Long-term outcomes of cataract surgery with toric intraocular lens implantation by the type of preoperative astigmatism.

Surgical outcomes of toric intraocular lens (IOL) implantation for 8 years after surgery were analyzed. Data were retrospectively collected in 176 eyes of 176 patients before and 1 month, 1, 3, 5, and 8 years after phacoemulsification and implantation of a toric IOL. Preoperative corneal and postoperative manifest astigmatism was analyzed by converting to power vector notations; horizontal/vertical (J0) and oblique (J45) astigmatism components. Toric IOL implantation significantly reduced pre-existing astigmatism by decreasing J0 in eyes with preoperative with-the-rule (WTR) astigmatism, increasing J0 in eyes with against-the-rule (ATR) astigmatism, and correcting J45 in eyes with oblique astigmatism. After surgery, the eyes with preoperative ATR astigmatism showed a significant ATR astigmatic shift, and J0 at 5 and 8 years was significantly smaller than that at 1 month postoperatively. Uncorrected distance visual acuity was also significantly worse at 5 and 8 years than at 1 month postoperatively. In eyes with WTR and oblique astigmatism, the effects of toric IOLs on astigmatism and visual acuity were sustained for 8 years. The long-term astigmatism-correcting effects did not differ among the models of toric IOL used in this study, SN6AT3-8 (Alcon Laboratories). In eyes with preoperative ATR astigmatism, astigmatism-correcting effects of toric IOLs decreased at 5 years and later postoperatively, indicating that overcorrection may be considered at the time of cataract surgery. In eyes with WTR and oblique astigmatism, the effects of toric IOLs were maintained throughout the 8-year follow-up period.

Effect of small-incision sutureless cataract surgery on the natural course of astigmatism over 10 to 20 years.

PURPOSE: To retrospectively assess astigmatic changes over 10 years and 20 years after small-incision cataract surgery. SETTING: 5 ophthalmic surgical sites in Japan. DESIGN: Retrospective case series. METHODS: Data were collected from patients who had undergone phacoemulsification and implantation of an intraocular lens through a 2.2 to 2.4 mm incision. Preoperative corneal and postoperative manifest astigmatism were converted to power vector notations: horizontal/vertical (J 0 ) and oblique (J 45 ) astigmatism components. RESULTS: 422 eyes of 422 patients were followed for 10 years, and data preoperatively and at 1 month and at 1 year, 3 years, 5 years, 8 years, and 10 years postoperatively were analyzed. The mean J 0 decreased significantly ( P < .001, repeated measures analysis of variance) with an against-the-rule (ATR) shift of 0.363 ± 0.433 diopter (D) over 10 years, but the mean J 45 did not change significantly ( P = .150). Double-angle plot analyses also showed similar ATR shifts in all astigmatism groups. In the subgroup analysis conducted in 34 patients who were followed for 20 years, J 0 declined significantly ( P < .001) by 0.649 ± 0.576 D, whereas J 45 did not ( P = .516). The postoperative changes in J 0 and J 45 were not significantly different between eyes with preoperative with-the-rule, ATR, or oblique astigmatism. CONCLUSIONS: Postoperative astigmatism continued to shift toward ATR during the follow-up period of 20 years after small-incision cataract surgery, which seems to reflect the natural course of corneal astigmatic changes that commonly occur with aging. ATR astigmatic shifts were similar in both pattern and magnitude regardless of the type of preoperative astigmatism.

Intraindividual comparison of aspherical and spherical intraocular lenses of same material and platform.

PURPOSE: There have been few studies which compared aspherical and spherical intraocular lenses (IOLs) of same material and platform in bilateral cataract cases. We performed an intraindividual comparison of ocular aberration and scotopic, mesopic, and photopic contrast sensitivity with aspherical and spherical IOLs, using the same IOL material and platform manufactured by the same company. DESIGN: Prospective, randomized, controlled study. PARTICIPANTS: Eighty-two eyes of 41 patients undergoing bilateral cataract surgery. METHODS: One eye of a patient was assigned to acrylic foldable aspherical IOL (Tecnis ZA9003, Advanced Medical Optics), and the contralateral eye was allocated to acrylic foldable spherical IOL (AR40e, Advanced Medical Optics). All patients were examined at 2 days, 1 week, and 1 month postoperatively. MAIN OUTCOME MEASURES: Best-corrected visual acuity (BCVA), contrast sensitivity under scotopic (15 lux), mesopic (70 lux), and photopic (180 lux) conditions, corneal and ocular wavefront aberrations, anterior chamber depth, amount of IOL decentration and tilt, pupil diameter under scotopic (3 lux) and photopic (250 lux) conditions, area of anterior capsule opening, degree of posterior capsule opacification, and all-distance visual acuity. RESULTS: There was no significant difference between IOLs in BCVA, anterior chamber depth, amount of IOL decentration and tilt, pupil diameter, area of anterior capsule opening, and degree of posterior capsule opacification. In corneal wavefront aberrations, there was no difference in 3rd-, 4th-, and total higher-order root-mean-square (RMS). In ocular wavefront aberration, aspherical IOL showed significantly lower 4th-order (P<0.001) and total higher-order RMS (P<0.001) than spherical IOL, but not in 3rd-order RMS (P = 0.103). Contrast sensitivity under scotopic conditions was significantly better with aspherical IOL than with spherical IOL at 3 (P = 0.0015), 6 (P = 0.0192), and 12 cycles per degree (P = 0.0315). Contrast sensitivity under mesopic and photopic conditions was not significantly different between IOLs. There was no between-group difference in visual acuity at 0.3, 0.5, 0.7, 1.0, or 5.0 meters measured with full distance correction. CONCLUSIONS: Acrylic foldable aspherical IOL (Tecnis ZA9003) yielded significantly lower ocular wavefront aberration and better contrast sensitivity under scotopic condition without compromising depth of focus. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.

