High-risk factors for zonular complications during cataract surgery in eyes with pseudoexfoliation syndrome.

AIMS: To predict high-risk factors for zonular complications during cataract surgery due to pre-existing severe zonular dehiscence in eyes with pseudoexfoliation (PXF) syndrome. METHODS: 315 eyes of 315 consecutive patients with PXF scheduled for phacoemulsification surgery underwent preoperative examination of various ocular parameters using an anterior segment-optical coherence tomography and other devices. When zonular complications occurred during surgery due to zonular dehiscence, scleral fixation of the intraocular lens (IOL) or implantation of a capsular tension ring (CTR) was performed. High-risk factors for these intraoperative zonular complications were examined using classification-tree and logistic regression analyses. RESULTS: Of the 315 eyes, 31 (9.84%) underwent scleral IOL fixation or CTR implantation. High-risk factors identified by classification-tree analysis were a small pupillary diameter after mydriasis <6.30 mm, a shallow anterior chamber depth <2.074 mm and lens decentration >0.260 mm. Based on exact logistic regression analysis, the OR was 4.81-fold higher for eyes with poor mydriasis than for eyes without poor mydriasis (p=0.006, 95% CI 1.49 to 18.23), 23.99-fold higher for eyes with poor mydriasis and a shallow anterior chamber (p<0.001, 5.92 to 109.02) and 287.39-fold higher for eyes with poor mydriasis, a shallow chamber and great lens decentration (p<0.001, 50.46 to infinity). CONCLUSION: In eyes with PXF, high-risk factors for zonular complications during cataract surgery due to pre-existing severe zonular dehiscence were poor mydriasis, shallow anterior chamber and large lens decentration, suggesting the importance of evaluating these conditions preoperatively.

Comparison of Long-Term Corneal Astigmatic Changes After Cataract Surgery in Eyes With Superior or Horizontal Clear Corneal Incisions.

PURPOSE: To compare long-term corneal astigmatic changes after stabilization of surgically induced astigmatism (SIA) subsequent to phacoemulsification between eyes that underwent superior clear corneal incision (CCI) or horizontal CCI. DESIGN: Retrospective, comparative case series. METHODS: We examined the anterior corneal astigmatism of eyes that underwent a 2.4-mm superior CCI (superior CCI group, n = 43) or horizontal CCI (horizontal CCI group, n = 43) preoperatively, on the postoperative day that SIA stabilized (baseline), and at ≥7 years post-baseline using an autokeratometer. Corneal astigmatic changes from baseline to ≥7 years post-baseline (mean duration 8.74 years in the superior CCI group and 9.05 years in the horizontal CCI group) were decomposed to vertical/horizontal (Rx) and oblique astigmatic change components (Ry) and were compared between the 2 groups. RESULTS: The mean corneal astigmatism components changed significantly toward against-the-rule (ATR) astigmatism in the superior CCI group and with-the-rule astigmatism in the horizontal CCI group within 6 months postoperatively. After stabilization of the SIA, both groups showed a significant increase in the mean Rx and no significant change in the mean Ry over approximately 9 years, indicating a long-term ATR shift. The mean changes in the Rx and Ry did not differ significantly between the superior and horizontal CCI groups. Double-angle plots revealed a similar degree of ATR shift between the 2 groups over the 9 years. CONCLUSIONS: After stabilization of the SIA, a similar degree of ATR change occurred subsequent to superior and horizontal CCIs over approximately 9 years, suggesting that CCI direction does not affect long-term astigmatic changes.

Posterior vitreous detachment after cataract surgery in eyes with high myopia: an optical coherence tomography study.

