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Al-Shymali O, Cantó-Cerdán M, Alió Del Barrio JL, McAlinden C, Yebana P, Alio JL. Managing dissatisfaction after multifocal intraocular lens implantation through lens exchange using monofocal or alternative multifocal IOLs. Acta Ophthalmol 2024. [PMID: 38780148 DOI: 10.1111/aos.16720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To manage patient dissatisfaction following multifocal intraocular lens (MF-IOL) implantation by IOL exchange with either a monofocal or an alternative MF-IOL, and to compare outcomes in these two groups. METHODS MF-IOL exchange was performed in 32 patients (64 eyes) with neuroadaptation failure. The MF-to-MF group involved patients who had a MF-IOL exchanged with another MF-IOL of a different optical profile and the MF-to-MO group involved patients who had a MF-IOL exchanged to a monofocal IOL. Visual outcomes and complications were analysed. The Quality of Vision (QoV) questionnaire, Visual Function Index (VF-14) and its Rasch-revised version (VF-8R) were also used to assess outcomes. RESULTS There were no significant differences (p > 0.05) in the QoV scores between the two groups, both preoperatively and postoperatively. Preoperatively, there were no significant differences in VF-14 scores between both groups (p > 0.05). Postoperatively, there were statistically significant differences in VF-14 (total score, intermediate vision and near vision) in favour of the MF-to-MF group (p < 0.05). The postoperative VF-8R score in the MF-to-MF group was significantly better than the MF-to-MO group (p ≤ 0.001). Uncorrected and corrected near as well as corrected distance visual acuities were significantly better (p < 0.05) in the MF-to-MF group compared to the MF-to-MO group at 3 months. CONCLUSION Patient dissatisfaction and neuroadaptation failure following MF-IOL implantation can be managed by an IOL exchange with an alternative optical design of MF-IOL or a monofocal IOL. Although, in the current study, the MF-to-MF group showed some better postoperative results, both options are feasible solutions.
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Affiliation(s)
- Olena Al-Shymali
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
| | - Mario Cantó-Cerdán
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
| | - Jorge L Alió Del Barrio
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
- Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain
| | - Colm McAlinden
- Corneo Plastic Unit & Eye Bank, Queen Victoria Hospital, East Grinstead, UK
- Eye & ENT Hospital of Fudan University, Shanghai, China
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - Pilar Yebana
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
| | - Jorge L Alio
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
- Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain
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Son HS, Chang DF, Li C, Liu L, Zafar S, Lum F, Woreta FA. Visual Acuity Outcomes and Complications after Intraocular Lens Exchange: An IRIS® Registry (Intelligent Research in Sight) Analysis. Ophthalmology 2024; 131:403-411. [PMID: 37858872 DOI: 10.1016/j.ophtha.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023] Open
Abstract
PURPOSE To assess risk factors for worse visual acuity (VA) outcomes after intraocular lens (IOL) exchange, and the most common postsurgical complications. DESIGN Retrospective cohort study. PARTICIPANTS Eyes from patients 18 years of age and older in the IRIS® Registry (Intelligent Research in Sight) that underwent IOL exchange in the United States between 2013 and 2019. METHODS Vision improvement compared with baseline was determined at 1 year after surgery. A multivariable generalized estimating equation model adjusting for demographic factors and baseline vision was used to identify factors associated with VA worse than 20/40 at 1 year. MAIN OUTCOME MEASURES Visual outcomes and postoperative complications after lens exchange. RESULTS A total of 46 063 procedures (n = 41 925 unique patients) were included in the analysis. Overall, VA improved from a mean ± standard deviation (SD) of 0.53 ± 0.58 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/70) before surgery to a mean ± SD of 0.31 ± 0.40 logMAR (Snellen equivalent, 20/40) at 1 year. Among eyes with VA recorded at both baseline and 1 year after surgery, 60.5% achieved VA of 20/40 or better at 1 year. Vision of worse than 20/40 at 1 year was associated with greater age (odds ratio [OR], 1.16 per 5-year increase; 95% confidence interval [CI], 