Search

Purpose: The purpose of this study was to analyze the safety of primary intraocular lens implantation in a large number of eyes in children aged <24 months., Methods: The medical records of patients aged 5-24 months, who underwent primary intraocular lens implantation in the capsular bag, were reviewed. A foldable three-piece acrylic intraocular lens was implanted by the same surgeon using a single surgical technique. Patients who had <1 year of follow-up after the surgery were excluded. The main outcome measurements included visual acuity, myopic shift, follow-up complications, and additional surgeries., Results: Sixty-eight patients (93 eyes) were analyzed. The mean age of the patients at the time of surgery was 15.06 ± 6.19 months (range: 5-24 months), and the spherical equivalent 1 month after surgery was 3.62 ± 2.32 D. After 5.67 ± 3.10 years, the spherical equivalent was -0.09 ± 3.22 D, and the corrected distance visual acuity was 0.33 ± 0.33 and 0.64 ± 0.43 logMAR in bilateral and unilateral cases, respectively (p=0.000). The highest myopic shift was observed in infants who underwent surgery at ages 5 and 6 months. The most frequent complications included visual axis opacification and corectopia. Glaucoma and retinal detachment were not reported., Conclusion: Primary in-the-bag intraocular lens implantation in children aged 5-24 months is safe, and is associated with low rates of adverse events and additional surgery.

A 29-gauge model test fine needle is used to create a beveled intrascleral tunnel; with microforceps, a 6-0 polypropylene suture is placed in the bore of the needle, which is used as a guide to pass and externalize the monofilament through the sclera. This maneuver is repeated by passing the suture ends through the intraocular lens (IOL) eyelets. The folded IOL is inserted and centered, the sutures are cut, and the flanges are created by thermocautery and inserted into the scleral tunnel. This technique was performed on 7 patients and visual acuity was recorded. The 4-flanged technique for scleral fixation using a 4-eyelet IOL was an effective and a safe treatment in the setting of aphakia., (Copyright © 2021 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Objective: To compare the effects of hydrophobic and hydrophilic materials in square-edged acrylic intraocular lenses (IOLs) on the development of posterior capsule opacification (PCO) after pediatric cataract surgery., Methods: Patients were randomly assigned to group 1 (hydrophobic acrylic square-edged IOLs; 13 eyes) or group 2 (hydrophilic acrylic square-edged IOLs; 13 eyes). The study evaluated PCO rates using Evaluation of Posterior Capsule Opacification (EPCO) 2000 software at one, three, six and 12 months postoperatively. Postoperative measurements also included corrected distance visual acuity (CDVA), neodymium:yttrium-aluminum-garnet (Nd:YAG) capsulotomy and postoperative complications other than PCO., Results: Both groups had significant increases in PCO rates after one year. Comparison of the groups showed no significant differences in the EPCO scores at three (group 1, 0.007±0.016 vs group 2, 0.008±0.014; p=0.830), six (group 1, 0.062±0.103 vs group 2, 0.021±0.023; p=0.184), or twelve months postoperatively (group 1, 0.200±0.193 vs group 2, 0.192±0.138; p=0.902). We also found no significant group differences regarding the change (delta, Δ) in EPCO scores between three and six months (group 1, 0.055±0.09 vs group 2, 0.013±0.02; p=0.113) or between six and twelve months postoperatively (group 1, 0.139±0.14 vs group 2, 0.171±0.14; p=0.567). Twenty-three percent of patients required Nd:YAG capsulotomy at the twelve-month visit., Conclusions: No differences in PCO rates were found between hydrophobic and hydrophilic acrylic square-edged IOLs in children between five and twelve years of age at one year of follow-up.