PURPOSE: To compare the progression of posterior vitreous detachment (PVD) after cataract surgery in eyes with high myopia with that in eyes without high myopia. STUDY DESIGN: Prospective observational study. METHODS: Eighty eyes of 80 patients with high myopia and 160 eyes of 160 patients without high myopia scheduled for phacoemulsification were recruited. PVD status was examined using swept-source optical coherence tomography at 2 days postoperatively (baseline) and at 3, 6, and 12 months postbaseline and classified into 5 stages: 0 (no PVD), 1 (paramacular PVD), 2 (perifoveal PVD), 3 (peripapillary PVD), and 4 (complete PVD). The PVD stage and incidence of progression to complete PVD of the 2 groups were compared. RESULTS: The mean PVD stage did not differ significantly between the groups at baseline or at 3 months postbaseline but was significantly more progressed in the high myopia group than in the nonhigh myopia group at 6 months and 12 months postbaseline (P ≤ 0.0201). The Kaplan-Meier survival rate for complete PVD was significantly lower in the high myopia group (P = 0.0129). After adjusting for age, sex, and baseline PVD stage, the hazard ratio for complete PVD was 1.68-fold higher in the high myopia group than in the nonhigh myopia group (P = 0.0326, 95% CI 1.04-2.70). CONCLUSION: After cataract surgery, PVD progressed significantly faster in eyes with high myopia than in eyes without high myopia, and the relative risk for complete PVD was 1.68-fold higher in eyes with high myopia, suggesting that highly myopic eyes are at considerably high risk for retinal disease postoperatively.

Long-term changes in the refractive effect of a toric intraocular lens on astigmatism correction.

PURPOSE: To examine the long-term changes in the astigmatism-correcting effect of a toric intraocular lens (IOL) after stabilization of surgically induced astigmatic changes due to cataract surgery. METHODS: Unilateral eyes of 120 patients that received a toric IOL for against-the-rule (ATR) or with-the-rule (WTR) astigmatism were enrolled. Manifest refractive and anterior corneal astigmatism, and ocular residual astigmatism which is mainly derived from internal optics were examined preoperatively, at approximately 2 months postoperatively (baseline) and at 5 ~ 10 years postbaseline. The astigmatism was decomposed to vertical/horizontal (Rx) and oblique components (Ry), which was compared between baseline and 5 ~ 10 years postbaseline. RESULTS: In the eyes having ATR astigmatism, the mean Rx and Ry of the manifest refractive and corneal astigmatism significantly changed toward ATR astigmatism between the baseline and 5 ~ 10 years postbaseline (p ≤ 0.0304), but those of ocular residual astigmatism did not change significantly between the 2 time points. In the eyes having WTR astigmatism, the Rx and Ry of refractive, corneal, and ocular residual astigmatism did not change significantly between the 2 time points. Double-angle plots revealed an ATR shift in refractive and corneal astigmatism and no marked change in the ocular residual astigmatism in the eyes with ATR astigmatism, and there is no change in this astigmatism in the eyes with WTR astigmatism. CONCLUSION: The long-term changes with age in the effect of a toric IOL significantly deteriorated due to an ATR shift of corneal astigmatism in the eyes having ATR astigmatism, while it was maintained in eyes having WTR astigmatism, suggesting that ATR astigmatism should be overcorrected.

Long-term changes in manifest refraction subsequent to cataract surgery.

PURPOSE: To examine the long-term refractive changes after stabilization of surgically induced changes (SICs) subsequent to cataract surgery. SETTING: Private hospital. DESIGN: Case-control study. METHODS: Manifest refraction of 300 eyes of 300 patients who underwent phacoemulsification and 300 eyes of 300 age-matched and sex-matched patients without surgery was examined the day on which SICs stabilized (baseline) and ≥7 years postbaseline using an autorefractometer. Refraction was divided into 3 components: spherical power (M), vertical/horizontal astigmatism (J0), and oblique astigmatism (J45) using power vector analysis, and the components were compared between the 2 timepoints and between groups. RESULTS: Data of All 600 eyes were collected. In the surgery group, the mean M and J45 did not change significantly between baseline and ≥7 years postbaseline, but the J0 significantly decreased between the 2 timepoints (P < .001), indicating an against-the-rule (ATR) shift. In the nonsurgery group, the mean M significantly increased and J0 significantly decreased between the timepoints (P < .001), whereas J45 did not change significantly. The mean change in M between the 2 timepoints was significantly smaller in the surgery group (P < .001), whereas the changes in J0 and J45 did not differ significantly between the timepoints. CONCLUSIONS: Spherical power did not change and refractive astigmatism significantly changed toward ATR astigmatism during the more than 7-year follow-up after stabilization of SICs in pseudophakic eyes, whereas hyperopic and ATR shifts occurred in phakic eyes, and the astigmatic changes were comparable between pseudophakic and phakic eyes.

