Comparison of Two Presbyopia-Correcting Trifocal Intraocular Lenses: A Prospective Study.

Objectives: To evaluate the clinical results of a new trifocal intraocular lens (IOL) with sinusoidal design by comparing with a traditional trifocal IOL. Materials and Methods: A total of 79 patients undergoing uneventful microincisional cataract surgery with bilateral implantation of one of two types of trifocal IOLs, the Acriva Trinova IOL (VSY) or Acrysof IQ PanOptix IOL (Alcon), were enrolled in this prospective study. Visual and refractive outcomes, contrast sensitivity (CS), and defocus curve were assessed at 3 months after surgery. Patient satisfaction and incidence of photic phenomena were also evaluated. Results: The number of patients/eyes were 48/96 in the Trinova group and 31/62 in the PanOptix group. There were no significant differences between the groups for monocular and binocular corrected/uncorrected distance or intermediate (at 60 cm) and near visual acuities (VA) postoperatively. The Trinova group had statistically significantly better intermediate VA at 80 cm than the PanOptix group (p<0.05). The CS results of both groups were within the normal limits. In the binocular defocus curve of both IOLs, we observed a peak of good VA at 0.0 diopters defocus and a useful wide range for intermediate distances. The incidence of photic phenomena in the Trinova group was lower at postoperative 1 month (p<0.05) but this difference disappeared at 3 months. A total of 47 patients (97.9%) in the Trinova group and 30 patients (96.7%) in the PanOptix group stated that they would recommend the same IOL. Conclusion: Both trifocal IOLs provide good visual quality outcomes and patient satisfaction.

A Modified Girth-Hitch Suture Technique to Rescue Single-Haptic Dislocation of Scleral Fixated IOL's.

PURPOSE: To describe the technique of modified girth-hitch suture for one side transscleral fixation to rescue a single haptic dislocation. METHODS: In this surgical technique report, dislocated scleral fixated posterior chamber IOL were secured to the sclera using 10-0 polypropylene suture looped around the IOL haptic. Three types of IOL were secured in this study (4 case of 1-piece PMMA IOL, 1 case of 3-piece acrylic IOL with PMMA loop and 1 case of acrylic foldable IOL with a two-plate loop design). RESULTS: Six patients, who had subluxation of the scleral-fixated posterior-chamber IOL due to single-knot dehiscence, underwent refixation of scleral-fixated IOL surgery using this technique. In all cases successful repositioning with stable and central fixation of the IOLs was achieved. No intraoperative or postoperative complications were noted. CONCLUSION: Internal re-fixation with a girth-hitch suture is relatively quick and convenient method for management of a dislocated IOL haptic on one side.

Comparison of Hybrid Contact Lenses and Rigid Gas-Permeable Contact Lenses in Moderate and Advanced Keratoconus.

Objectives: We aimed to compare the clinical results and topographic data of the new generation hybrid contact lens (HCL) and rigid gas-permeable contact lens (RGPCL) in patients with moderate and advanced keratoconus. Materials and Methods: In this prospective study, HCL users comprised group 1 and RGPCL users comprised group 2. Snellen uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and lens-corrected visual acuity (LCVA); manifest spherical-cylindrical values; corneal topography measurements (flat keratometry [K1], vertical keratometry [K2], mean K, maximum K [Kmax], central corneal thickness [CCT], and thinnest corneal thickness [TCT]); and cone location were recorded. Results: The study included 83 eyes of 51 patients in group 1 and 61 eyes of 40 patients in group 2. The groups were similar in age and gender (p>0.05). Mean LCVA (logMAR) was significantly lower than BCVA in both groups (p<0.001). The mean visual gain with contact lenses (Snellen chart) was 3.4±1.8 lines in group 1 and 4.0±2.1 lines in group 2. There was no significant difference between the two groups in BCVA, LCVA, or lines gained (p>0.05). There was also no significant difference between the two groups in terms of keratoconus stages, mean Kmax, CCT, TCT, or cone location (p>0.05), while mean UCVA (logMAR) and mean K were higher in group 2 (p<0.05). In both groups, the visual gain with lenses was higher in eyes with central cones, and there was significantly greater visual increase in group 2 (p=0.039). Conclusion: In moderate and advanced keratoconus, HCLs improved vision as much as RGPCLs and both lenses were more effective for central cones. Nevertheless, longer term of follow-up and larger numbers of patients are needed for long term follow-up results of HCL.