1.14-1.18) and higher logMAR baseline VA (OR, 1.14 per 0.1-logMAR increase; 95% CI, 1.14-1.15), as well as Black or African American (OR, 1.96; 95% CI, 1.68-2.28), Hispanic (OR, 1.82; 95% CI, 1.59-2.08), and Asian (OR, 1.48; 95% CI, 1.21-1.81) race or ethnicity versus White race, Medicaid (OR, 1.78; 95% CI, 1.40-2.25) versus private insurance, smoking history (OR, 1.22; 95% CI, 1.11-1.35), and concurrent anterior (OR, 1.65; 95% CI, 1.51-1.81) and posterior (OR, 1.53; 95% CI, 1.41-1.66) vitrectomy versus no vitrectomy. Female sex was associated with better VA at 1 year. At 1 year, epiretinal membrane (10.9%), mechanical lens complication (9.4%), and dislocation of the replacement lens (7.1%) were the most common complications. CONCLUSIONS In this large national cohort, the annual number of IOL exchanges rose steadily over time. Vision improved in 60.2% of patients; worse visual outcomes were associated with greater age, worse baseline vision, Black race, Hispanic ethnicity, Medicaid insurance, smoking, and concurrent vitrectomy. Epiretinal membrane was the most common complication. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Hyeck-Soo Son
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Ophthalmology, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany
| | | | - Charles Li
- American Academy of Ophthalmology, San Francisco, California
| | - Lynn Liu
- American Academy of Ophthalmology, San Francisco, California
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Guo D, He W, Wei L, Song Y, Qi J, Yao Y, Chen X, Huang J, Lu Y, Zhu X. The Zhu-Lu formula: a machine learning-based intraocular lens power calculation formula for highly myopic eyes. EYE AND VISION (LONDON, ENGLAND) 2023; 10:26. [PMID: 37259154 DOI: 10.1186/s40662-023-00342-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/12/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND To develop a novel machine learning-based intraocular lens (IOL) power calculation formula for highly myopic eyes. METHODS A total of 1828 eyes (from 1828 highly myopic patients) undergoing cataract surgery in our hospital were used as the internal dataset, and 151 eyes from 151 highly myopic patients from two other hospitals were used as external test dataset. The Zhu-Lu formula was developed based on the eXtreme Gradient Boosting and the support vector regression algorithms. Its accuracy was compared in the internal and external test datasets with the Barrett Universal II (BUII), Emmetropia Verifying Optical (EVO) 2.0, Kane, Pearl-DGS and Radial Basis Function (RBF) 3.0 formulas. RESULTS In the internal test dataset, the Zhu-Lu, RBF 3.0 and BUII ranked top three from low to high taking into account standard deviations (SDs) of prediction errors (PEs). The Zhu-Lu and RBF 3.0 showed significantly lower median absolute errors (MedAEs) than the other formulas (all P < 0.05). In the external test dataset, the Zhu-Lu, Kane and EVO 2.0 ranked top three from low to high considering SDs of PEs. The Zhu-Lu formula showed a comparable MedAE with BUII and EVO 2.0 but significantly lower than Kane, Pearl-DGS and RBF 3.0 (all P < 0.05). The Zhu-Lu formula ranked first regarding the percentages of eyes within ± 0.50 D of the PE in both test datasets (internal: 80.61%; external: 72.85%). In the axial length subgroup analysis, the PE of the Zhu-Lu stayed stably close to zero in all subgroups. CONCLUSIONS The novel IOL power calculation formula for highly myopic eyes demonstrated improved and stable predictive accuracy compared with other artificial intelligence-based formulas.
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Affiliation(s)
- Dongling Guo
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Wenwen He
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Ling Wei
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yunxiao Song
- University of Illinois at Urbana-Champaign, Illinois, USA
| | - Jiao Qi
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yunqian Yao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xu Chen
- Shanghai Aier Eye Hospital, Shanghai, China
| | - Jinhai Huang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
- Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yi Lu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.
- Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai, China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China.
| | - Xiangjia Zhu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.
- Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai, China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China.
