Anterior capsule cover and axial movement of intraocular lens

Incidence and factors for pseudoaccommodation after monofocal lens implantation: the Monofocal Extended Range of Vision study

PURPOSE

To screen patients with a monofocal intraocular lens (IOL) for incidence of unaided 20/40 and 0.3 LogMAR for distance and near (pseudoaccommodation) and to find factors for pseudoaccommodation.

SETTINGS

University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom.

DESIGN

Prospective study.

METHODS

This was a single-eye study ( ClinicalTrials.gov : NCT04011696). At 3 to 9 months, refraction, uncorrected and corrected distance and uncorrected near visual acuity (logMAR), spherical equivalent (SEQ), mesopic pupil size (PS), total eye spherical (Z 40 ), vertical coma (Z 3-1 ) aberrations, reading speed and smallest print size were assessed. Refractive astigmatism (RA) was classified as against-the-rule, with-the-rule, oblique and no astigmatism. Data on preoperative axial length (AL) and anterior chamber depth (ACD) were collected.

RESULTS

29 patients (9.6%, 95% CI, 6.5-13.5) had pseudoaccommodation. In cases vs controls, median SEQ, PS, total Z 40 , Z 3-1 , reading speed, smallest print size, preoperative ACD, preoperative AL were: -0.39 vs 0.0 diopters; 3.62 vs 4.10 mm; 0.01 vs 0.02 μm; 0.018 vs 0.022 μm; 106 vs 133 words per minute; 0.30 vs 0.50 logMAR; 2.94 vs 3.13 mm, 23.4 vs 23.7 mm, respectively. RA was not different between the groups. Univariate analysis revealed preoperative ACD (odds ratio [OR], 0.38, 95% CI, 0.16-0.94, P = .04), SEQ (OR, 0.61, 95% CI, 0.42-0.88, P = .01), total Z 40 (OR, 0.0003, 95% CI, 0.00-0.39, P = .03) and PS (OR, 0.39, 95% CI, 0.22-0.69, P < .041) to be significant. Whereas multivariable logistic regression identified: preoperative AL (OR, 0.62, 95% CI, 0.42-0.91, P = .02), SEQ (OR, 0.49, 95% CI, 0.31-0.78, P = .01), Z 40 (OR, 0.00, 95% CI, 0.0-0.01, P = .01) and PS (OR, 0.41, 95% CI, 0.23-0.75, P = .01) to be significant.

CONCLUSIONS

A combination of low myopic SEQ, lower Z 40 , shorter preoperative AL, and smaller PS increases the chances of pseudoaccommodation.

Anterior capsule coverage and rotational stability of an acrylic toric intraocular lens

PURPOSE

To investigate factors related to the rotational stability of an acrylic toric intraocular lens (IOL).

SETTING

Four ophthalmic surgical sites in Japan.

DESIGN

Prospective case series.

METHODS

The study included 120 eyes of 120 patients undergoing phacoemulsification and implantation of a toric IOL (AcrySof IQ, Alcon Laboratories, Inc.). At 1 hour postoperatively, the area of continuous curvilinear capsulorhexis (CCC) was measured, and the state of anterior capsule coverage on the IOL optic (total on or partial on) was recorded. The toric IOL axis orientation was assessed at the end of surgery and at 1 hour, 1 week, 1 month, and 6 months postoperatively. Multiple regression analysis was performed to explore any clinical factors relevant to IOL rotation from the end of surgery to 6 months postoperatively. The explanatory variables included age, anterior chamber depth preoperatively, axial length, type of corneal astigmatism (with-the-rule, against-the-rule, or oblique astigmatism), area of CCC, state of anterior capsule overlap on IOL optic (total coverage vs partial coverage), and surgical sites (surgeons).

RESULTS

The multiple regression analysis in 110 eyes of 110 patients indicated that anterior capsule overlap on the IOL optic was the only variable associated with IOL rotation at 6 months postoperatively (P = .0482). The mean absolute rotation at 6 months was 1.96 ± 1.81 degrees in the total on group and 3.79 ± 3.12 degrees in the partial on group (P = .0004).

CONCLUSIONS

Rotational stability of a single-piece, acrylic toric IOL was better in eyes with total anterior capsule coverage than that in those with partial anterior capsule coverage on the IOL optic.

