Implantation of three-piece silicone toric additive IOLs in challenging clinical cases with high astigmatism.

PURPOSE: To analyze the refractive outcomes and safety of three-piece silicone toric sulcus-fixated add-on intraocular lenses (IOLs) (HumanOptics/Dr.Schmidt Intraocularlinsen, Erlangen, Germany) in complex clinical cases with high astigmatism such as in cases with previous penetrating keratoplasty. METHODS: Interventional case series of 21 eyes of 20 patients enrolled at two German centers. Functional results including power vector analysis, accuracy of IOL power calculation, rotational stability, and postoperative complications were evaluated from 2 months to 6 years postoperatively. RESULTS: The preoperative subjective cylinder exceeded or was equal to -6.00 diopters (D) in 81% of eyes (range: -2.00 to -17.00 D). The median follow-up period was 7.6 months (range: 57 days to 6 years). The efficacy analysis focused on the 2 to 6 months follow-up visit. Postoperatively, there was a median reduction of astigmatism by 70.59% (subjective cylinder range: 0.00 to -5.00 D), improvement of uncorrected distance visual acuity, and unchanged median corrected distance visual acuity. The attempted spherical equivalent was achieved within ± 0.50 D in 45% and within ± 1.00 D in 65% of cases. Five eyes received secondary surgical alignment of axis. Other complications related to the surgical procedure were mainly transient shortly after implantation, such as intraocular pressure elevation (2 of 21 eyes) or corneal edema (2 of 21 eyes). Persisting changes were seen only in rare cases and included pigment dispersion (1 of 21 eyes) or corneal edema requiring a second keratoplasty within 9 months after surgery (2 of 21 eyes). CONCLUSIONS: Toric add-on IOLs may be useful in reducing high astigmatism and anisometropia and increasing spectacle independence even in complex clinical conditions with high refractive errors.

Femtosecond laser correction of presbyopia (INTRACOR) in emmetropes using a modified pattern.

PURPOSE: To evaluate functional results and corneal changes after femtosecond laser correction of presbyopia (INTRACOR, Technolas Perfect Vision GmbH) in emmetropes using a modified treatment pattern over a 12-month period. METHODS: Twenty eyes from 20 emmetropic patients were treated with a modified intrastromal INTRACOR pattern consisting of 5 central rings and 8 radial cuts in a prospective, nonrandomized, uncontrolled, open, single-center, clinical study. Refraction, visual acuity, endothelial cell density, corneal pachymetry, total corneal power, and stray light were evaluated preoperatively and 1 (except endothelial cell density and stray light), 3, 6, and 12 months postoperatively. Patients filled out a subjective questionnaire at 12 months postoperatively. RESULTS: Comparison of preoperative versus 12-month postoperative median values revealed a significant improvement in uncorrected near visual acuity (UNVA) from 0.60 (20/80) to 0.10 logMAR (20/25) (P<.0001) and a significant decrease in corrected distance visual acuity (CDVA) from -0.10 (20/16) to 0.00 logMAR (20/20), which equals a median loss of one line (P=.0005). Fifteen percent of patients lost two lines of CDVA in the treated eye. Subjective spherical equivalent refraction remained unchanged at 0.00 diopters (D) (P=.194). After INTRACOR treatment, significant corneal steepening of 1.40 D and midperipheral flattening of 0.50 D occurred (both P<.0001). Corneal pachymetry at the thinnest point and endothelial cell density did not change significantly (P=.829 and P=.058, respectively). CONCLUSIONS: After 12 months, the modified INTRACOR pattern improved UNVA in emmetropic patients without inducing a myopic shift or significant changes in endothelial cell density or pachymetry.

Intrastromal femtosecond laser presbyopia correction: 1-year results of a multicenter study.

