Clinical reviews

Purpose: To evaluate and compare the performance of two diffractive trifocal and one extended depth of focus (EDOF) intraocular lenses (IOLs).

Methods: In this 6-month, single-center, prospective, randomized, comparative study, patients undergoing routine cataract surgery were randomized to receive one of two trifocal IOLs (AcrySof IQ PanOptix; Alcon Laboratories, Inc., Fort Worth, TX, or FineVision Micro F; PhysIOL SA, Liège, Belgium) or an EDOF IOL (TECNIS Symfony; Abbott Medical Optics, Inc., Abbott Park, IL). There were 20 patients in each group. The primary outcome was binocular and monocular uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuity. The secondary outcomes were quality of vision and aberrometry.

Results: There was no statistically significant difference between groups in either monocular (P = .717) or binocular (P = .837) UDVA. Monocular and binocular UNVA were statistically and significantly better for both trifocal lenses than for the EDOF IOL (P = .002). The percentage of patients with J2 UNVA was 52.5% monocularly and 70% binocularly for the TECNIS Symfony IOL, 81.5% monocularly and 100% binocularly for the AcrySof IQ PanOptix IOL, and 82.5% monocularly and 95% binocularly for the FineVision Micro F IOL. There was no significant difference in binocular UIVA between groups; VA was better than 0.6 in 55%, 53%, and 35% of patients with the TECNIS Symfony, AcrySof IQ Pan-Optix, and FineVision Micro F IOLs, respectively. Overall, 90% patients achieved spectacle independence. There were no differences in visual symptoms and aberrometry among groups.

Conclusions: All three IOLs provided good visual acuity at all distances, a high percentage of spectacle independence, and little or no impact of visual symptoms on the patients' daily functioning. Near vision was statistically better for both trifocal IOLs compared to the EDOF IOL.

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Purpose: To compare the refractive and visual performance of three Extended Depth of Focus (EDOF) intraocular lenses (IOLs) after uncomplicated cataract surgery.

Setting: Centre IRIDIS, Albi, France.

Design: Comparative retrospective study.

Methods: Patients with cataracts and without other eye diseases were enrolled for monocular implantation of EDOF IOLs on the dominated eye by the same surgeon between 2018 and 2021, using either the IsoPure (BVI-PhysIOL, Belgium), the Synthesis+ (Cutting Edge, France), or the Lucidis (SAV-IOL, Swiss). Refraction, Uncorrected Distance Visual Acuity (UDVA), Corrected Distance VA (CDVA), Uncorrected Near VA (UNVA), Distance-Corrected Near VA (DCNVA), 25% Contrast CDVA, and Defocus Curve were assessed 3-months postoperatively.

Results: A total of 64 eyes of 64 patients were included in this study (IsoPure n = 22; Synthesis+ n = 20, Lucidis n = 22). CDVA, 25% Contrast CDVA and DCNVA were significantly better for Lucidis than IsoPure or Synthesis+. No significant difference was observed for CDVA and 25% Contrast CDVA between IsoPure and Synthesis+. DCNVA was significantly better for Lucidis and Synthesis+ with respectively 0.08 LogMAR ± 0,09 and 0.29 LogMAR ± 0.13, compared to 0.40 LogMAR ± 0.17 for IsoPure (p < 0.05).

Conclusions: Lucidis showed more efficient distance, low contrast, and near vision than IsoPure and Synthesis+. Synthesis+ seems to be more efficient in intermediate vision than other groups. Each EDOF IOLs provided good distance vision without creating spontaneous complaints of photic phenomena. Refractive EDOF IOLs, especially Lucidis, are efficient for patients wishing to improve their vision without dysphotopsia.

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Purpose : The aim of this study is to describe a technique for performing cataract surgery with a femtosecond laser (FLACS) in infants with bilateral polar cataract, by using a viscoelastic substance to visualize the posterior capsule.

Methods : A 2-year-old male presented with bilateral polar cataract visualized on slitlamp examination. His best-corrected visual acuity (BCVA) was 20/200 in OD and 20/100 in OS. The keratometry (SRK-Tformula) is obtained with IOL Master and the axial length with Ultrasound biomicroscopy. He underwent bilateral FLACS (Victus,B&L) followed by implantation of a intraocular lens (IOL). Anterior capsulotomy of 5 mm is performed by the laser. The eye has been opened for lens aspiration without complications. A capsular tension ring is implanted in the bag using a cohesive viscoelastic substance to avoid the future phimosis. A hole is created in the posterior capsule using a 27G needle and filled a short-chains viscoelastic device through the gap in the vitreal chamber, between the posterior capsula and the hyaloid. A new docking of the laser is performed after the closure of the corneal wounds. The real time-integrated optical coherence tomography (OCT) also visualizes the posterior capsule pushed up by the viscoelastic, allowing a centered central posterior capsulotomy of 4.5 mm, followed by mechanical anterior vitrectomy. A IOL is implanted in the bag of both eyes.

Results : The child was followed up on day 1, day 5, at 2 weeks, 4 weeks and 8 weeks. At each follow-up visit, complete ocular examinations including orthoptic examination of both eyes were performed.The cornea was clear and the intraocular pressure(IOP) was 15mmHg in OU at every visit.At 4 weeks the BCVA was 20/30 in OU.Anterior and posterior capsulotomies were complete and uniform, without tears. The IOL was centered in the bag. No complications were encountered.

