ZEPTO-assisted pseudophakic capsulotomy: Precision pulse technology for management of capsular contraction syndrome.

We describe a novel technique that uses precision pulse capsulotomy (PPC) to perform a secondary capsulotomy for the management of anterior capsule contraction syndrome (ACCS), a condition that comprises a late complication after cataract surgery and intraocular lens (IOL) implantation. Micropulse secondary capsulotomy offers a controlled and safe approach for patients with severe anterior capsule contraction syndrome and may be considered as an alternative surgical technique.

Long-term Clinical Outcomes After Bilateral Implantation of Two Trifocal Diffractive IOLs.

PURPOSE: To show clinical outcomes after bilateral implantation of either a hydrophobic FineVision POD F GF or a hydro-philic FineVision POD F intraocular lens (IOL) (Beaver-Visitec International, Inc). METHODS: A total of 110 patients with cataract were randomized to receive either POD F GF or POD F IOLs and followed up for 2 years. The measurements included refraction, monocular and binocular uncorrected and corrected distance (UDVA and CDVA), intermediate (UIVA and DCIVA), and near (UNVA and DCNVA) visual acuities, defocus curve, photopic and mesopic contrast sensitivity, photic phenomena, and patient-reported outcomes. RESULTS: The mean spherical equivalent was similar in both groups and stable across visits (< 0.25 diopters [D]). At 2 years, 81.8% and 90.5% of eyes were within ±0.50 D in the POD F GF and POD F IOL groups, respectively (100% for ±1.00 D in both groups). At 2 years, 100% and 90.5% of the patients presented a binocular CDVA of 20/25 or better; 93.9% and 85.7% of patients a DCIVA of 20/25 or better and 87.5% and 70% of patients a DCNVA of 20/25 or better, for the POD F GF and POD F IOL groups, respectively. The defocus curve showed continuous visual acuity, being 20/32 or better in both groups over a 4.50 D range. Both groups presented good contrast sensitivity for photopic and mesopic conditions, and the size and intensity of halo and glare phenomena were similar between the two. Both groups also included a high percentage of patients who reported that they had stopped wearing glasses and greater than 80% satisfaction and recommendation levels. CONCLUSIONS: This study showed comparable long-term visual and refractive outcomes of both IOL models after cataract surgery. [J Refract Surg. 2023;39(12):798-807.].

Effectiveness and safety of VISULAS® green selective laser trabeculoplasty: a prospective, interventional multicenter clinical investigation.

PURPOSE: To evaluate the effectiveness and safety of Selective Laser Trabeculoplasty (SLT) with the SLT mode of the VISULAS® green laser in patients with primary open-angle glaucoma (POAG). METHODS: This prospective, interventional multicenter clinical investigation included patients with POAG who either needed a treatment escalation because the individual intraocular pressure (IOP) target was not met or treatment initiation and had an IOP ≥ 17 mmHg at baseline in the study eye. The study was conducted in five research centers across Germany. Approximately 100 laser applications were delivered to 360° of the trabecular meshwork. Glaucoma medications were not modified during the 3-month follow-up to allow evaluation of the sole effect of VISULAS® green with SLT. Efficacy outcomes were postoperatively absolute and relative IOP changes at 1 and 3 months. Safety outcomes analyzed the rate of intra- and postoperative adverse events. RESULTS: Thirty-four eyes of 34 POAG patients were included. The overall mean number of preoperative glaucoma medications was 2.2 ± 1.4 in 29 treated eyes, 5 eyes were treatment naïve. Mean baseline IOP (mmHg) was 21.0 ± 2.69 and was reduced by - 3.53 ± 3.34 [95% CI - 4.61; - 2.45] and - 3.59 ± 3.41 [95% CI - 4.64; - 2.53] at the 1- and 3-month follow-up, respectively (p < 0.0001), with 48.5% of cases achieving a ≥ 20% IOP reduction at 3 months [95% CI = 30.8%; 66.5%]. The mean relative IOP reduction was - 16.4% and - 16.3% at 1 and 3 months, respectively (p < 0.0001). Potentially device- or procedure-related adverse events were mild to moderate and included 3 postoperative IOP-spikes and 6 reports regarding eye pain and discomfort. All were resolved without sequelae. CONCLUSIONS: SLT performed with the VISULAS® green laser achieved clinically significant additional IOP reductions in medically treated as well as in treatment naïve eyes with POAG and there were no relevant safety issues. The results are comparable to other reported SLT studies.