PURPOSE: To investigate functional outcomes of the INTRACOR femtosecond laser-based intrastromal procedure to treat presbyopia. METHODS: Sixty-three eyes from 63 presbyopic patients (median age: 54 years) with mild hyperopia were enrolled in this prospective, ethics committee-approved, multi-center, nonrandomized clinical trial. The INTRACOR procedure was performed using the Technolas femtosecond laser (Technolas Perfect Vision GmbH) in the nondominant eye. Postoperatively, follow-up was performed at 1 day, 1 week, and 1, 3, 6, and 12 months and included near and distance visual acuity tests, slit-lamp examinations, and corneal topography. RESULTS: All 63 surgeries were uneventful. Twelve months postoperatively, outcomes of 58 (92.1%) eyes were available for evaluation. Median uncorrected distance visual acuity (0.1 logMAR [range: 0.5 to 0.0 preoperatively and 0.5 to -0.1 postoperatively]) and corrected distance visual acuity (CDVA) (0.0 logMAR [range: 0.2 to -0.2 preoperatively and 0.3 to -0.1 postoperatively]) remained stable. Median spherical equivalent changed from +0.63 diopters (D) preoperatively to 0.00 D postoperatively. Median uncorrected near visual acuity increased significantly from 0.7 logMAR (range: 1.0 to 0.2) preoperatively to 0.2 logMAR (range: 0.8 to -0.1) postoperatively and eyes gained a median of 4 lines (range: 1 to 9 lines). Losses of 2 lines of CDVA were noted in 7.1% of eyes. Ring cuts were faintly visible at 12 months. CONCLUSIONS: The INTRACOR presbyopia procedure showed good and stable visual acuity outcomes over 12-month follow-up but loss of CDVA occurred in 7% of eyes. Overall patient satisfaction with the procedure was approximately 80%. Short treatment time and maintained corneal surface integrity are advantages of this procedure.

Intraocular pressure during corneal flap preparation: comparison among four femtosecond lasers in porcine eyes.

PURPOSE: To compare the course of intraocular pressure (IOP) during corneal flap preparation using four different femtosecond lasers in porcine globes. METHODS: Forty-eight (12 in each group) enucleated globes were successfully cannulated through the optic nerve. Intraocular pressure was measured continuously through the cannula during a normal lamellar flap creation (regular procedure) using four femtosecond lasers (IntraLase, Abbott Medical Optics; VisuMax, Carl Zeiss Meditec AG; Femtec, Technolas Perfect Vision; and Femto LDV, Ziemer Ophthalmic Systems AG). In an additional measurement (worst-case procedure), the patient interface was pressed against the globe with increasing force until the applanation maneuver was automatically aborted by those devices capable of doing so. RESULTS: During the regular procedure, the maximum IOP reached was 135±16 mmHg when using the Intra-Lase, 65±20 mmHg with the VisuMax, 205±32 mmHg with the Femtec, and 184±28 mmHg with the Femto LDV. During the worst-case procedure, a maximum IOP of 260±53 mmHg was reached with the IntraLase, 105±13 mmHg with the VisuMax, and 248±51 mmHg with the Femtec. CONCLUSIONS: There is considerable variation in IOP among the tested femtosecond lasers during a regular lamellar flap creation and during the worst-case procedure. The VisuMax femtosecond laser seems to cause the lowest IOP rise in both settings.

Bilateral Implantation of a New Refractive Multi-Segmented Multifocal Intraocular Lens in Cataract or Refractive Lens Exchange Patients.

PURPOSE: To evaluate the safety and efficacy of a new multi-segmented refractive multifocal intraocular lens (IOL) after phacoemulsification and refractive lens exchange (RLE). PATIENTS AND METHODS: In this prospective, multicenter clinical trial, 63 presbyopic subjects who had cataract or where RLE candidates were bilaterally implanted with the Precizon Presbyopia IOL (Ophtec BV, Groningen, the Netherlands) after phacoemulsification. The study was conducted at 6 clinical centers in Germany, the Netherlands, Belgium, Turkey and Spain. Subjects were evaluated at baseline and at 1 day, 1 week, 1 and 3 months postoperatively for monocular and binocular uncorrected (UDVA) and corrected distance visual acuity (CDVA), uncorrected (UIVA) and distance-corrected intermediate visual acuity (DCIVA), uncorrected (UNVA), corrected (CNVA) and distance-corrected near visual acuity (DCNVA), contrast sensitivity and quality of vision. RESULTS: Three months postoperatively, binocular UDVA and CDVA of ≥20/40 was achieved in 98.4% (60/61) and 100%, respectively. Binocular UIVA and DCIVA of ≥20/40 was achieved in 96.7% (59/61) and 93.4% (57/61) respectively. Binocular UNVA, CNVA and DCNVA of ≥20/40 was achieved in 93.4% (57/61), 98.4% (60/61) and 95% (57/60) subjects, respectively. Complete spectacle independence was achieved in 80% (49/61) patients; 93% of patients reported that they were quite or very satisfied with the outcomes of the procedure. CONCLUSION: Precizon Presbyopia IOL implantation is a safe and effective method to provide good visual acuity at all distances in presbyopic and cataract patients.

