European multicenter study of the AcrySof ReSTOR apodized diffractive intraocular lens.

OBJECTIVE: To report the safety and effectiveness of the AcrySof ReSTOR apodized diffractive intraocular lens (IOL), model MA60D3, when implanted into the capsular bag. DESIGN: Multicenter European study including university clinics, eye hospitals, and private ophthalmic surgical centers. PARTICIPANTS: One hundred twenty-seven subjects implanted in cataractous eyes in an open multicenter study. INTERVENTION: After phacoemulsification, the foldable 3-piece hydrophobic acrylic apodized diffractive IOL was implanted in the capsular bag using a Monarch injector with an A-cartridge. The mean preoperative patient age was 68.4+/-12 years. Intraocular lens implant power ranged from 18.0 to 25.0 diopters (D) in 0.5-D increments. MAIN OUTCOME MEASURES: Distance visual acuity (VA), near VA, spectacle dependence, unwanted visual symptoms, and patient satisfaction. RESULTS: At the 6-month postoperative visit, binocular (both eyes simultaneously) mean uncorrected distance and near logarithm of the minimum angle of resolution VAs for the MA60D3 were 0.04+/-0.14 and 0.09+/-0.12 (n = 118), respectively. In addition, 88.0% and 84.6% of ReSTOR subjects achieved spectacle independence for distance and near vision, respectively. Glare and halos were reported as severe by only 8.5% and 4.2% of patients, respectively. Ninety-two percent of patients stated that they would choose to have the same lens implanted again after the first implant, and 95.7% answered likewise after the second implant. CONCLUSIONS: The AcrySof ReSTOR MA60D3 IOL demonstrated excellent near VA without compromising distance vision. Spectacle independence and patient satisfaction were high, whereas unwanted photic phenomena were clinically acceptable.

Cost of cataract surgery after implantation of three intraocular lenses.

BACKGROUND: Posterior capsule opacification is one of the most frequent adverse events following cataract surgery. This manuscript reports the lifetime cost of complications linked to posterior capsule opacification using three types of intraocular lens with square edges. METHODS: Costs were estimated from a retrospective study of patients who underwent cataract surgery and data from the literature. The lenses studied were hydrophobic acrylic (SA60AT and AR40E) and hydrophilic acrylic (XL-Stabi) lenses with square edges. The frequency of Nd-Yag laser capsulotomies after 4 years' survival was estimated by two methods: the first involved linear adjustment of the rate at 5 and 6 years follow-up and then application of a constant rate after 6 years; the second involved linear adjustment after 5 years follow-up. The economic perspective was that of the French Sickness Fund. RESULTS: After 3 years' follow-up the percentage of patients who had not undergone laser Nd-Yag capsulotomy was 86.9% with SA60AT, 76.6% with AR40E and 54.6% with XL-Stabi lenses (p < 0.001). The total cost of capsulotomy and management of complications per patient lifetime was estimated to be euro90.5 for SA60AT, euro189.5 for AR40E and euro288.0 for XL-Stabi lenses by the first extrapolation method. With the second method of extrapolation the costs were euro94.8, euro200.0 and euro300.2, respectively. INTERPRETATION: Lower costs for cataract surgery and management of related complications were observed with the two hydrophobic acrylic lenses; the lowest costs were observed with SA60AT lenses as they were associated with fewer Nd-Yag laser capsulotomies.

Incidence of Nd:YAG laser capsulotomies after cataract surgery: comparison of 3 square-edged lenses of different composition.

OBJECTIVE: To compare the incidence of Nd:YAG laser treatment following 3 square-edged intraocular lenses (IOLs) of different composition implanted during cataract surgery. DESIGN: Patient chart analysis. PARTICIPANTS: Patients aged 50-85 years and given a hydrophobic acrylic IOL (either SA60AT or AR40E) or hydrophilic acrylic IOL (XL-Stabi) were included. Analysis was conducted of 767 eyes treated with SA60AT (n = 250), AR40E (n = 254), or XL-Stabi (n = 263). METHODS: This retrospective study involved patients who had undergone cataract surgery between 2001 and 2002. Ophthalmology centres were accepted into the study if they used at least 2 of the IOLs being investigated. The medical files of patients fulfilling the inclusion criteria were listed, and eligible cases were selected randomly. Patients' characteristics were obtained from their medical files. Data on postsurgical complications and Nd:YAG laser treatment over 3 years were also extracted. Follow-up data were obtained from the medical files and the patients' ophthalmologists. Time to Nd:YAG laser treatment was analysed using Kaplan-Meier survival curves adjusted with a Cox model. RESULTS: After 3 years' follow-up the proportions of patients who had not received Nd:YAG laser treatment were 87.0% with SA60AT, 76.6% with AR40E, and 54.6% with XL-Stabi (p < 0.001). Cox's model adjusted for centre effects and the presence of diabetes estimated risk ratios of 2.8 for AR40E (p < 0.0005) and 5.1 for XL-Stabi (p < 0.0001), compared with the reference lens SA60AT. CONCLUSIONS: Of the 3 square-edged lenses studied, the SA60AT was associated with a lower incidence of Nd:YAG laser treatment than either AR40E or XL-Stabi.