Objective: To evaluate the efficiency of long-term cataract surgery using low-cost intraocular lens implantation in community campaigns., Methods: Fifty-eight randomly selected patients were evaluated four years after phacoemulsification and Ioflex intraocular lens implantation. Causes of low visual acuity related to the intraocular lens were evaluated, and treatment costs were calculated., Results: The mean age of patients was 72±10.2 years. Four years after surgery, 25 eyes (43.0%) had decreased visual acuity related to the intraocular lens: posterior capsule opacification was noted in 24 eyes (41.3%), and intraocular lens opacification was noted in one eye (1.7%). The total cost of the post-surgical complication treatments represented 6.3% of the initial budget of the entire surgical patient group., Conclusions: The efficiency of cataract surgery with low-cost Ioflex intraocular lens implantation was significantly reduced in a long-term follow-up study because postoperative complications related to intraocular lenses emerged at higher rates than when the gold-standard treatment was used.

Purpose: To investigate potential differences in predictability, efficacy, and safety of corneal excimer laser to correct residual myopia, hyperopia, and astigmatism in eyes previously implanted with multifocal intraocular lenses using distinct optical surfaces and platforms for multifocality., Methods: This prospective comparative study included 37 eyes submitted to laser in situ keratomileusis correction for residual errors after implantation of either an apodized diffractive-refractive (Restor) or a full-diffractive (Tecnis) multifocal intraocular lens. Data analysis included investigation of predictability, efficacy, and safety of excimer laser surgery to correct residual errors. A double-angle plot, using vector analysis, was also created to evaluate predictability of astigmatism correction., Results: At 6-month follow-up, statistical analyses revealed a significant improvement when comparing preoperative (0.51 ± 0.25 and 0.44 ± 0.18) and postoperative values (0.17 ± 0.10 and 0.09 ± 0.07) of uncorrected distance visual acuity (P < 0.0001 and <0.0001), preoperative (0.92 ± 0.61 and 1.02 ± 0.45) and postoperative values (0.33 ± 0.23 and 0.19 ± 0.17) of manifest refractive spherical equivalent (P = 0.0006 and <0.0001), and preoperative (-1.08 ± 0.70 and -0.65 ± 0.42) and postoperative values (-0.25 ± 0.28 and -0.14 ± 0.21) of astigmatism (P < 0.0001 and <0.0001) in eyes implanted with Restor and Tecnis, respectively. Vector analysis revealed a predictable correction of astigmatism in all groups. Ninety-two percent of total eyes achieved a manifest refractive spherical equivalent within ±0.5 of emmetropia., Conclusions: Corneal excimer laser refractive surgery seems to be equally effective to correct different residual errors, including astigmatism, in eyes implanted with intraocular lenses with various platforms for multifocality.

Purpose: To evaluate whether implantation of an aspheric intraocular lens (IOL) results in reduced ocular aberrations and improved contrast sensitivity after cataract surgery and, therefore, changes on frequency-doubling technology (FDT) testing., Methods: The present prospective clinical study enrolled 25 patients with bilateral cataract (50 eyes), who randomly received either an aspheric (Akreos AO) or a spherical (Akreos Fit) IOL in one eye and the other IOL in the second eye. Assessment 12 months postoperatively included photopic and mesopic contrast sensitivity testing. Higher-order aberrations (HOAs) were computed. FDT testing was divided into four areas to evaluate the variation of the values at different points. The median values of the local pattern thresholds (median area contrast sensitivity [MACS]) obtained with that division were calculated., Results: The Akreos AO group obtained statistically significantly lower values of HOAs and spherical aberration compared with the Akreos Fit group. There was a statistically significant between-group difference in contrast sensitivity under mesopic conditions at all spatial frequencies. No statistically significant differences were observed in mean deviation and pattern standard deviation. The aspheric IOL exhibited higher MACS in all areas, although a statistically significant difference was reached only in the 20-degree field area (P=0.043)., Conclusion: Aspheric IOLs significantly reduced spherical aberration and HOAs, improving mesopic contrast sensitivity. Although there was a trend toward slightly improved FDT in the aspheric IOL group, it was not statistically significant.

