Real-World Clinical Results with the Hoya Vivinex Impress Intraocular Lens with Enhanced Depth of Focus.

BACKGROUND: In cataract surgery, intraocular lenses (IOLs) with enhanced depth of focus are an option to correct presbyopia. The purpose of this quality assurance analysis was to evaluate visual acuity and patient satisfaction after implantation of the Hoya Vivinex Impress IOL. METHODS: The Hoya Vivinex Impress IOL was implanted in patients undergoing cataract surgery at the Pallas Klinik, Olten, Switzerland. Five weeks postoperatively, a clinical examination and a survey on patient satisfaction were conducted. RESULTS: A total of 17 eyes (9 patients; mean age 64 years) underwent cataract surgery with implantation of a Hoya Vivinex Impress IOL. Five weeks postoperatively, mean uncorrected distance visual acuity (UDVA) was 0.2 logMAR, uncorrected intermediate visual acuity (UIVA) was 0.0 logMAR, and uncorrected near visual acuity (UNVA) was 0.2 logMAR. The mean distance-corrected visual acuity results were 0.0 logMAR, 0.1 logMAR, and 0.3 logMAR, respectively. Reading the newspaper without glasses was possible for 33.4% of patients. Visual disturbances such as halos and glares were not reported. CONCLUSION: Cataract surgery with Hoya Vivinex Impress IOL implantation revealed good distance and intermediate vision and, in some patients, functional near vision as well as a high patient satisfaction.

Characterizing glare effects associated with diffractive optics in presbyopia-correcting intraocular lenses.

PURPOSE: To objectively quantify glare of intraocular lenses (IOLs) using a diffractive principle to extend the visual range and to identify models with increased susceptibility to inducing glare. SETTING: David J Apple Laboratory, Heidelberg, Germany. DESIGN: Laboratory investigation. METHODS: Glare was assessed by means of a straylight parameter with a standard C-Quant intended for 7 degrees. In addition, 2 C-Quant modifications were used to test lower angles (ie, 2.5 degrees and 3.5 degrees). The following IOL models were assessed: PanOptix, AT Lisa Tri, Synergy, and Triumf, the latter 2 with chromatic aberration correction at distance. Straylight from trifocal IOLs was compared against a monofocal W-60R lens. The C-Quant test was performed through the studied IOLs by using additional optical components attached to their ocular. RESULTS: Straylight (deg 2 sr -1 ) of the control was <1 at all tested angles, with the trifocal models showing comparable straylight at 7 degrees. At 3.5 degrees, Triumf's straylight increased to 15.5 ± 0.6, followed by Synergy (6.2 ± 1.1), PanOptix (4.1 ± 0.3), and AT Lisa Tri (2.0 ± 0.8). The chromatic aberration-correcting models demonstrated correspondingly higher straylight (Synergy: 18.8 ± 1.3; Triumf: 17.3 ± 0.5) at 2.5 degrees compared with PanOptix (4.3 ± 0.4), AT Lisa Tri (2.1 ± 0.1), and monofocal IOLs yielding minimal or no increase. CONCLUSIONS: Trifocal IOLs induced increased straylight, but it was limited to lower angles, which may cause difficulties detecting these effects using a standard clinical approach. The latest IOL designs featuring chromatic aberration correction at far focus seem more susceptible than the established trifocal IOLs to inducing a glare phenomenon.

Evaluation of Nozzle Tip Damage in Intraocular Lens Injectors with V-Shaped Notch.

