Visual Performance Following Bilateral Implantation of Refractive Rotationally Asymmetric Bifocal Intraocular Lens (LS-313 MF30) or Apodized Diffractive Bifocal Intraocular Lens (ReSTOR SN6AD1)

Enhancing the biocompatibility of phakic intraocular lens via selective fibronectin trapping

Myopia has become a significant public health problem in recent decades, resulting in a profound public health and financial burden. The phakic intraocular lens (PIOL) utilized in myopia intraocular refractive surgery is constantly facing challenges in terms of uveal biocompatibility. Inspired by the "sandwich theory", this study proposes the hypothesis that fibronectin (FN) can improve biocompatibility, and then creatively constructs a selective in-situ trap FN strategy. Specifically, PIOL surfaces with amide bonds covalently linking collagen were prepared, where selectivity was achieved by specific binding of collagen to FN. The obtained collagen modified material reduces immune response by reducing M1 polarization of macrophages, and its functionality and safety have been verified in vitro and in vivo. The grafting of collagen on the PIOL surface was able to occupy adsorption sites and inhibit the non-specific adsorption of other proteins while mimicking the extracellular matrix (ECM) microenvironment, further reducing the foreign body rejection. Overall, this strategy helps to address the issue of uveal biocompatibility in PIOL from a material design perspective, providing more economical and diversified options for patients with surgical needs. STATEMENT OF SIGNIFICANCE: 1. A phakic intraocular lens material with high ocular biocompatibility has been prepared. 2. By introducing acrylic anhydride and activating it, collagen is covalently grafted onto the surface of HEMA without altering its structure. 3. By utilizing the collagen binding domain in the structure of fibronectin, selective adsorption of fibronectin is enhanced, forming extracellular matrix analogs that reduce macrophage M1 polarization and lower inflammation.

Comparison of Visual Performance Between Mix-and-Match and Bilateral Implantation of Rotationally Asymmetric Multifocal Intraocular Lenses

Objective

To evaluate and compare the clinical outcomes of rotationally asymmetric multifocal intraocular lenses (IOLs) in a mix-and-match approach or bilateral implantation.

Methods

In this prospective study, patients were split into two groups based on the types of IOLs implanted. The mix group received mix-and-match implantation of a LENTIS Mplus LS-313 +1.50D IOL in the dominant eye and a LENTIS Mplus LS-313 +3.0D IOL in the fellow eye. The bilateral group received bilateral implantation of LENTIS Mplus LS-313 +3.00D IOLs. A three-month follow-up was performed after the surgery. Binocular visual acuity at various distances, subjective refraction and defocus curves were assessed. Subjective questionnaires included the overall satisfaction, a self-assessment of visual quality, spectacle independence, and presence of photic phenomena were completed.

Results

The study was completed by 52 patients in total (25 mix-and-match, 27 bilateral). The mean binocular uncorrected intermediate visual acuity in the mix group and the bilateral group were 0.10 ± 0.12 logMAR and 0.23 ± 0.14 logMAR, respectively, demonstrating a significant difference (P = 0.005). The mix group performed better in intermediate vision (range: -1.00 to -2.00 D) than the bilateral group (all P< 0.05), according to binocular defocus curves. About 92.0% of patients in the mix group did not need spectacles for intermediate distance vision compared to 59.26% in the bilateral group (P = 0.0001).

Conclusion

The mix-and-match implantation of the +1.50D and +3.00D rotationally asymmetric multifocal IOLs provided good binocular visual outcomes and resulted in better intermediate vision than bilateral implantation of +3.00D IOLs.

Comparison of visual outcomes in patients with cataracts and high myopia after implantation of a zonal refractive multifocal or diffractive bifocal intraocular lens

This study compares the optical quality of zonal refractive multifocal and diffractive bifocal intraocular lenses (IOLs) and visual outcomes after implantation in 93 patients(93 eyes) with cataracts and high myopia. A retrospective analysis was conducted to measure visual acuity at far, intermediate, and near distances, defocus curves, wavefront aberrations, modulation transfer function (MTF), a Quality of Vision questionnaire (QoV) and visual quality self-evaluation were examined at 3 months. The results demonstrated the ZMB group showed better uncorrected near visual acuity (P < 0.01), and the MF15 group showed better uncorrected intermediate visual acuity (P < 0.001). The ZMB group provided better MTF than the MF15 group (P < 0.01) but demonstrated a worse QoV score, especially for the severity of glare, halo, and starburst (P < 0.05). The satisfaction score and spectacle independence rate in the ZMB group were higher than in the MF15 group (P < 0.01). LS-313MF15 and TecnisZMB00 offered excellent visual restoration, stable distance visual acuity, and good subjective visual function.

Laboratory Evaluation of Halos and Through-Focus Performance of Three Different Multifocal Intraocular Lenses

PURPOSE

To compare the halo features and through-focus performance of three different multifocal intraocular lenses (MIOLs) that provide distance, intermediate, and near vision in a clinical trial.

METHODS

A trifocal diffractive MIOL (AT LISA tri 839MP; Carl Zeiss Meditec), a diffractive extended depth-of-focus MIOL (TECNIS Symfony ZXR00; Abbott Laboratories, Inc), and a rotational asymmetric refractive MIOL (SBL-3; Lenstec, Inc) were assessed in a modified International Organization for Standardization eye model. The modulation transfer function (MTF) at the IOLs' foci was obtained using aperture sizes of 3 and 4.5 mm. Through-focus MTF curves were compared among all MIOLs. Images of the slit pattern were used to assess halo formation and characteristics.

RESULTS

The AT LISA tri and Symfony IOLs showed symmetric halos. The halos of the AT LISA tri IOL were larger but weaker in distance and near foci, whereas the halos of the Symfony IOL were smaller and fainter in intermediate focus. The halos of the SBL-3 IOL were asymmetric and appeared as tangentially downward weaker halos. The optical performance of diffractive MIOLs gradually deteriorated as the aperture increased. The distance foci of the AT LISA tri and SBL-3 IOLs were of similar superior optical quality, the intermediate focus of the Symfony IOL showed the best optical quality, and the near focus of the SBL-3 IOL outperformed the near foci of the remaining IOLs.

CONCLUSIONS

The differences in the design of the MIOLs translate to differences in optical performance at their foci, through-focus expressions, and halo features, which can provide further information to surgeons when selecting what IOL to implant. [J Refract Surg. 2022;38(9):552-558.].