Refractive surgery trends and practice style changes in Germany over a 3-year period.

PURPOSE: To study the current practice styles and preferences of refractive surgeons in Germany. METHODS: In February 2008, a seven-item questionnaire regarding the practice of refractive surgery was mailed to 282 members of the German Society of Intra-ocular Lens Implantation, Interventional, and Refractive Surgery (DGII) and the Commission of Refractive Surgery (KRC). Most questions were identical to our 2005 German refractive surgery survey. All data were analyzed in a masked fashion. RESULTS: The response rate was 42.2%. The majority (68%) of respondents reported that they perform refractive surgery in laser centers (exclusively or partially) followed by general hospitals (19.4%) and universities (12.6%). Although LASIK was the predominant type of refractive surgery performed (80.6%), other refractive procedures included refractive lens exchange (60.2%), photorefractive keratectomy (47.6%), phakic intraocular lens implants (45.6%), laser-assisted subepithelial keratectomy (36.9%), epithelial laser in situ keratomileusis (15.5%), intracorneal rings (5.8%), and limbal relaxing incisions (2.9%). The volume of refractive surgery procedures and the preferred type of excimer laser systems, microkeratomes, and diagnostic devices varied at different institutions. Most respondents performed either wavefront-guided custom ablation or wavefront-optimized ablation (63.1%) compared with conventional excimer laser correction (36.9%). CONCLUSIONS: Refractive surgery practice styles and preferences in Germany are comparable to trends in other European countries. Although LASIK is the most commonly performed refractive procedure, the numbers of various surface ablation techniques and refractive intraocular lens procedures are increasing.

Early outcomes of INTRACOR femtosecond laser treatment for presbyopia.

PURPOSE: To investigate early functional outcomes of the INTRACOR femtosecond laser-based intrastromal procedure to treat presbyopia. METHODS: Twenty-five eyes of 25 presbyopic patients were enrolled in this prospective, ethics committee-approved study. Following detailed preoperative examination, the INTRACOR procedure was performed using the TECHNOLAS femtosecond laser (Technolas Perfect Vision GmbH) in the non-dominant eye. Postoperatively, follow-up examinations were performed at 1 day, 1 week, and 1 and 3 months, including near and distance visual acuity, slit-lamp microscopy, and corneal topography. RESULTS: All 25 surgeries were uneventful. The mean postoperative uncorrected near visual acuity increased from 0.7+/-0.16 logMAR to 0.26+/-0.21 logMAR and the mean uncorrected distance visual acuity changed slightly from 0.11+/-0.11 logMAR to 0.05+/-0.1 logMAR at 3 months postoperative. Regarding best distance correction, mean sphere changed from +0.75+/-0.23 diopters (D) preoperatively to +0.15+/-0.31 D postoperatively and mean cylinder from -0.33+/-0.17 D to -0.42+/-0.23 D. Postoperative healing was uneventful, and in all eyes, the cornea was clear within a few hours after surgery without any remaining cavitation gas bubbles. CONCLUSIONS: The INTRACOR procedure for presbyopia showed good visual acuity outcomes in the early postoperative period. The short treatment time in combination with maintained corneal integrity suggests this new technique has good potential for the treatment of presbyopia.

Dynamic stimulation of accommodation.