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Al-Shymali O, McAlinden C, Alio del Barrio JL, Canto-Cerdan M, Alio JL. Patients’ dissatisfaction with multifocal intraocular lenses managed by exchange with other multifocal lenses of different optical profiles. EYE AND VISION 2022; 9:8. [PMID: 35227312 PMCID: PMC8887122 DOI: 10.1186/s40662-022-00280-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 02/08/2022] [Indexed: 11/15/2022]
Abstract
Background The aim of the study was to evaluate the outcomes of dissatisfied patients reporting poor visual quality following implantation of multifocal intraocular lenses (MF-IOLs), managed by IOL exchange with another multifocal optical profile. Methods This is a retrospective series of cases. MF-IOL exchange was done in 15 dissatisfied patients (30 eyes) with the perception of poor visual quality for far distance affected by neuroadaptation failure. Patients underwent a bilateral exchange of a MF-IOL with another MF-IOL of a different optical profile. Visual outcomes and complications were analyzed. Questionnaires including Quality of Vision (QoV), Visual Function Index-14 (VF-14) and its Rasch-revised version (VF-8R) and a satisfaction questionnaire were also used for outcome evaluation. Results The mean elapsed time from implantation to explantation-reimplantation was 11.8 months. The QoV scores improved significantly across all the three subscales. Visual function improved with a change in VF-14 score from 60.41 ± 24.81 to 90.16 ± 10.91 (P < 0.001). The VF-8R score improved as well. The uncorrected distance visual acuity improved from 0.24 to 0.12 logMAR after exchange (P < 0.001) and corrected distance visual acuity improved from 0.15 to 0.04 logMAR (P < 0.001). Safety and efficacy indexes reached 1.46 and 1.16, respectively. Concerning patients’ satisfaction following MF-IOL exchange, 80% of the patients reported they would have the MF-IOL reimplantation procedure again. Conclusions Patient dissatisfaction with neuroadaptation failure following MF-IOL implantation can be managed in 80% of our cases by MF-IOL exchange with a different MF-IOL optical profile.
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Al-Shymali O, Alió del Barrio JL, McAlinden C, Canto M, Primavera L, Alio JL. Multifocal intraocular lens exchange to monofocal for the management of neuroadaptation failure. EYE AND VISION (LONDON, ENGLAND) 2022; 9:40. [PMID: 36316701 PMCID: PMC9623973 DOI: 10.1186/s40662-022-00311-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/07/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND The aim of this study was to evaluate visual, refractive, quality of vision, visual function and satisfaction of multifocal intraocular lens (MF-IOL) exchange with a monofocal IOL (MNF-IOL) in dissatisfied patients following MF-IOL implantation. METHODS This was a retrospective case series. Bilateral IOL exchange (MF-IOL to MNF-IOL) was performed in 13 patients (26 eyes) with neuroadaptation failure. Questionnaires including the Quality of Vision (QoV), Visual Function Index (VF-14 and Rasch-revised VF-8R version), and a satisfaction questionnaire were used. RESULTS The mean time for IOL exchange was 15 months. The corrected distance visual acuity (CDVA) improved from 20/26 to 20/23 (P = 0.028). The uncorrected near visual acuity (UNVA) worsened after exchange from 20/47 to 20/62 (P = 0.024). QoV scores improved significantly across all three subscales after exchange. Visual function for far distance improved with a change in VF-14 score from 74.2 ± 24.8 to 90.9 ± 9.1 (P = 0.03). The VF-8R score showed worsening although not statistically significant. Near vision spectacle independence was totally or partially lost in all cases. Ten patients (77%) reported they would not repeat the lens exchange. Safety and efficacy indices changed from 1.23 to 0.85, respectively, at three months to 1.24 (P = 0.871) and 0.89 (P = 0.568), respectively, at one year. CONCLUSION IOL exchange (multifocal to monofocal) to solve neuroadaptation failure in this case series resulted in significant improvements in dysphotopsia and improved distance visual function. However, UNVA worsened and patient satisfaction after exchange remained suboptimal with 77% claiming they would not repeat the lens exchange, suggesting the value of near vision spectacle independence for these patients.
