An intraocular telescopic lens for macular degeneration.

Age-related macular degeneration is a leading cause of visual loss in adults older than 60 years of age. Once vision has been seriously compromised, the only means of improving visual function are optical devices that produce magnification of images. These devices fall into three categories: (1) high-plus lenses, (2) external telescopes, and (3) a high-minus center intraocular lens combined with external high-plus glasses. The authors designed a new intraocular lens with an entire telescope in its center. In vitro tests were performed to evaluate modulation transfer function, visual field, and optical aberrations. Implantation in cadaver eyes was performed to test the surgical technique and safety. Test results showed that satisfactory modulation transfer function and optic aberration were achieved, and implantation in cadaver eyes was proven to be feasible and safe. It was concluded that a fully implanted intraocular telescopic lens is an effective optical solution for age-related macular degeneration.

A motorized hand piece for injectable lenses.

Foldable lenses represent a major breakthrough in the effort to achieve ever smaller incisions. The plate-haptic or "taco-style" lenses are folded and implanted by a device called an injector. Although customized for each manufacturer's lens, the injectors all have a common design principle: the intraocular lens (IOL) is folded within a funnel-like structure of the tip and is advanced by a plunger that pushes and delivers the lens. To maintain optimal hand stabilization and injector management, both hands are usually required. This does not leave a hand to help with IOL positioning. To improve handling, a simple, mechanized system has been created for a new injector system that allows the delivery of the plate-haptic lens with one hand, in a pen-like fashion.

Silicone-covered forceps for rigid intraocular lens implantation.

Metal implantation forceps can damage the surface of poly(methyl methacrylate) and heparin-surface-modified intraocular lenses (IOLs) during insertion. A new implantation forceps with silicone sleeves covering the tips has been successfully used during IOL implantation. Scanning electron microscopic studies showed that the silicone sleeves prevent forceps-induced IOL surface defects.

Forceps for capsulorhexis.

Conventional continuous curvilinear capsulorhexis (CCC) by forceps is connected with use of viscoelastics. A new model of forceps allows CCC without a viscoelastic and has the advantage of a bent-needle cystotome because the terminal part of the instrument is the size of a bent needle. The instrument retains the forceps' ability to grasp tissue firmly and prevents anterior chamber collapse during CCC. I performed the CCC using the new forceps without a viscoelastic in 198 eyes.

Twelve year follow-up of unfenestrated polysulfone intracorneal lenses in human sighted eyes.

PURPOSE: To evaluate unfenestrated polysulfone intracorneal lenses (ICLs) in human sighted eyes 12 years after their implantation and to assess eyes that had the ICLs explanted. SETTING: A department of clinical ophthalmology at a general hospital and the Department of Pathology at the National Institute of Ophthalmology, London, Great Britain. METHODS: In this retrospective study, seven eyes were evaluated 12 to 14 years after ICL implantation. Case notes were scrutinized for preoperative ophthalmic history, and patients were interviewed and examined to establish outcome of the ICL implantation. Histopathological correlates were made for two study patients who had had ICL explantation and penetrating keratoplasty (PKP). RESULTS: Uncorrected visual acuity in eyes retaining the ICL ranged between hand motion and 20/40, improving to 20/32 with correction. Corneal clarity varied between complete lucency to extensive opacity on each ICL surface. No corneal vascularization, endothelial decompensation, or uveitis was seen in eyes with clear ICLs. Acuity in eyes in which the ICL was explanted was between 20/20 corrected and finger counting in cases of PKP and between 20/200 and hand motion in eyes after lamellar keratoplasty. CONCLUSION: Despite satisfactory surgical technique in some eyes, unfenestrated polysulfone appears to be associated with color change and varying degree of stromal opacity in eyes evaluated 12 years postoperatively and thus cannot be considered clinically acceptable.

Clinical evaluation of a 5.5 mm three-zone refractive multifocal intraocular lens.