We describe the analysis of accommodation using wavefront measurements in phakic and pseudophakic eyes. Accommodation measurements were performed in phakic and pseudophakic eyes using a dynamic stimulation aberrometry (DSA) device (Optana) as an attachment to the WASCA aberrometer (Carl Zeiss Meditec AG). Aberrations were measured for distance fixation (3.0 m) and near fixation (0.3 to 0.11 m) presenting different accommodative stimuli (3.0 to 9.0 diopters). The device was able to detect changes in aberrations using near and distance stimulation. Eyes with phakic iris-fixated intraocular lenses (IOLs) showed normal age-correlated accommodation. In pseudophakic eyes, accommodation varied depending on the IOL. With monofocal IOLs (eg, MA60AC, Alcon), there was no accommodation; with an accommodating IOL (eg, Synchrony, Visiogen), there was a low level of accommodation. The DSA device is capable of measuring accommodation using wavefront data. It will help to further analyze changes in accommodation-related wavefront aberrations.

Clinical outcomes after implantation of a toric intraocular lens with a transitional conic toric surface.

PURPOSE: To evaluate the postoperative outcomes after implantation of a hydrophilic toric intraocular lens (tIOL) with a transitional conic toric surface in patients with astigmatism undergoing refractive lens exchange (RLE) or cataract surgery. METHODS: In this monocentric study, clinical outcomes following implantation of the hydrophilic Precizon toric IOL model 565 (Ophtec) were analysed. For intraoperative axis alignment, the Verion Image Guided System was used. Intended versus achieved refraction, IOL position, visual acuity outcomes and power vector analyses were evaluated 3 months postoperatively. RESULTS: Forty-three eyes of 28 patients (40 eyes cataract, 3 eyes RLE) received a Precizon toric IOL with a cylindrical power between 1.0 and 7.5 D. Target refraction was emmetropia except for four eyes that had a myopic target. The median postoperative IOL rotation at slit lamp was 3° with a range from 0° to 16°. Uncorrected distance visual acuity (UDVA) increased from median 0.5 logMAR preoperatively to median 0.06 logMAR at 3 months postoperatively. Corrected distance visual acuity increased from 0.20 to -0.02 logMAR. Median preoperative subjective cylinder was 1.5 D and 3 months postoperatively 0.25 D. CONCLUSION: Preoperative diagnostics, IOL selection and correct intraoperative positioning of tIOLs are essential for good outcomes and postoperative spectacle independence following cataract or RLE surgery. Visual acuities and rotational stability of the Precizon toric IOL showed very good outcomes and the subjective postoperative astigmatism could be reduced significantly.

Penetrating keratoplasty using femtosecond laser.

PURPOSE: To evaluate femtosecond laser technology for penetrating keratoplasty in patients with various corneal diseases. DESIGN: Interventional case series. METHODS: Five patients aged 45 to 81 years underwent penetrating keratoplasty using the 20/10 Perfect Vision Femtec femtosecond laser system in September 2005. Patients had granular corneal dystrophy, Fuchs endothelial dystrophy, keratoconus, and herpetic keratitis with endothelial decompensation. Histopathology was performed to analyze the cut quality of donor and recipient cornea. RESULTS: All procedures were performed without any complications. In all cases, the donor cornea was cut with an 8.0 or 8.1 mm diameter and the recipients' cornea with a 7.8 mm diameter. A complete perforating cut was achieved in all corneas. Histology of donor and recipient specimen showed a straight, smooth cut without any abnormalities. CONCLUSIONS: Penetrating keratoplasty can be performed with the Femtec femtosecond laser safely and accurately. The postoperative outcome was uneventful.

Long-term results of sealed capsule irrigation using distilled water to prevent posterior capsule opacification: a prospective clinical randomised trial.