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Affiliation(s)
- Olena Al-Shymali
- grid.419256.dCornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
| | - Jorge L. Alió del Barrio
- grid.419256.dCornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain ,grid.26811.3c0000 0001 0586 4893Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain
| | - Colm McAlinden
- grid.461312.30000 0000 9616 5600Department of Ophthalmology, Royal Gwent Hospital, Newport, UK
| | - Mario Canto
- grid.419256.dCornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
| | - Laura Primavera
- grid.419256.dCornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
| | - Jorge L. Alio
- grid.419256.dCornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain ,grid.26811.3c0000 0001 0586 4893Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain ,grid.26811.3c0000 0001 0586 4893Vissum Miranza Alicante, Universidad Miguel Hernandez, Calle Cabañal 1, 03016 Alicante, Spain
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Stewart SA, McNeely RN, Chan WC, Moore JE. Visual and Refractive Outcomes Following Exchange of an Opacified Multifocal Intraocular Lens. Clin Ophthalmol 2022; 16:1883-1891. [PMID: 35706684 PMCID: PMC9191835 DOI: 10.2147/opth.s362930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To assess the visual and refractive outcomes following exchange of an opacified multifocal intraocular lens (IOL). Patients and Methods A consecutive series of 37 eyes (31 patients) that underwent IOL exchange between November 2015 and May 2021 were included in this study. The indication for surgery in all cases was opacification of a multifocal IOL. Outcome measures included design and anatomical location of the secondary IOL, intraoperative and postoperative complications, visual acuity and refractive accuracy. Results An opacified Lentis Mplus multifocal IOL was explanted from all eyes and replaced with a monofocal IOL in 21 eyes (57%) and multifocal IOL in 16 eyes (43%). Secondary IOLs were implanted in the capsular bag or sulcus or were iris-fixated. IOL exchange was performed at a mean interval of 7 years after the primary surgery. Anterior vitrectomy was required for vitreous prolapse in 9 eyes (24%). Mean corrected distance visual acuity (CDVA) postoperatively was −0.02 ± 0.08 logMAR for eyes with a monofocal secondary IOL and 0.02 ± 0.08 logMAR for eyes with a multifocal secondary IOL. Mean refractive prediction error was −0.57 ± 0.67 D in the multifocal-monofocal group and −0.33 ± 0.59 D in the multifocal–multifocal group. Conclusion An opacified multifocal IOL can be exchanged for a monofocal or multifocal IOL, depending on available capsular support and the patient’s desired refractive outcome. Vitreous prolapse requiring anterior vitrectomy is the most common intraoperative complication. An improvement in visual acuity and a low postoperative complication rate were achieved in this cohort of patients.
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Affiliation(s)
- Stephen A Stewart
- Cathedral Eye Clinic, Belfast, Northern Ireland, UK
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland, UK
- Correspondence: Stephen A Stewart, Cathedral Eye Clinic, Belfast, Northern Ireland, UK, Tel +44 28 9032 2020, Email
| | | | - Wing C Chan
- Cathedral Eye Clinic, Belfast, Northern Ireland, UK
| | - Jonathan E Moore
- Cathedral Eye Clinic, Belfast, Northern Ireland, UK
- Biomedical Sciences Research Institute, University of Ulster, Coleraine, Northern Ireland, UK
- Department of Ophthalmology, Tianjin Medical University, Tianjin, People’s Republic of China
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Hou YC, Kuo YW. Late intraocular lens exchange in dissatisfied patients with multifocal intraocular lens implantation. Taiwan J Ophthalmol 2022; 12:109-112. [PMID: 35399976 PMCID: PMC8988965 DOI: 10.4103/tjo.tjo_55_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/26/2020] [Indexed: 11/30/2022] Open
Abstract
Intraocular lens (IOL) exchange may be required after multifocal IOL implantation due to dissatisfaction. Late IOL exchange is more challenging when it is done with capsulotomy. We presented a retrospective case series study enrolling four consecutive eyes reviewing late IOL exchange due to decreased vision and dysphotopsia. High residual hyperopia, astigmatism, and IOL tilt occurred in 3 eyes, respectively. The mean time to the IOL exchange was 15.8 ± 10.63 months. After separation of the adhesions by visco-dissection assisted with a 27-gaze needle and sinskey hook, IOL was explanted. One-piece IOL was implanted in the bag in two eyes without posterior capsulotomy, whereas three-piece IOL was implanted in the sulcus after viscoelastic tamponade in the other 2 eyes with capsulotomy. No complication occurred and dysphotopsia disappeared. The mean logarithm of the minimum angle of resolution best-corrected visual acuity significantly improved from 0.33 ± 0.12 preoperatively to 0.11 ± 0.13 postoperatively. In conclusion, late IOL exchange could be safely performed with proper technique and achieve good results.
