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Levinger N, Erdinest N, London N, Levinger E, Goldfeather Ben Zaken S, Barequet D, Barequet I, Achiron A, Levinger S. Femtosecond LASER-Assisted Double Intraocular Lens Exchange in Nanophthalmic Eyes. Case Rep Ophthalmol 2024; 15:143-149. [PMID: 38348443 PMCID: PMC10861217 DOI: 10.1159/000536190] [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: 06/27/2023] [Accepted: 01/01/2024] [Indexed: 02/15/2024] Open
Abstract
Introduction Though patients with nanophthalmos frequently endure decreased quality of vision with contact lenses or spectacles, refractive surgery is generally an inadequate alternative due to the associated high refractive error. A refractive lens exchange (RLE) is an alternative option but is technically challenging, requiring accuracy in biometry measurements and procedures. Case Presentation This case discusses a 27-year-old female with nanophthalmos (axial lengths 17.6 mm and 17.4 mm, right and left eyes, respectively) who underwent a femtosecond laser-assisted (FLA) RLE with simultaneous implantation of a monofocal and a Sulcoflex trifocal (Rayner, Britain) lens in each eye. Preoperative cycloplegic refraction was +11.50/-0.75 × 145 and +12.00/-1.00 × 35 in the RE and LE, respectively. Best-corrected visual acuity (BCVA) at distance and near in the RE and LE was 6/7.5 and J1, 6/8.5 and J2, respectively. Uncorrected visual acuity (UCVA) was >6/120 and >J14 for each eye. FLA RLE was performed in the RE, then in the LE 2 weeks later. In each eye, a monofocal (44.0 D, RE, and LE) and a Sulcoflex trifocal lens (both implants, Rayner, Britain) were implanted in one procedure. Distance and near UCVA measured 6 weeks post-op RE and 1-month post-op LE at 6/8.5 and J1 in the RE, 6/10 and J1 in the LE. The RE and LE refraction and BCVA were +0.50/-1.00 × 115, 6/7.5, and plano/-1.00 × 55, 6/8.5, respectively. The post-op outcomes were uneventful. Conclusion A single procedure concurrently implanting a monofocal and Sulcoflex trifocal intraocular lens in nanophthalmic eyes resulted in an excellent UCVA. This procedure can be considered esthetic and reconstructive as it significantly improves patient appearance and function.
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Affiliation(s)
- Nadav Levinger
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Hadassah Medical Center, Jerusalem, Israel
| | - Nir Erdinest
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
| | | | - Eliya Levinger
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shalhevet Goldfeather Ben Zaken
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
| | - Dana Barequet
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Irit Barequet
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Asaf Achiron
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shmuel Levinger
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
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Rocha-de-Lossada C, García-Lorente M, La Cruz DZD, Rodríguez-Calvo-de-Mora M, Fernández J. Supplemental Toric Intraocular Lenses in the Ciliary Sulcus for Correction of Residual Refractive Astigmatism: A Review. Ophthalmol Ther 2023; 12:1813-1826. [PMID: 37145259 PMCID: PMC10287861 DOI: 10.1007/s40123-023-00721-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/17/2023] [Indexed: 05/06/2023] Open
Abstract
PURPOSE This study conducted a critical review of the peer-reviewed literature on the use of supplemental toric intraocular lenses (STIOL) in the ciliary sulcus to correct residual refractive astigmatism. METHODS This review used PubMed as a database from 1 January 2010 to 13 March 2023. According to the inclusion and exclusion criteria defined, 14 articles were selected for the current review. RESULTS The data of 155 eyes were analyzed. Most of the studies reviewed had a short follow-up and poor or limited design, including case reports, case series, and retrospective cohorts. The follow-up period ranged from 43 days to 4.5 years. STIOL rotation was the most frequently described complication in the literature, with a mean rotation of 30.48 ± 19.90°. These patients required repositioning in 50 of 155 eyes (32.25%). Moreover, four eyes (2.58%) required scleral fixation sutures and two eyes (1.29%) iris fixation. Other complications were high intraocular pressure (3 eyes, 1.93%), transient corneal edema (2 eyes, 1.29%), corneal decompensation (2 eyes, 1.29%), and pigment dispersion (1 eye, 0.64%). From the total, 57.41% of eyes (89 eyes from 155) achieved within ± 0.50D of target refractive astigmatism. It is important to highlight that at least 52 eyes out of the 155 (33.54%) had an abnormal cornea with irregular astigmatism. CONCLUSION STIOL seem to offer good visual and refractive outcomes. However, STIOL showed variable rotational stability, especially in some platforms. Further studies with a more robust design, methodology, and standardized analysis methods are needed to confirm these trends.
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Affiliation(s)
- Carlos Rocha-de-Lossada
- Ophthalmology Department, Clínica QVision, Vithas Almería, Almería, Spain.
- Ophthalmology Department, Vithas Málaga, Malaga, Spain.
- Ophthalmology Department, Hospital Regional Universitario Málaga, Malaga, Spain.
- Departamento de Cirugía, Área de Oftalmología, Universidad de Sevilla, Seville, Spain.
| | | | - Diego Zamora-de La Cruz
- Anterior Segment Department, Instituto de Oftalmología Fundación Conde de Valenciana, Mexico City, Mexico
- Anterior Segment Department, Hospital Mexiquense de Salud Visual, ISEM, Naucalpan de Juárez, Mexico
| | - Marina Rodríguez-Calvo-de-Mora
- Ophthalmology Department, Clínica QVision, Vithas Almería, Almería, Spain
- Ophthalmology Department, Vithas Málaga, Malaga, Spain
- Ophthalmology Department, Hospital Regional Universitario Málaga, Malaga, Spain
| | - Joaquín Fernández
- Ophthalmology Department, Clínica QVision, Vithas Almería, Almería, Spain
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Baur ID, Labuz G, Yildirim TM, Auffarth GU, Khoramnia R. Reversible Multifocality Achieved Through Polypseudophakia. Klin Monbl Augenheilkd 2023; 240:981-988. [PMID: 37391182 DOI: 10.1055/a-2079-1692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Simultaneous implantation of a monofocal or monofocal toric intraocular lens (IOL) into the capsular bag and a multifocal IOL into the ciliary sulcus, referred to as duet procedure, allows us to create multifocality that is more easily reversible than the implantation of a capsular bag-fixated multifocal IOL. The optical quality and results after the duet procedure are equivalent to those of a capsular bag-fixated multifocal IOL. Patients who cannot tolerate the side effects of multifocal optics or who develop an ocular condition leading to loss of function such as age-related macular degeneration (AMD) or glaucoma in the course of their lives may benefit from the reversibility of the procedure.