Purpose: To report the incidence of late postoperative opacification of a hydrophilic acrylic foldable intraocular lens (IOL)., Setting: Altino Ventura Foundation, Pernambuco, Brazil., Design: Cross-sectional study., Methods: Patients were examined 4 years after phacoemulsification with Ioflex IOL implantation in the rural areas of Pernambuco, Brazil, as part of a community campaign for underprivileged people. The patients had a detailed ophthalmic examination to detect late IOL opacification. The patients' charts were reviewed for preexisting ocular pathology and corrected distance visual acuity (CDVA) before and 1 month after surgery. The IOL opacification was classified according to its location and severity., Results: All surgeries were uneventful intraoperatively and postoperatively. Six (7%) of the 87 eyes (58 patients) examined had a diagnosis of late IOL opacification; asteroid hyalosis and high myopia were associated ocular findings in 2 of the eyes. The preoperative CDVA ranged from hand motions (HM) to 20/80. The postoperative CDVA ranged from 20/20 to 20/40 except in 1 eye with posterior segment disease. Over the 4-year follow-up, 2 of the 6 eyes had a decrease in visual acuity to HM and 20/80, respectively, as a result of late IOL opacification. They had IOL replacement and CDVA improved to 20/60 and 20/20, respectively. A third eye with severe late opacification was not referred for IOL replacement because of macular disease., Conclusion: Intraocular lens opacification was observed in 7% of the eyes studied. No risk factors could be determined., (Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate the possible effect of aspherical or yellow tinted intraocular lens (IOL) on contrast sensitivity and blue-on-yellow perimetry., Methods: This prospective randomized bilateral double-masked clinical study included 52 patients with visually significant bilateral cataracts divided in two groups; 25 patients (50 eyes) received aspherical intraocular lens in one eye and spherical intraocular lens in the fellow eye; and 27 patients (54 eyes) received ultraviolet and blue light filter (yellow tinted) IOL implantation in one eye and acrylic ultraviolet filter IOL in the fellow eye. The primary outcome measures were contrast sensitivity and blue-on-yellow perimetry values (mean deviation [MD] and pattern standard deviation [PSD]) investigated two years after surgery. The results were compared intra-individually., Results: There was a statistically significant between-group (aspherical and spherical intraocular lens) difference in contrast sensitivity under photopic conditions at 12 cycles per degree and under mesopic conditions at all spatial frequencies. There were no between-group significant differences (yellow tinted and clear intraocular lens) under photopic or mesopic conditions. There was no statistically significant difference between all intraocular lens in MD or PSD., Conclusion: Contrast sensitivity was better under mesopic conditions with aspherical intraocular lens. Blue-on-yellow perimetry did not appear to be affected by aspherical or yellow tinted intraocular lens. Further studies with a larger sample should be carried out to confirm or not that hypotheses.