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Dragnea DC, Tru Latin Small Letter T With Comma Below A RN, Goemaere J, Tassignon MJ, Dhubhghaill SN. Intraocular Bag-in-the-Lens Exchange: Indications, Outcomes and Complications. J Cataract Refract Surg 2021; 48:568-575. [PMID: 34417783 DOI: 10.1097/j.jcrs.0000000000000787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/06/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the indications, outcomes, and complications regarding the Bag-in-the-lens (BIL) intraocular lens (IOL) exchanges over a period of 13 years in a tertiary ophthalmologic centre. SETTING Department of Ophthalmology of the University Hospital of Antwerp (UZA). DESIGN Observational retrospective study. PATIENTS AND METHODS Between 2003 and 2020, 12 176 patients were operated using the BIL technique. We included adult patients who underwent an intraocular BIL exchange and recorded the demographics, indications, outcomes, and complications. RESULTS Fifty-nine eyes of 59 patients who underwent a BIL exchange between 2007 and 2020 were included (0.48%). The mean age was 61.15 ±13.53 years. The mean time between primary surgery and IOL exchange was 25.73 ± 41.88 months. The main indication for explantation was refractive surprise mostly related to the patients' risk factors e.g. preoperative corneal and refractive surgery. The mean preoperative uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were 0.36 ± 0.24 and 0.79 ± 0.24 respectively. The postoperative 1 month-UDVA and CDVA were 0.66 ± 0.28 and 0.86 ± 0.19 respectively. The improvement in UDVA was statistically significant (<0.0001). The most common peroperative complication was damage to the anterior hyaloid in 9 eyes (15%), which did not prohibit reimplantation of a secondary BIL. CONCLUSIONS BIL to BIL exchange is an viable and successful technique that provides good refractive results with few, manageable complications. Because of the tertiary profile of our centre with referral of complex cases, BIL was our preferred IOL in patients at risk of postoperative refractive surprise.
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Affiliation(s)
- Diana Carmen Dragnea
- Department of Ophthalmology, Antwerp University Hospital, Wilrijk, Belgium Department of Medicine, University of Antwerp, Wilrijk, Belgium University of Medicine and Pharmacy, Târgu Mure[Latin Small Letter s with comma below], Romania
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Yusef YN, Yusef SN, Ivanov MN, Vvedenskiy AS, Fokina ND, Alkharki L, Shashorina SA. [Evolution of IOL exchange. Part 1. Development of methods for IOL exchange]. Vestn Oftalmol 2020; 136:248-253. [PMID: 33063973 DOI: 10.17116/oftalma2020136052248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The review presents the history of development and improvement of methods for intraocular lens (IOL) exchange. Existing techniques of IOL exchange are comparatively analyzed.
