Binocular and Monocular Implantation of Small-Aperture Intraocular Lenses in Cataract Surgery.

PURPOSE: To compare the clinical outcomes with the extended depth of focus small-aperture intraocular lens (IOL) (IC-8; AcuFocus, Irvine, CA) for presbyopia compensation when implanted monocularly or binocularly. METHODS: Visual outcomes, defocus curve, patient satisfaction, and visual symptoms during a 6-month follow-up were evaluated in 11 patients (contralateral group) implanted monocularly with this IOL and with an aspheric monofocal IOL in the fellow eye (myopic target) and 6 patients (bilateral group) implanted bilaterally with the IC-8 IOL (dominant eye with plano target, fellow eye with myopic target). RESULTS: Bilateral implantation of the IC-8 IOL resulted in an extended range of focus, with better intermediate and near vision. Monocular implantation of the IC-8 IOL resulted in a significantly higher overall satisfaction score and lower halo score. CONCLUSIONS: Bilateral implantation of the IC-8 IOL resulted in an extended range of focus, with better intermediate and near vision than monocular implantation of this IOL. [J Refract Surg. 2018;34(9):629-631.].

Photorefractive intrastromal corneal crosslinking for treatment of myopic refractive error: Findings from 12-month prospective study using an epithelium-off protocol.

PURPOSE: To assess the long-term effectiveness and safety of photorefractive intrastromal corneal crosslinking (CXL) in patients with low myopia. SETTING: Ruhr University Eye Hospital, Bochum, Germany. DESIGN: Prospective case series. METHODS: Healthy eyes with myopia were treated with photorefractive intrastromal CXL using the Mosaic System. Riboflavin 0.1% solution (VibeX Rapid) was topically administered, followed by 365 nm ultraviolet-A (30 mW/cm2) irradiance. Efficacy was assessed by the uncorrected distance visual acuity (UDVA), manifest refraction spherical equivalent (MRSE), and keratometry. Safety was assessed by corrected distance visual acuity (CDVA), slitlamp biomicroscopy, endothelial cell count, and adverse event rates. RESULTS: Fourteen patients (24 eyes) with a mean age of 35.7 years were included. At all follow-ups, a statistically significant improvement in UDVA was observed (all P < .001). The CDVA progressively improved from 1 month postoperatively and a statistically significant improvement was achieved at 12 months (P < .001). The average reduction in manifest sphere was 0.90 diopter (D) ± 0.40 (SD) by 12 months. There were no significant differences in mean manifest sphere and MRSE at 3, 6, or 12 months. Compared with baseline, significant reductions in corneal curvature were also observed at all follow-ups (all P < .05). There were no significant changes in endothelial cell density (P = 1.00) or number of cells (P = .95) at 12 months postoperatively, and no adverse events were reported. CONCLUSION: Photorefractive intrastromal CXL was a safe and efficacious treatment of refractive error in patients with low myopia.

Atypical endophthalmitis after intraocular collamer lens implantation.

Unilateral endophthalmitis occurred after bilateral immediately sequential intraocular collamer lens (Visian Implantable Collamer Lens) implantation for the correction of myopic astigmatism in a 49-year-old woman. The surgeries and initial recovery were unremarkable. However, after 3 days, the patient noticed increasing blurring of vision in the left eye and presented to our clinic. The anterior segment of this eye was quiet, while the vitreous cavity was densely infiltrated. Immediate explantation of the corrective lens and vitrectomy combined with intravitreal antibiotic injection were performed. Staphylococcus epidermidis was detected in the vitreous tap and treated with intravenous antibiotics, antibiotic eyedrops, and parabulbar injections of dexamethasone. The corrected distance visual acuity recovered to 20/20 over a 6-month period. However, a cataract developed thereafter.

Implantation of a Corneal Inlay in Pseudophakic Eyes: A Prospective Comparative Clinical Trial.

PURPOSE: To compare the clinical outcomes of binocular cataract surgery with and without pinhole corneal inlay implantation. METHODS: In the inlay-cataract group, a small aperture corneal inlay was implanted in addition to cataract surgery in the non-dominant eye and routine cataract surgery was performed in the dominant eye. In the control group, conventional cataract surgery was performed in both eyes in separate consecutive surgeries 2 weeks apart. The target refraction was emmetropia. Visual acuity, refraction, contrast sensitivity, and visual field were analyzed 1, 4, and 12 weeks after surgery. RESULTS: Sixteen patients with advanced cataracts underwent cataract surgery on both eyes in separate surgeries. There was no statistically significant difference regarding mean age, Lens Opacities Classification System grading, and refractive outcome. The difference in uncorrected distance visual acuity between the control group and inlay-cataract group was not statistically significant after 12 weeks (P = .59). Mean uncorrected intermediate visual acuity was significantly better in the inlay-cataract group (P = .03). Near visual acuity was better in the inlay-cataract group, but it was not statistically significant (P = .07). There was no statistically significant difference between groups under binocular photopic and mesopic conditions with and without glare. The results of the visual field examination showed no statistically significant difference between both eyes. CONCLUSIONS: The findings demonstrate that implantation of monofocal IOLs in combination with a small aperture corneal inlay in the non-dominant eye helps to increase intermediate and near visual acuity. The implantation of small aperture corneal inlays seems to be an interesting alternative for pseudophakic patients who desire spectacle independence. [J Refract Surg. 2018;34(11):746-750.].

Photorefractive intrastromal corneal crosslinking for the treatment of myopic refractive errors: Six-month interim findings.

PURPOSE: To evaluate the safety and efficacy of photorefractive intrastromal corneal crosslinking (CXL) in low myopia. SETTING: Ruhr University Eye Hospital, Bochum, Germany. DESIGN: Prospective case series. METHODS: Healthy eyes with myopia or myopic astigmatism had photorefractive intrastromal CXL using the Mosaic system to apply ultraviolet-A (UVA) 365 nm (30 mW/cm2) irradiance (total calculated UVA dose of 10 J/cm2 or 15 J/cm2) with riboflavin 0.1% solution. Efficacy was determined by the change in the manifest refraction spherical equivalent (MRSE), uncorrected distance visual acuity (UDVA), and corneal curvature. Safety was determined by the corrected distance visual acuity (CDVA), slitlamp biomicroscopy, endothelial cell count, and adverse events. RESULTS: Twenty-six eyes of 14 patients with a mean age of 30.8 years ± 9.3 (SD) were included. There were statistically significant improvements in UDVA 1, 3, and 6 months postoperatively (all P < .001). A significant improvement in CDVA was observed (P = .02). Improvements in the mean manifest sphere and MRSE versus baseline were noted at all visits (P < .001), with a mean change of 0.99 ± 0.47 diopter (D) and 0.97 ± 0.48 D, respectively, by 6 months postoperatively. Significant reductions in corneal curvature versus baseline occurred at all follow-up visits (all P < .05). At 1 month, there were no significant changes in the endothelial cell density (P = .282) or number of cells (P = .069). No safety issues or complications were reported. CONCLUSION: The findings show that patterned CXL using a custom CXL system is safe and effective for reducing myopic refractive error.