INTRODUCTION: Damage to the nozzle tips of intraocular lens (IOL) injectors has been associated with various adverse events and even IOL surface abnormalities after IOL implantation. In this study, nozzle tip damage of three different injector models with v-notched nozzle tips was systematically evaluated using our self-developed system - the Heidelberg Score for IOL injector damage. METHODS: Nozzle tip damage was categorized into 6 grades: no damage (grade 0), slight scratches (1), deep scratches (2), extensions (3), cracks (4), and bursts (5). Each grade was assigned to a score of 0-5. In each IOL injector group, all IOLs were divided into 2 subgroups based on IOL power: +15 to +21D group and +21 to +26D group. The total scores for each group were the sum of scores for all injectors in this group. Further analysis was performed on the nozzle tip configuration and parameters in each injector model. RESULTS: The median (Q1-Q3) for each injector group in group +15 to +21D was 1.5 (1-2) for Avansee, 4 (3-4) for iSert, and 4 (3-4) for multiSert. A statistically significant difference was found between Avansee and iSert (p < 0.001) as well as between Avansee and multiSert (p < 0.01) in terms of median scores. The median (Q1-Q3) for each injector group in group +21 to +26D was 1.5 (1-2) for Avansee, 4 (4-4) for iSert, and 3 (3-3.75) for multiSert. A statistically significant difference was found between Avansee and iSert in terms of median scores (p < 0.001). The outer cross-sectional diameters were 1.80 and 1.78 mm for Avansee, 1.70 and 1.69 mm for iSert, and 1.69 and 1.68 mm for multiSert. The radii of each notch-based circle were 0.21 mm (Avansee), 0.09 (iSert), and 0.06 (multiSert), respectively. The tip angles for three injector models were 48° (Avansee), 46° (iSert), and 37° (multiSert). CONCLUSIONS: Avansee showed the least nozzle tip damage of all three groups. Compared with our earlier study using preloaded injectors with intact endpieces, all the injector groups with v-notched nozzle tips had more damage to the nozzle tip. It was found that the closer the notch of the nozzle tip was to the letter "V," the more damaged the nozzle tip was after IOL implantation.

Imaging Function and Relative Light Transmission of Explanted Opacified Hydrophilic Acrylic Intraocular Lenses.

We evaluated the influence of intraocular lens (IOL) opacification on the optical performance of explanted hydrophilic acrylic IOLs. We performed a laboratory analysis of 32 Lentis LS-502-1 (Oculentis GmbH, Berlin, Germany) IOLs, explanted due to opacification, in comparison with six clear unused samples of the same IOL model. Using an optical bench setup, we obtained modulation transfer function (MTF), Strehl ratio, two-dimensional MTF, and United States Air Force (USAF) chart images. In addition, we assessed light transmission through the IOLs. The MTF values of opacified IOLs at 3-mm aperture were similar to those of clear lenses, with the median (interquartile range) values of 0.74 (0.01) vs. 0.76 (0.03) at the spatial frequency of 50 line pairs per millimeter in clear and opacified IOLs, respectively. The Strehl ratio of opacified lenses was not lower than that of clear lenses. The USAF-chart analysis showed a considerable reduction in brightness in opacified IOLs. The median (interquartile range) relative light transmission of opacified IOLs in comparison to clear lenses was 55.6% (20.8%) at the aperture size of 3 mm. In conclusion, the explanted opacified IOLs had comparable MTF values to those of clear lenses but significantly reduced light transmission.

Evaluating the Predictability of Postoperative Target Refraction Using the Prototype of a New Intraoperative Aberrometer. / Evaluation des Prototyps eines neuen intraoperativen Aberrometers für die Vorhersage der postoperativen Zielrefraktion.

Despite all the progress in cataract and refractive lens surgery, refractive surprise is common in clinical practice. A significant postoperative refractive error is particularly annoying - and contributes to the patient's dissatisfaction with the procedure and the surgeon - when a multifocal IOL, an EDOF-IOL or a toric IOL has been implanted. The relatively new technology of intraoperative aberrometry offers the surgeon the option to intraoperatively measure the eye and its refraction, either directly after lens extraction and/or following IOL implantation. Currently, three different systems are available. In a number of studies, the technology has shown a better refractive predictability than preoperative biometry. Besides giving an evaluation of the prototype of a new intraoperative aberrometer, the I-O-W-A system, we also present our results on the influence of the kind of anaesthesia chosen and of two different IOL designs on the predictability of intraoperative aberrometry.

Repeated High-Fluence Accelerated Slitlamp-Based Photoactivated Chromophore for Keratitis Corneal Cross-Linking for Treatment-Resistant Fungal Keratitis.

