Clinical outcomes with a new design in multifocal intraocular lens: a pilot study.

PURPOSE: To evaluate the clinical and visual outcomes, quality of near vision and the influence of photic phenomena in patients bilaterally implanted with a new Precizon Presbyopic multifocal intraocular lens (IOL). METHODS: In this prospective consecutive case series, 20 eyes of 10 patients were included (mean age 63.80 ± 12.55 years). Uncorrected and corrected visual acuity (far, intermediate and near), subjective refraction, binocular defocus curve, contrast sensitivity (CSV-1000) and quality of vision and satisfaction questionnaires were measured. The follow-up was 12 months after surgery. RESULTS: At 12 months after surgery, uncorrected distance visual acuity (UDVA) improved with surgery (p = 0.001) with a value of 0.08 ± 0.08 logMAR. Uncorrected near visual acuity (UNVA) was 0.22 ± 0.12 logMAR and distance corrected near visual acuity (DCNVA) was 0.16 ± 0.13 logMAR. Intermediate distance visual acuity (UIVA) was 0.22 ± 0.10 logMAR. Contrast sensitivity outcomes were similar to normal population in photopic conditions and slightly reduced in mesopic conditions of lighting. Defocus curve showed that this multifocal IOL was able to provide a visual acuity (VA) equal or better to 0.16 logMAR between defocus levels of + 1.00 to - 2.50 D. Good patient satisfaction was obtained in quality of vision and satisfaction questionnaires outcomes. CONCLUSIONS: The Precizon Presbyopic NVA IOL (OPHTEC BV) provides good visual outcomes. This multifocal IOL provides a high percentage of spectacle independence due to good VA at far, intermediate and near distances and satisfactory contrast sensitivity. High patient satisfaction was observed in quality of vision and satisfaction questionnaires with a low percentage of patients manifesting photic phenomena.

Clinical features of patients inappropriately undiagnosed of pulmonary embolism.

PURPOSES: The objective of this study was to identify clinical factors associated with delayed diagnosis of acute pulmonary embolism (PE) in the emergency department (ED). BASIC PROCEDURES: A retrospective observational study was performed at three University affiliated Hospitals; 436 consecutive patients who presented to the ED with an acute PE confirmed by chest computed tomography from 2008 to 2011 were included. Patients were divided into 3 groups: group 1, PE was diagnosed while the patient was still in the ED; group 2, PE was diagnosed during hospitalization; group 3, patients who were sent home with a wrong alternative diagnosis and returned to the ED and were diagnosed of PE. MAIN FINDINGS: One hundred forty-six patients (33.5%) had a delayed diagnosis of PE--21.5% belong to group 2 and 11.9% to Group 3. Chronic coexisting medical conditions like asthma or chronic obstructive pulmonary disease were independent predictors of a delayed diagnosis in patients who were admitted to hospital whereas non-specific and less severe symptoms like the presence of pleuro-mechanic thoracic pain, fever, hemoptysis, or the presence of a pulmonary infiltrate in chest x-ray were independent predictors of a delayed diagnosis in patients who were sent home. PRINCIPAL CONCLUSIONS: Delay in diagnosis of acute PE is frequent despite current diagnostic strategies. Patients are sent home or admitted to hospital with a wrong diagnosis depending on clinical presentation or coexisting medical conditions.

Vector analysis of astigmatic changes after cataract surgery with implantation of a new toric multifocal intraocular lens.

PURPOSE: To analyze the astigmatic changes after cataract surgery with the implantation of a new toric multifocal intraocular lens (IOL) using the Alpins vector method. SETTING: Vissum-Instituto de Oftalmológico de Alicante, Alicante, Spain. DESIGN: Prospective case series. METHODS: After cataract surgery with implantation of an AT Lisa 909M toric multifocal IOL, the visual, refractive, corneal topographic, internal astigmatism, defocus curves, and contrast sensitivity outcomes were evaluated over 6 months. Refractive astigmatic changes (target astigmatism [TIA]; surgically induced astigmatism [SIA]; difference vector; magnitude of error; flattening effect; torque) were analyzed using the Alpins vectorial method. RESULTS: The study enrolled 23 eyes (12 patients). Postoperatively, there was a significant reduction in refractive cylinder (P < .01) with an associated visual improvement for near (P = .03) and distance (P=.01). The magnitude of SIA vector was significantly larger than the TIA 3 months postoperatively (P = .03). The mean magnitude of the difference vector was 0.67 diopter (D) ± 0.51 (SD) at 6 months. The mean magnitude of error remained positive and close to zero over the entire follow-up (P ≥ .19). The mean magnitude of torque vector was 0.49 ± 0.54 D at 6 months. Significant positive correlation was found between the magnitude of torque and the difference vector (r ≥ 0.70, P<.01). CONCLUSION: The new toric IOL restored distance and near visual function with excellent predictability in eyes with moderate to high corneal astigmatism having cataract surgery.