BACKGROUND: We investigated long-term safety and efficacy of sealed capsule irrigation (SCI) during cataract surgery to prevent posterior capsule opacification (PCO). METHODS: One eye of each of 17 patients (mean age: 70.1+/-9.7 years) who presented with bilateral cataracts was randomly chosen for SCI treatment. After phacoemulsification, the capsular bag was vacuum sealed with the PerfectCapsule device (Milvella) followed by SCI using distilled water for two minutes. No vacuum loss occurred during irrigation. Each patient's fellow eye served as a control. One hydrophilic acrylic intraocular lens model was implanted in all eyes. Five patients had to be excluded due to deep anterior chamber, small pupil or unilateral surgery. Follow-up examinations took place one day and one, three, six, 12 and 24 months after surgery. We evaluated safety parameters, anterior capsule (AC) overlapping and PCO. RESULTS: Postoperatively, mean best corrected visual acuity, pachymetry, endothelial cell count, intraocular pressure, AC overlapping and PCO showed no statistically significant difference between SCI and the control group (p>0.05, Wilcoxon test). CONCLUSION: SCI is a safe procedure and enables the specific pharmacological targeting of lens epithelial cells inside the capsular bag. Using distilled water, however, it is not possible to reduce PCO development significantly. Thus, alternative substances should be evaluated.

Clinical Evaluation of an Extended Depth of Focus Intraocular Lens With the Salzburg Reading Desk.

BACKGROUND: Clinical evaluation of an extended depth of focus (EDOF) intraocular lens (IOL) regarding visual performance at various distances, reading performance on an electronic reading desk, and depth of focus on the defocus curve. METHODS: In this prospective study, 30 eyes of 15 patients who received the Tecnis Symfony IOL (Abbott Medical Optics, Inc., Santa Ana, CA) were examined 3.60 ± 1.54 months postoperatively. Uncorrected and corrected distance (UDVA and CDVA), uncorrected and distance-corrected intermediate (UIVA and DCIVA), and uncorrected and distance-corrected near (UNVA and DCNVA) visual acuity were determined. The defocus curve was performed with distance correction. Furthermore, the reading acuity at the preferred near and intermediate distances was measured with consideration of the reading distance, speed, and print size. A subjective questionnaire was also administered. RESULTS: Results showed a median UDVA of 0.03 logMAR or 20/21.43 Snellen (range: 0.44 to -0.18 logMAR or 20/55.08 to 20/13.21 Snellen), UNVA of 0.20 logMAR or 20/31.70 Snellen (range: 0.46 to 0.00 logMAR or 20/57.68 to 20/20 Snellen), and UIVA of -0.03 logMAR or 20/18.67 Snellen (range: 0.14 to -0.18 logMAR or 20/27.61 to 20/13.21 Snellen). The improved performance at intermediate distance was confirmed by an uncorrected reading acuity of 0.09 logMAR or 20/24.61 Snellen (range: 0.36 to 0.00 logMAR or 20/45.82 to 20/20.00 Snellen) at a preferred intermediate distance of 64.10 cm (range: 52.0 to 75.0 cm). The defocus curve showed an extended range of visual acuity of 0.10 logMAR or better between 1.00 and -1.50 diopters. CONCLUSIONS: The EDOF IOL design provided a wide range of improved visual and reading function between far and intermediate distances and also improved near visual acuity. Patients reported a high rate of satisfaction and spectacle independence at the various distances. [J Refract Surg. 2017;33(10):664-669.].

Comparison of the performance and safety of 2 ophthalmic viscosurgical devices in cataract surgery.