Progression of posterior vitreous detachment after cataract surgery.

PURPOSE: To compare the progression of posterior vitreous detachment (PVD) between eyes that underwent cataract surgery and eyes that did not undergo surgery in non-highly myopic patients. METHODS: One-hundred twenty-five eyes of 125 patients scheduled for phacoemulsification and 125 eyes of 125 age-matched patients who did not undergo surgery were enrolled. PVD status was evaluated using swept-source optical coherence tomography at 2 days (baseline), and 1, 3, 6, and 12 months postoperatively, and classified into five stages: 0 (no), 1 (paramacular), 2 (perifoveal), 3 (peripapillary), and 4 (complete). The PVD stage and incidence of progression to complete PVD were compared between groups. RESULTS: The mean PVD stage significantly progressed over the 12 months in the surgery group (P = 0.0004), but did not change significantly in the non-surgery group. The PVD stage did not differ significantly between groups at 2 days, or 1, 3, and 6 months postoperatively, but was significantly more progressed in the surgery group than in the non-surgery group at 12 months (P = 0.0390). After adjusting for age, sex, axial length, and baseline PVD stage, the relative risk for progression to complete PVD was 7.1-fold higher in the surgery group than in the non-surgery group (P < 0.0001, 95% confidence interval 2.9-17.3). CONCLUSION: PVD progressed significantly faster in eyes after cataract surgery compared with eyes that did not undergo surgery, and the relative risk of progression to complete PVD was approximately seven-fold higher within 1 year, indicating that the risk for PVD-related diseases is high after cataract surgery.

Pupillary light response after cataract surgery in healthy patients.

PURPOSE: To examine the changes in the pupillary light response after phacoemulsification and to compare the difference in the response among patients in different age categories. STUDY DESIGN: Prospective observational study. METHODS: Four-hundred twenty-two eyes of 422 patients in 3 age categories (60-69 years, 70-79 years, and 80-89 years) scheduled for phacoemulsification were consecutively enrolled. The eyes underwent examinations with an infrared pupillometer to obtain the parameters of the pupillary light response preoperatively and at 1 day and 1 and 3 months postoperatively. Differences in the parameters of the pupillary response were compared among 4 time intervals and the 3 age categories. RESULTS: The mean maximum and minimum pupillary diameters significantly decreased at 1 day postoperatively and returned to the preoperative level by 1 month postoperatively (P<.0001). The mean percentage of pupillary constriction was significantly reduced at 1 and 3 months postoperatively compared with preoperatively and at 1 day postoperatively (P<.0001). The average pupillary constriction and dilation velocities were significantly lower at 1 and 3 months postoperatively than they were preoperatively and at 1 day postoperatively (P<.0001). The latency to constriction did not differ significantly among the time intervals. The percentage of pupillary constriction was significantly smaller, and the average constriction and dilation velocities were lower in association with higher age categories at all time intervals (P≤.0185). CONCLUSION: The pupillary light response was impaired several months after cataract surgery and worsened with increasing patient age, indicating that cataract surgery may compromise the pupillary constriction and dilation functions in association with age.

Effect of Refractive Astigmatism on All-Distance Visual Acuity in Eyes With a Trifocal Intraocular Lens.