Purpose: To determine whether the improvement in intermediate vision after bilateral implantation of an aspheric multifocal intraocular lens (IOL) with a +3.00 diopter (D) addition (add) occurs at the expense of optical quality compared with the previous model with a +4.00 D add., Setting: Department of Ophthalmology, University of São Paulo, São Paulo, Brazil., Design: Prospective randomized double-masked comparative clinical trial., Methods: One year after bilateral implantation of Acrysof Restor SN6AD1 +3.00 D IOLs or Acrysof Restor SN6AD3 +4.00 D IOLs, optical quality was evaluated by analyzing the in vivo modulation transfer function (MTF) and point-spread function (expressed as Strehl ratio). The Strehl ratio and MTF curve with a 4.0 pupil and a 6.0 mm pupil were measured by dynamic retinoscopy aberrometry. The uncorrected and corrected distance visual acuities at 4 m, uncorrected and distance-corrected near visual acuities at 40 cm, and uncorrected and distance-corrected intermediate visual acuities at 50 cm, 60 cm, and 70 cm were measured., Results: Both IOL groups comprised 40 eyes of 20 patients. One year postoperatively, there were no statistically significant between-group differences in the MTF or Strehl ratio with either pupil size. There were no statistically significant between-group differences in distance or near visual acuity. Intermediate visual acuity was significantly better in the +3.00 D IOL group., Conclusion: Results indicate that the improvement in intermediate vision in eyes with the aspheric multifocal + 3.00 D add IOL occurred without decreasing optical quality over that with the previous version IOL with a +4.00 D add., (Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the possible side effects and potential protection 5 years after implantation of an intraocular lens (IOL) with a blue-light filter (yellow tinted)., Setting: Ophthalmology Department, University of São Paulo, São Paulo, Brazil., Design: Prospective randomized clinical study., Methods: Patients with bilateral visually significant cataract randomly received an ultraviolet (UV) and blue light-filtering IOL (Acrysof Natural SN60AT) in 1 eye and an acrylic UV light-filtering only IOL (Acrysof SA60AT) in the fellow eye. The primary outcome measures were contrast sensitivity, color vision, and macular findings 5 years after surgery., Results: The study enrolled 60 eyes of 30 patients. There were no significant clinical or optical coherence tomography findings in terms of age-related macular degeneration in any eye. There were no statistically significant differences in central macular thickness between the 2 IOL groups (P=.712). There were also no significant between-group differences under photopic or scotopic conditions at any spatial frequency studied. No statistically significant differences in the color discrimination test were found between the 2 IOL groups (P=.674)., Conclusions: After 5 years, there were no significant differences in color perception, scotopic contrast sensitivity, or photopic contrast sensitivity between the blue light-filtering (yellow-tinted) IOL and the IOL with a UV-light filter only (untinted). The potential advantage of the tinted IOL in providing protection to macular cells remains unclear., (Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine whether implantation of a multifocal intraocular lens (IOL) with a lower addition (+3.00 diopters [D]) at the lens plane results in better intermediate visual acuity 1 year after surgery compared with a multifocal IOL with higher addition (+4.00 D)., Methods: This prospective, randomized, double-masked study included 80 eyes from 40 patients. Twenty patients were implanted bilaterally with the ReSTOR +3.00-D add IOL and 20 patients were implanted bilaterally with the ReSTOR +4.00-D add IOL. Primary outcome measures were distance, intermediate, and near visual acuity. Secondary outcomes were defocus curves, best reading distance, mesopic and photopic contrast sensitivity, quality of life, and spectacle independence. Monocular and binocular visual acuity were measured as uncorrected and corrected distance visual acuity at 4 m, uncorrected near and distance-corrected near visual acuity at 40 cm, and uncorrected intermediate visual acuity and distance-corrected intermediate visual acuity at 50, 60, and 70 cm., Results: Twelve months postoperatively, no statistically significant difference between groups in distance and near visual acuity was noted. The ReSTOR +3.00-D add group performed better than the ReSTOR +4.00-D add group at all intermediate distances studied. The ReSTOR +4.00-D group chose a reading distance 8 cm closer than the +3.00-D group. Both groups performed similarly with respect to contrast sensitivity, quality of life, and spectacle independence rates., Conclusions: Patients implanted with a multifocal IOL with lower addition (ReSTOR +3.00 D) had better performance at intermediate distances compared with the ReSTOR +4.00-D add IOL with similar performance for distance and near visual acuity, contrast sensitivity, and quality of life.