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Affiliation(s)
- Isabella Diana Baur
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Univ.-Augenklinik Heidelberg, Deutschland
| | - Grzegorz Labuz
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Univ.-Augenklinik Heidelberg, Deutschland
| | - Timur Mert Yildirim
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Univ.-Augenklinik Heidelberg, Deutschland
| | - Gerd U Auffarth
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Univ.-Augenklinik Heidelberg, Deutschland
| | - Ramin Khoramnia
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Univ.-Augenklinik Heidelberg, Deutschland
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Chatterjee D, Mittal V. Novel custom designed toric piggyback intraocular lens for the correction of residual postoperative astigmatism. Indian J Ophthalmol 2023; 71:2247-2250. [PMID: 37202961 PMCID: PMC10391418 DOI: 10.4103/ijo.ijo_2198_22] [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: 05/20/2023] Open
Abstract
We report the outcomes of a custom-designed toric piggyback intraocular lens in a patient with high postoperative residual astigmatism. A 60-year-old male patient underwent customized toric piggyback IOL for postoperative residual astigmatism of 13 D, with follow-up examinations for IOL stability and refractive outcomes. The refractive error stabilized at two months and remained stable at one year, with a correction of nearly 9 D of astigmatism. The IOP remained within normal limits, and there were no postoperative complications. The IOL remained stable in the horizontal position. To our knowledge, this is the first case report of correction of unusually high astigmatism by a novel smart toric design of piggyback IOL.
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Affiliation(s)
- Debapriya Chatterjee
- Cornea and Refractive Surgery Services, LJ Eye Institute, Ambala, Haryana, India
| | - Vikas Mittal
- Cornea and Refractive Surgery Services, LJ Eye Institute, Ambala, Haryana, India
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Baur ID, Auffarth GU, Łabuz G, Khoramnia R. Clinical outcomes in patients after duet procedure for reversible trifocality using a supplementary trifocal IOL. Am J Ophthalmol 2022; 241:217-226. [PMID: 35526588 DOI: 10.1016/j.ajo.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE We report the clinical outcomes of patients who had primary lens implantation in the capsular bag and subsequently a supplementary trifocal lens implanted in the ciliary sulcus (duet procedure) to create reversible trifocality. DESIGN Retrospective interventional case series. METHODS Twenty-five patients were included in this single center clinical study, who had undergone either refractive lens exchange for presbyopia correction or cataract surgery. All had lens removal by phacoemulsification and duet procedure to achieve reversible trifocality. Preoperatively and three months postoperatively, uncorrected (UDVA) and corrected distance visual acuity (CDVA) were assessed, as well as uncorrected (UNVA), distance corrected (DCNVA) and corrected near visual acuity (CNVA). At the postoperative examination, uncorrected (UIVA), distance corrected (DCIVA) and corrected intermediate visual acuity (CIVA), defocus curve testing and dysphotopsia evaluation were also performed. RESULTS Monocular UDVA and CDVA improved from 0.71 ± 0.43 logMAR and 0.12 ± 0.16 logMAR preoperatively to 0.04 ± 0.10 logMAR and -0.01 ± 0.09 logMAR postoperatively. Monocular UNVA and DCNVA were both 0.06 ± 0.08 logMAR and UIVA and DCIVA 0.00 ± 0.10 logMAR and -0.02 ± 0.10 logMAR postoperatively. Monocular defocus curve testing revealed a visual acuity of 0.2 logMAR or better from +0.75 to -3.5 diopters. CONCLUSIONS Duet procedure using a trifocal supplementary IOL provided excellent results for far, near and intermediate distance, comparable to those reported for capsular bag fixated trifocal IOLs. The duet procedure offers the advantage of an exit-strategy in cases with a future loss of function or side effects associated with the optics.
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Valvecchia G, Cervantes-Coste G, Asis O, Pereyra F, Garza-León M, Gomez Caride G, Ferlini L, Gonzalez-Salinas R. Clinical outcomes of the piggyback secondary implantation of a novel multifocal lens in the ciliary sulcus: A case series. Eur J Ophthalmol 2021; 33:1367-1372. [PMID: 34240643 DOI: 10.1177/11206721211029474] [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: 11/16/2022]
Abstract
PURPOSE Evaluate the clinical outcomes of the secondary piggyback add-on IOL implantation in the ciliary sulcus for pseudophakic patients previously implanted with a monofocal IOL, who pursue a spectacle-free option after IOL surgery. METHODS A prospective case series including seven pseudophakic patients who underwent an in-the-bag monofocal IOL implantation. All eyes underwent a piggyback IOL implantation of the new sulcus designed A4 AddOn IOL in the ciliary sulcus as a secondary procedure for pseudophakic patients pursuing a spectacle-free option for near and intermediate distance after IOL surgery. RESULTS Seven eyes from six patients were included in this study, from which 4 (71.43%) were female, with a mean age of 58.33 ± 3.5 years (range 54-63; 95% CI 54.66, 62.01). The postoperative spherical equivalent at the 3-month visit was -0.10 m ± 0.82. Also, the UDVA was 0.11 ± 0.08 logMAR, the UIVA 0.01 ± 0.03, and the UNVA 0.01 ± 0.03 3 months after their surgical procedure. CONCLUSIONS The A4 AddOn multifocal IOL's secondary piggyback implant is an efficient alternative for monofocal pseudophakic patients seeking presbyopia solutions. This sulcus-designed IOL provides an optimal visual outcome for near and distance vision.
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Affiliation(s)
| | - Guadalupe Cervantes-Coste
- Anterior Segment Surgery Department, Asociación Para Evitar la Ceguera en México I.A.P., Mexico City, Mexico
| | - Oscar Asis
- Hospital Perpetuo Socorro, Las Palmas de Gran Canaria, Spain
| | - Federico Pereyra
- Centro de Ojos Quilmes, Quilmes, Buenos Aires Province, Argentina
| | - Manuel Garza-León
- Clinical Science Department, Science of Health Division, University of Monterrey, San Pedro Garza García, Nuevo León, Mexico
| | | | - Leonardo Ferlini
- Centro de Ojos Quilmes, Quilmes, Buenos Aires Province, Argentina
| | - Roberto Gonzalez-Salinas
- Anterior Segment Surgery Department, Asociación Para Evitar la Ceguera en México I.A.P., Mexico City, Mexico
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Karjou Z, Jafarinasab MR, Seifi MH, Hassanpour K, Kheiri B. Secondary Piggyback Intraocular Lens for Management of Residual Ametropia after Cataract Surgery. J Ophthalmic Vis Res 2021; 16:12-20. [PMID: 33520123 PMCID: PMC7841270 DOI: 10.18502/jovr.v16i1.8244] [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: 02/15/2020] [Accepted: 09/28/2020] [Indexed: 01/15/2023] Open
Abstract
Purpose To investigate the indications, clinical outcomes, and complications of secondary piggyback intraocular lens (IOL) implantation for correcting residual refractive error after cataract surgery. Methods In this prospective interventional case series, patients who had residual refractive error after cataract surgery and were candidates for secondary piggyback IOL implantation between June 2015 and September 2018 were included. All eyes underwent secondary IOL implantation with the piggyback technique in the ciliary sulcus. The types of IOLs included Sulcoflex and three-piece foldable acrylic lenses. Patients were followed-up for at least one year. Results Eleven patients were included. Seven patients had hyperopic ametropia, and four patients had residual myopia after cataract surgery. The preoperative mean of absolute residual refractive error was 7.20 ± 7.92, which reached 0.42 ± 1.26 postoperatively (P< 0.001). The postoperative spherical equivalent was within ±1 diopter of target refraction in all patients. The average preoperative uncorrected distance visual acuity was 1.13 ± 0.35 LogMAR, which significantly improved to 0.41 ± 0.24 LogMAR postoperatively (P = 0.008). There were no intra- or postoperative complications during the 22.4 ± 9.5 months of follow-up. Conclusion Secondary piggyback IOL implantation is an effective and safe technique for the correction of residual ametropia following cataract surgery. Three-piece IOLs can be safely placed as secondary piggyback IOLs in situations where specifically designed IOLs are not available.