PURPOSE: To investigate the effect of refractive astigmatism on all-distance visual acuity (VA) in eyes implanted with a diffractive trifocal or bifocal intraocular lens (IOL). DESIGN: Cross-sectional study. METHODS: Fifty eyes with trifocal IOLs (PanOptix; Alcon) and 50 eyes with bifocal IOLs (ReSTOR +3D) were enrolled. After simulating astigmatism by adding cylindrical lenses of 0, 0.5, 0.75, 1.0, and 1.5 diopters (D), the corrected logarithm of minimal angle of resolution (logMAR) VA was measured using an all-distance vision tester. RESULTS: Mean VAs at most distances significantly worsened in proportion to the added astigmatism (P ≤ .0111) with no significant differences in near VA at 0.3 m in the trifocal group or in intermediate VA at 0.7 m in the bifocal group. Mean intermediate VA at 0.5 m was significantly better in the trifocal group than in the bifocal group when the astigmatism was 0.75 D or less (P ≤ .0472), but VA at distances of ∞ and 5.0 m were significantly worse in the trifocal group when the astigmatism was 0.5 D or more (P ≤ .0457). Useful mean logMAR VA of 0.20 was achieved at all distances when the astigmatism was 0.75 D or less in the trifocal group and 1.0 D or less in the bifocal group. CONCLUSIONS: All-distance VA, particularly distance VA, worsened more in proportion to astigmatism with a trifocal IOL than with a bifocal IOL. Useful VA was achieved when the astigmatism was 0.75 D or less with a trifocal IOL, suggesting that astigmatism correction is necessary when astigmatism is more than 0.75 D.

Short-Term Changes in Prediction Error after Cataract Surgery in Eyes Receiving 1 of 3 Types of Single-Piece Acrylic Intraocular Lenses.

PURPOSE: To compare short-term changes in refractive prediction error (PE) after phacoemulsification among eyes receiving different types of single-piece acrylic intraocular lenses (IOLs). DESIGN: Randomized clinical trial. METHODS: A total of 195 eyes of 195 patients scheduled for implantation of a single-piece acrylic IOL were randomly assigned to receive 1 of 3 IOLs: 1) an Alcon model SN60WF, 2) a Hoya model XY-1, or 3) an AMO model ZCB00V. Manifest spherical equivalent (MRSE) value, PE, and changes in PE were examined at 1 day and at 1 and 2 months postoperatively and were compared among groups. RESULTS: The mean MRSE and PE significantly changed toward myopia between 1 day and 2 months postoperatively in all groups (P < .0001). The MRSE and PE did not differ significantly among groups at 1 day and 1 month postoperatively and were significantly smaller in the SN60WF group than in the XY-1 and ZCB00V groups at 2 months (P ≤ .0006). The PE change between 1 day and 2 months postoperatively was significantly smaller in the SN60WF group than in the other groups (P = .0062). IOL type and changes in anterior chamber depth and corneal curvature independently correlated with PE changes. CONCLUSIONS: The MRSE and PE showed a significant myopic change for 2 months postoperatively in eyes implanted with 1 of 3 types of single-piece acrylic IOLs and were significantly smaller in the SN60WF than in the XY-1 and ZCB00V groups. Changes in PE during the 2 postoperative months were smaller in the SN60WF IOLs than in the other IOLs, suggesting that postoperative refractive stability differs among single-piece acrylic IOLs.

Comparison of visual outcomes between bilateral trifocal intraocular lenses and combined bifocal intraocular lenses with different near addition.

PURPOSE: To compare outcomes in patients implanted bilaterally with a trifocal intraocular lens (IOL) with patients implanted with bifocal IOLs having different near addition in each eye. STUDY DESIGN: Nonrandomized comparative study. METHODS: Seventy-eight patients scheduled for multifocal IOL implantation were divided into a trifocal group (n=32) implanted bilaterally with trifocal IOLs (Alcon TFNT00), and a combined bifocal group (n=46) implanted with a bifocal IOL with +3.0 diopter (D) addition in the dominant eye and +4.0D addition in the nondominant eye. At 3 months postoperatively, binocular all-distance visual acuity (VA), binocular contrast VA alone and with glare (glare VA), near stereoacuity, and incidence of patients reporting halo symptoms were assessed. RESULTS: Both mean binocular uncorrected and corrected VAs at far to intermediate distances were significantly better in the trifocal group than in the combined bifocal group (P≤0.0325), while binocular near VA did not differ significantly between groups. Mean photopic and mesopic contrast VA and glare VA at most contrasts, and stereoacuity were significantly better in the trifocal group than in the combined bifocal group (P≤0.0426). The incidence of patients reporting moderate halo symptoms was significantly greater in the trifocal group (P=0.0482). CONCLUSIONS: Bilateral implantation of a trifocal IOL provided significantly better binocular VA at far to intermediate distances and comparable near VA compared with combined implantation of bifocal IOLs with +3.0D and +4.0D addition. Contrast VA and stereoacuity were significantly better, but the incidence of halo symptoms tended to be worse in patients with trifocal IOLs.