Clinical safety and efficacy of a hydrophilic acrylic intraocular lens in a real-world population: a 1-year follow-up retro-prospective study.

BACKGROUND: This multicentre, retro-prospective real-world study evaluated the visual, refractive and safety outcomes of a monofocal lens 1 year after implantation in cataract patients with or without pre-existing ocular pathologies. METHODS: Records from 4 centres in Germany and Sweden were reviewed to select eyes with aged-related cataracts, having undergone crystalline lens extraction by phacoemulsification and implantation of a CT ASPHINA 409 IOL. Preoperative, 1-month and 3-month postoperative data was collected retrospectively. In addition, included patients attended a prospective visit 12 months or later after surgery. The examination included: monocular uncorrected (UDVA) and corrected distance visual acuity (CDVA), subjective refraction, slit-lamp examination, optical biometry, intraocular pressure (IOP), endothelial cell count and postoperative complications. RESULTS: 282 eyes, including 94 with pre-existing ocular pathologies, were analysed. Twelve months after the surgery, 95% of eyes achieved monocular CDVA equal or better than 0.3 logMAR, mean postoperative CDVA was 0.06 ± 0.17 logMAR, and mean UDVA 0.31 ± 0.29 logMAR. Visual acuity outcomes were better in eyes with no pre-existing ocular pathologies, but both groups showed a statistically significant improvement after surgery compared with preoperative values (p ≤ 0.002). The mean sphere and spherical equivalent values also improved significantly postoperatively (p = 0.003). Overall, 62.1% of eyes had spherical equivalent within ±0.5 D and 80.9% within ±1.0 D. The IOL was stable in the capsular bag as demonstrated by tilt and decentration measurements. IOP, corneal status, and endothelial cell count values were in the normal range. Nd:YAG treatment was performed on 9.9% of the eyes. CONCLUSION: The implantation of the monofocal CT ASPHINA 409 IOL was beneficial to restore vision in eyes with or without concomitant ocular pathology such as macular degeneration, glaucoma, Sicca syndrome, epiretinal membrane, cornea guttata, or amblyopia. Good to excellent long-term visual and refractive outcomes, and a low rate of complications in both healthy and pathological eyes were found 12 months after the surgery. TRIAL REGISTRATION: Trial registered on under the identification NCT03145103 (date of registration 9 May 2017).

Comparison of Visual Outcomes and Patient Satisfaction After Bilateral Implantation of an EDOF IOL and a Mix-and-Match Approach.