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Affiliation(s)
- Zahra Karjou
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Jafarinasab
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad-Hassan Seifi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kiana Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Kheiri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Baur ID, Auffarth GU, Yildirim TM, Mayer CS, Khoramnia R. Reversibility of the duet procedure: Bilateral exchange of a supplementary trifocal sulcus-fixated intraocular lens for correction of a postoperative refractive error. Am J Ophthalmol Case Rep 2020; 20:100957. [PMID: 33102931 PMCID: PMC7575835 DOI: 10.1016/j.ajoc.2020.100957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/17/2020] [Accepted: 10/03/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose We present the case of a 49-year old female who underwent bilateral exchange of a supplementary trifocal sulcus-fixated intraocular lens (IOL) to correct a residual refractive error. Six months beforehand, she had been treated for hyperopia, astigmatism and presbyopia with a duet procedure to create reversible trifocality. Observations Refractive lens exchange with combined implantation of a monofocal toric IOL into the capsular bag and a trifocal supplementary IOL into the ciliary sulcus (duet procedure) had been performed in both eyes. Decreased uncorrected distance visual acuity due to the refractive outcome of −0.75 diopter sphere (DS)/-0.25 diopter cylinder (DC)x10° for the right eye and −1.0DS for the left eye as well as the perception of photic phenomena were inacceptable for the patient. In the second operations, we exchanged the supplementary IOLs to correct the residual refractive error and achieve the target refraction of emmetropia. UDVA increased from 0.50 logMAR in both eyes prior to the IOL exchange to −0.22 logMAR in the right eye and −0.20 logMAR in the left eye. Binocular uncorrected near and intermediate visual acuity were −0.10 logMAR and 0.00 logMAR respectively after exchanging the sulcus-fixated supplementary IOLs, allowing for complete spectacle independence. Conclusions This case demonstrates one of the most important benefits of the duet procedure: the possibility, if necessary, to easily remove or exchange the supplementary IOL from the ciliary sulcus. The duet procedure offers a safe treatment option in the event of postoperative complications like residual refractive error or intolerance to a multifocal optic.
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Affiliation(s)
- Isabella Diana Baur
- Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Gerd Uwe Auffarth
- Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Timur Mert Yildirim
- Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christian Steffen Mayer
- Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Ramin Khoramnia
- Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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Gundersen KG, Potvin R. Refractive and Visual Outcomes After Implantation of a Secondary Toric Sulcus Intraocular Lenses. Clin Ophthalmol 2020; 14:1337-1342. [PMID: 32546940 PMCID: PMC7244900 DOI: 10.2147/opth.s255725] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/06/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the rotational stability, visual acuity and refractive error after sulcus implantation of a secondary toric IOL. Setting One clinical practice in Haugesund, Norway. Design Non-interventional single-arm diagnostic study. Methods Eligible subjects who had previous successful primary cataract or refractive lens exchange surgery in one or both eyes and the AddOn® secondary toric IOL implanted in the sulcus were evaluated at a single postoperative diagnostic visit to measure visual outcomes. Subjects with surgical complications (either primary or secondary) or pathology that would affect best-corrected visual acuity (eg, amblyopia) were excluded. Clinical evaluations at the diagnostic visit included measurement of visual acuity, manifest refraction and IOL orientation. Results Eighteen eyes were evaluated. After secondary IOL implantation, mean residual refractive astigmatism was significantly reduced (1.66 ± 0.92 to 0.32 ± 0.25 D). There was no appreciable change in the spherical equivalent refraction. Sixteen of 18 eyes (89%) had residual refractive astigmatism ≤0.50D, and no eye had more than 0.75D after secondary IOL implantation. Mean UCVA was 0.00 ± 0.03 logMAR, with no eyes worse than 0.10. Mean BCVA was −0.05 ± 0.03 logMAR (20/20+2), with all eyes having BCVA of 0.00 logMAR. The mean change in orientation was near zero, with a mean absolute change of 4.9 ± 3.7 degrees. Sixteen of 18 eyes (89%) had a lens orientation ≤10 degrees from intended, with no eye oriented more than 13 degrees from intended. Conclusion The AddOn® toric sulcus IOL significantly reduced postoperative refractive astigmatism in patients with high astigmatism after their primary cataract or RLE surgery, providing very good uncorrected distance vision.
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Levinger E, Mimouni M, Finkelman Y, Yatziv Y, Shahar J, Trivizki O. Outcomes of refractive error correction in pseudophakic patients using a sulcus piggyback intraocular lens. Eur J Ophthalmol 2020; 31:422-426. [PMID: 31992075 DOI: 10.1177/1120672120903560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to assess the results of a sulcus intraocular lens (Sulcoflex) for pseudophakic refractive errors following phacoemulsification cataract surgery. METHODS This retrospective clinical observational cohort study included consecutive eyes in which a Sulcoflex was implanted. Uncorrected distance visual acuity and corrected distance visual acuity as well as refractive outcomes were assessed. The minimum follow-up time required for inclusion was 3 months. RESULTS In total, 15 eyes (n = 15) were evaluated. The mean follow-up was 14 months (range: 3-18 months). The Sulcoflex aspheric (653L) was implanted in 13 eyes and the Sulcoflex toric (653T) in two eyes. The preoperative mean logMAR (Snellen) uncorrected distance visual acuity and corrected distance visual acuity were 0.88 (20/150) and 0.27 (20/40), respectively. The postoperative mean logMAR (Snellen) corrected distance visual acuity was 0.15 (20/30). The preoperative mean spherical equivalent was -0.22 ± 5.95 D and the postoperative mean spherical equivalent was -1.59 ± 1.45 D. There was a significant and strong correlation (r = 0.64, p < 0.001) between the attempted and the achieved spherical equivalent. CONCLUSION The Sulcoflex is a safe and viable option for patients with residual refractive error following cataract surgery.