PURPOSE: The purpose of this study was to report a case of fungal keratitis resistant to standard-of-care antimicrobial treatment and successful resolution, thanks to the repeated high-fluence accelerated photoactivated chromophore for keratitis-corneal cross-linking (PACK-CXL). METHODS: This was a case report. RESULTS: A 79-year-old male patient with previous Descemet membrane endothelial keratoplasty presented with a corneal ulcer that was resistant to topical antimicrobial therapy and amniotic membrane placement. Fungal keratitis was diagnosed, and the cornea was on the verge of perforation. After over a month of topical and systemic therapy without marked improvement, the patient underwent 2 repeated high-fluence accelerated CXL procedures (7.2 J/cm2 using a UV irradiation of 30 mW/cm2 for 4 minutes) over an interval of 8 days (accumulated fluence of 14.4 J/cm2), which resulted in significant clinical improvement, with consolidation into a quiescent scar. CONCLUSIONS: PACK-CXL protocols delivering a total UV fluence of 5.4 J/cm2 (as per the original Dresden protocol for corneal ectasia cross-linking) can be an effective primary therapy for initial or superficial corneal infections because approximately half of the energy is absorbed in the first 100 µm of a riboflavin-soaked cornea. However, fungal keratitis may require higher fluences than 5.4 J/cm2 because, unlike ectatic corneas, corneal ulcers are not transparent, and the infection may involve deep stroma. This case illustrates how repeated high-fluence accelerated PACK-CXL can be used to successfully treat fungal keratitis resistant to conventional topical and systemic medications.

Occurrence and outcome of firework-related ocular injuries in Switzerland: A descriptive retrospective study.

BACKGROUND: Firework-related ocular injuries (FWROI) are a major cause of preventable visual impairment. This study aimed to analyze the occurrence and outcome of FWROI in Switzerland. METHODS: This retrospective multicenter study included patients with FWROI from seven centers in Switzerland from January 2009 to August 2020. Demographic information, type of injuries, medical and surgical treatments, the best corrected visual acuity (BCVA) at baseline and end of follow-up, occurrence and type of secondary complications, and duration of hospitalization were analyzed. RESULTS: A total of 105 patients (119 eyes) with a mean age of 27.1 ± 15.9 years were included in the study (71.4% male patients; 29.5% underage). Most injuries occurred around New Year's Eve (32.4%) and the Swiss national holiday on 1 August (60.9%). The most common anterior segment findings were conjunctival or corneal foreign bodies (58%), whereas Berlin's edema was the most common posterior segment finding (11.4%). Globe ruptures were found in four patients. The mean BCVA in all patients at first presentation was 0.4 ± 0.8 logMAR and improved to 0.3 ± 0.8 logMAR at last follow-up. A primary surgical intervention was performed in 48 eyes (40.3%). Hospitalization directly after the trauma was necessary for 18 patients for a mean of 5.8 ± 4.1 days, and a total of 4.9 ± 7.6 follow-up visits were needed. CONCLUSION: This study provides the first data on FWROI in Switzerland, which are helpful for further preventive and educational programs and comparisons with other countries.

Clinical Outcomes of Combined Implantation of an Extended Depth of Focus IOL and a Trifocal IOL in a Korean Population.

PURPOSE: To evaluate monocular and binocular visual performance and patient-reported outcomes following combined implantation of a diffractive extended depth of focus (EDoF) IOL (Carl Zeiss AT LARA 829MP) and a diffractive trifocal IOL (Carl Zeiss AT LISA tri 839MP). METHODS: This prospective study enrolled consecutive patients undergoing lens phacoemulsification of cataract and combined implantation of an EDoF IOL in the dominant eye and a trifocal IOL in the nondominant eye. Assessment included uncorrected visual acuity at near distances (UNVA), intermediate distances (UIVA), and far distances (UDVA), uncorrected defocus curve, contrast sensitivity (CS), reading speed, and patient satisfaction, evaluated six months after the surgery with the Visual Function Questionnaire (VFQ-25). RESULTS: A total of 25 patients were enrolled. At six months postoperatively, outcomes of binocular UNVA, UIVA, and UDVA were superior to those of monocular outcomes. The binocular defocus curve showed significantly better results in comparison with the AT LISA tri IOL eyes at defocus levels of -1.0 D and -1.5 D (P=0.008 and P=0.002, respectively) and compared to the AT LARA IOL eyes at defocus levels of -3.0, -3.5 D, and -4.0 D (P=0.019, P=0.019, and P=0.035, respectively). All of the patients were spectacle-free at far and intermediate distances, while 4% of patients needed spectacles at the near distance. Reading speed showed a rather high and gentle slope curve between 0.1 logMAR and 0.4 logMAR, and optical phenomena were improved after combined implantation of IOLs except halos. There were no significant differences in CS between the binocular and monocular results of each IOL. CONCLUSIONS: The combined implantation of an EDoF IOL and a trifocal IOL seems to be a good option for patients with demands for spectacle independence in their daily life, with minimal photic phenomena.