PURPOSE: To compare the clinical performance and safety of 2 ophthalmic viscosurgical devices (OVDs)-Twinvisc (OVD 1) and Duovisc (OVD 2)-in cataract surgery. SETTING: European multicenter study. DESIGN: Prospective randomized controlled study. METHODS: Patients with cataract had phacoemulsification and intraocular lens implantation in 1 eye. They were randomly assigned to receive OVD 1 or OVD 2. Preoperative and postoperative examinations over 3 months included mean intraocular pressure (IOP), incidence of IOP peaks (≥30 mm Hg and ≥24 mm Hg), endothelial cell count (ECC), corneal thickness, and intraocular inflammation. A subjective evaluation of the OVDs was performed. RESULTS: The study comprised 220 patients. The incidence of IOP peaks and the mean IOP were not statistically significantly different between the 2 groups at any of the follow-up visits. At 6 hours, the incidence of IOP spikes 30 mm Hg or higher was 6.5% and 7.2% in the OVD 1 and the OVD 2 groups, respectively (P = .846). For the IOP spikes 24 mm Hg or higher, the incidence was 16.8% and 25.2%, respectively (P = .128). Three months postoperatively there was no statistically significant difference in ECC and pachymetry between the 2 groups. Mild inflammation was noticed up to 7 days postoperatively after which it resolved in both groups. Subjectively, the OVD 2 was easier to use, whereas the OVD 1 had better cohesive and dispersive properties. CONCLUSIONS: Both OVDs have similar performance and safety profiles in phacoemulsification cataract surgery. No clinically relevant differences were found between the 2 devices regarding transient IOP spikes, mean IOP, corneal endothelium injury, or inflammation.

Femtosecond laser-assisted corneal flap cuts: morphology, accuracy, and histopathology.

PURPOSE: Precision in corneal flap cutting is essential in LASIK surgery. Current mechanical microkeratomes have a very good performance record; however, in a few cases, complications can occur during the microkeratome pass and flap cut. Femtosecond lasers offer an alternative to the mechanical cut and can provide additional features regarding the flap morphology. In this study, we analyzed femtosecond laser flaps regarding their morphology, cut accuracy, and histopathology. METHODS: Forty-five fresh porcine cadaveric eyes were prepared for femtosecond laser flap cutting with the Femtec femtosecond laser system (20/10 Perfect Vision, Heidelberg, Germany). The eyes were assigned to three different thickness groups, with 120-, 140-, or 180-microm cut depth, respectively. In addition, different flap diameters ranging from 8.0 to 9.5 mm and rim edge angulations between 60 degrees and 90 degrees were performed. After the cut, the eyes were examined under a microscope regarding accuracy and potential defects, and flap thickness and diameter were measured. In addition, flaps were prepared for further histopathologic examination. RESULTS: All flap cuts were easily performed without any intraoperative complications. Flap thickness measurements revealed a median (in micrometers) of 110.5 (intended thickness 120), 142.5 (intended 140), and 180.0 (intended 180), respectively. The flap diameter for an intended size between 8.0 and 9.5 mm was within a range of +/-0.4 mm, the median at the maximum was 0.3 mm off. Histopathology revealed very low to almost no changes in the stromal structure of the cornea and correct hinge angulations. CONCLUSIONS: LASIK flap cuts were easily performed without any complications. The accuracy and morphology were very precise and consistent. Histopathology revealed a smooth cut with hinge angulations, as expected.

Reliability of corneal and total wavefront aberration measurements with the SCHWIND Corneal and Ocular Wavefront Analyzers.

PURPOSE: To evaluate the reliability of the SCHWIND Corneal and Ocular Wavefront Analyzers. METHODS: This study comprised 115 eyes of 58 healthy volunteers (26 [44.8%] women and 32 [55.2%] men) with no corneal or lenticular pathologies and normal visual acuity. All eyes underwent three consecutive measurements by one examiner with the Corneal Wavefront Analyzer and the Ocular Wavefront Analyzer (Hartmann-Shack principle). Corneal wavefront errors were calculated using the topography data, a standard eye model, and ray tracing. The reliability was tested for 2nd, 3rd, and 4th order aberrations as mean values of the standard deviations for all measurements. RESULTS: Mean patient age was 23 +/- 2.1 years. The mean refraction was -0.77 +/- 1.56 diopters (D) (range: +3.33 to -5.28 D). The repeatability test revealed a good reliability for both machines with a slightly better value for the Ocular Wavefront Analyzer for 3rd and 4th order higher order aberrations (P < .05, Wilcoxon test). CONCLUSIONS: Wavefront measurements of corneal and total optical aberrations performed with the Corneal Wavefront Analyzer and the Ocular Wavefront Analyzer have good reliability. Both measurements are recommended prior to any refractive surgery treatment.

Precision of NIDEK OPD-scan measurements.