PURPOSE: To evaluate visual outcomes at different distances (near, intermediate, and far), depth of focus, optical quality, quantitative dysphotopsia, and patient satisfaction in two groups. METHODS: The extended depth of focus (EDOF) only group (n = 40 eyes) was implanted bilaterally with an EDOF intraocular lens (IOL) and the mixed group (n = 40 eyes) was implanted with the same EDOF IOL in the dominant eye and a trifocal IOL in the fellow eye. At the 3-month postoperative visit, refractive outcomes and monocular and binocular uncorrected (UDVA) and corrected (CDVA) distance visual acuities for far UDVA, CDVA, distance-corrected intermediate visual acuity (DCIVA) at 80 cm, uncorrected near visual acuity (UNVA), distance-corrected near visual acuity (DCNVA) at 40 cm, and binocular defocus curve were evaluated. RESULTS: The mean spherical equivalent (SE) 3 months postoperatively was -0.16 ± 0.41 diopters (D) in the EDOF only group and -0.39 ± 0.63 D in the mixed group. In the EDOF only group, binocular visual acuities were: UDVA = -0.04 ± 0.07 logMAR (20/18); CDVA = -0.04 ± 0.06 logMAR (20/18); DCIVA (80 cm) = 0.07 ± 0.19 logMAR (20/23); DCNVA (40 cm) = 0.32 ± 0.15 logMAR (20/42); and UNVA (40 cm) = 0.24 ± 0.17 logMAR (20/35). In the mixed group, binocular visual acuities were: UDVA = 0.03 ± 0.09 logMAR (20/21) (P = .08); CDVA = -0.01 ± 0.07 logMAR (20/20) (P = .25); DCIVA (80 cm) = 0.24 ± 0.23 logMAR (20/35) (P = .08); DCNVA (40 cm) = 0.19 ± 0.07 logMAR (20/31) (P = .03); and UNVA (40 cm) = 0.18 ± 0.10 logMAR (20/30) (P = .37). CONCLUSIONS: Effective restoration of visual acuity was demonstrated in both groups, with high levels of visual quality and patient satisfaction. Better results in near visual acuity were demonstrated in the mixed group. [J Refract Surg. 2019;35(7):408-416.].

Outcomes of combining a trifocal and a low-addition bifocal intraocular lens in patients seeking spectacle independence at all distances.

PURPOSE: To assess the visual and refractive outcomes and patient satisfaction after cataract surgery in patients with a diffractive multifocal intraocular lens (IOL) with a low addition (add) power (+2.75 diopters [D]) (Tecnis ZKB00) in the dominant eye and a diffractive trifocal IOL (AT LISA tri 839MP) in the nondominant eye. SETTING: Augenärzte Gerl, Kretz, and Kollegen, Head Office, Ahaus, Germany. DESIGN: Prospective case series. METHODS: All patients had implantation of the low-add multifocal IOL in the dominant eye and a trifocal IOL in the fellow eye. Patients were evaluated preoperatively and 3 months postoperatively for monocular and binocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity, intermediate and near visual acuities, the binocular defocus curve, and manifest refraction. Dysphotopic phenomena were objectively evaluated and subjective patient satisfaction questionnaires administered. RESULTS: The study included 42 patients (84 eyes). The mean postoperative spherical equivalent was -0.06 D ± 0.57 (SD). The binocular visual acuities were 0.00 ± 0.05 logarithm of the minimum angle of resolution (logMAR) (UDVA), 0.19 ± 0.11 logMAR (uncorrected intermediate visual acuity at 80 cm), 0.16 ± 0.10 logMAR (distance-corrected intermediate visual acuity at 80 cm), 0.11 ± 0.09 logMAR (uncorrected near visual acuity at 40 cm), and 0.08 ± 0.09 logMAR (distance-corrected near visual acuity at 40 cm). The binocular defocus curve showed a visual acuity of 0.20 logMAR or better between +0.50 D and -3.00 D. Of the patients, 92%, 92%, and 75% reported never wearing spectacles for distance, intermediate, or near distance, respectively. CONCLUSION: The mix-and-match approach seemed to provide functional visual performance at all distances while achieving spectacles independence in the majority of patients.

Clinical Evaluation of an Extended Depth of Focus Intraocular Lens With the Salzburg Reading Desk.