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Affiliation(s)
- Yu N Yusef
- Research Institute of Eye Diseases, Moscow, Russia
| | - S N Yusef
- Research Institute of Eye Diseases, Moscow, Russia
| | - M N Ivanov
- Research Institute of Eye Diseases, Moscow, Russia
| | | | - N D Fokina
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - L Alkharki
- Research Institute of Eye Diseases, Moscow, Russia
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Kassumeh S, Luther JK, Wertheimer CM, Brandt K, Schenk MS, Priglinger SG, Wartak A, Apiou-Sbirlea G, Anderson RR, Birngruber R. Corneal Stromal Filler Injection as a Novel Approach to Correct Presbyopia-An Ex Vivo Pilot Study. Transl Vis Sci Technol 2020; 9:30. [PMID: 32832235 PMCID: PMC7414620 DOI: 10.1167/tvst.9.7.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/10/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the ex vivo feasibility of corneal stromal filler injection to create bifocality to correct presbyopia by flattening the central posterior corneal surface and thus increase refractive power. Methods Femtosecond laser-assisted corneal stromal pockets of varying diameters close to the posterior corneal curvature were cut into rabbit eyes ex vivo. Subsequently, hyaluronic acid was injected to flatten the central posterior curvature. Refractive parameters were determined using perioperatively acquired three-dimensional optical coherence tomography (OCT) scans. Using micrometer-resolution OCT, corneal endothelial cell morphology and density were evaluated. Results Following filler injection into the corneal stromal pockets, a fair volume-dependent increase of central refractive power up to 4 diopters (dpt) was observed. Unremarkable refractive changes of the peripheral posterior (3 mm, 0.20 ± 0.11 dpt; 2 mm, 0.11 ± 0.10 dpt) and the anterior corneal curvature (3 mm, 0.20 ± 0.34 dpt; 2 mm, 0.33 ± 0.31 dpt) occurred. Only negligible changes in astigmatism were observed. Different sizes of optical zones could be established. Furthermore, no alterations of corneal endothelial morphology or endothelial cell density (2831 ± 356 cells/mm2 vs. 2734 ± 292 cells/mm2; P = 0.552) due to the adjacent laser treatment were observed. Conclusions The ex vivo investigations proved the principle of injecting a filler material into femtosecond laser-created corneal stromal pockets close to the posterior corneal curvature as an efficacious, individually adjustable, and novel approach to correct presbyopia without ablating corneal tissue. Translational Relevance Due to the aging population worldwide, presbyopia is an increasing problem; thus, our study may encourage further exploration to extend the treatment spectrum of clinically used femtosecond laser systems to correct presbyopia.
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Affiliation(s)
- Stefan Kassumeh
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany
| | - Jannik K Luther
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Institute of Biomedical Optics, University of Luebeck, Luebeck, Germany
| | | | - Katharina Brandt
- Institute of Biomedical Optics, University of Luebeck, Luebeck, Germany
| | - Merle S Schenk
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany
| | | | - Andreas Wartak
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gabriela Apiou-Sbirlea
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - R Rox Anderson
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Reginald Birngruber
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Institute of Biomedical Optics, University of Luebeck, Luebeck, Germany
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Huang JR, Liao HF, Wan CH, Gong LM, He LF, Jiang HJ, Li B, Shao Y. Three-year clinical observation of the outcomes of transepithelial and epithelial-off accelerated corneal collagen crosslinking treatment for different types of progressive keratoconus. Exp Ther Med 2020; 20:786-795. [PMID: 32742324 PMCID: PMC7388227 DOI: 10.3892/etm.2020.8741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/04/2019] [Indexed: 11/20/2022] Open
Abstract
In the present study, the clinical and long-term effects of accelerated transepithelial corneal collagen crosslinking (ATE-CXL) and accelerated epithelial-off corneal collagen crosslinking (A-CXL) for the treatment of different types of progressive keratoconus were compared. A total of 70 patients, including 96 eyes with advanced keratoconus, were enrolled in the study. ATE-CXL or A-CXL was performed on one or two eyes of each subject according to corneal thickness, keratoconus type and surgical approach. Patients were divided into the following four groups: Group A, ATE-CXL for central keratoconus; group B, A-CXL for central keratoconus; group C, ATE-CXL for peripheral keratoconus; and group D, A-CXL for peripheral keratoconus. Uncorrected distant visual acuity (UDVA), best-corrected distant (BD)VA and corneal astigmatism (CA) were evaluated in all patients by routine ophthalmology pre-operatively and 3 years post-operatively. Topographical features, including maximum corneal curvature (Kmax), thinnest corneal thickness (TCT), anterior corneal elevation (ACE) and corneal endothelial cell density (ECD) were also compared across groups. The results suggested that pre- and post-operative UDVA, BDVA, Kmax, CA and ACE values differed in all four groups (P<0.05), whereas no differences were observed between pre- and post-operative TCT and ECD (P>0.05). Concordant results were obtained between groups A and C and groups B and D. ATE-CXL achieved better control of central keratoconus UDVA, Kmax and CA as compared with A-CXL. The difference between pre- and post-operative UDVA, Kmax and CA as compared with A-CXL was highly correlated with the change in intraocular pressure and treatment effectiveness. There was a statistically significant improvement in BDVA with ATE-CXL for treatment of central keratoconus compared with that after A-CXL treatment (P=0.032). There were statistically significant improvements in BDVA (P=0.047), CA (P=0.045) and ACE (P=0.012) with A-CXL treatment of peripheral keratoconus when compared with ATE-CXL treatment. Central, and to a lesser extent, peripheral, keratoconus may be effectively controlled by either approach, with disease stabilization 3 years later. ATE-CXL is suggested to be the most suitable treatment for keratoconus of <400 µm with a corneal thickness of >400 µm; however, A-CXL yields superior long-term outcomes.