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Affiliation(s)
- Eliya Levinger
- Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yaron Finkelman
- Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Yatziv
- Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Shahar
- Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer Trivizki
- Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Postoperative rotation of supplementary sulcus-supported toric intraocular lenses. J Cataract Refract Surg 2019; 43:285-288. [PMID: 28366378 DOI: 10.1016/j.jcrs.2016.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/27/2016] [Accepted: 12/01/2016] [Indexed: 11/20/2022]
Abstract
We describe 7 cases in which supplementary sulcus-based toric intraocular lenses (IOLs) rotated postoperatively, requiring surgical realignment. The initial rotation was identified clinically between 3 months and 36 months postoperatively. All eyes had keratoconus, with and without prior keratoplasty, and 6 had longer than average axial lengths. No preceding trauma could be identified for 5 of the eyes. One eye had 3 episodes of postoperative IOL rotation, eventually requiring suture fixation to stabilize the IOL. This series indicates that postoperative rotation of a supplementary sulcus-based toric IOL may occur in eyes with or without preceding trauma. Eyes with keratoconus are at risk for postoperative rotation of the IOL, and suture fixation may be required to obtain stability.
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Uy HS, Tesone-Coelho C, Ginis H. Enhancement-procedure outcomes in patients implanted with the Precisight multicomponent intraocular lens. Clin Ophthalmol 2019; 13:107-114. [PMID: 30662254 PMCID: PMC6327896 DOI: 10.2147/opth.s188383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Eyes that have undergone phacoemulsification with implantation of a multicomponent intraocular lens (MCIOL) may further undergo an enhancement procedure for correction of residual refractive errors. The enhancement procedure is accomplished by exchanging the front lens used in the primary surgery with another lens containing the correct dioptric power. We evaluated the efficacy and safety of enhancement procedures among eyes that received an MCIOL. Methods A total of 25 eyes that had undergone phacoemulsification with implantation of an MCIOL were found to have a residual error of refraction (spherical equivalent ≥0.75 D) 3 months after primary cataract surgery, and underwent further enhancement surgery. The main study outcomes were uncorrected and corrected distance visual acuity, subjective refraction, anterior-chamber depth, pachymetry, and endothelial cell count. Results There was a statistically significant improvement in uncorrected distance visual acuity of approximately two lines after enhancement surgery (0.20±0.20-0.02±0.08 logMAR, P<0.001) and a significant decrease in residual spherical equivalent from 1.3±1.1 D to 0±0.38 D (P<0.001). There were no statistically significant changes in pre- and postenhancement corrected distance visual acuity, anterior-chamber depth, pachymetry, or keratometry. There was a statistically significant decrease (2.6%) in endothelial cell count (P<0.01), which could have been endothelial equilibration from the primary procedure. All enhancement surgeries were uneventful, and no major complications were observed. Conclusion The MCIOL-enhancement procedure demonstrates statistical and clinical improvement in uncorrected distance visual acuity and correction of postoperative refractive errors. The Precisight IOL may be a useful choice for patients with high risk of having significant residual refractive errors after primary cataract surgery.
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Affiliation(s)
- Harvey S Uy
- Peregrine Eye and Laser Institute, Makati, Philippines, .,Department of Ophthalmology and Visual Sciences, University of the Philippines, Manila, Philippines,
| | | | - Harilaos Ginis
- Research Department, Athens Eye Hospital, Athens, Greece
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Schempf T, Jung HC. Off-Label Use of Phakic Intraocular Lens with a "Piggyback" Technique. Case Rep Ophthalmol 2018; 9:465-472. [PMID: 30519183 PMCID: PMC6276743 DOI: 10.1159/000494712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/21/2018] [Indexed: 12/03/2022] Open
Abstract
Purpose We report a case of a highly myopic pseudophakic patient who received off-label placement of a phakic intraocular lens (pIOL) via a “piggyback” technique, allowing the placement of an intraocular lens (IOL) in his fellow eye, resulting in improved visual acuity and emmetropia. Case Report A 66-year-old, highly myopic, pseudophakic male with an IOL implant in his left eye was referred for second opinion for surgical options for his phakic right eye. Given the severe myopic status of both eyes, he received off-label placement of a posterior chamber pIOL with a piggyback technique for the pseudophakic left eye followed by standard cataract surgery and intraocular lens implantation in the right eye. For the left eye, uncorrected best visual acuity improved from 20/70 to 20/25. Conclusion This case demonstrates the successful off-label use of a phakic IOL in a pseudophakic, highly myopic patient with a piggyback technique, resulting in improved visual acuity and ultimately allowing IOL placement in the fellow eye for emmetropia. This off-label use of pIOL can offer ophthalmologists an alternative option for pseudophakic patents with severe refractive error.
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Affiliation(s)
- Tadgh Schempf
- New York University School of Medicine, New York, New York, USA
| | - Hoon C Jung
- University of Washington Department of Ophthalmology, Seattle, Washington, USA.,Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
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McLintock CA, McKelvie J, Gatzioufas Z, Wilson JJ, Stephensen DC, Apel AJG. Outcomes of toric supplementary intraocular lenses for residual astigmatic refractive error in pseudophakic eyes. Int Ophthalmol 2018; 39:1965-1972. [PMID: 30374760 DOI: 10.1007/s10792-018-1027-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 09/21/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate rotational stability and visual and refractive outcomes of supplementary toric IOLs (Sulcoflex Toric 653T, Rayner Intraocular Lenses Ltd) for residual astigmatic refractive error in pseudophakic eyes. METHODS A retrospective interventional case series was conducted in a single surgeon practice. Charts of patients who had Sulcoflex Toric supplementary IOLs inserted between June 2009 and September 2015 were reviewed. Outcomes were compared between eyes with and without prior corneal transplant. Patients with at least 3-months follow-up were included. RESULTS In 51 eyes, mean UDVA improved from 20/86 to 20/43 (p = 0.002), though UDVA was better in eyes without corneal grafts (20/31) than eyes with (20/62). The proportion of eyes achieving 20/20 UDVA was 43%, 61% and 17% overall, in eyes with prior graft and in eyes with no prior graft, respectively. Sixty-four percentage achieved a spherical equivalent of within 0.5D of target (84% no graft, 34% prior graft). Fifty-three percentage of eyes achieved a cylinder of within 0.5D of target (no graft: 73%, prior graft: 0%). Mean lens rotation was 8.23° on day 1, and mean maximal rotation during follow-up was 17.63°. Sixty-two percentage of IOLs required repositioning. Of those that required repositioning, this was conducted a mean of 2.3 times. The mean final IOL rotation (following repositioning if required) was 6.17°. CONCLUSION Sulcoflex Toric supplementary IOLs result in good visual and refractive outcomes in eyes with no prior corneal graft. However, outcomes are sub-optimal in eyes with prior corneal transplantation, and the majority of lenses require repositioning.
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Affiliation(s)
- Cameron A McLintock
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia.
