted (P=.03). In eyes with hyperopic LASIK, a trend toward overcorrection was noted (P=.005). CONCLUSIONS: In eyes with previous corneal refractive surgery, IOL power calculation can be performed with reasonable accuracy using the Orbscan II central 2-mm total-mean power. This method had better outcomes in eyes with previous RK, myopic LASIK, and myopic PRK than in eyes with hyperopic LASIK or RK with LASIK.

Spherical aberration and depth of focus in eyes implanted with aspheric and spherical intraocular lenses: a prospective randomized study.

PURPOSE: To compare distance-corrected, near, and intermediate visual acuities as a measurement of depth of focus and spherical aberration of eyes implanted with aspheric and spherical intraocular lenses (IOLs). DESIGN: Randomized prospective study. PARTICIPANTS: One hundred twenty eyes of 60 patients with bilateral cataract implanted with 3 IOL models (AcrySof IQ, AcrySof SN60AT [Alcon Laboratories, Fort Worth, TX], and Sensar AR40 [Allergan Surgical, Irvine, CA]). METHODS: Pupil diameter was analyzed by using a Colvard pupillometer (OASIS Medical, Inc., Glendora, CA) under photopic, mesopic, and scotopic conditions. Distance (6 m), intermediate (1 m), and near (0.33 m) visual acuities were measured with distance correction in place 90 days after surgery. Wavefront analysis (LadarWave; Alcon Laboratories) was performed using 5-mm and measured photopic pupil diameter at 30 and 90 days after surgery. MAIN OUTCOME MEASURES: To evaluate spherical aberration and depth of focus (by means of distance-corrected near and intermediate visual acuity) in patients implanted with aspheric and spherical IOLs. RESULTS: Photopic pupil sizes in each group were similar at 30 days after surgery. At 90 days after surgery, mean logarithm of the minimum angle of resolution distance-corrected near visual acuity (+/-standard deviation [SD]) was 0.50+/-0.20 in the AcrySof IQ group, 0.38+/-0.17 in the AcrySof SN60AT group, and 0.45+/-0.16 in Sensar AR40 group. Mean spherical aberration values (+/-SD) were 0.03+/-0.05 microm in the AcrySof IQ group, 0.24+/-0.04 microm in the AcrySof SN60AT group, and 0.14+/-0.07 microm in the Sensar AR40 group. The AcrySof IQ group showed a statistically significant lower induction of spherical aberration and worse distance-corrected near visual acuity. The AcrySof SN60AT group showed statistically significant higher mean spherical aberration values and better distance-corrected near and intermediate visual acuity. CONCLUSIONS: The reduction of total spherical aberration after aspheric IOL implantation may degrade distance-corrected near and intermediate visual acuity.

Wavefront analysis and contrast sensitivity of aspheric and spherical intraocular lenses: a randomized prospective study.

PURPOSE: To compare visual performance, total and high order wavefront aberrations (coma, spherical aberration, and other terms), and contrast sensitivity in 120 eyes implanted with one monofocal aspheric intraocular lens (IOL) and two spherical IOLs. DESIGN: Randomized prospective study. METHODS: Sixty patients were randomized to receive three IOL types: Alcon AcrySofIQ (40 eyes), AcrySofNatural (40 eyes), and advanced medical optic (AMO)Sensar (40 eyes). Complete ophthalmologic examination including uncorrected visual acuity (UCVA), best-spectacle corrected visual acuity (BSCVA), corneal topography, and wavefront analysis were performed preoperatively, 30 days, and 90 days postoperatively. Pelli-Robson chart test and functional acuity contrast testing (FACT-Optec6500) were performed approximately 50 days after surgery. Statistical analyses were performed using analysis chi(2), analysis of variance (ANOVA), and multiple comparisons Tukey test. RESULTS: After 90 days, all eyes had postoperative BSCVA > or =20/32. The AcrySofIQ IOL showed statistically significant less induction of spherical aberration (P < .001) when compared with the AMOSensar and the AcrySofNatural IOLs. The AMOSensar presented significantly less spherical aberration then the AcrySofNatural (P < .05). The AcrySofIQ also had lower values of total and high-order aberration (HOA) (P < .05) when compared with the AMOSensar and the AcrySofNatural. The mean values of trefoil 9, coma, and HOA root mean square (RMS) decreased between one and three months (P < .001, P < .001, P = .023, P < .001, respectively) in all groups. Mean Pelli-Robson contrast sensitivity values in photopic condition were similar between the groups. The AcrySofIQ showed better results in 3cpd spatial frequency in mesopic condition using FACT-Optec 6500 (P = .008), although there were no statistical differences in photopic and mesopic with glare conditions.

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.

Endophthalmitis: incidence and prevention.

PURPOSE OF REVIEW: To present current peer-reviewed articles related to the incidence and prevention of postoperative endophthalmitis. RECENT FINDINGS: Recent literature indicates that the incidence of postoperative endophthalmitis may be on the rise. Although the preoperative use of antibiotics as prophylaxis is still controversial, it is becoming more common. SUMMARY: The reports of endophthalmitis analyzed from peer-reviewed ophthalmic journals suggest that the incidence of endophthalmitis has increased, ranging from 0.1 to 0.18% in different countries. This may be related to factors associated with the incision. Although some resistance has been detected, fourth-generation fluoroquinolones seem to be a proper antibiotic for endophthalmitis prophylaxis because of their spectrum, mode of action, and penetration.