Comparative analysis of in vitro accelerated glistening formation in foldable hydrophobic intraocular lenses.

PURPOSE: To analyse and compare the propensity to form glistenings in 4 different types of hydrophobic acrylic intraocular lenses (IOLs): Alcon AcrySof ® MA60AC, HOYA iSert® PC-60AD, Bausch&Lomb enVista, and Kowa Avansee™ PU6A. METHODS: We used an accelerated laboratory method to create glistenings. IOLs were first immersed in saline at 45 °C for 24 h and then at 37 °C for 2.5 h. Microvacuole (MV) density and size were documented and calculated using an image analysis program. RESULTS: Median density of glistenings [MV/mm2] for Alcon AcrySof ® MA60AC was 623 (range 507-804), for HOYA iSert® PC-60AD 1358 (range 684-2699), for Bausch&Lomb enVista 2 (range 1-2), and for Kowa Avansee™ PU6A 1 (range 1-4). The prevailing MV size was: 0-5 µm for Hoya IOLs, 5-10 µm for Alcon IOLs, 20-50 µm for Bausch&Lomb IOLs, and 5-50 µm for Kowa IOLs. CONCLUSIONS: Glistenings could be induced in all studied IOLs using the accelerated laboratory method. The Alcon AcrySof ® MA60AC and HOYA iSert® PC-60AD IOLs showed MV of high density, while the glistenings in the Hoya IOLs were smaller in size compared to the Alcon IOLs. The MV density was minimal in the Bausch&Lomb enVista and Kowa Avansee™ PU6A IOLs. The propensity of the Alcon AcrySof ® MA60AC IOLs to form glistenings in vitro correlated with the findings of clinical results that are already published.

In-vitro glistening formation in six different foldable hydrophobic intraocular lenses.

BACKGROUND: Glistenings describe small, refractile microvacuoles that may arise within the intraocular lens (IOL) material and reduce the patients' quality of vision. Lenses composed of hydrophobic acrylic material are particularly affected by glistening formation. In this study, we compared the tendency of glistening formation in six different types of hydrophobic acrylic intraocular lenses (IOLs). METHODS: We used a well-established accelerated laboratory method to develop glistenings in the following IOLs: Vivinex XY1 (Hoya), AcrySof SN60WF (Alcon), Tecnis ZCB00 (AMO), Avansee PN6A (Kowa), Aktis SP NS-60YG (Nidek), and CT Lucia 601P (Zeiss). IOLs were first immersed in saline at 45 °C for 24 h and then at 37 °C for 2.5 h in a water bath. Microvacuole (MV) density and size (Miyata grading) were documented and calculated using an image analysis program. RESULTS: The mean glistening density [MV/mm2] and mean Miyata grading (in brackets) were: Vivinex: 11.6 ± 5.7 (0), SN60WF: 264.4 ± 110.3 (2.6), Tecnis: 6.0 ± 2.8 (0), Avansee: 2.2 ± 0.7 (0), Aktis: 851.4 ± 59.4 (3+) and CT Lucia: 71.0 ± 71.6 (1). CONCLUSIONS: While all tested IOLs showed glistenings with the accelerated laboratory method, the Aktis and SN60WF showed the highest microvacuole density, followed by the CT Lucia. In comparison, the Vivinex, Tecnis, and Avansee IOLs showed far fewer number of glistenings.