- Queen Victoria Hospital, Holtye Road, East Grinstead, RH19 3DZ, UK.
| | - James McKelvie
- Queen Victoria Hospital, Holtye Road, East Grinstead, RH19 3DZ, UK
| | - Zisis Gatzioufas
- Queen Victoria Hospital, Holtye Road, East Grinstead, RH19 3DZ, UK
| | - Jessica J Wilson
- The Eye Health Centre, 87 Wickham Terrace, Brisbane, QLD, 4000, Australia
| | - David C Stephensen
- The Eye Health Centre, 87 Wickham Terrace, Brisbane, QLD, 4000, Australia
| | - Andrew J G Apel
- The Eye Health Centre, 87 Wickham Terrace, Brisbane, QLD, 4000, Australia
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia
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Alfonso JF, Lisa C, Alfonso-Bartolozzi B, Fernández-Vega-Cueto L, Montés-Micó R. Implantable Collamer Lens
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for Management of Pseudophakic Ametropia in Eyes With a Spectrum of Previous Corneal Surgery. J Refract Surg 2018; 34:654-663. [DOI: 10.3928/1081597x-20180815-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/13/2018] [Indexed: 11/20/2022]
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Roszkowska AM, Urso M, Signorino GA, Spadea L, Aragona P. Photorefractive keratectomy after cataract surgery in uncommon cases: long-term results. Int J Ophthalmol 2018; 11:612-615. [PMID: 29675379 DOI: 10.18240/ijo.2018.04.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/12/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the efficacy and safety of the excimer laser correction of the residual refractive errors after cataract extraction with intraocular lens (IOL) implantation in uncommon cases. METHODS Totally 24 patients with high residual refractive error after cataract surgery with IOL implantation were examined. Twenty-two patients had a history of phacoemulsification and IOL implantation, and two had extra-capsular cataract extraction with IOL implantation. Detailed examination of preoperative medical records was done to explain the origin of the post-cataract refractive errors. All patients underwent photorefractire keratectomy (PRK) enhancement. The mean outcome measures were refraction, uncorretted visual acuity (UCVA), best corrected visual acuity (BCVA) and corneal transparency and follow up ranged from 1 to 8y. RESULTS The principal causes of residual ametropia was inexact IOL calculation in abnormal eyes with high myopia and congenital lens abnormalities, followed by corneal astigmatism both suture induced and preexisting. After cataract surgery and before the laser enhancement the mean spherical equivalent (SE) was -0.56±3 D ranging from -4.62 to +2.25 D in high myopic patients, instead it was -1±1.73 D ranging from -3.25 to +3.75 D in the astigmatic eyes, with a mean cylinder of -3.75±0 ranging from -3 to +5.50 D. After laser refractive surgery the mean SE was 0.1±0.73, ranging from -0.50 to +1.50 in the myopic group, and it was -0.50±0.57 ranging from -1.25 to +0.50 in astigmatic patients, with a mean cylinder of -0.25±0.75. In myopic patients the mean UCVA and BCVA were 0.038±0.072 logMAR and 0.018±0.04 respectively, both ranging from 0.10 to 0.0. In astigmatic patients, the mean UCVA and BCVA were 0.213±0.132 and 0.00±0.0 respectively, UCVA ranging from 0.50 to 0.22 and BCVA was 0.00. All patients presented normal corneal transparency. No ocular hypertension was detected and no corneal haze was observed. All registered values remained stable also at the end line evaluation. CONCLUSION The excimer laser treatment of residual refractive errors after cataract surgery with IOL implantation in abnormal eyes resulted in satisfactory and stable visual outcome with good safety and efficacy.
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Affiliation(s)
- Anna Maria Roszkowska
- Department of Surgery, Ophthalmology Clinic, University Hospital of Messina, Messina 98124, Italy.,Department of Ophthalmology, Andrzej Frycz Modrzewski Krakow University, Kraków 33332, Poland
| | - Mario Urso
- Department of Surgery, Ophthalmology Clinic, University Hospital of Messina, Messina 98124, Italy
| | | | - Leopoldo Spadea
- Department of Medical-Surgical Sciences and Biotechnologies, La Sapienza University of Rome, Rome 00185, Italy
| | - Pasquale Aragona
- Department of Surgery, Ophthalmology Clinic, University Hospital of Messina, Messina 98124, Italy
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Jun JH, Bang SP. Transscleral fixation of a toric intraocular lens by a slipable suture technique. Can J Ophthalmol 2018; 53:e29-e32. [PMID: 29426457 DOI: 10.1016/j.jcjo.2017.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 05/15/2017] [Accepted: 06/13/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Jong Hwa Jun
- Department of Ophthalmology, School of Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea.
| | - Seung Pil Bang
- Department of Ophthalmology, School of Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea
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Assessment of a novel pinhole supplementary implant for sulcus fixation in pseudophakic cadaver eyes. Eye (Lond) 2017; 32:637-645. [PMID: 29075017 DOI: 10.1038/eye.2017.239] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 07/17/2017] [Indexed: 11/08/2022] Open
Abstract
PurposeTo evaluate a novel small-aperture supplementary implant that applies the principle of pinholes for management of irregular astigmatism, in postmortem human eyes.MethodsPseudophakic human cadaver eyes were imaged by anterior segment optical coherence tomography (AS-OCT) to assess position of the in-the-bag intraocular lens (IOL). Eyes were prepared as per the Miyake-Apple technique. Two versions of the supplementary implant (open-loop and tripod designs) were then inserted into the sulcus of each eye. Evaluations under AS-OCT and from anterior and posterior views of the anterior segment were used to assess IOL fixation, centration, tilt, and interlenticular distance (ILD). This experimental study has been conducted in John A. Moran Eye Center, University of Utah.ResultsNine eyes were selected, with various sizes, primary IOL materials/designs, and Soemmering's ring formation. The open-loop model exhibited a mild degree of decentration and tilt in 2 eyes with zonular dehiscence. Mild decentration and tilt of the tripod were observed in 4 eyes; in 1 additional eye it was centered but mildly tilted. Three eyes with zonular dehiscence had one of the closed loops of the tripod located posteriorly to the ciliary processes. In all cases, an ILD was observed between the lenses (open loop: 0.65±0.13 mm; tripod: 0.41±0.12 mm).ConclusionsIt is important to take into account anatomical aspects related to ciliary sulcus fixation of supplementary IOLs. Both designs evaluated, exhibited appropriate centration and ILD. The open-loop design had less risk of tilt in association with haptics protruding posteriorly through areas of zonular weakness.