BACKGROUND: Clinical evaluation of an extended depth of focus (EDOF) intraocular lens (IOL) regarding visual performance at various distances, reading performance on an electronic reading desk, and depth of focus on the defocus curve. METHODS: In this prospective study, 30 eyes of 15 patients who received the Tecnis Symfony IOL (Abbott Medical Optics, Inc., Santa Ana, CA) were examined 3.60 ± 1.54 months postoperatively. Uncorrected and corrected distance (UDVA and CDVA), uncorrected and distance-corrected intermediate (UIVA and DCIVA), and uncorrected and distance-corrected near (UNVA and DCNVA) visual acuity were determined. The defocus curve was performed with distance correction. Furthermore, the reading acuity at the preferred near and intermediate distances was measured with consideration of the reading distance, speed, and print size. A subjective questionnaire was also administered. RESULTS: Results showed a median UDVA of 0.03 logMAR or 20/21.43 Snellen (range: 0.44 to -0.18 logMAR or 20/55.08 to 20/13.21 Snellen), UNVA of 0.20 logMAR or 20/31.70 Snellen (range: 0.46 to 0.00 logMAR or 20/57.68 to 20/20 Snellen), and UIVA of -0.03 logMAR or 20/18.67 Snellen (range: 0.14 to -0.18 logMAR or 20/27.61 to 20/13.21 Snellen). The improved performance at intermediate distance was confirmed by an uncorrected reading acuity of 0.09 logMAR or 20/24.61 Snellen (range: 0.36 to 0.00 logMAR or 20/45.82 to 20/20.00 Snellen) at a preferred intermediate distance of 64.10 cm (range: 52.0 to 75.0 cm). The defocus curve showed an extended range of visual acuity of 0.10 logMAR or better between 1.00 and -1.50 diopters. CONCLUSIONS: The EDOF IOL design provided a wide range of improved visual and reading function between far and intermediate distances and also improved near visual acuity. Patients reported a high rate of satisfaction and spectacle independence at the various distances. [J Refract Surg. 2017;33(10):664-669.].

Multifocal Intraocular Lenses and Extended Depth of Focus Intraocular Lenses.

Presbyopia and cataract patients' desire for increased spectacle independence after surgery is one of the main drivers for the development of multifocal intraocular lenses (MIOLs) and extended depth of focus (EDOF) intraocular lenses (IOLs). As education, biometry, diagnostics, surgical techniques, and MIOL/EDOF IOL designs have improved over the past decade, an increasing number of cataract surgeons have become cataract-refractive surgeons to help address this need. There is not 1 single MIOL/EDOF IOL, however, that suits all patients' needs. The wide variety of MIOLs and EDOF IOLs, their optics, and their respective impact on our patients' quality of vision have to be fully understood to choose the appropriate IOL for each individual; MIOL/EDOF IOL surgery has to be customized. This review article looks at the different optical aspects and clinical consequences of MIOLs/EDOF IOLs to help surgeons find an appropriate solution for each of their individual patients.

LYSOPHOSPHATIDIC ACIDS AND AUTOTAXIN IN RETINAL VEIN OCCLUSION.

PURPOSE: To analyze the levels of lysophosphatidic acids (LPAs) and autotaxin (ATX) in undiluted vitreous of untreated patients with retinal vein occlusion (RVO). METHODS: Sixty-four vitreous samples (40 RVO, 24 controls with idiopathic floaters) were analyzed in this retrospective case series using LC/MS for LPAs 16:0, 18:0, 18:1, 20:4, and ELISA kits or Luminex technology for ATX, angiopoetin-1 (ANG-1), interleukin-6 (IL-6), interleukin-7 (IL-7), interleukin-8 (IL-8), monocyte chemoattractant protein-1 (MCP-1), pigment epithelium-derived factor (PEDF), and vascular endothelial growth factor (VEGF). LPA and ATX levels were correlated with the visual acuity, central macular thickness (CMT), average retinal thickness (AvT), vitreal cytokine levels and with each other. RESULTS: Levels of every LPA species tested and ATX were significantly increased in the vitreous fluid from all patients with RVO (total LPAs: 968.0 ± 842.3 nM; ATX: 2.5 ± 1.02 nM) compared with controls (total LPAs: 225.2 ± 292.8 nM, P < 0.0001; ATX: 1.9 ± 1.00 nM, P = 0.005). There were strong positive correlations between the vitreal levels of IL-6, IL-8, MCP-1, VEGF and LPAs. CONCLUSION: Levels of LPAs and ATX were positively correlated with proinflammatory cytokines and VEGF and might thus play an important role in the development of macular edema secondary to RVO.

