Comparative analysis of visual outcomes with 4 intraocular lenses: Monofocal, multifocal, and extended range of vision.

PURPOSE: To compare the visual acuity, refractive outcomes, and quality of vision in patients with bilateral implantation of 4 intraocular lenses (IOLs). SETTINGS: Department of Neurosciences, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, Verona, and Carones Ophthalmology Center, Milano, Italy. DESIGN: Prospective case series. METHODS: The study included patients who had bilateral cataract surgery with the implantation of 1 of 4 IOLs as follows: Tecnis 1-piece monofocal (monofocal IOL), Tecnis Symfony extended range of vision (extended-range-of-vision IOL), Restor +2.5 diopter (D) (+2.5 D multifocal IOL), and Restor +3.0 D (+3.0 D multifocal IOL). Visual acuity, refractive outcome, defocus curve, objective optical quality, contrast sensitivity, spectacle independence, and glare perception were evaluated 6 months after surgery. RESULTS: The study comprised 185 patients. The extended-range-of-vision IOL (55 patients) showed better distance visual outcomes than the monofocal IOL (30 patients) and high-addition apodized diffractive-refractive multifocal IOLs (P ≤ .002). The +3.0 D multifocal IOL (50 patients) showed the best near visual outcomes (P < .001). The +2.5 D multifocal IOL (50 patients) and extended-range-of-vision IOL provided significantly better intermediate visual outcomes than the other 2 IOLs, with significantly better vision for a defocus level of -1.5 D (P < .001). Better spectacle independence was shown for the +2.5 D multifocal IOL and extended-range-of-vision IOL (P < .001). CONCLUSIONS: The extended-range-of-vision IOL and +2.5 D multifocal IOL provided significantly better intermediate visual restoration after cataract surgery than the monofocal IOL and +3.0 D multifocal IOL, with significantly better quality of vision with the extended-range-of-vision IOL.

Prevalence and risk factors of eye diseases in adult patients with obstructive sleep apnoea: results from the SLE.E.P.Y cohort study.

OBJECTIVES: To assess the occurrence of glaucoma, eyelid, corneal and macular disorders in a cohort of patients with obstructive sleep apnoea (OSA) diagnosed by overnight polysomnography and to investigate into the risk factors for the above eye diseases (EDs). DESIGN: Cross-sectional cohort study between 2014 and 2015. SETTING: Unit of Respiratory Medicine and Eye Clinic of the University of Verona. PARTICIPANTS: 431 consecutive patients were considered eligible. Of these, 87 declined to participate, 35 were untraceable and 13 were deceased. INTERVENTIONS: A complete ophthalmic evaluation of both eyes for each patient. PRIMARY AND SECONDARY OUTCOME MEASURES: Best-corrected distance visual acuity, intraocular pressure, corneal, macular and optic nerve optical coherence tomography, ocular aberrometry, optic nerve laser polarimetry, visual field test, and eyelid examination. RESULTS: 296 patients aged 64.5±12.8 years, 23% female and 77% male, underwent ophthalmic examination. There was 56% (n=166) prevalence of eyelid disorders, 27% (n=80) of corneal disorders, 13% (n=39) of macular disorders and 11% (n=33) of glaucoma. Advancing age was not associated with the severity of OSA, while significant differences were found for gender, body mass index, Oxygen Desaturation Index, smoking habit, hypertension and diabetes. Severe OSA was significantly associated with glaucoma (OR, 95% CI 1.05 to 5.93, p=0.037). CONCLUSIONS: EDs were more prevalent in our patinets with OSA than in the general population. Severe Apnoea/Hypopnoea Index level seemed to play a role as risk factor only for glaucoma.

Comparative Analysis of the Clinical Outcomes With a Monofocal and an Extended Range of Vision Intraocular Lens.

PURPOSE: To evaluate and compare the clinical outcomes with an aspheric monofocal intraocular lens (IOL) and an extended range of vision (ERV) IOL based on achromatic diffractive technology. METHODS: This was a prospective comparative study including 80 eyes undergoing cataract surgery with implantation of the monofocal Tecnis ZCB00 IOL (Abbott Medical Optics Inc., Santa Ana, CA) (monofocal group: 30 eyes of 15 patients) or the ERV Tecnis Symfony IOL (Abbott Medical Optics, Inc.) (ERV group: 50 eyes of 25 patients). Visual, refractive, contrast sensitivity, defocus curve, ocular optical quality (Optical Quality Analysis System; Visiometrics SL, Terrassa, Spain), and quality of life (National Eye Institute Refractive Error Quality of Life Instrument 42 Questionnaire) outcomes were evaluated during a 3-month follow-up. RESULTS: Significantly better postoperative uncorrected monocular and binocular distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuities were found in the ERV group (P ≥ .013). Postoperative spherical equivalent was within ±1.00 diopters in 94% and 100% of eyes in the ERV and the monofocal groups, respectively. Binocular UIVA and UNVA of 0.20 or better (Snellen 20/30) were observed in all cases in the ERV group and in 13.3% and 6.7% of eyes of the monofocal group, respectively. No significant differences among groups were observed in contrast sensitivity (P ≥ .156) or ocular optical quality parameters (P ≥ .084). In the monocular defocus curve, all visual acuities were better in the ERV group (P ≤ .002), except for the +0.50-diopter defocus level (P = .367). Significantly better scores were obtained for dependence on correction (P = .003) and suboptimal correction (P = .038) subscales in the ERV group. CONCLUSIONS: The extended range of vision IOL provides better distance, intermediate, and near visual acuity than the aspheric monofocal IOL, while maintaining the same level of visual quality. [J Refract Surg. 2016;32(7):436-442.].

Retinal and vitreous hemorrhage after traumatic impact of dexamethasone implant in a vitrectomized eye.

PURPOSE: To report a case of retinal and vitreous hemorrhage after intravitreal injection of dexamethasone implant (0.7 mg Ozurdex) and its management. METHODS: A 49-year-old man treated for diabetic macular edema developed vitreous and retinal hemorrhage after intravitreal injection of dexamethasone implant caused by a retinal impact during the injection procedure. RESULTS: Retinal and vitreous hemorrhage absorbed spontaneously after 3 months. No retinal damage was detected. Intraocular pressure increased to 38 mm Hg after the injection and was well-controlled by medical therapy (dorzolamide hydrochloride-timolol maleate ophthalmic solution administered BID and oral acetazolamide 250 mg once a day). Since the surgeon performed the injection carefully without exerting any pressure on the eye, a device malfunction likely caused the implant to be injected too powerfully. CONCLUSIONS: Vitreous and retinal hemorrhage can occur after direct impact of an Ozurdex implant against the retina during the injection. So far this has never been described in the literature. Intraocular pressure elevation can worsen due to trabecular blockage by red blood cells. Spontaneous resolution can occur but vitrectomy is a therapeutic option if the hemorrhage persists.