PURPOSE: To evaluate the repeatability of wavefront measurements using the NIDEK OPD-Scan. METHODS: A total of 179 eyes from 90 healthy volunteers (57 women and 33 men) with no corneal or lenticular pathology and normal visual acuity were enrolled in this study. Mean patient age was 39 years (range: 17 to 85 years). All patients underwent four consecutive measurements by one examiner with the NIDEK OPD-Scan. Total, corneal, and internal wavefront errors were measured and calculated with the device, using slit retinoscopy. Repeatability of the measurements was evaluated for spherical aberration, coma, and trefoil. RESULTS: The repeatability test revealed a good result for all three higher order aberrations evaluated. The best repeatability values were found for total aberrations, followed by internal and corneal aberrations. CONCLUSIONS: The NIDEK OPD-Scan has good precision in the wavefront measurement of total, corneal, and internal optical aberrations.

Comparison of a new image-guided system versus partial coherence interferometry, Scheimpflug imaging, and optical low-coherence reflectometry devices: Keratometry and repeatability.

PURPOSE: To determine the repeatability of keratometry of the Verion image-guided system and to compare the keratometry (K) values with those of established biometric devices. SETTING: International Vision Correction Research Centre, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. DESIGN: Prospective case series. METHODS: One randomly chosen eye of volunteers was examined with partial coherence interferometry (PCI) (IOLMaster 500), optical low-coherence reflectometry (OLCR) (Lenstar LS 900), a Scheimpflug device (Pentacam HR), and the new image-guided system by the same examiner. None of the eyes had ocular pathology. Three consecutive measurements were performed with the image-guided system and 1 with the other devices. The flat, steep, and average corneal radii; steep axis; and white-to-white (WTW) distance were analyzed and compared. RESULTS: One hundred twenty-three eyes of 123 volunteers (mean age 37.9 years ± 16.2 [SD]) had valid measurements for all examinations and were available for analysis. The image-guided system measured statistically significant smaller flat, steep, and average corneal radii than the Scheimpflug device, statistically significant larger flat and average corneal radii than the PCI device, and no statistically significant different values than the OLCR device. The measured steep axis did not differ significantly in any comparison. The WTW measurements were significantly higher than those of all other devices. The analysis of repeatability of the image-guided system showed high intraclass correlation coefficients (range 0.919 to 0.997). CONCLUSIONS: The new image-guided system had high repeatability for K, steep axis, and WTW measurements. The WTW measurements with the image-guided system were significantly higher than those using the other devices. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.

Influence on intraocular lens power calculation of corneal radii measurement using an image-guided system.

PURPOSE: To analyze the influence on intraocular lens (IOL) power calculation of corneal radii measured by the Verion Image-Guided System in comparison with those measured by partial coherence interferometry (PCI) (IOLMaster) and optical low-coherence reflectometry (OLCR) (Lenstar) systems. SETTING: International Vision Correction Research Centre, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. DESIGN: Prospective case series. METHODS: One eye of ophthalmologically healthy volunteers was examined with the image-guided, PCI, and OLCR systems. Corneal radii could be measured with all 3 devices; axial length (AL) and anterior chamber depth (ACD) could be measured with PCI and OLCR only. The IOL power calculations for the Acrysof SN60WF IOL using 4 formulas were compared between the image-guided system and both the PCI device and OLCR device. For IOL calculation with the image-guided system, the AL and ACD of the device used for comparison were applied. RESULTS: Of the 150 volunteers, 136 (mean age 39.60 years ± 17.31 [SD]) had valid measurements with all 3 devices and were included in the analysis. Compared with PCI, the image-guided system measured statistically significant larger values for corneal radii and IOL power calculations for all 4 formulas. There were no statistically significant differences between the image-guided system and the OLCR device. In both groups, the surgeon would have chosen the same IOL power in approximately 60% to 65% of cases and a ±0.5 diopter different IOL power in approximately 30% to 35% of cases when using the image-guided system. CONCLUSIONS: The IOL power calculation using the image-guided system showed statistically significant differences compared with the PCI device but not when compared with the OLCR device. The clinical relevance of this theoretical approach remains to be evaluated. FINANCIAL DISCLOSURE: Drs. Auffarth and Holzer received travel grants and lecture fees from Alcon Pharma GmbH and Carl Zeiss Meditec AG.