The effects of peripheral anterior synechiae on refractive outcomes after cataract surgery in eyes with primary angle-closure disease

Objective of the study was to investigate the effects of peripheral anterior synechiae (PAS) on refractive outcomes after cataract surgery in eyes with primary angle-closure disease (PACD).This is a retrospective, cross-sectional study. Seventy eyes of 70 PACD patients who underwent phacoemulsification and intraocular lens implantation. Patients were divided into 2 groups based on the presence of PAS on preoperative gonioscopy. The predictive power of the intraocular lens was calculated by the SRK/T, Hoffer Q, Haigis, and Holladay formulae. The mean absolute error (MAE) and predicted refractive errors were compared between PAS (+) and PAS (-) groups. We also evaluated the refractive errors with regards to the extent of PAS in the subanalyses.The mean MAE was greater in the PAS (+) group with all formulae (0.61-0.70 diopters [D] vs 0.33-0.45 D, all P < .05). The eyes with PAS tended towards myopia (-0.30 D to -0.51 D vs -0.05 D to +0.24 D, all P < .05). However, the MAEs or predicted refractive errors were not different, irrespective of the extent of PAS in the subanalyses (all, P > .05).The presence or absence of PAS may influence the postoperative refractive outcomes in PACD patients.

Femtosecond laser-assisted cataract surgery in shallow anterior chamber cases

PURPOSE

To assess the effectiveness, safety and predictability of femtosecond laser-assisted cataract surgery (FLACS) in eyes with shallow anterior chamber (AC).

METHODS

This is a prospective consecutive clinical study. All eyes presented an anterior chamber depth (ACD) ≤ 2.1 mm and were submitted to FLACS with monofocal intraocular lens (mIOL) or trifocal intraocular lens (tIOL) implantation. Uncorrected distance visual acuity (VA) and corrected distance VA values were used to assess efficacy and safety of the surgery. Refraction, intraocular pressure (IOP), endothelial cell density (ECD) and ACD were evaluated before and 6 months post-surgery.

RESULTS

Phacoemulsification was carried out successfully in all eyes, without intra- or postoperative complications. Efficacy and safety indexes were 0.96 and 1.26 for the mIOL group, and 0.87 and 1.01 for the tIOL group, respectively. The mean postoperative spherical equivalent was - 0.06 ± 0.28D and - 0.14 ± 0.38D for the mIOL and tIOL groups, respectively. The ECD varied from 2470 ± 483 to 2009 ± 538 cells/mm² (p < 0.05) and from 2443 ± 319 to 2245 ± 628 cells/mm² (p = 0.06) for the mIOL and tIOL groups, respectively. IOP significantly decreased (p < 0.05) after the surgery from 14.34 to 12.85 mmHg for the mIOL group and from 14.37 to 11.91 mmHg for the tIOL group, with a general reduction of medical hypotensive treatment in both groups (85% of cases required ≤ number of medications). ACD changed significantly (p < 0.05) from 1.96 ± 0.15 mm to 3.75 ± 0.30 mm after the surgery in the mIOL group and from 1.94 ± 0.15 mm to 3.23 ± 0.21 mm for the tIOL group.

CONCLUSION

FLACS with implantation of either mIOL or tIOL may provide good efficacy, safety and predictability in eyes with shallow AC.

Long-term visual outcomes and patient satisfaction following bilateral implantation of trifocal intraocular lenses

Purpose

To study the long-term visual and refractive outcomes and evaluate patient satisfaction after bilateral implantation of trifocal intraocular lenses (IOLs).

Setting

Nethradhama Superspeciality Eye Hospital, Bangalore.

Design

Prospective, nonrandomized study.

Methods

Eligible patients undergoing bilateral phacoemulsification with trifocal IOL implantation were included. Follow-up examinations were conducted at day 1, 1 week, 1 month, 6 months, and 12 months. Postoperatively, 1 month onward evaluation of uncorrected and distance-corrected far and near visual acuity; reading acuity and reading speeds (using Salzburg Reading Desk) at 70, 80, and 90 cm; contrast sensitivity; defocus curves; and patient satisfaction was carried out.

Results

Fifty eyes from 25 patients with a mean age of 58±13.44 years were included. All eyes showed significant improvement in spherical equivalent, uncorrected distance visual acuity, corrected distance visual acuity, uncorrected near visual acuity, and corrected near visual acuity at 1 month compared to preoperative values (P<0.05), with no significant change in these parameters thereafter until the last follow-up (P>0.05). At 12 months, mean uncorrected reading acuities and reading speeds at 70, 80, and 90 cm were in the range of 0.09–0.04 logMAR units and 153.6–169.0 words per minute, respectively, with significantly better results at 80 cm. Five eyes underwent YAG laser capsulotomy for early posterior capsule opacification (PCO) at a mean follow-up of 7.2±2.9 months. Contrast sensitivity scores at 12 months were comparable to 1 month (P>0.05 for all spatial frequencies). All patients reported good tolerance and 100% independence from spectacles for all activities.