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Assessment of a new hydrophilic acrylic supplementary IOL for sulcus fixation in pseudophakic cadaver eyes. Eye (Lond) 2017; 31:802-809. [PMID: 28106890 DOI: 10.1038/eye.2016.310] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 11/30/2016] [Indexed: 11/08/2022] Open
Abstract
PurposeManagement of refractive errors after cataract surgery includes spectacles or contact lens, secondary laser vision correction, intraocular lens (IOL) exchange, or piggyback lens implantation. We evaluated for the first time a single-piece hydrophilic acrylic IOL designed for supplementary sulcus fixation in postmortem pseudophakic human eyes.MethodsPseudophakic human cadaver eyes were imaged by anterior segment optical coherence tomography (AS-OCT) to assess position of the primary IOL. Eyes were prepared as per the Miyake-Apple technique. The supplementary IOL (Medicontur A4 Addon IOL family) was then inserted into the ciliary sulcus. AS-OCT and photographs from anterior and posterior views were used to assess IOL centration, tilt, and interlenticular distance from the primary IOL.ResultsData were obtained from 12 eyes having primary IOLs of varying materials and designs in the bag and representing different sizes of eyes and severity of Soemmering's ring formation. The A4 Addon IOL was successfully inserted into the ciliary sulcus and was well centered in all cases. Four cases of tilt were observed on AS-OCT: three with mild tilt due to pre-existing zonular dehiscence, and one due to a localized area of Soemmering's ring formation. Interlenticular distance ranged from 0.34 to 1.24 mm and was not dependent on severity of Soemmering's ring or type of primary IOL.ConclusionsThe A4 Addon IOL was designed for sulcus fixation as a supplementary lens, with a large diameter, a square-shaped optic, four smooth loop haptics, and a convex-concave optical surface. It exhibited appropriate centration and interlenticular distance with different primary in-the-bag IOLs.
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Sinha R, Singh R, Sharma VK, Titiyal JS. Piggy back intraocular lens for the correction of buckling surgery-induced refractive error in pseudophakia. BMJ Case Rep 2016; 2016:bcr-2016-217570. [PMID: 28039346 DOI: 10.1136/bcr-2016-217570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 29-year-old man presented to us with bilateral pseudophakia with suboptimal vision in right eye. His uncorrected distance visual acuity (UDVA) on Snellen's chart was 6/36 and 6/9 in right eye (OD) and left eye (OS), respectively. It improved to 6/9 OD with -5.00DS/-0.50DC at 90° and 6/6 OS with -0.5DC at 100°. He had undergone buckling surgery 1 year back for rhegmatogenous retinal detachment in right eye and subsequently developed a myopic refractive error. A spherical piggyback intraocular lens (IOL; Rayner Sulcoflex, East Sussex) was implanted in the sulcus for refractive correction. The postoperative UDVA at 4 weeks was 6/6p. The intraocular pressure was normal and there was no significant endothelial cell loss. Piggyback IOLs can be an effective tool to correct the induced refractive error due to an increase in axial length following buckling surgery.
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Affiliation(s)
| | - Reena Singh
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Jeewan S Titiyal
- Department of Ophthalmology, Dr RP Centre, AIIMS, New Delhi, India
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21
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Hoffman RS, Vasavada AR, Allen QB, Snyder ME, Devgan U, Braga-Mele R. Cataract surgery in the small eye. J Cataract Refract Surg 2016; 41:2565-75. [PMID: 26703508 DOI: 10.1016/j.jcrs.2015.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 05/17/2015] [Accepted: 05/28/2015] [Indexed: 12/29/2022]
Abstract
UNLABELLED The surgical management of cataract in the small eye presents the ophthalmic surgeon with numerous challenges. An understanding of the anatomic classification in addition to a thorough preoperative assessment will help individualize each case and enable the surgeon to better prepare for the obstacles that might be encountered during surgery. Small eyes are especially challenging in terms of intraocular lens (IOL) calculations and possible current limitations of available IOL powers, which could necessitate alternative means of achieving emmetropia. Surgical strategies for minimizing complications and maximizing good outcomes can be developed from knowledge of the anatomic differences between various small-eye conditions and the pathologies that may be associated with each. A thorough understanding of the challenges inherent in these cases and the management of intraoperative and postoperative complications will ensure that surgeons approaching the correction of these eyes will achieve the best possible surgical results. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Richard S Hoffman
- From the Casey Eye Institute, Oregon Health and Science University (Hoffman), Portland, Oregon, USA; Iladevi Cataract & University of Cincinnati (Snyder), Cincinnati, Ohio, USA; Jules Stein Eye Institute, UCLA School of Medicine (Devgan), Los Angeles, California, USA; University of Toronto (Braga-Mele), Toronto, Ontario, Canada.
| | - Abhay R Vasavada
- From the Casey Eye Institute, Oregon Health and Science University (Hoffman), Portland, Oregon, USA; Iladevi Cataract & University of Cincinnati (Snyder), Cincinnati, Ohio, USA; Jules Stein Eye Institute, UCLA School of Medicine (Devgan), Los Angeles, California, USA; University of Toronto (Braga-Mele), Toronto, Ontario, Canada
| | - Quentin B Allen
- From the Casey Eye Institute, Oregon Health and Science University (Hoffman), Portland, Oregon, USA; Iladevi Cataract & University of Cincinnati (Snyder), Cincinnati, Ohio, USA; Jules Stein Eye Institute, UCLA School of Medicine (Devgan), Los Angeles, California, USA; University of Toronto (Braga-Mele), Toronto, Ontario, Canada
| | - Michael E Snyder
- From the Casey Eye Institute, Oregon Health and Science University (Hoffman), Portland, Oregon, USA; Iladevi Cataract & University of Cincinnati (Snyder), Cincinnati, Ohio, USA; Jules Stein Eye Institute, UCLA School of Medicine (Devgan), Los Angeles, California, USA; University of Toronto (Braga-Mele), Toronto, Ontario, Canada
| | - Uday Devgan
- From the Casey Eye Institute, Oregon Health and Science University (Hoffman), Portland, Oregon, USA; Iladevi Cataract & University of Cincinnati (Snyder), Cincinnati, Ohio, USA; Jules Stein Eye Institute, UCLA School of Medicine (Devgan), Los Angeles, California, USA; University of Toronto (Braga-Mele), Toronto, Ontario, Canada
| | - Rosa Braga-Mele
- From the Casey Eye Institute, Oregon Health and Science University (Hoffman), Portland, Oregon, USA; Iladevi Cataract & University of Cincinnati (Snyder), Cincinnati, Ohio, USA; Jules Stein Eye Institute, UCLA School of Medicine (Devgan), Los Angeles, California, USA; University of Toronto (Braga-Mele), Toronto, Ontario, Canada
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Refractive Results: Safety and Efficacy of Secondary Piggyback Sensar™ AR40 Intraocular Lens Implantation to Correct Pseudophakic Refractive Error. J Ophthalmol 2016; 2016:4505812. [PMID: 27313869 PMCID: PMC4904093 DOI: 10.1155/2016/4505812] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/10/2016] [Indexed: 11/17/2022] Open
Abstract
In this study we evaluate the visual outcomes, safety, efficacy, and stability of implanting of second sulcus intraocular lens (IOL) to correct unsatisfied ametropic patients after phacoemulsification. Methods. Retrospective study of 15 eyes (15 patients) underwent secondary intraocular lens implanted into the ciliary sulcus. The IOL used was a Sensar IOL three-piece foldable hydrophobic acrylic IOL. The first IOL in all patients was acrylic intrabagal IOL implanted in uncomplicated phacoemulsification surgery. Results. Fifteen eyes (15 patients) were involved in this study. Preoperatively, mean logMAR UDVA and CDVA were 0.88 ± 0.22 and 0.19 ± 0.13, respectively, with a mean follow-up of 28 months (range: 24 to 36 months). At the end of the follow-up, all eyes achieved logMAR UDVA of 0.20 ± 0.12 with postoperative refraction ranging from 0.00 to −0.50 D of attempted emmetropia. Conclusions. Implantation of the second sulcus SensarAR40 IOL was found to be safe, easy, and simple technique for management of ametropia following uncomplicated phacoemulsification.
