[Postoperative Results after Implantation of a Toric, Aspheric Intraocular Lens]. / Postoperative Ergebnisse nach Implantation einer torischen, asphärischen Intraokularlinse.

PURPOSE: The purpose of this study was to evaluate the functional results and quality of vision after implantation of an aspheric, aberration-neutral, monofocal toric intraocular lens (IOL). PATIENTS AND METHODS: 18 eyes of 13 patients were enrolled in this prospective clinical study. The T-flex aspheric, aberration-free toric IOL (Rayner Intraocular Lenses Limited, U. K.) was implanted after femtosecond or standard phacoemulsification. Follow-up examinations were performed two to four months after surgery; these included subjective refraction, ETDRS uncorrected (UDVA) and corrected distance visual acuity (CDVA), wavefront analysis, measurements of stray light (C-Quant), and a questionnaire. RESULTS: Median UDVA was 0.06 logMAR (range: 0.30 to - 0.18 logMAR) postoperatively. Median CDVA increased from 0.20 logMAR (range: 0.64 to 0.00 logMAR) preoperatively to - 0.07 logMAR (range: 0.16 to - 0.26 logMAR) postoperatively. The median difference between achieved versus intended spherical equivalent was - 0.08 D (range: - 1.25 to + 0.65 D). Median subjective cylinder improved from - 2.00 D (range: - 6.50 to - 0.25 D) preoperatively to - 0.50 D (range: - 1.25 to 0.00 D) postoperatively. The median spherical aberrations (6 mm pupil size) were - 0.38 µm (range: - 0.69 to - 0.10 µm) postoperatively. Measurements of stray light (C-Quant) revealed a median value of 1.28 log(s) (range: 0.92 to 1.61 log[s]). CONCLUSION: The T-flex aspheric toric IOL provided beneficial and predictable functional results after surgery. The implantation of the T-flex is an effective method to correct a large range of corneal astigmatism.

[Functional results after implantation of an aspheric, aberration-neutral intraocular lens]. / Funktionelle Ergebnisse nach Implantation einer asphärischen, aberrationsneutralen Intraokularlinse.

PURPOSE: The aim of this study was to perform a clinical evaluation of the functional results and quality of vision after implantation of an aspheric, aberration-neutral, monofocal intraocular lens (IOL). PATIENTS AND METHODS: 47 eyes of 34 patients (median age: 68 years) with cataract were enrolled in this prospective clinical study that had Ethics Committee approval. The C-flex or Superflex aspheric IOL (Rayner, UK) was implanted after phacoemulsification. Follow-up examinations were performed two to four months after surgery including subjective refraction, ETDRS uncorrected (UDVA) and corrected distance visual acuity (CDVA), wavefront analysis, analysis of stray light (C-Quant), contrast sensitivity under different lighting conditions (F. A. C. T.) and a questionnaire. RESULTS: Two to four months after surgery, median UDVA was 0.08 logMAR (range: 0.64 to - 0.18 logMAR, n = 41). Median CDVA increased from 0.30 logMAR (range: 1.00 to - 0.02 logMAR) preoperatively to - 0.08 logMAR (range: 0.16 to - 0.22 logMAR) postoperatively (n = 47). Median difference between achieved vs. intended (Holladay 1-formula) spherical equivalent was + 0.06 D (range: - 1.06 to + 0.87 D). Median total HOA RMS (6 mm pupil size) was 0.66 µm (range: 0.41 to 1.19 µm). The median spherical aberrations were - 0.36 µm (range: - 0.70 to - 0.17 µm). Analysis of stray light (C-Quant) revealed a median value of 1.21 log(s) (range: 0.79 to 1.57 log[s]). CONCLUSION: The C-flex and Superflex aspheric IOLs provide good and predictable functional results. Patients are not negatively influenced by stray light and show slightly negative spherical aberrations.

[Functional results after bilateral intrastromal femtosecond laser correction of presbyopia]. / Funktionelle Ergebnisse nach Korrektur der Presbyopie mittels bilateraler intrastromaler Femtosekundenlaserbehandlung.