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Affiliation(s)
- Jin-Rong Huang
- Department of Ophthalmology, The Affiliated Eye Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China.,Department of Ophthalmology, The First Affiliated Hospital of Jiangxi Medical College, Shangrao, Jiangxi 334000, P.R. China
| | - Hong-Fei Liao
- Department of Ophthalmology, The Affiliated Eye Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Chun-Hong Wan
- Department of Ophthalmology, The First Affiliated Hospital of Jiangxi Medical College, Shangrao, Jiangxi 334000, P.R. China
| | - Li-Miao Gong
- Department of Ophthalmology, The First Affiliated Hospital of Jiangxi Medical College, Shangrao, Jiangxi 334000, P.R. China
| | - Liang-Fei He
- Department of Ophthalmology, The First Affiliated Hospital of Jiangxi Medical College, Shangrao, Jiangxi 334000, P.R. China
| | - Hong-Ji Jiang
- Department of Ophthalmology, The First Affiliated Hospital of Jiangxi Medical College, Shangrao, Jiangxi 334000, P.R. China
| | - Biao Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
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Leung EH, Gibbons A, Koch DD. Cost-Effectiveness of Preoperative OCT in Cataract Evaluation for Multifocal Intraocular Lens. Ophthalmology 2020; 127:859-865. [PMID: 32173111 PMCID: PMC7311225 DOI: 10.1016/j.ophtha.2020.01.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To determine the cost effectiveness of an adjunctive screening OCT during the preoperative evaluation of a patient considering cataract surgery with a multifocal intraocular lens (IOL) implantation. DESIGN Cost-effectiveness analysis. PARTICIPANTS A 67-year-old man with 20/60 vision undergoing evaluation for first-eye cataract surgery. METHODS The cost-effectiveness analysis of the reference patient undergoing a preoperative cataract examination with and without a screening OCT was performed, evaluating for vitreoretinal diseases including an epiretinal membrane, age-related macular degeneration, vitreomacular traction, and cystoid macular edema. It was assumed that patients with macular pathologies detected before surgery would receive a monofocal IOL and be referred to a retina specialist for evaluation and management. The Medicare reimbursable cost of an OCT was $41.81. All costs and benefits were adjusted for inflation to 2019 United States dollars and discounted 3% per annum over a 16-year time horizon. Probability sensitivity analyses and 1-way deterministic sensitivity analyses were performed to assess for uncertainty. MAIN OUTCOME MEASURES Incremental cost-effectiveness ratio and incremental cost-utility ratio (ICUR) measured in quality-adjusted life years (QALYs). RESULTS Approximately 20.5% of patients undergoing cataract surgery may have macular pathologies, of which 11% may not be detected on the initial clinical examination. In the base case, an adjunctive preoperative OCT was cost effective from a third-party payer and societal perspective in the United States. In the probability sensitivity analyses, the ICURs were within the societal willingness-to-pay threshold of $50 000/QALY in approximately 64.4% of the clinical scenarios. CONCLUSIONS A preoperative screening OCT during the evaluation of a patient considering a multifocal IOL added to the costs of the cataract surgery, but the OCT increased the detection of macular pathologies and improved the QALYs over time. An adjunctive screening OCT can be cost effective from a third-party payer and societal perspective.