Proteomic Analysis of Vitreous Humor in Retinal Vein Occlusion.

PURPOSE: To analyze the protein profile of human vitreous of untreated patients with retinal vein occlusion (RVO). METHODS: Sixty-eight vitreous humor (VH) samples (44 from patients with treatment naïve RVO, 24 controls with idiopathic floaters) were analyzed in this clinical-experimental study using capillary electrophoresis coupled to mass spectrometer and tandem mass spectrometry. To define potential candidate protein markers of RVO, proteomic analysis was performed on RVO patients (n = 30) and compared with controls (n = 16). To determine validity of potential biomarker candidates in RVO, receiver operating characteristic (ROC) was performed by using proteome data of independent RVO (n = 14) and control samples (n = 8). RESULTS: Ninety-four different proteins (736 tryptic peptides) could be identified. Sixteen proteins were found to be significant when comparing RVO and control samples (P = 1.43E-05 to 4.48E-02). Five proteins (Clusterin, Complement C3, Ig lambda-like polypeptide 5 (IGLL5), Opticin and Vitronectin), remained significant after using correction for multiple testing. These five proteins were also detected significant when comparing subgroups of RVO (central RVO, hemi-central RVO, branch RVO) to controls. Using independent samples ROC-Area under the curve was determined proving the validity of the results: Clusterin 0.884, Complement C3 0.955, IGLL5 1.000, Opticin 0.741, Vitronectin 0.786. In addition, validation through ELISA measurements was performed. CONCLUSION: The results of the study reveal that the proteomic composition of VH differed significantly between the patients with RVO and the controls. The proteins identified may serve as potential biomarkers for pathogenesis induced by RVO.

Proteomics of vitreous in neovascular age-related macular degeneration.

Neovascular age-related macular degeneration (nAMD) has been described as a predominantly inflammatory and proangiogenic retino-choroidal disease. Vitreous humor (VH) is the adjacent and accessible compartment which, due to the vicinity to the retina, might best represent changes of protein-based mediators of nAMD. The aim of this clinical-experimental study was to analyze the nAMD associated VH proteome of previously untreated patients whilst taking different groups of nAMD into account, based on their clinical presentation (clinical diagnosis groups). Electrophoresis coupled online to mass spectrometry (CE-MS) as well as liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) were used to analyze VH of 108 nAMD patients and 24 controls with idiopathic floaters. A total of 101 different proteins with at least two unique peptides could be identified. Using a stringent statistical analysis with implementation of the closed test principle, we were able to identify four proteins that may be involved in the pathophysiology of nAMD: Clusterin, opticin, pigment epithelium-derived factor and prostaglandin-H2 d-isomerase. Using independent samples, ROC-Area under the curve was determined proving the validity of the results: Clusterin 0.747, opticin 0.656, pigment epithelium-derived factor 0.514, prostaglandin-H2 d-isomerase 0.712. In addition, validation through ELISA measurements was performed. The identified proteins may serve as potential biomarkers or even targets of therapy for nAMD.

Randomized Clinical Trial to Compare Micropulse Photocoagulation Versus Half-dose Verteporfin Photodynamic Therapy in the Treatment of Central Serous Chorioretinopathy.