Conclusion

Trifocal IOLs provided excellent unaided vision at all distances. Reading performance was good through the complete intermediate distance range. PCO occurrence and subsequent YAG capsulotomy did not affect the long-term visual outcomes.

Comparison of IOL power calculation and refractive outcome after laser refractive cataract surgery with a femtosecond laser versus conventional phacoemulsification

PURPOSE

To compare intraocular lens (IOL) power calculation and refractive outcome between patients who underwent laser refractive cataract surgery with a femtosecond laser and those with conventional cataract surgery.

METHODS

In this prospective study, 77 eyes from 77 patients underwent laser refractive cataract surgery (laser group; Alcon LenSx femtosecond laser), and conventional cataract surgery with phacoemulsification was performed in 57 eyes from 57 patients (conventional group). Biometry was done with optical low coherence reflectometry (Lenstar LS900, Haag-Streit AG), and IOL calculation was performed with third-generation IOL formulas (SRK/T, Hoffer Q, and Holladay). The refractive outcome was analyzed using the mean absolute error (MAE; difference between predicted and achieved postoperative spherical equivalent refraction), and multivariable regression analysis was performed to compare the two groups.

RESULTS

No significant differences were found between age, axial length, keratometry, and preoperative corrected visual acuity in the laser and conventional groups (P>.05; Mann-Whitney U test). At least 6 weeks after surgery, MAE was significantly lower in the laser group (0.38±0.28 diopters [D]) than in the conventional group (0.50±0.38 D) (P=.04). The difference was the greatest in short (axial length <22.0 mm, 0.43±0.41 vs 0.63±0.48) and long (axial length >26.0 mm, 0.33±0.24 vs 0.63±0.42) eyes.

CONCLUSIONS

Laser refractive cataract surgery with a femtosecond laser resulted in a significantly better predictability of IOL power calculation than conventional phacoemulsification surgery. This difference is possibly due to a more precise capsulorrhexis, resulting in a more stable IOL position.

Intraocular lens stability and refractive outcomes after cataract surgery using primary posterior continuous curvilinear capsulorrhexis

PURPOSE

To evaluate the amount of intraocular lens (IOL) decentration and refractive changes after cataract surgery using posterior continuous curvilinear capsulorrhexis (PCCC).

DESIGN

Prospective comparative case series.

PARTICIPANTS

We included 86 eyes of 77 patients who had cataract surgery using PCCC (the PCCC group), and 79 eyes of 68 patients treated without PCCC (the control group).

METHODS

Foldable IOLs with polymethylmethacrylate haptics (VA-60BB, Hoya Corporation, Tokyo, Japan) were implanted in both groups. The best-corrected visual acuity (BCVA) was assessed. Automated refractokeratometry, Scheimpflug imaging (Pentacam; Oculus, Wetzlar, Germany), and slit-lamp photography with retroillumination were performed at each follow-up visit over 6 months. The axial shift of each IOL was measured as the distance between the corneal endothelium and the anterior surface of the IOL on Scheimpflug images. The horizontal shift was assessed as the distance between the geometric center of the IOL and the centers of the pupil and the limbus.

MAIN OUTCOME MEASURES

Best-corrected visual acuity, horizontal and axial shift of the IOL, and automated refraction.

RESULTS

There was no difference between the 2 groups in the mean BCVA before surgery and at any postoperative follow-up. The mean horizontal shift of the IOL after 6 months was 0.25 ± 0.14 mm for the pupil and 0.31 ± 0.17 mm for the limbus in the PCCC group (P = 0.315), and 0.26 ± 0.09 mm and 0.31 ± 0.13 mm, respectively, in the control group (P = 0.115). These were not different from the measurement on the postoperative day 1 (P = 0.515, P = 0.263, P = 0.421, and P = 0.875, respectively). At each follow-up visit over 6 months, there was no difference in the horizontal shift between the 2 groups (P > 0.05). The IOL shifted insignificantly in the PCCC group (-0.08 ± 0.24 mm anterior shift), but the shift was significant in the control group (-0.42 ± 0.27 mm anterior shift; P = 0.009). The mean postoperative refractive shift 6 months after surgery compared with refraction on the first day after surgery was -0.16 ± 0.67 diopter (D) in the PCCC group and -0.60 ± 0.70 D in the control group (P = 0.042).

CONCLUSIONS

During cataract surgery, PCCC is useful to stabilize and minimize postoperative refractive changes. The IOL displacement attributable to capsular contraction is less when cataract surgery involves PCCC.