Effect of Spherical Equivalent Error on Visual Acuity at Various Distances in Eyes With a Trifocal Intraocular Lens.

PURPOSE: To examine the effect of manifest refraction spherical equivalent error on visual acuity at various distances in eyes that received a trifocal intraocular lens (IOL). METHODS: Sixty eyes of 30 patients who underwent bilateral implantation of a trifocal IOL (Alcon PanOptix TFNT00; Alcon Laboratories, Inc., Fort Worth, TX) were enrolled. Corrected visual acuity from far to near distances was measured using an all-distance vision tester after simulating the spherical equivalent error by adding spherical lenses with refractive powers of +1.00, +0.50, 0.00, -0.50, and -1.00 diopters (D); addition of a plus lens simulates myopia, whereas addition of a minus lens simulates hyperopia. RESULTS: Mean visual acuity at all distances differed significantly among the spherical lens added groups (P ≤ .0374). Mean distance visual acuity at infinity, 5, and 3 m was significantly worse in all lens added groups (+1.00, +0.50, -0.50, and -1.00 D) than in the no lens group (P < .0001). Mean intermediate visual acuity at 1 and 0.7 m did not differ significantly between each of the lens added groups and the no lens group. Mean near visual acuity at 0.3 m was significantly better in the +1.00 and +0.50 D groups and significantly worse in the -0.50 and -1.00 D groups than in the no lens group (P ≤ .0044). CONCLUSIONS: A manifest spherical equivalent error of slight myopia significantly improved near visual acuity but worsened distance visual acuity, whereas that of slight hyperopia worsened both distance and near visual acuity in eyes with trifocal IOLs, suggesting that slight myopia is a better target refraction than slight hyperopia, although emmetropia is the optimum target. [J Refract Surg. 2019;35(5):274-279.].

Effect of Topical Hypotensive Medications for Preventing Intraocular Pressure Increase after Cataract Surgery in Eyes with Glaucoma.

PURPOSE: To compare the effects of a topical intraocular pressure (IOP)-lowering medication for preventing an IOP increase after cataract surgery in eyes with glaucoma. DESIGN: Randomized clinical study. METHODS: A total of 165 eyes of 165 patients with primary open-angle glaucoma or pseudoexfoliation glaucoma scheduled for phacoemulsification were randomly assigned to 1 of 3 groups to receive each medication immediately postoperatively: 1) prostaglandin F2α analog (travoprost), 2) ß-blocker (timolol maleate), or 3) carbonic anhydrase inhibitor (brinzolamide). Intraocular pressure (IOP) was measured using a rebound tonometer at 1 hour preoperatively, at the end of surgery, and at 2, 4, 6, 8, and 24 hours postoperatively. The incidence of eyes exhibiting a marked IOP increase to greater than 25 mm Hg was compared among the groups. RESULTS: At 1 hour preoperatively and at the end of surgery, mean IOP did not differ significantly among the groups. Mean IOP increased significantly between 4 and 8 hours postoperatively and then decreased at 24 hours postoperatively in all groups (P < .0001). Mean IOP was significantly lower in the brinzolamide group than in the travoprost or timolol group at 4, 6, and 8 hours postoperatively (P ≤ .0374) and did not differ significantly among groups at 2 and 24 hours postoperatively. The incidence of an IOP spike was significantly lower in the brinzolamide group than in the travoprost and timolol groups (P = .0029). CONCLUSIONS: Brinzolamide reduces the short-term IOP increase after cataract surgery more effectively than travoprost or timolol in eyes with glaucoma, suggesting that brinzolamide is preferable for preventing an IOP spike.