BACKGROUND AND OBJECTIVE: To evaluate subthreshold diode-laser micropulse (SDM) versus half-dose verteporfin photodynamic therapy (hd-PDT) in central serous chorioretinopathy (CSC). PATIENTS AND METHODS: 62 eyes of 62 patients were prospectively followed for changes in fluorescein angiography (FA), fundus autofluorescence (FAF), central macular thickness (CMT), best-corrected visual acuity (BCVA), and contrast visual acuity (CVA) after SDM (n=20) or hdPDT (n=24). CSC observation served as control group (n=18). RESULTS: Both treatment groups (60% SDM vs. 66.7% hdPDT) showed significant improvement in reduction of leakage activity compared to the control group (37.5%) at 16 weeks. CMT decreased by 69.7 µm (SDM), 109.8 µm (hdPDT), and 89 µm (control). BCVA improved by +6.7 (SDM group), +8.5 (hdPDT), and +1.5 ETDRS letters (control). CVA was best improved in the hdPDT group. No secondary RPE alterations could be detected by FAF after any intervention. CONCLUSION: In comparison to the control group, hdPDT and SDM resulted in reduced leakage activity in FA and enhanced photopic and scotopic visual acuity in patients with CSC.

Binocular function to increase visual outcome in patients implanted with a diffractive trifocal intraocular lens.

BACKGROUND: To evaluate binocular visual outcome for near, intermediate and distance compared to monocular visual outcome at the same distances in patients implanted with a diffractive trifocal intraocular lens (IOL). METHODS: The study comprised of 100 eyes of 50 patients that underwent bilateral refractive lens exchange or cataract surgery with implantation of a multifocal diffractive IOL (AT LISA tri 839MP, Carl Zeiss Meditech, Germany). A complete ophthalmological examination was performed preoperatively and 3 month postoperatively. The main outcome measures were monocular and binocular uncorrected distance (UDVA), corrected distance (CDVA), uncorrected intermediate (UIVA), and uncorrected near visual acuities (UNVA), keratometry, and manifest refraction. RESULTS: The mean age was 59.28 years ± 9.6 [SD] (range 44-79 years), repectively. There was significant improvement in UDVA, UIVA, UNVA and CDVA. Comparing the monocular results to the binocular results there was a statistical significant better binocular outcome in all distances (UDVA p = 0.036; UIVA p < 0.0001; UNVA p = 0.001). The postoperative manifest refraction was in 86 % of patients within ± 0.50 [D]. CONCLUSIONS: The trifocal IOL improved near, intermediate, and distance vision compared to preoperatively. In addition a statistical significant increase for binocular visual function in all distances could be found. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00007837.

Clinical Outcomes after Binocular Implantation of a New Trifocal Diffractive Intraocular Lens.

Purpose. To evaluate visual, refractive, and contrast sensitivity outcomes, as well as the incidence of pseudophakic photic phenomena and patient satisfaction after bilateral diffractive trifocal intraocular lens (IOL) implantation. Methods. This prospective nonrandomized study included consecutive patients undergoing cataract surgery with bilateral implantation of a diffractive trifocal IOL (AT LISA tri 839MP, Carl Zeiss Meditec). Distance, intermediate, and near visual outcomes were evaluated as well as the defocus curve and the refractive outcomes 3 months after surgery. Photopic and mesopic contrast sensitivity, patient satisfaction, and halo perception were also evaluated. Results. Seventy-six eyes of 38 patients were included; 90% of eyes showed a spherical equivalent within ±0.50 diopters 3 months after surgery. All patients had a binocular uncorrected distance visual acuity of 0.00 LogMAR or better and a binocular uncorrected intermediate visual acuity of 0.10 LogMAR or better, 3 months after surgery. Furthermore, 85% of patients achieved a binocular uncorrected near visual acuity of 0.10 LogMAR or better. Conclusions. Trifocal diffractive IOL implantation seems to provide an effective restoration of visual function for far, intermediate, and near distances, providing high levels of visual quality and patient satisfaction.

Clinical Outcomes After Implantation of a Trifocal Toric Intraocular Lens.