Lenticular Imaging: A New Experimental and Quantitative Analysis of Capsular Dynamics, "Choi-Apple View".

PURPOSE: Development of a means for quantitative estimation of lenticular and zonular dynamics by using real-time imaging of human autopsy eyes during implantation of different intraocular lens (IOL) models. METHODS: Isolated lenticular structures from human autopsy eyes were prepared in vitro. The following IOLs were implanted: a one-piece C-loop haptic IOL, a three-piece C-loop haptic IOL, and a one-piece plate-type IOL. The amount of deformation of lenticular structures during implantation was calculated and the movements visualized with two cameras. The results were transformed to two-dimensional graphs using a newly developed image-processing algorithm. RESULTS: For both one-piece plate-type and one-piece C-loop haptic IOLs, the amount of capsular bag deformation from its initial shape was greater in the direction of posterior center of the capsule, as detected by side camera, than in the direction of the equator (or periphery), as detected by front camera. The mean peak deformation values were 51% and 36% (as measured by side and front cameras, respectively) for one-piece plate-type IOL and 25% and 20% for one-piece C-loop haptic IOL. For three-piece C-loop haptic IOL, the capsular bag distention was almost equal in both posterior and peripheral directions, with mean peak deformation values reaching 39% and 38%. CONCLUSIONS: The new experimental means of lenticular imaging and quantified dynamics from two different angles allowed three-dimensional understanding of specific behavior of each IOL. Our model not only exposes the capsular bag for recording during implantation, but also objectively compares the individual movement values and reveals different zonular and capsular stress patterns, depending on IOL model. TRANSLATIONAL RELEVANCE: The novel "Choi-Apple View" allows a three-dimensional quantitative analysis of capsular dynamics and IOL implantation behavior.

The impact of glistenings on the optical quality of a hydrophobic acrylic intraocular lens.

PURPOSE: To study the effect of glistenings on the optical quality of a hydrophobic acrylic intraocular lens (IOL). SETTING: David J. Apple Laboratory, Heidelberg, Germany. DESIGN: An in vitro laboratory study. METHODS: An accelerated aging protocol was used to induce glistenings (microvacuoles) in 38 hydrophobic acrylic IOLs. The IOLs were warmed to 45°C and then cooled to 37°C. Image analysis of light-microcopy photographs determined the number and size of microvacuoles (MV). A classification was applied based on the glistening number per mm2: grade 0 (none), grade 1 (1-100), grade 2 (101-200), grade 3 (201-500) and grade 4 (more than 500). An optical bench was used to measure each IOL's modulation transfer function (MTF) and Strehl ratio to evaluate the impact of glistenings on image quality. RESULTS: Glistenings were observed in all IOLs. The mean glistening numbers ± SD (MV/mm2) in grades 1 through 4 were 74 ± 12.7, 142 ± 22.2, 297 ± 76.2, and 1509 ± 311.9, respectively. The mean glistening sizes in grades 1 through 4 were 13.28 ± 3.85 µm, 15.88 ± 2.08 µm, 16.85 ± 3.23 µm, and 15.27 ± 2.25 µm, respectively. Statistical analysis showed that grades 1 through 3 did not change the optical quality; however, in grade 4, the MTF and the Strehl ratio were significantly affected. CONCLUSION: A limited number of glistenings (<500 MV/mm2) had no effect on the image quality. Although statistically significant deteriorations in the MTF and the Strehl ratio were observed in grade 4, the effects found were small and are unlikely to affect the visual quality.

Injectable 0.19-mg fluocinolone acetonide intravitreal implant for the treatment of non-infectious uveitic macular edema.