Corneal shape changes of the total and posterior cornea after temporal versus nasal clear corneal incision cataract surgery.

AIM: To compare changes in the shape and astigmatism of the total and posterior cornea between eyes with a nasal clear corneal incision (CCI) and eyes with a temporal CCI in cataract surgery. METHODS: The left eyes of 100 patients undergoing phacoemulsification were randomly assigned to undergo a 2.4 mm nasal (nasal CCI group) or temporal CCI (temporal CCI group). Corneal astigmatic changes were compared between groups using power vector analysis, and corneal shape changes were compared using videokeratography maps at 2 days, and at 2, 4 and 8 weeks postoperatively. RESULTS: The mean J0 and J45 values of the total cornea were significantly greater in the nasal CCI group than in the temporal CCI group at 2 and 4 weeks postoperatively (p≤0.0392), but did not differ significantly between groups at 2 days and 8 weeks. The videokeratography maps revealed a wedge-shaped flattening in the total cornea and a steepening in the posterior cornea around the CCIs in both groups at 2 days postoperatively; those were more prominent in the nasal CCI group than in the temporal CCI group. The wound-related changes diminished by 8 weeks postoperatively in the total and posterior cornea, and were not markedly different between groups at 8 weeks postoperatively. CONCLUSION: Corneal shape and astigmatic changes were comparable between groups at 8 weeks postoperatively, although the changes were greater after nasal CCI than after temporal CCI in the early postoperative periods, indicating that nasal or temporal CCI can be selected based on the surgeon's preference.

Short-term Dynamics after Single- and Three-piece Acrylic Intraocular Lens Implantation: A Swept-source Anterior Segment Optical Coherence Tomography Study.

Accurate alignment of an intraocular lens (IOL) is indispensable for achieving accurate postoperative refractive outcomes. Thus, we evaluated decentration and tilt of single- and three-piece IOLs, as well as anterior chamber depth (ACD), at 3 hours, 24 hours, 2 weeks, and 4 weeks after cataract surgery, using swept-source anterior segment optical coherence tomography. There was no significant difference in postoperative visual acuity between eyes with single- or three-piece IOLs. Absolute values of IOL decentration at 24 hours and 2 weeks after surgery were significantly larger (P = 0.008 and 0.046, respectively) in eyes with the single-piece IOL than in those with the three-piece IOL. Both single- and three-piece IOLs tended to tilt toward the inferotemporal direction; however, there was no significant difference in the absolute values of IOL tilt at any postoperative time point. ACD at 24 hours after surgery was significantly deeper (P = 0.009) in eyes with the three-piece IOL, compared with eyes with the single-piece IOL. Therefore, although both single- and three-piece IOL locations varied transiently after surgery, IOL locations were similar between both IOLs at 4 weeks after surgery and were not associated with any statistical difference in visual function.

Intraocular pressure elevation after cataract surgery and its prevention by oral acetazolamide in eyes with pseudoexfoliation syndrome.

PURPOSE: To examine whether intraocular pressure (IOP) increases immediately after cataract surgery in eyes with pseudoexfoliation (PXF) syndrome and to assess whether orally administered acetazolamide can prevent the IOP elevation. SETTING: Hayashi Eye Hospital, Fukuoka, Japan. DESIGN: Prospective case series. METHODS: Patients with PXF syndrome scheduled for phacoemulsification were randomly assigned to 1 of 3 groups: (1) oral acetazolamide administered 1 hour preoperatively (preoperative administration group), (2) administered 3 hours postoperatively (postoperative administration group), and (3) not administered (no administration group). The IOP was measured using a rebound tonometer 1 hour preoperatively, upon completion of surgery, and at 1, 3, 5, 7, and 24 hours postoperatively. RESULTS: The study comprised 96 patients (96 eyes). The mean IOP increased at 3, 5, and 7 hours postoperatively in all groups. At 1 hour and 3 hours postoperatively, the IOP was significantly lower in the preoperative administration group than in the postoperative group and no administration group (P ≤ .001). At 5, 7, and 24 hours postoperatively, the IOP was significantly lower in the preoperative group and postoperative administration group than in the no administration group (P ≤. 045). An IOP spike higher than 25 mm Hg occurred less frequently in the preoperative administration group than in the postoperative administration group and the no administration group (P = .038). CONCLUSIONS: Intraocular pressure increased at 3, 5, and 7 hours after cataract surgery in eyes with PXF syndrome. Oral acetazolamide administered 1 hour preoperatively reduced the IOP elevation throughout the 24-hour follow-up; acetazolamide administered 3 hours postoperatively reduced the elevation at 5 hours postoperatively and thereafter.