PURPOSE: To evaluate the visual, refractive, and contrast sensitivity outcomes, as well as the level of photic phenomena, after cataract surgery with implantation of a trifocal diffractive toric intraocular lens (IOL). METHODS: This prospective study included 56 eyes with corneal astigmatism of 1.00 diopters (D) or greater of 28 patients (age: 23 to 78 years) undergoing cataract surgery with implantation of the trifocal toric IOL AT LISA tri toric 939MP (Carl Zeiss Meditec, Jena, Germany). Monocular and binocular visual outcomes, refractive changes, contrast sensitivity, and photic phenomena perception (Halo & Glare Simulator; Eyeland-Design Network GmbH, Vreden, Germany) were evaluated at 3 months postoperatively. RESULTS: Mean 3-month postoperative monocular uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuities were 0.13±0.15, 0.08±0.15, and 0.13±0.18 logMAR, respectively. Binocular postoperative CDVA, DCIVA, and DCNVA values were 0.10 logMAR or better in all cases. A total of 88.2%, 88.2%, and 95.5% of eyes achieved binocular UDVA, UIVA, and UNVA values of 0.20 logMAR or better, respectively. Postoperative refractive cylinder was 0.50 D or less and 1.00 D or less in 78.6% and 98.2% of eyes, respectively. Photopic contrast sensitivity was significantly better than mesopic values for the spatial frequencies of 6 (P=.007), 12 (P=.005), and 18 cycles/degree (P=.011). Mean size and intensity of halos were 50.67±15.69 and 54.89±17.86, respectively. Mean glare size and intensity were 39.67±3.51 and 44.67±15.01, respectively. CONCLUSIONS: The evaluated trifocal diffractive toric IOL provides an effective restoration of the distance, intermediate, and near vision after cataract surgery with good levels of visual quality and minimal photic phenomena.

High order aberration and straylight evaluation after cataract surgery with implantation of an aspheric, aberration correcting monofocal intraocular lens.

AIM: To evaluate the quality of vision in respect to high order aberrations and straylight perception after implantation of an aspheric, aberration correcting, monofocal intraocular lens (IOL). METHODS: Twenty-one patients (34 eyes) aged 50 to 83y underwent cataract surgery with implantation of an aspheric, aberration correcting IOL (Tecnis ZCB00, Abbott Medical Optics). Three months after surgery they were examined for uncorrected (UDVA) and corrected distance visual acuity (CDVA), contrast sensitivity (CS) under photopic and mesopic conditions with and without glare source, ocular high order aberrations (HOA, Zywave II) and retinal straylight (C-Quant). RESULTS: Postoperatively, patients achieved a postoperative CDVA of 0.0 logMAR or better in 97.1% of eyes. Mean values of high order abberations were +0.02±0.27 (primary coma components) and -0.04±0.16 (spherical aberration term). Straylight values of the C-Quant were 1.35±0.44 log which is within normal range of age matched phakic patients. The CS measurements under mesopic and photopic conditions in combination with and without glare did not show any statistical significance in the patient group observed (P≥0.28). CONCLUSION: The implantation of an aspherical aberration correcting monofocal IOL after cataract surgery resulted in very low residual higher order aberration (HOA) and normal straylight.

Clinical Outcomes and Capsular Bag Stability of a Four-Point Haptic Bitoric Intraocular Lens.

PURPOSE: To evaluate the visual, refractive, and aberrometric outcomes of a bitoric intraocular lens (IOL) and its stability and alignment within the capsular bag. METHODS: A retrospective study including 41 eyes of 24 patients with preexisting corneal astigmatism of 0.75 diopters or greater undergoing cataract surgery with implantation of the bitoric IOL AT TORBI 709M (Carl Zeiss Meditec, Jena, Germany). Visual and refractive outcomes were evaluated during a 3-month follow-up period. The misalignment between intended and real axis and the levels of corneal, internal, and ocular aberrations (KR-1W; Topcon, Tokyo, Japan) were also evaluated. RESULTS: A total of 76% and 97% of eyes had a postoperative spherical equivalent within ± 0.50 and ± 1.00 diopters of emmetropia, respectively. Likewise, a total of 86% and 95% of eyes had a postoperative absolute value of refractive cylinder of 0.50 or less and 1.00 or less diopters, respectively. Mean postoperative corrected distance visual acuity was 0.00 logMAR (20/20 Snellen). Mean values of postoperative monocular and binocular uncorrected distance visual acuity were 0.10 and 0.00 logMAR (20/25 and 20/20 Snellen), respectively. The aberrometric analysis confirmed that the magnitude of ocular higher-order aberrations was mainly due to corneal optics and that the corneal astigmatism correction was sufficient with the toric IOL. Mean absolute IOL misalignment was 3.5° with values ranging from 0° to 10°. CONCLUSIONS: The bitoric IOL AT TORBI 709M is able to provide a predictable correction of corneal astigmatism with low postoperative levels of ocular higher-order aberrations.

