Incidence of Nd:YAG capsulotomy after implantation of AcrySof multifocal and monofocal intraocular lenses: a case controlled study.

PURPOSE: To compare the frequency of posterior capsulotomies in patients receiving a multifocal or monofocal intraocular lens (IOL) of a similar design following cataract extraction. METHODS: Four hundred seventeen eyes underwent cataract extraction and IOL implantation; 275 eyes received the AcrySof SN6OWF (Alcon Laboratories Inc) one-piece monofocal lens (monofocal group) and 142 eyes received the RESTOR multifocal lens (SN60D3 or SA60D3, Alcon Laboratories Inc) (multifocal group). Surgery was performed by two surgeons at one site. Primary outcome measures were incidence, time of onset, and preoperative corrected distance visual acuity (CDVA) for those patients receiving posterior capsulotomies. RESULTS: After average 22-month postoperative follow-up (range: 2 to 41 months), 22 (15.49%) eyes in the multifocal group underwent posterior capsulotomies compared with 16 (5.82%) eyes in the monofocal group (P = .0014). The main indication for Nd:YAG laser capsulotomy in the multifocal group was complaint of poor quality of vision rather than decreased CDVA. The multifocal group underwent capsulotomies after a mean of 8.8 months (range: 1.7 to 29.2 months), whereas the monofocal group required capsulotomies after a mean of 10.4 months (range: 0.8 to 28.6 months) (P = .559). Mean logMAR CDVA before capsulotomy was 0.113 (range: 0 to 0.6) for the multifocal group and 0.244 (range: 0 to 0.48) for the monofocal group (P = .073). CONCLUSIONS: Use of the RESTOR multifocal IOL in clinical practice may result in more frequent Nd:YAG laser capsulotomies. Reasons for this may include increased visual demands of patients receiving presbyopic-correcting IOLs or complex visual phenomena associated with the interaction of multifocal optics and posterior capsule opacification.

Reorientation of inverted endothelial graft during Descemet stripping automated endothelial keratoplasty.

We describe a technique during Descemet stripping automated endothelial keratoplasty for reorientation of an inverted endothelial graft. This technique allows the inversion to be predictably corrected with minimal manipulation and trauma to the endothelium, thereby reducing the risk of primary failure and subsequent repeat of the transplant.