Prospective intrapatient comparison of 6.0-millimeter optic single-piece and 3-piece hydrophobic acrylic foldable intraocular lenses.

PURPOSE: To compare postoperative performance and stability of 6.0-mm optic single- and 3-piece acrylic foldable intraocular lenses (IOLs). DESIGN: Prospective, randomized, self-controlled trial. PARTICIPANTS: Eighty eyes of 40 patients with bilateral senile cataracts. INTERVENTION: Phacoemulsification and IOL implantation were performed. One eye of a patient was randomly assigned to the SA60AT single-piece IOL, and the contralateral eye was allocated to the MA60AC 3-piece IOL. MAIN OUTCOME MEASURES: Best-corrected visual acuity (BCVA), spherical equivalent, aqueous flare intensity, anterior chamber depth, amount of IOL decentration and tilt, area of anterior capsule opening, and degree of posterior capsule opacification (PCO) were measured 2 days, 1 week, and 1, 3, 6, and 12 months after surgery. Specular microscopy was performed at 12 months postoperatively. RESULTS: In the SA60AT group, the anterior chamber depth did not show significant changes after surgery (P>0.05; paired t test), and the refraction remained highly stable throughout the 1-year study period. The MA60AC group showed significant shallowing of the anterior chamber (P<0.05) and a myopic shift (P<0.05) up to 1 month after surgery. There were no significant differences between the 2 groups (P>0.05) in BCVA, aqueous flare intensity, the amount of IOL decentration, IOL tilt, area of anterior capsule opening, and degree of PCO throughout the 12-month follow-up period. CONCLUSIONS: Both the SA60AT single-piece and MA60AC 3-piece lenses showed a minimum amount of decentration, tilt, anterior capsule contraction, and PCO. Although the MA60AC showed significant forward shift and myopic refractive changes after surgery, the SA60AT displayed little axial movement associated with highly stable refraction after surgery. This feature of the SA60AT should facilitate earlier spectacle prescription and quicker visual/social rehabilitation of patients after cataract surgery.

Ray-tracing intraocular lens power calculation using anterior segment optical coherence tomography measurements.

PURPOSE: To assess the efficiency of ray-tracing intraocular lens (IOL) power calculation with anterior segment optical coherence tomography (AS-OCT) in normal eyes with cataract. SETTING: Miyata Eye Hospital, Miyakonojo, Miyazaki, Japan. DESIGN: Case series. METHODS: The study comprised consecutive patients who had cataract surgery and obtained a corrected visual acuity of 0.15 logMAR or better postoperatively. Preoperatively, Placido topography and AS-OCT measurements were taken during a routine examination. The predicted postoperative refractions were obtained using 3 methods: the SRK/T formula with autokeratometry, ray-tracing calculation with Placido topography data, and ray-tracing calculations with AS-OCT measurement of both corneal surfaces. The refractive errors from the manifest refraction spherical equivalent were compared 1 month postoperatively, and the effects of corneal eccentricity and posterior corneal curvature were evaluated. RESULTS: Seventy patients (102 eyes) were enrolled. There was no significant difference in refractive errors (P=.89). The refractive error with the SRK/T formula was correlated significantly with corneal eccentricity (P=.0017); the ray-tracing calculations were unaffected. There was a weak correlation with the posterior corneal curvature in the ray-tracing calculations performed with Placido topography (P<.0002). CONCLUSION: The accuracy of the ray-tracing IOL power calculations using AS-OCT data was comparable to that of the conventional formula and minimized the effect of corneal eccentricity and posterior corneal curvature.

One-year prospective intrapatient comparison of aspherical and spherical intraocular lenses in patients with bilateral cataract.

PURPOSE: To conduct longitudinal, intrapatient comparisons of aspherical and spherical silicone intraocular lenses (IOL) of the same material and platform in patients undergoing bilateral cataract surgery. DESIGN: Prospective, randomized study. METHODS: Sixty-two eyes of 31 patients were randomized to receive a silicone aspherical IOL (Tecnis Z9000; AMO Inc, Santa Ana, California, USA) in 1 eye and a silicone spherical IOL (CeeOn 911A; AMO Inc) in the other eye. Best spectacle-corrected visual acuity (BSCVA); corneal and ocular wavefront aberrations; contrast sensitivity under photopic (180 lux), intermediate (75 lux), and scotopic (15 lux) illumination; amount of IOL decentration and tilt; and degree of posterior capsular opacification were measured at 1, 3, 6, and 12 months after surgery. All-distance visual acuity (VA) was measured 3 months after surgery. RESULTS: There were no significant differences between IOLs with regard to BSCVA, amount of IOL decentration and tilt, degree of posterior capsule opacification, and all-distance VA at any point after surgery. Regarding corneal wavefront aberrations, there was no difference in third- and fourth-order root mean square (RMS). In ocular wavefront aberrations, aspherical IOLs showed significantly lower fourth-order RMS (P < .001) than spherical IOLs throughout the study, but not in third-order RMS. Contrast sensitivity under photopic and mesopic conditions was not different between IOLs, but contrast sensitivity under scotopic conditions was significantly better with aspherical IOLs than with spherical IOLs (P < .01) at all measurement points. CONCLUSIONS: The silicone aspherical IOL (Tecnis Z9000; AMO Inc) significantly reduced ocular spherical aberration and improved scotopic contrast sensitivity, and these results were consistent through the 1-year follow-up.