Clinical evaluation of a new pupil independent diffractive multifocal intraocular lens with a +2.75 D near addition: a European multicentre study.

PURPOSE: To evaluate the clinical outcomes after cataract surgery with implantation of a new diffractive multifocal intraocular lens (IOL) with a lower near addition (+2.75 D.). METHODS: 143 eyes of 85 patients aged between 40 years and 83 years that underwent cataract surgery with implantation of the multifocal IOL (MIOL) Tecnis ZKB00 (Abbott Medical Optics,Santa Ana, California, USA) were evaluated. Changes in uncorrected (uncorrected distance visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity) and corrected (corrected distance visual acuity, corrected near visual acuity) logMAR distance, intermediate visual acuity and near visual acuity, as well as manifest refraction were evaluated during a 3-month follow-up. Additionally, patients were asked about photic phenomena and spectacle dependence. RESULTS: Postoperative spherical equivalent was within ±0.50 D and ±1.00 D of emmetropia in 78.1% and 98.4% of eyes, respectively. Postoperative mean monocular uncorrected distance visual acuity, uncorrected near visual acuity and uncorrected intermediate visual acuity was 0.20 LogMAR or better in 73.7%, 81.1% and 83.9% of eyes, respectively. All eyes achieved monocular corrected distance visual acuity of 0.30 LogMAR or better. A total of 100% of patients referred to be at least moderately happy with the outcomes of the surgery. Only 15.3% of patients required the use of spectacles for some daily activities postoperatively. CONCLUSIONS: The introduction of low add MIOLs follows a trend to increase intermediate visual acuity. In this study a near add of +2.75 D still reaches satisfying near results and leads to high patient satisfaction for intermediate visual acuity.

Intermediate and near visual acuity of an aspheric, bifocal, diffractive multifocal intraocular lens with +3.25 D near addition.

PURPOSE: To evaluate the clinical outcomes after cataract surgery with implantation of a new diffractive multifocal intraocular lens with a lower near addition. METHODS: A prospective multicenter clinical study including 44 eyes of 44 patients (age range: 43 to 82 years) that underwent cataract surgery with implantation of the Tecnis ZLB00 multifocal intraocular lens (Abbott Medical Optics, Santa Ana, CA). Changes in uncorrected and corrected distance, intermediate, and near visual acuity, and manifest refraction were evaluated during a 3-month follow-up. Additionally, patients were asked about photic phenomena and spectacle dependence. RESULTS: Postoperative spherical equivalent was within 0.50 and ± 1.00 diopters of emmetropia in 91.2% and 100% of eyes, respectively. Postoperative monocular uncorrected distance, near, and intermediate visual acuities were 0.10 logMAR (20/25 Snellen) or better in 82.5%, 86.5%, and 68.8% of eyes, respectively. All eyes achieved monocular corrected distance and near visual acuity of 0.10 logMAR (20/25 Snellen) or better. All patients reported to be satisfied with the outcomes of the surgery. Only 6 patients (13.6%) required the use of spectacles for some daily activities postoperatively, and 8 patients (18.2%) reported mild perception of halos. CONCLUSIONS: The introduction of low addition multifocal intraocular lenses follows a trend to increase intermediate visual acuity. Still, a near addition of +3.25 diopters reached satisfying near results and led to high patient satisfaction.