PURPOSE: To evaluate the results of implanting the P359-TUV 5.5 mm three-zone refractive multifocal intraocular lens (IOL). SETTING: Musashino Red Cross Hospital, Tokyo, Japan. METHODS: The lens was implanted in 29 eyes of 19 patients who were followed for a mean of 13.5 months. Distance visual acuity (DVA), near visual acuity (NVA), and contrast sensitivity were measured postoperatively. RESULTS: Ninety-three percent of eyes obtained 20/20 or better DVA with correction and J1 or better NVA with correction. Seventy-nine percent obtained J1 or better NVA with distance correction and 93% obtained J3 or better. Postoperative astigmatism was easier to control than with the former large model multifocal IOL. In almost all cases, good DVA and NVA could be obtained without correction and the cases that did not need spectacle correction increased. In unilaterally implanted cases, contrast sensitivity was slightly less in eyes with multifocal IOLs than in eyes with monofocal IOLs. In bilaterally implanted cases, there was no significant difference in contrast sensitivity between the multifocal and monofocal eyes. CONCLUSION: The small model P359-TUV lens is an effective multifocal lens, especially when implanted bilaterally.

Visual results of progressive multifocal posterior chamber intraocular lens implantation.

PURPOSE: To evaluate corrected and uncorrected near, intermediate, and distance visual acuities in eyes with a progressive multifocal intraocular lens (IOL) and to determine the effect of the lens on contrast sensitivity. SETTING: Multicenter study. METHODS: This prospective study comprised 59 eyes that had uneventful cataract surgery and implantation of a progressive multifocal IOL at three study centers. Uncorrected and corrected near, intermediate, and distance visual acuities were measured, as was contrast sensitivity at different frequencies. One year results are reported. Patient satisfaction was assessed using a subjective questionnaire. RESULTS: Distance visual acuity improved from 0.13 Snellen lines uncorrected and 0.23 with best correction preoperatively to 0.77 and 0.96 lines, respectively, postoperatively. Uncorrected preoperative near acuity was 13.28 Jaeger lines and best corrected acuity, 8.93 lines. These improved to 4.75 and 2.69 lines, respectively. The differences between visual acuity at intermediate distances and best distance and near acuities were not significant. Patient satisfaction was highest with vision under good light conditions and when viewing larger objects. CONCLUSION: Visual performance with the multifocal progressive IOL was adequate at various distances without additional correction. It was less satisfactory under poor light conditions.

Sulcus fixated posterior chamber lenses with and without suture in cases lacking capsular support.

In a prospective study ten commercially available anterior chamber lenses with S-shaped haptics and multipoint support were implanted into the posterior chamber in cases of secondary lens implantation after intracapsular cataract operation. The lenses were trans-sclerally fixed by two sutures through the ciliary sulcus. They showed more immediate stability than ten C-loop posterior chamber lenses of a control group and remained firmly fixed without complications during a follow-up of up to 54 months. To overcome the disadvantages of suture fixation a sutureless sulcus self-fixation PCL was developed and implanted into six eyes with special indications. After more than one year of follow-up no late adverse reaction was noted.

Use of a mirror needle holder with transsclerally sutured posterior chamber intraocular lenses.

A mirror needle holder has been designed to facilitate the passage of a needle through the ciliary sulcus during transscleral fixation of posterior chamber (PC) intraocular lens (IOLs). Two human postmortem eyes were used to demonstrate the efficacy of this mirror used as the needle holder. This method was compared with the current method of passing sutures without view of the ciliary sulcus. The mirror needle holder demonstrated precise passage of the needle into the ciliary sulcus by direct visualization of the ciliary processes and sulcus. This method may avoid the complications associated with transsclerally sutured PC IOLs during penetrating keratoplasty and secondary IOL placement.

Cracked cartridges during foldable intraocular lens implantation.

We describe five routine phacoemulsification procedures in which a longitudinal split in the injector cartridge occurred during foldable intraocular lens (IOL) implantation. In some cases, this was associated with a broken lens. All lenses (STAAR AA-4203VF) were folded, and implantation was attempted through a 3.5 mm corneal or scleral incision. Visual outcome was not adversely affected in any case. The systems for introducing foldable IOLs have not been perfected, and further refinements in materials and techniques are required.