Comparison of effects of mydriatic drops (1% cyclopentolate and 0.5% tropicamide) on anterior segment parameters.

Purpose: The purpose of this study is to investigate and compare the effects of cyclopentolate and tropicamide drops on anterior segment parameters in healthy individuals. Methods: Two hundred and fifty-eight eyes of 129 healthy volunteers were included in this randomized clinical study. Cyclopentolate 1% drop was applied to 75 (58%) participants (group 1) and tropicamide 0.5% drop was applied to 54 (42%) participants (group 2). Flat keratometry (K1), steep keratometry (K2), axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), white-to-white (WTW) distance, pupil diameter, total pupil offset and intraocular lens (IOL) power were measured before and after drops, using Lenstar 900 optical biometry. Results: The increase in CCT, ACD, pupil diameter, and pupil offset was significant in group 1 after the drop (P < 0.05), while the increase in ACD, pupil diameter, and pupil offset was significant in group 2 (P < 0.05). When the two groups were compared, there was no significant difference in K1, K2, CCT, ACD, WTW, pupil diameter, pupil offset, and IOL power (using Sanders-Retzlaff-Kraff T formula) changes after drops (P > 0.05), whereas the change in AL was significant (P = 0.01). Conclusion: The effects of cyclopentolate and tropicamide drops on anterior segment parameters were similar; they did not make significant changes in K1, K2, AL, WTW, and third-generation IOL power calculation. However, ACD values significantly changed after these drops; thus, measuring anterior segment parameters before mydriatic agents should be taken into account particularly for fourth-generation IOL formulas and phakic IOL implantation. The change in pupil offset, which can be important in excimer laser and multifocal IOL applications, was not clinically significant.

Five-Year Long-Term Results of Standard Collagen Cross-Linking Therapy in Patients with Keratoconus

Objectives: We aimed to demonstrate the 5-year visual, topographic, and aberrometry long-term results of standard collagen cross-linking (CCL) treatment in keratoconus patients. Materials and Methods: The files and topographic measurements of patients who underwent standard CCL treatment for progressive keratoconus were retrospectively reviewed. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction values, and topographic values were evaluated. Results: Thirty-seven eyes of 27 patients were included in the study. The female to male ratio was 15 (56%)/12 (44%) and the mean age was 22.16±6.4 (12-39) years. The increase in UCVA and BCVA was statistically significant at postoperative 1-5 years (all p values <0.05). The changes in the spherical equivalent after CCL were not statistically significant (p>0.05), but the decrease in the manifest astigmatism values were significant after CCL at 3-5 years (p<0.05). Decrease in K2 (steep keratometry) and K apex values were statistically significant at 1-5 years (p<0.05). There was a significant decrease in the thinnest corneal thickness compared to the preoperative values up to 6 months and 1-4 years (p<0.05), but the change at 5 years was not significant (p=0.08). Post-CCL reductions in high-order aberrations and spherical aberrations were significant at postoperative 5 years and 3-5 years (p<0.05). Conclusion: In long-term follow-up, CCL treatment is seen to arrest keratoconus progression, increase vision, and improve visual quality by reducing higher-order aberrations and spherical aberrations. For these reasons, CCL treatment continues to be the first treatment modality in patients with progressive keratoconus.

Implantation of a double iris-claw intraocular lens in an aphakic nanophthalmic eye.

A 55-year-old female with an aphakic nanophthalmic eye underwent a secondary intraocular lens implantation (IOL) with double Artisan aphakia iris claw IOLs (ICIOLs) and was evaluated in this research. The patient's preoperative best-corrected visual acuity (BCVA) of the right eye was 0.4 (0.4 logMAR) (with + 21.00 D), postoperative 1st and 3rd month, 1st year, and 3 years BCVAs were 0.4 (0.4 logMAR). The intraocular pressure was 15 mmHg preoperatively, and 14, 12, 12, and 15 mmHg postoperatively at 1st and 3rd month, 1st year, and 3 years, respectively. The preoperative endothelial cell density (ECD) was 2372 cells/mm2, and postoperative ECDs were 2352, 2391, 2246, and 2240 cells/mm2 at 1st and 3rd months, at 1st year, and 3 years respectively. In aphakic nanophthalmic eyes with inadequate capsular support, which require high IOL dioptry, the implantation of double ICIOLs (one in front of the iris and the other behind the iris) seems to be safe and provides good visual rehabilitation.