Purpose: To determine whether implantation of an intraocular lens (IOL) with an aspheric surface (Akreos AO, Bausch & Lomb Inc) results in reduced ocular aberrations (spherical aberration) and improved Strehl ratio and modulation transfer function (MTF) after cataract surgery., Methods: In an intraindividual, randomized, double-masked, prospective study of 50 eyes (25 patients) with bilateral cataract, an IOL with modified anterior and posterior surfaces (Akreos AO) was implanted in one eye and a biconvex IOL with spherical surfaces (Akreos Fit, Bausch & Lomb Inc) implanted in the fellow eye. Ocular aberrations, Strehl ratio, and MTF curve with 4.5-, 5.0-, and 6.0-mm pupils were measured with a NIDEK OPD-Scan dynamic retinoscopy aberrometer 3 months after surgery. Uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively) were also measured., Results: No statistically significant difference was noted between eyes in postoperative UDVA and CDVA at 1 month. At 3 months, the Akreos AO IOL group obtained statistically significant lower values of higher order and spherical aberrations with 4.5-, 5.0-, and 6.0-mm pupil diameters than the Akreos Fit IOL group (P<.05). The value of Strehl ratio was statistically significantly higher in eyes with the Akreos AO IOL for 4.5- and 6.0-mm pupils (P<.05). The MTF curve was better in the Akreos AO IOL group in 4.5-, 5.0-, and 6.0-mm pupils (P<.05)., Conclusions: The aspheric Akreos AO IOL induced significantly less spherical aberration than the Akreos Fit IOL for 4.5-, 5.0-, and 6.0-mm pupils. Modulation transfer function and Strehl ratio were also better in eyes implanted with the Akreos AO IOL than the Akreos Fit., (Copyright 2011, SLACK Incorporated.)

Purpose: To compare reading ability after cataract surgery and bilateral implantation of multifocal intraocular lenses (IOLs) with a +3.00 diopter (D) addition (add) or a +4.00 D add., Setting: Department of Ophthalmology, University of São Paulo, São Paulo, Brazil., Design: Prospective comparative study., Methods: Patients scheduled for cataract surgery were randomly assigned to bilateral implantation of an aspheric AcrySof ReSTOR multifocal IOL with a +3.00 diopter (D) addition (add) or a +4.00 D add. The reading speed, critical print size, and reading acuity were measured binocularly with best correction using MNREAD acuity charts 6 months after surgery. Patients were tested with the chart at the best patient-preferred reading distance and at 40 cm. Binocular uncorrected and best distance-corrected visual acuities at far and near were also measured., Results: The study enrolled 32 patients. At the best reading distance, the results were similar between the 2 IOL groups in all reading parameters. When tested at 40 cm, reading speed at all print sizes from 0.3 to 0.0 (all P<.001), critical print size (P<.001), and reading acuity (P = .014) were statistically significantly better in the +3.00 D IOL group than in the +4.00 D IOL group. Uncorrected and corrected visual acuities at far and near were similar between the 2 groups., Conclusion: Although the 2 IOL groups had similar performance in reading parameters, patients had to adjust to their best reading distance. The +3.00 D IOL performed better than the +4.00 D IOL at 40 cm., (Copyright © 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate wavefront performance and modulation transfer function (MTF) in the human eye after the implantation of diffractive or refractive multifocal intraocular lenses (IOLs)., Materials and Methods: This was a prospective, interventional, comparative, nonrandomized clinical study. Uncorrected distance and near visual acuity, and wavefront analysis including MTF curves (iTrace aberrometer, Tracey Technologies, Houston, TX, USA) were measured in 60 patients after bilateral IOL implantation with 6 months of follow-up. Forty eyes received the diffractive ReSTOR (Alcon), 40 eyes received the refractive ReZoom (Advanced Medical Optics) and 40 eyes, the Tecnis ZM900 (Advanced Medical Optics). The comparison of MTF and aberration between the intraocular lenses was performed using analysis of variance (ANOVA), followed by the Dunn test when necessary., Results: The mean uncorrected distance visual acuity was similar in all three groups of multifocal IOLs. The ReSTOR group provided better uncorrected near visual acuity than the ReZoom group (P<0.001), but similar to the Tecnis group. Spherical aberration was significantly higher in the ReZoom group (P=0.007). Similar MTF curves were found for the aspheric multifocal IOL Tecnis and the spheric multifocal IOL ReSTOR, and both performed better than the multifocal IOL ReZoom in a 5 mm pupil (P<0.001 at all spatial frequencies)., Conclusions: Diffractive IOLs studied presented similar MTF curves for a 5 mm pupil diameter. Both diffractive IOLs showed similar spherical aberration, which was significantly better with the full-diffractive IOL Tecnis than with the refractive IOL ReZoom.