BACKGROUND: A retrospective observational clinical study to evaluate the safety and effectiveness of the injectable 0.19-mg fluocinolone acetonide intravitreal implant (ILUVIEN) in the treatment of non-infectious uveitic macular edema. RESULTS: Data are presented from eight patients (11 eyes) with non-infectious uveitic macular edema who were treated with a 0.19-mg fluocinolone acetonide implant. Nine out of 11 eyes were pseudophakic prior to implantation of fluocinolone acetonide implant, and both phakic eyes required cataract surgery during the follow-up period (the median follow-up was 19 months; range, 8-42 months). Effectiveness and safety were assessed from changes in central retinal thickness (measured using spectral domain optical coherence tomography), corrected distance visual acuity, uveitic activity, and intraocular pressure. The main outcome measures were changes in central retinal thickness, corrected distance visual acuity, uveitic activity, and intraocular pressure. In 11/11 eyes, central retinal thickness improved between months 1 and 3. The mean maximum decrease of central retinal thickness throughout the follow-up period was 168 ± 202 µm (± standard deviation). Nine out of 11 eyes showed an improvement in corrected distance visual acuity (between + 1 and + 8 lines), and 2/11 eyes lost corrected distance visual acuity (- 1 and - 3 lines, respectively). Nine out of 11 eyes presented with inactive inflammation during the follow-up period, and in 1/11 eyes, there was a relapse at month 42. Four out of 11 eyes presented with a relapse of macular edema between months 3 and 8. The mean increase in intraocular pressure was 2.1 ± 4.7 mmHg. Nine eyes were pseudophakic prior to implantation of the injectable fluocinolone acetonide intravitreal implant. Both phakic patients developed a cataract that was treated with cataract surgery in the follow-up period. CONCLUSIONS: In this small case series with long-term follow-up, treatment of non-infectious uveitic macular edema with the injectable fluocinolone acetonide implant was associated with improved central retinal thickness and corrected distance visual acuity and a manageable safety profile. The advantage of this device is the long-term drug release and the fact that it can be injected into the vitreous as a minor surgical procedure, which is in contrast to other treatment options.

[Endogenous Endophthalmitis: Epidemiology, Clinic, Therapy and Visual Outcome]. / Endogene Endophthalmitis: Ursachen, Keimspektrum, Therapie und Visusverlauf.

BACKGROUND: Endogenous endophthalmitis is a rare and severe inflammation of the eye in the context of a systemic infectious disease, which can lead to the loss of the affected eye in the worst case. MATERIAL AND METHODS: In a 5-year period, 20 eyes were treated for endogenous endophthalmitis and evaluated retrospectively. Evaluation parameters were epidemiological data, causes, concomitant diseases, assessment of the pathogen spectrum, therapy and visual acuity. RESULTS: 13.2% (n = 20/152; 20 eyes of 17 patients) of all endophthalmitis cases were of endogenous origin. In 15% (n = 3/20) of the cases, bilateral endogenous endophthalmitis was present. The cause for the endophthalmitis was generalised sepsis in 9 of 17 cases, an infection of the urogenital tract in 2 of 17 cases and endocarditis and liver abscess in 1 of 17 cases, respectively. In 4 of 17 cases, no primary foci were detected. Eight of 17 patients suffered from diabetes mellitus, 6 of 17 from renal insufficiency and 2 of 17 from malignancies, pneumonia or rheumatism. Two of 17 patients had had an organ transplantation, 15 of 17 suffered from cardiovascular diseases, 3 of 17 were immunosuppressed and 2 of 17 reported drug abuse. Four of 17 infections were caused by streptococci, 3 of 17 by Candida, 2 of 17 by herpes viruses and 1 of 17 by Staphylococcus aureus and Bacillus cereus. No pathogen could be found in 5 cases. The time interval between the onset of symptoms and diagnosis and the beginning of the therapy was 4 days (min.: 1 day; max.: 39 days). This was significantly longer in comparison with other causes of endophthalmitis (p < 0.001). Median visual acuity (VA) was 2.0 logMAR (n = 19/20) at the first presentation. One month and three months after initiation of the therapy VA was 1.3 logMAR (both n = 15/20), VA was 0.1 logMAR (n = 9/20) at the one year follow-up. Retinal detachment occurred in 2 of 20 eyes and recurrence of the endophthalmitis in 1 of 20 eyes within the one year follow-up, 5 of 17 patients died. Enucleation was never necessary. CONCLUSION: Endogenous endophthalmitis is often misdiagnosed due to a severe underlying non-ophthalmological disease. Delayed presentation with consequent late initiation of therapy is an unresolved problem, because colleagues from other fields are often unexperienced in diagnosing the ocular infection. This is also a cause of the already poor visual prognosis. Ophthalmologists can usually only influence the choice of the proper therapy.