Near and intermediate visual and reading performance of patients with a multifocal apodized diffractive intraocular lens using an electronic reading desk.

PURPOSE: To functionally evaluate an apodized diffractive multifocal intraocular lens (IOL) using an electronic reading desk (Salzburg Reading Desk). SETTING: University Eye Clinic Heidelberg, Heidelberg, Germany. DESIGN: Prospective case series. METHODS: After implantation of an Acrysof IQ Restor +3.0 diopter (D) multifocal IOL, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuities, and uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuities were determined. Criteria for evaluating reading acuity were the reading speed and print size. Monocular and binocular examinations were performed with the electronic reading desk at fixed distances and at the patient's preferred near and intermediate distances. In addition, a subjective questionnaire was administered. RESULTS: Forty eyes (20 patients) were enrolled. Monocularly, the medians were UDVA, 0.00 logMAR (range 0.26 to -0.14 logMAR); CDVA, -0.08 logMAR (range 0.16 to -0.24 logMAR); 40 cm UNVA, 0.04 logMAR (range 0.24 to -0.10 logMAR); DCNVA, 0.00 logMAR (range 0.18 to -0.22 logMAR); 80 cm UIVA, 0.15 logMAR (range 0.40 to -0.18 logMAR); DCIVA, 0.16 logMAR (range 0.42 to -0.14 logMAR). The monocular reading desk examinations resulted in an uncorrected reading acuity of 0.11 logMAR (range 0.49 to -0.01 logMAR) at 40 cm and 0.30 logMAR (range 0.48 to 0.00 logMAR) at 80 cm. Patients reported a high rate of spectacle independence and satisfaction in everyday life. CONCLUSION: The +3.0 D IOL provided good postoperative functional results at far and near and improved the visual and reading acuity at an intermediate distance. FINANCIAL DISCLOSURES: The International Vision Correction Research Centre has received research grants, travel expenses, and lecture fees from various intraocular lens manufacturers. None of the authors has a financial or proprietary interest in any material or method mentioned.

Long-term outcomes of intrastromal femtosecond laser presbyopia correction: 3-year results.

BACKGROUND/AIMS: To analyse visual outcomes and corneal changes 3 years after intrastromal femtosecond laser presbyopia treatment. METHODS: In a prospective, unicentric clinical trial, 25 presbyopic patients received INTRACOR treatment (Technolas femtosecond laser) on their non-dominant eye. Examinations were performed preoperatively as well as 1, 24 and 36 months postoperatively and included refraction, near, intermediate and distance visual acuity tests, reading speed, corneal topography, stray light measurement, endothelial cell count and slit-lamp examination. RESULTS: Comparison of preoperative versus 36 months postoperative values showed in median an improvement of uncorrected near visual acuity (UNVA) from 0.70 logMAR to 0.10 logMAR (p<0.001). Corrected distance visual acuity (CDVA) was reduced from -0.10 logMAR to 0.00 logMAR (p<0.001). The spherical equivalent preoperatively was 0.625 D and after an initial myopic shift after 1 month (0.125 D) and 24 months (0.25 D), the 36 months value (0.50 D) returned to resemble the preoperative value in statistical terms (p=0.123). A significant corneal steepening of 1.50 D in the treated area was measured. Pachymetry (thinnest point) revealed a statistically significant, but clinically insignificant corneal thickening from 535 to 549 µm (p=0.033). Endothelial cell count did not change. 92.86% of patients felt comfortable with the surgery result. CONCLUSION: INTRACOR treatment after 36 months improved UNVA to varying degrees. The effect can be explained by a corneal steepening. An initial myopic shift was reversible. Reductions especially in CDVA have to be taken into account and therefore careful patient selection and information is obligatory. TRIAL REGISTRATION NUMBER: NCT01164358 and NCT01025050, Results.