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Supplementary, Sulcus-Fixated Intraocular Lens in the Treatment of Spherical and Astigmatic Refractive Errors in Pseudophakic Eyes After Keratoplasty. Cornea 2016; 34:1052-6. [PMID: 26114825 DOI: 10.1097/ico.0000000000000506] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the efficacy, refractive outcomes, and complications of supplementary intraocular lens (IOL) implantation in pseudophakic eyes after keratoplasty. METHODS This is a retrospective review of pseudophakic postkeratoplasty eyes after implantation of a custom-designed, sulcus-fixated, supplementary "piggyback" IOL to correct refractive errors. The outcome measures included preoperative and postoperative uncorrected distance visual acuity (UDVA), spectacle-corrected distance visual acuity (CDVA), refractive correction, and complications. RESULTS This study evaluated 10 eyes (10 patients) with previous penetrating or deep anterior lamellar keratoplasty with a mean follow-up period of 12.2 ± 10.7 months (range, 2-33 months). All eyes showed improved UDVA postoperatively with 70% achieving ≥20/40. Median UDVA (logarithm of the minimum angle of resolution) improved from 1.2 (20/280, range 20/70-20/2000) preoperatively to 0.3 (20/40, range 20/20-20/60) postoperatively at the latest follow-up visit (P < 0.01). Five eyes (50%) had improvement in CDVA by at least 1 line of Snellen acuity with all eyes achieving ≥20/40 and 70% achieving ≥20/25. Median CDVA (logarithm of the minimum angle of resolution) was 0.2 (20/30, range 20/20-20/50) preoperatively compared with 0.1 (20/25, range 20/20-20/40) postoperatively (P = 0.03). In 8 eyes that received toric secondary IOLs, the mean refractive astigmatism decreased by 84% from 5.7 diopters (D) (range, 4-9 D) to 0.9 D (range, 0.2-3.0 D) (P = 0.01). Postoperative refractive astigmatism was ±1 D of predicted astigmatism for 7 of 8 eyes. No eyes lost any lines of UDVA or CDVA, and there were no keratoplasty rejection/failure events. CONCLUSIONS Implantation of a supplementary, sulcus-based IOL is an effective approach to reduce spherical and astigmatic refractive errors in pseudophakic eyes after keratoplasty.
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Abstract
Phakic intraocular lenses revolutionize refractive surgery and continue to serve as an excellent option for vision correction in patients who are not ideal candidates for laser vision correction. This article will review special indications of phakic intraocular lenses in the clinical practice.
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Affiliation(s)
- Roberto Pineda
- Keratorefractive Surgery Service, Massachusetts Eye and Ear Infirmary, Boston MA, USA
| | - Tulika Chauhan
- Keratorefractive Surgery Service, Massachusetts Eye and Ear Infirmary, Boston MA, USA
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Liekfeld A, Ehmer A, Schröter U. Visual function and reading speed after bilateral implantation of 2 types of diffractive multifocal intraocular lenses: Add-on versus capsular bag design. J Cataract Refract Surg 2015; 41:2107-14. [DOI: 10.1016/j.jcrs.2015.10.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 04/09/2015] [Accepted: 04/13/2015] [Indexed: 10/22/2022]
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Stability and safety of MA50 intraocular lens placed in the sulcus. Eye (Lond) 2015; 29:1438-41. [PMID: 26139047 DOI: 10.1038/eye.2015.105] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 04/29/2015] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To describe the safety and stability of sulcus placement of the MA50 intraocular lens (IOL). PATIENTS AND METHODS Consecutive patients with MA50 IOLs placed in the sulcus at the University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA, from 1997 to 2012 were identified. Inclusion criteria included patients with over 4 weeks of follow-up data. AEL was compared with incidence of IOL decentration using at two-tailed Student's t-test. RESULTS Fifty eyes of 49 patients meeting the inclusion criteria were identified. Four weeks post-operatively, the average best-corrected visual acuity was 20/30. IOL decentration occurred in 14% of patients; patients with decentered IOLs had a significantly longer average AEL (25.37 mm) than patients whose IOL remained centered (23.94 mm, P=0.017). Other complications included uveitis-glaucoma-hyphema syndrome (12%), iritis (8%), and glaucoma (6%). There were no cases of pigment dispersion syndrome or need for lens exchange. Twelve eyes (24%) had intra-operative optic capture by the anterior capsule, none of which had post-operative decentration. CONCLUSION The MA50 IOL is a reasonable, stable option for placement in the sulcus, with a low-risk profile; however, in eyes with longer AEL and presumably larger anterior segment, surgeons should consider placing an IOL with longer haptic distance than the MA50 to maintain centration. Optic capture of the MA50 IOL by the anterior capsule should be considered for longer eyes, as it is protective against decentration.