PURPOSE: The purpose of this study was to evaluate the results of bilateral intrastromal femtosecond laser correction of presbyopia (INTRACOR). METHODS: In a prospective study 17 patients were enrolled who had previously received binocular treatment in a two-step approach. Postoperative (4-8 months) outcomes were compared with a matched control group who had undergone only unilateral surgery of the non-dominant eye (n = 17 patients, 24 months after surgery). RESULTS: The binocular distance corrected near visual acuity (DCNVA) showed the same median but lower scattering of values after bilateral treatment: 0.10 (median in logMAR) (0.30/- 0.10 min/max) (study) versus 0.10 (0.50/- 0.10) (control). In the study group, however, a higher loss of binocular corrected distance visual acuity (CDVA) was found: 23.5 %, 70.6 %, 5.9 % (0, - 1, - 2 lines) (study) versus 35.3 %, 64.7 % and 0 %, respectively (control). CONCLUSIONS: Regarding the reduced CDVA INTRACOR should initially only be performed in the non-dominant eye. In selected cases binocular treatment can improve DCNVA; however, careful risk-benefit assessment and informed consent are necessary.

[Effect of intrastromal correction of presbyopia with femtosecond laser (INTRACOR) on mesopic contrast sensitivity]. / Auswirkungen intrastromaler Presbyopiebehandlung mittels Femtosekundenlaser (INTRACOR) auf die mesopische Kontrastsensitivität.

BACKGROUND: The aim of this study was to examine the mesopic contrast sensitivity (CS) and glare sensitivity following intrastromal femtosecond laser correction of presbyopia (INTRACOR). PATIENTS AND METHODS: In this study 25 patients with slight hyperopia and presbyopia underwent femtosecond laser correction in the non-dominant eye. Mesotest II measurements (OCULUS Optikgeräte, Wetzlar, Germany) were performed with and without glare at each of four different contrast levels preoperatively as well as 3, 6, 12, 18 and 24 months postoperatively. Data were compared using the Wilcoxon-test with a level of significance of p < 0.05. RESULTS: After 24 months the median CS decreased from 1:2 to 1:2.7 without glare and from 1:23 to 0 with glare. Of all patients 36% showed loss in CS without and 52% with glare and CS did not show any statistically significant differences between the treated and the untreated fellow eyes after 12 and 24 months. Overall 9 out of 18 monocular treated patients showed no binocular night driving ability according to the recommendations of the German Society of Ophthalmology (DOG) and the Professional Association of German Ophthalmologists (BVA) 24 months following INTRACOR. CONCLUSIONS: INTRACOR can lead to a slight reduction of mesopic contrast sensitivity and an increase of glare sensitivity. Possible consequences on night driving ability should be discussed with the patients prior to treatment.

[Agreement of subjective and objective refraction measurements following INTRACOR femtosecond laser treatment]. / Übereinstimmung subjektiver und objektiver Refraktionsmessungen nach INTRACOR-Femtosekundenlaser-Behandlung.

BACKGROUND: The goal of this study was to determine the accuracy of autorefraction measurements in patients after INTRACOR intrastromal femtosecond laser treatment of presbyopia by comparing the agreement between the subjective and objective refraction. PATIENTS AND METHODS: In this study the data of 19 patients with a mean age of 56.5±6.0 years following INTRACOR treatment were analyzed pre-operatively and 12 months postoperatively. Measurements of the subjective refraction and the results of the autorefractor Nidek-660A in miosis were compared. INTRACOR is a refractive intrastromal femtosecond laser treatment to correct presbyopia. During the procedure a series of five concentric rings in the central stroma are cut which cause a change in the curvature of the cornea. RESULTS: The differences in sphere and spherical equivalent between subjective refraction and autorefraction were not significant (t-test p>0.05 and Wilcoxon test p>0.05). Comparing the cylinder of the two measurements a significant difference (t-test p<0.05) was found. Focusing on the difference of the postoperative measurements of the subjective refraction and autorefraction a correlation (within ±0.5 D) of 89% in the sphere, 100% in cylinder and 68% in the spherical equivalent was detected. With one exception the differences in sphere, cylinder and the spherical equivalent were within ±1.25 D. In several patients the performance of the autorefraction with the Nidek-660A was somewhat complicated and the measures had to be repeated frequently. CONCLUSION: The agreement between subjective refraction and objective measurements of the Nidek-660A of patients following INTRACOR-treatment was good. However there was a significant difference in the cylinder values. Therefore thorough comparison of measurements obtained with the autorefractor and the subjective refraction is recommended.