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Affiliation(s)
- Ella H Leung
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.
| | - Allister Gibbons
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Douglas D Koch
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
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Son HS, Kim SH, Auffarth GU, Choi CY. Prospective comparative study of tolerance to refractive errors after implantation of extended depth of focus and monofocal intraocular lenses with identical aspheric platform in Korean population. BMC Ophthalmol 2019; 19:187. [PMID: 31426775 PMCID: PMC6700984 DOI: 10.1186/s12886-019-1193-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 08/02/2019] [Indexed: 11/24/2022] Open
Abstract
Background To evaluate the clinical outcomes of extended depth of focus (EDOF) and monofocal intraocular lenses (IOLs) that share identical aspheric platform and compare their visual acuity tolerance to postoperative refractive errors. Methods This non-randomized, prospective comparative study included 120 eyes undergoing cataract surgery with implantation of either Tecnis ZCB00 IOL (Abbott Medical Optics Inc., Santa Ana, CA) (monofocal group: 60 eyes of 30 patients) or Tecnis Symfony IOL (Abbott Medical Optics, Inc.) (EDOF group: 60 eyes of 30 patients). Monocular and binocular visual outcomes, changes in refraction, defocus curve, contrast sensitivity, and perception of photic phenomena (Halo & Glare Simulator; Eyeland Design Network, Vreden, Germany) were evaluated 3 months postoperatively. To compare the refractive tolerance, each group was divided into three subgroups according to the postoperative uncorrected distance visual acuity (UDVA) and postoperative spherical equivalent (SE). Results In the EDOF group, the mean 3-months postoperative monocular UDVA, intermediate (UIVA), and near (UNVA) visual acuities were 0.03 ± 0.07, 0.09 ± 0.15, and 0.24 ± 0.16 logMAR, respectively. A total of 100, 96.55, and 68.97% of eyes in the EDOF group achieved binocular UDVA, UIVA, and UNVA values of 0.20 logMAR or better, respectively. In respect to refractive tolerance, the EDOF group showed higher SE values and statistically significantly better mean UDVA than the monofocal group in all subgroups, with UDVA of − 0.013 and 0.028 logMAR for EDOF and monofocal groups (p = 0.037), respectively, in the subgroup where SE was within ±0.50 D, UDVA of 0.004 and 0.048 logMAR for EDOF and monofocal groups (p = 0.046), respectively, in the subgroup where SE was within − 1.00 D, and UDVA of 0.020 and 0.083 logMAR for EDOF and monofocal groups (p = 0.026), respectively, in the subgroup where SE was more than − 1.00 D. The mean patient satisfaction scores for spectacle-free distance, intermediate, and near visual acuities were 86.0, 85.0, and 66.0, respectively. Conclusions The EDOF IOL provided excellent postoperative visual outcomes in far and intermediate distances, with high patient satisfaction rate. Regarding the postoperative refractive tolerance to SE, the Tecnis Symfony IOL showed better tolerance to residual postoperative refractive error than the monofocal IOL with the same material and optical platform.
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Affiliation(s)
- Hyeck-Soo Son
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Seong Ho Kim
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Gerd U Auffarth
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Chul Young Choi
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea.
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Al-Shymali O, Alió JL. Multifocal Intraocular Lenses: Neuroadaptation Failure Corrected by Exchanging with a Different Multifocal Intraocular Lens. ESSENTIALS IN OPHTHALMOLOGY 2019. [DOI: 10.1007/978-3-030-21282-7_11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Secondary IOLs: ACIOL vs Iris Sutured vs Scleral Fixated vs Phakic IOL in Aphakic Settings. CURRENT OPHTHALMOLOGY REPORTS 2018. [DOI: 10.1007/s40135-018-0184-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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