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O'Brart DPS, Hirji N. Isolated dislocation of a supplementary sulcus pseudophakic intraocular lens. J Cataract Refract Surg 2015; 41:1315-7. [PMID: 26088738 DOI: 10.1016/j.jcrs.2015.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 01/26/2015] [Indexed: 11/15/2022]
Abstract
UNLABELLED We report the case of a woman with pseudoexfoliation who presented with a hyperopic refractive surprise and uncontrolled intraocular pressure (IOP) following cataract surgery and in-the-bag intraocular lens (IOL) implantation in the left eye. Trabeculectomy was performed, and a supplementary (piggyback) sulcus IOL was inserted. At 5 years, the uncorrected distance visual acuity (UDVA) was 20/16 and the IOP was less than 21 mm Hg. Following head trauma, the patient experienced blurred vision. The UDVA was 20/125, correcting to 20/25 with +3.00 -0.75 × 105. The IOL in the capsular bag was not dislocated, but the sulcus IOL was not in the posterior chamber; it was found by ultrasound in the temporal anterior vitreous gel. At-risk patients having supplementary IOL insertion should be warned of this possible late problem. FINANCIAL DISCLOSURE Neither author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- David P S O'Brart
- From the Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Nashila Hirji
- From the Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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Pallikaris IG. March consultation #2. J Cataract Refract Surg 2015; 41:689. [PMID: 25804591 DOI: 10.1016/j.jcrs.2015.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Clinical results with a supplementary toric intraocular lens for the correction of astigmatism in pseudophakic patients. Eur J Ophthalmol 2015; 25:302-8. [PMID: 25633616 DOI: 10.5301/ejo.5000564] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the visual outcomes of pseudophakic patients who underwent supplementary toric intraocular lens (IOL) implantation to correct astigmatic refractive errors. METHODS Pseudophakic patients referred for the implantation of a supplementary toric IOL (Sulcoflex Toric 653T) were evaluated. Uncorrected and corrected distance visual acuities (UDVA and CDVA, respectively), spherical equivalent (SE) refraction, rotational stability, higher order aberrations (HOA), and photopic glare and no-glare contrast sensitivity (CSV-1000, VectorVision) were evaluated. RESULTS A total of 10 eyes of 10 patients were included. The mean age was 56.42 ± 5.9 years (range 45-65 years). Mean follow-up was 6.99 ± 5.1 months (6-18 months). Postoperatively, UDVA improved to 0.10 ± 0.12 (0.3 to -0.1) (p = 0.004) and CDVA to 0.07 ± 0.12 (0.3 to -0.1) (p = 0.021). Mean SE was -0.30 ± 0.56 D (-1.00 to +0.75) (p = 0.001). Mean toric IOL axis rotation at 6-month follow-up was 3.0° ± 2.45° (0-6). Ocular aberrometry values decreased after surgery (for average HOA root mean square, p = 0.008). Photopic contrast sensitivity (for all spatial frequencies) showed a trend for improvement after surgery; however, this was not borne out from the analysis (p>0.05). CONCLUSIONS The implantation of the Sulcoflex Toric IOL to correct astigmatism in pseudophakic patients provided excellent visual outcomes, predictability of refractive results, rotational stability, and optical performance. The implantation of this IOL is a safe and effective technique to correct pseudophakic cylindrical refractive errors and reduce spectacle dependence in these patients.
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Abdelghany AA, Alio JL. Surgical options for correction of refractive error following cataract surgery. EYE AND VISION 2014; 1:2. [PMID: 26605349 PMCID: PMC4604120 DOI: 10.1186/s40662-014-0002-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/13/2014] [Indexed: 11/10/2022]
Abstract
Refractive errors are frequently found following cataract surgery and refractive lens exchange. Accurate biometric analysis, selection and calculation of the adequate intraocular lens (IOL) and modern techniques for cataract surgery all contribute to achieving the goal of cataract surgery as a refractive procedure with no refractive error. However, in spite of all these advances, residual refractive error still occasionally occurs after cataract surgery and laser in situ keratomileusis (LASIK) can be considered the most accurate method for its correction. Lens-based procedures, such as IOL exchange or piggyback lens implantation are also possible alternatives especially in cases with extreme ametropia, corneal abnormalities, or in situations where excimer laser is unavailable. In our review, we have found that piggyback IOL is safer and more accurate than IOL exchange. Our aim is to provide a review of the recent literature regarding target refraction and residual refractive error in cataract surgery.
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Affiliation(s)
- Ahmed A Abdelghany
- Clinical research fellow in Vissum Corporación Alicante, Universidad Miguel Hernández, Alicante, Spain ; Minia University, Minia, Egypt
| | - Jorge L Alio
- Vissum Corporación, Alicante, Spain ; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain ; Avda de Denia s/n, Edificio Vissum, Alicante, 03016 Spain
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Moshirfar M, McCaughey MV, Santiago-Caban L. Corrective Techniques and Future Directions for Treatment of Residual Refractive Error Following Cataract Surgery. EXPERT REVIEW OF OPHTHALMOLOGY 2014; 9:529-537. [PMID: 25663845 DOI: 10.1586/17469899.2014.966817] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Postoperative residual refractive error following cataract surgery is not an uncommon occurrence for a large proportion of modern-day patients. Residual refractive errors can be broadly classified into 3 main categories: myopic, hyperopic, and astigmatic. The degree to which a residual refractive error adversely affects a patient is dependent on the magnitude of the error, as well as the specific type of intraocular lens the patient possesses. There are a variety of strategies for resolving residual refractive errors that must be individualized for each specific patient scenario. In this review, the authors discuss contemporary methods for rectification of residual refractive error, along with their respective indications/contraindications, and efficacies.
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Affiliation(s)
- Majid Moshirfar
- Department of Ophthalmology, Co-Director Cornea and Refractive Surgery Division, Francis I. Proctor Foundation, University of California San Francisco, 10 Koret Way, K101, San Francisco, CA 94143, USA
| | | | - Luis Santiago-Caban
- Ophthalmology Department, University of Puerto Rico School of Medicine, San Juan, PR 00936
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Abstract
PURPOSE OF REVIEW To provide a review of the recent literature on the management of residual refractive error after cataract surgery. RECENT FINDINGS Laser in-situ keratomileusis (LASIK) is the most accurate procedure to correct residual refractive error after cataract surgery. Lens-based procedures, such as intraocular lens (IOL) exchange or piggyback lens implantation, are also possible alternatives in cases with extreme ametropia, corneal abnormalities, or in situations where excimer laser is not available. In this review, we found that Piggyback IOL were safer and more accurate than IOL exchange. SUMMARY Emmetropia is our main target today in modern cataract surgery. Accurate biometric analysis, selection and calculation of the adequate IOL, and modern techniques for cataract surgery all help surgeons to move toward the goal of cataract surgery as a refractive procedure free from refractive error. However, in spite of all these inputs, residual refractive error still occasionally occurs after cataract surgery and LASIK seems to be the most accurate method for its correction.
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Venter JA, Oberholster A, Schallhorn SC, Pelouskova M. Piggyback Intraocular Lens Implantation to Correct Pseudophakic Refractive Error After Segmental Multifocal Intraocular Lens Implantation. J Refract Surg 2014; 30:234-9. [DOI: 10.3928/1081597x-20140321-02] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 01/16/2014] [Indexed: 11/20/2022]
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Lee JS, Kim YH, Park JY, Kim SI. A Case of Corrected Residual Refractive Error after Cataract Surgery with the Sulcoflex Piggyback IOL. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.12.1890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jong Soo Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | | | - Jung Yul Park
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | - Sung Il Kim
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
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Enhancements After Premium IOL Cataract Surgery: Tips, Tricks, and Outcomes. CURRENT OPHTHALMOLOGY REPORTS 2013. [DOI: 10.1007/s40135-013-0031-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Portaliou DM, Grentzelos MA, Pallikaris IG. Multicomponent intraocular lens implantation: Two-year follow-up. J Cataract Refract Surg 2013; 39:578-84. [DOI: 10.1016/j.jcrs.2012.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 11/04/2012] [Accepted: 11/07/2012] [Indexed: 12/01/2022]
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Thomas BC, Auffarth GU, Reiter J, Holzer MP, Rabsilber TM. Implantation of Three-Piece Silicone Toric Additive IOLs in Challenging Clinical Cases With High Astigmatism. J Refract Surg 2013; 29:187-93. [DOI: 10.3928/1081597x-20130212-01] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 01/10/2013] [Indexed: 11/20/2022]
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