Binocular visual function of myopic pseudophakic monovision.

PURPOSE: To compare binocular visual function of myopic pseudophakic patients with myopic monovision to patients without monovision. STUDY DESIGN: Randomized comparative study METHODS: Sixty patients were randomized to one of two groups: patients whose refraction was targeted to -2.75 diopters (D) in the dominant eye and -1.75D in the nondominant eye (myopic monovision group), and patients whose refraction was targeted to -2.75D bilaterally (non-monovision group). Binocular uncorrected and corrected visual acuity at various distances was measured using an all-distance vision tester, and contrast visual acuity and near stereoacuity were examined. RESULTS: In the myopic monovision group mean refraction was -2.74D in the dominant eyes and -1.94D in the nondominant eyes, and in the non-monovision group it was -2.96D bilaterally. Mean binocular uncorrected distance (UDVA) and intermediate visual acuity (UIVA) from 0.5 m to 5.0 m were significantly better in the myopic monovision group than in the non-monovision group (P≤ 0.0134), while binocular uncorrected near visual acuity (UNVA) at 0.3 m did not differ significantly between groups. The distribution of UIVA and UDVA was significantly better in the myopic monovision group (P≤ 0.0035). Corrected visual acuity at any distance, photopic and mesopic contrast visual acuity, and stereoacuity did not differ significantly between groups. CONCLUSION: Patients with myopic monovision exhibited significantly better binocular UIVA and UDVA than those without monovision, while UNVA, corrected visual acuity, contrast sensitivity, and stereoacuity were comparable between groups, suggesting that this method is useful for patients who want to see near and intermediate distances without spectacles.

Changes in shape and astigmatism of total, anterior, and posterior cornea after long versus short clear corneal incision cataract surgery.

PURPOSE: To compare changes in the shape and astigmatism of the total, anterior, and posterior cornea between eyes with long-length clear corneal incisions (CCIs) and eyes with short-length CCIs in cataract surgery. SETTING: Hayashi Eye Hospital, Fukuoka, Japan. DESIGN: Prospective case series. METHODS: Both eyes of patients having phacoemulsification with temporal CCIs were randomized to have a long-length (≥1.75 mm) or short-length (<1.75 mm) CCI. Corneal astigmatic changes were decomposed to vertical/horizontal (Jackson cross-cylinder, axes at 180 degrees and 90 degrees [J0]) and oblique changes (Jackson cross-cylinder, axes at 45 degrees and 135 degrees [J45]) using power vector analysis. Corneal shape changes were assessed using the average of the difference map on videokeratography 2 days and 2, 4, and 8 weeks postoperatively. RESULTS: The mean J0 and J45 values of the total cornea in the 120 eyes evaluated were significantly greater in the long CCI group than in the short CCI group at all follow-ups (P ≤ .0290). The videokeratography showed a wedge-shaped flattening in the total and anterior cornea and a steepening in the posterior cornea around the CCI 2 days postoperatively in both groups. This wound-related flattening of the total and anterior cornea rapidly reduced but persisted until 8 weeks, whereas the steepening of the posterior cornea disappeared within 4 weeks. These changes extended closer to the central cornea in the long CCI group than in the short CCI group. CONCLUSIONS: Corneal astigmatic changes were significantly greater after long CCI than after short CCI. The wound-related shape changes occurred immediately postoperatively but rapidly diminished.