Comparative analysis of clinical outcomes obtained with a new diffractive multifocal toric intraocular lens implanted through two types of corneal incision.

PURPOSE: To analyze and compare the clinical outcomes obtained after cataract surgery with the implantation of a new multifocal toric intraocular lens (IOL) using two different types of corneal incision. METHODS: Retrospective study including 64 eyes of 35 patients who underwent surgery with implantation of the AT LISA 909M multifocal toric IOL (Carl Zeiss Meditec) in 2 different ophthalmologic centers using different criteria for corneal incision size: sub-1.8 mm (micro-incision surgery [MICS] group) and 2.2 mm (mini-incision group). Visual, refractive, and corneal topographic outcomes were evaluated during 6-month follow-up. Additionally, refractive astigmatic changes were analyzed using the Alpins vectorial method. RESULTS: Significant reductions of refractive sphere and cylinder were observed postoperatively (P<.03), with associated visual improvements for near and distance (P<.01) in both groups. Mean postoperative magnitudes of difference vector, torque, and magnitude of error in the overall sample were 0.52±0.36 diopters (D), 0.36 ± 0.36 D, and 0.08 ± 0.38 D, respectively. A mean overcorrection of 4% in refractive astigmatism was found. Mean angle of error was 0.37± 5.50° and -4.51±13.16° for the MICS and mini-incision groups, respectively (P=.09). Significant positive correlations were found between the magnitudes of torque and difference vector (r=0.78, P<.01) as well as between the magnitude of torque and absolute angle of error (r=0.76, P<.01). CONCLUSIONS: Implantation of the AT LISA toric IOL using corneal incisions <2.2 mm provides excellent predictability for astigmatic correction.

Double-pass system analysis of the visual outcomes and optical performance of an apodized diffractive multifocal intraocular lens.

PURPOSE: To evaluate the postoperative ocular optical quality using a double-pass method and assess visual outcomes in eyes with an apodized multifocal intraocular lens (IOL) and to correlate the findings with IOL power. SETTING: Vissum Corporation, Alicante, Spain. DESIGN: Case series. METHODS: This study evaluated eyes that had cataract surgery with implantation of an AcrySof ReSTOR SN6AD3 multifocal IOL. Near and far visual acuities were measured postoperatively at 1 month and 6 months. Ocular optical quality was assessed at 1 month using a double-pass system (Optical Quality Analysis System), and the point-spread function (PSF) and modulation transfer function (MTF) were characterized. RESULTS: The study included 38 eyes of 19 patients with a mean age of 63.4 years ± 8.4 (SD). The improvements in uncorrected distance visual acuity (from 0.57 ± 0.31 logMAR preoperatively to 0.11 ± 0.13 logMAR 1 month postoperatively and 0.11 ± 0.12 logMAR at 6 months) were statistically significant (P<.00001), as were the improvements in uncorrected near visual acuity (0.76 ± 0.40 logMAR preoperatively to 0.21 ± 0.11 logMAR and 0.12 ± 0.09 logMAR, respectively) (P<.00001). The IOL power correlated significantly with PSF width (r = 0.57, P = .017) and the MTF cutoff frequency (r = -0.36, P = .05). Furthermore, the lower the IOL power, the better the near and distance visual acuities, especially 1 month postoperatively. CONCLUSION: The apodized multifocal IOL restored distance and near visual function, although IOL power was a limiting factor to the final visual outcomes and optical quality.

Visual and accommodative outcomes 1 year after implantation of an accommodating intraocular lens based on a new concept.

PURPOSE: To evaluate visual outcomes and accommodative gains 1 year after implantation of the NuLens accommodating intraocular lens (IOL). SETTING: Department of Refractive Surgery, Vissum Corp., Alicante, Spain. METHODS: This study comprised patients with cataract and atrophic macular degeneration. In each patient, the accommodating IOL was implanted in the eye with the worse visual acuity. At the 12-month follow-up visit, visual acuity and accommodation were measured to determine the efficacy of the IOL. Ultrasound biomicroscopy was used to measure accommodative amplitude. RESULTS: Ten eyes of 10 patients were evaluated. The mean number of lines patients could read increased from 1.0 preoperatively to 3.8 lines 6 months postoperatively, indicating improvement in uncorrected near visual acuity after IOL implantation. The mean change in cross-section measurements of the IOL was 0.06 mm at 1 month; the value peaked at 3 months (0.21 mm), after which it decreased steadily, becoming stable at 9 months (0.09 mm, which is equivalent to 10.00 diopters [D] of accommodation). Corrected near visual acuity improved slightly (0.7 Jaeger lines) at 12 months, with the best reading distance at 10 cm. These results suggest that the near and distance visual acuities were approximately equal and, therefore, the IOL can produce accommodation of 10.00 D. CONCLUSIONS: The accommodation mechanism of the IOL can produce an ocular power variation of 10.00 D. Near visual acuity improved without compromising distance visual acuity.