[In Vitro Evaluation of the Optical Quality of Segmental Refractive Multifocal Intraocular Lenses]. / In-vitro-Untersuchung zur optischen Qualität segmental refraktiver multifokaler Intraokularlinsen.

OBJECTIVES: In customised patient care, it is important to know the optical quality of different intraocular lenses (IOL). In this study, the optical quality of three segmental intraocular lenses were compared. MATERIALS AND METHODS: The LENTIS Comfort LS-313 MF15, LENTIS Mplus X LS-313 MF30 and LENTIS High Add IOL LS-313 MF80 (Oculentis, Berlin, Germany) with a far power of + 21 D were analysed at the optical bench OptiSpheric IOL PRO (Trioptics GmbH, Wedel, Germany). The lenses have almost the same optical design but differ in the power of the near segment. The MF15 has a + 1.5 D addition to improve vision in intermediate distances, the MF30 has a near addition of + 3 D and the MF80 has a near addition of + 8 D. The modulation transfer function area (MTFa) and the Strehl ratio were examined for apertures of 3 mm (photopic) and 4.5 mm (mesopic). RESULTS: The MTFa values for the far focus are 33.34/30.80/51.53 (MF15/MF30/MF80) with an aperture of 3 mm and 25.38/22.52/43.15 for 4.5 mm. The MTFa values for the intermediate focus are 29.85/16.21/6.25 for a 3 mm aperture and 23.92/8.05/3.08 for 4.5 mm. The MTFa values for the near focus are 9.75/21.49/33.12 for an aperture of 3 mm and 4.95/22.70/31.68 for 4.5 mm. The Strehl ratio of the far focus is 0.34/0.30/0.52 for an aperture of 3 mm and 0.24/0.22/0.43 for 4.5 mm. For the intermediate focus, the Strehl ratio is 0.30/0.17/0.07 for an aperture of 3 mm and 0.24/0.08/0.03 for 4.5 mm. The Strehl ratio of the near focus is 0.10/0.22/0.33 for an aperture of 3 mm and 0.05/0.23/0.32 for 4.5 mm. CONCLUSION: We confirmed that the addition influences the optical quality of segmental bifocal intraocular lenses. For the far focus, the results of the MF15 and MF30 are similar. In intermediate distances, the MF15 achieves the best results. For near distances, the MF30 achieves better optical values than the MF15. The lens MF80, which has been designed for patients with maculopathies, achieves good results for far and near distances.

Challenges and Complication Management in Novel Artificial Iris Implantation.

PURPOSE: Evaluation of postoperative artificial iris prosthesis-related complications. DESIGN: Retrospective cohort study. METHODS: Fifty-one consecutive patients underwent pupillary reconstruction using an artificial iris implant made from silicone between 2011 and 2015. Quantity and quality of complications were subclassified into three groups including mild, moderate, and severe complications. Their management and the learning curve were evaluated. RESULTS: In total, 13 (25.5%) of 51 included artificial iris implantations showed unexpected events in various degrees: mild complications: recurrent bleeding (n=1, 2.0%), slight but stable iris deviation (n=1, 2.0%), capsular fibrosis (n=2, 3.9%); moderate complications: suture cutting through the residual iris (n=1, 2.0%), glaucoma (n=3, 5.9%), and corneal decompensation (n=3, 5.9%); severe complications: artificial iris suture loosening (n=2, 3.9%) and dislocation (n=3, 5.9%), synechiae (n=2, 3.9%), glaucoma (n=2, 3.9%), and corneal decompensation (n=5, 9.8%) with the need for surgery, cystoid macular edema (n=3, 5.9%) and retinal detachment (n=1, 2.0%). The complication rate decreased from 83.3% (5 of 6 implantations) in the first year to 13.3% (2 of 15 implantations) in the 4th year. Nineteen of 45 evaluated patients showed a significant gain in best-corrected visual acuity (BCVA) from 1.09 ± 0.56 logMAR to 0.54 ± 0.48 logMAR (p < 0.001), and 13 of 45 eyes had a significant BCVA loss from 0.48 ± 0.39 logMAR to 0.93 ± 0.41 logMAR after surgery (p < 0.001). CONCLUSIONS: The artificial iris is a feasible option in the treatment of iris defects with a wide spectrum of postoperative complications. The significant reduction of complications after twelve implantations implicates that the procedure is not to be recommended in low volume settings.