Purpose: To evaluate intraindividual visual acuity, wavefront errors and modulation transfer functions in patients implanted with two diffractive multifocal intraocular lenses., Methods: This prospective study examined 40 eyes of 20 cataract patients who underwent phacoemulsification and implantation of a spherical multifocal ReSTOR intraocular lens in one eye and an aspheric Tecnis ZM900 multifocal intraocular lens in the other eye. The main outcome measures, over a 3-month follow-up period, were the uncorrected photopic distance and near visual acuity and the defocus curve. The visual acuity was converted to logMAR for statistical analysis and is presented in decimal scale. The wavefront error and modulation transfer function were also evaluated in both groups., Results: At the 3-month postoperative visit, the mean photopic distance uncorrected visual acuity (UCVA) was 0.74 +/- 0.20 in the ReSTOR group and 0.76 +/- 0.22 in the Tecnis group (p=0.286). The mean near UCVA was 0.96 +/- 0.10 in the ReSTOR group and 0.93 +/- 0.14 in the Tecnis group (p=0.963). The binocular defocus curve showed measurements between the peaks better than 0.2 logMAR. The total aberration, higher-order aberration and coma aberration were not significantly different between the groups. The spherical aberration was significantly lower in the Tecnis group than in the ReSTOR group. (p=0.004). Both groups performed similarly for the modulation transfer function., Conclusion: The ReSTOR SN60D3 and Tecnis ZM 900 intraocular lenses provided similar photopic visual acuity at distance and near. The diffractive intraocular lenses studied provided a low value of coma and spherical aberrations, with the Tecnis intraocular lens having a statistically lower spherical aberration compared to the ReSTOR intraocular lens. In the 5 mm pupil diameter analyses, both intraocular lens groups showed similar modulation transfer functions.

Purpose: Comparison of the visual performance and wavefront analysis between patients with Tecnis ZM900 aspheric and AcrySof ReStor SN60D3 spheric diffractive multifocal intraocular lenses (IOL)., Methods: This prospective comparative study included 78 eyes of 39 patients. The performed ophthalmologic evaluation included near, intermediate and distance corrected and uncorrected visual acuity, contrast sensitivity measurement (under photopic and mesopic conditions) and wavefront analysis with the OPD-Scan aberrometrer., Results: Uncorrected near and distance visual acuity and aberrometry analysis were similar with both intraocular lenses; nevertheless, intermediate visual acuity and contrast sensitivity under photopic conditions were statistically better with Tecnis ZM900., Conclusion: Both studied intraocular lenses promoted excellent near and distance postoperative visual acuity, in high contrast situations. Tecnis ZM900 IOL provided good quality of vision with high contrast condition in low luminosity with reduction in spherical aberration and improvements in intermediate visual acuity when compared to Restor IOL.

Purpose: To assess the differences in blue-yellow perimetry values in patients with an AcrySof Natural intraocular lens (IOL) in 1 eye and a conventional AcrySof IOL in the fellow eye., Setting: Cataract and glaucoma clinics of a medical school associated with a public hospital in Brazil., Methods: Forty-six patients had bilateral phacoemulsification and implantation of an AcrySof SN60AT IOL (Alcon) in 1 eye and an MA30AC IOL (Alcon) in the fellow eye. Blue-yellow perimetry was performed in both eyes, and the data were analyzed in blinded fashion using the Mann-Whitney U test., Results: No statistically significant differences were observed in short-wavelength automated perimetry (SWAP) values between the 2 IOLs., Conclusion: There was no interference by the yellow filter of the AcrySof Natural IOL in blue-yellow perception as determined by SWAP.