Microbial keratitis-induced endophthalmitis: incidence, symptoms, therapy, visual prognosis and outcomes.

BACKGROUND: To evaluate symptoms, therapies and outcomes in rare microbial keratitis-induced endophthalmitis. METHODS: Retrospective study with 11 patients treated between 2009 and 2014. Clinical findings, corneal diseases, history of steroids and trauma, use of contact lenses, number and type of surgical interventions, determination of causative organisms and visual acuity (VA) were evaluated. RESULTS: The incidence of transformation from microbial keratitis to an endophthalmitis was 0.29% (n = 11/3773). In 90.9% (n = 10/11), there were pre-existent eyelid and corneal problems, in 45.5% (n = 5/11) rubeosis iridis with increased intraocular pressure and corneal decompensation, and in 18.2% (n = 2/11), ocular trauma. Specimens could be obtained in 10 of 11 samples: 33.3% of those 10 specimens were Gram-positive coagulase-negative Staphylococci (n = 3/10) or Gram-negative rods (n = 3/10) and 10.0% Staphylococcus aureus (n = 1/10). In 30% (n = 3/10), no pathogens were identifiable. 72.7% (n = 8/11) of all keratitis-induced endophthalmitis were treated with vitrectomy and 9.1% (n = 1/11) with amniotic-membrane transplantation. In 27.3% (n = 3/11) the infected eye had to be enucleated - 18.2% (n = 2/11) primarily, 9.1% (n = 1/11) secondarily. No patient suffered from sympathetic ophthalmia. The median initial VA was 2.1 logMAR (n = 11/11). At one month, median VA was 2.0 logMAR (n = 7/11), after three months 2.0 logMAR (n = 6/11), and after one year 2.05 logMAR (n = 6/11). The change in VA was not significant (p > 0.99). 36.4% (n = 4/11) of the cases resulted in blindness. CONCLUSIONS: The overall outcome is poor. Enucleation should be weighed against the risk of local and systemic spread of the infection, prolonged rehabilitation and sympathetic ophthalmia.

Opacification of hydrophilic intraocular lenses associated with vitrectomy and injection of intraocular gas.

OBJECTIVE: To report 11 cases of intraocular lens (IOL) opacification after pars plana vitrectomy (PPV) involving intravitreal gas injection. METHODS AND ANALYSIS: Eleven cases of hydrophilic IOLs that opacified following PPV with intravitreal gas injection are described. Eight IOLs were explanted and analysed by light microscopy and scanning electron microscopy. Staining with alizarin red and von Kossa stains, as well as energy dispersive X-ray spectroscopy (EDX) were performed. Three IOLs were not explanted. The surgeons attached the clinical data. RESULTS: The IOLs were hydrophilic acrylic produced by six manufacturers. Six patients underwent primarily phacoemulsification with IOL implantation. PPV with intravitreal gas injection was performed 3 months-6 years afterwards. The other five patients underwent combined phacoemulsification with IOL implantation and PPV with intravitreal gas injection. IOL opacification was recorded 1 month -6 years after PPV. In eight patients, the IOLs were explanted 1 month-9 years after opacification was noticed. In three patients, the opacified IOL was not explanted. IOLs had opacified mainly anteriorly at the pupillary entrance or capsulorhexis opening. Light microscopy demonstrated granular surface deposits on the IOLs that stained positive for calcium by alizarin red and von Kossa stains. EDX analysis of the deposits detected calcium and phosphorus. CONCLUSIONS: Hydrophilic acrylic IOLs can opacify due to calcium deposition after PPV and intravitreal gas injection and may require IOL explantation. A hydrophobic IOL may be preferred when a simultaneous phacoemulsification and vitrectomy with intravitreal gas is performed.