Conclusions : The technique has been performed in a infant with congenital cataract and it can enhance the quality of pediatric cataract surgery.The capsule is very elastic and tends to tear peripherally in manual anterior capsulotomy.This can induce to a complete loss of the capsule protection during surgery, with damage of the capsular scaffold for the IOL placement. Using the viscoelastic to push up the capsule allow a better visualization of the capsular surface,in order to standardize the laser capsulotomy procedure and to obtain a safe,precise and repetitive surgery.

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Purpose: To compare endoscopic cyclophotocoagulation (ECP) and the Ahmed drainage implant in the treatment of refractory glaucoma.

Methods: Sixty-eight eyes of 68 patients with refractory glaucoma were prospectively assigned to either ECP or Ahmed tube shunt implantation. All procedures were performed by a single surgeon. Eyes that were included were pseudophakic with a history of at least one trabeculectomy with antimetabolite, an intraocular pressure (IOP) equal to or above 35 mm Hg on maximum tolerated medical therapy, and a visual acuity better than light perception. Exclusion criteria included eyes that had had previous glaucoma drainage device implantation or a cyclodestructive procedure. Success was defined as an IOP more than 6 mm Hg and less than 21 mm Hg, with or without topical anti-hypertensive therapy.

Results: The mean follow-up was 19.82 ± 8.35 months and 21.29 ± 6.42 months, for the Ahmed and ECP groups, respectively (P = 0.4). The preoperative IOP, 41.32 ± 3.03 mm Hg (Ahmed) and 41.61 ± 3.42 mm Hg (ECP) (P = 0.5), and the mean postoperative IOP, at 24 months follow-up, 14.73 ± 6.44 mm Hg (Ahmed) and 14.07 ± 7.21 mm Hg (ECP) (P = 0.7), were significantly different from baseline in both groups (P < 0.001). Kaplan-Meier survival curve analysis showed a probability of success at 24 months of 70.59% and 73.53% for the Ahmed and ECP groups, respectively (P = 0.7). Complications included choroidal detachment (Ahmed 17.64%, ECP 2.94%), shallow anterior chamber (Ahmed 17.64%, ECP 0.0%), and hyphema (Ahmed 14.7%, ECP 17.64%).

Conclusion: There was no difference in the success rate between the Ahmed Glaucoma Valve and ECP in refractory glaucoma. The eyes that underwent Ahmed tube shunt implantation had more complications than those treated with ECP.

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Purpose: To clinically evaluate a new extended depth of focus intraocular lens (ISOPURE, PhysIOL) with optic design modification based on a unique polynomial concept to improve intermediate vision while keeping the quality of distance vision equal to a monofocal lens.

Methods: 18 patients (11 female, 7 male, mean age of 69.4 years) with bilateral cataract and regular corneal astigmatism ≤ 1.0 D underwent bilateral cataract surgery with ISOPURE implantation. Patients were followed for up to 6 months. Measured parameters were uncorrected (UDVA) and corrected distance visual acuity (CDVA), uncorrected (UIVA) and distance-corrected intermediate visual acuity at 80 cm and 66 cm (DCI80VA, DCI66VA) subjective refraction, defocus curve, tolerance of cylinder induction, and contrast sensitivity. The data from all implanted eyes (all-eyes) and a subset only including the first eye implanted for each patient were analysed.

Results: The mean manifest refraction spherical equivalent (MRSE) decreased from 1.05 D pre-operatively to 0.15 D at the 4 - 6 month assessment, with 80.6% of eyes within ±0.50 D of emmetropia. At the final follow-up, mean (SD) monocular CDVA was 0.06 (0.04) logMAR, DCI80VA was 0.18 (0.08) logMAR and DCI66VA was 0.27 (0.13) logMAR. Despite a cylinder induction of 0.50 D, uncorrected distance visual acuity of 0.02 logMAR was still achieved.

Conclusion: The ISOPURE intraocular lens provides excellent distance corrected visual acuity for far and intermediate distances along with high contrast sensitivity and good tolerance of residual refractive cylinder.

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Purpose: To evaluate the clinical efficacy of trypan blue 0.1% dye (Blurhex) in creating a complete anterior and posterior capsulorhexis during pediatric cataract surgery.

Setting: Tertiary eyecare center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Methods: In a prospective randomized study, an anterior (ACCC) and posterior (PCCC) continuous curvilinear capsulorhexis were performed in pediatric patients. In Group 1 (n = 19), the ACCC and PCCC were created without use of trypan blue dye. In Group 2 (n = 23), intracameral trypan blue dye was used to stain the anterior and posterior capsules.

Results: In Group 1, 14 eyes (73.6%) had a complete ACCC and 10 (52.6%) had a complete PCCC. In Group 2, 21 eyes (91.3%) had a complete ACCC and 19 (82.6%) had a complete PCCC.

Conclusion: In cases of pediatric cataract, staining the anterior and posterior capsules with trypan blue 0.1% allowed recognition of capsule flaps and facilitated the creation of complete ACCCs and PCCCs.

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Purpose: To determine the hydrophobic, antiglistening, and bioadhesiveness properties of a new polymer, GF raw material, and to determine the suitability of this material for use in intraocular lenses (IOLs).

Setting: University of Liege, Liege, Belgium.

Design: Experimental study.

Methods: Intraocular lenses made of the new hydrophobic acrylic material were tested and compared with reference acrylic materials. The stability of their polymer matrix was estimated by testing for glistenings. The relative surface hydrophobicity was quantified via contact-angle measurements. The degrees of bioadhesiveness of the reference and test materials were assessed by in vitro porcine lens epithelial cell (LEC) culture.

Results: The glistening test showed that the new material had greater stability under worst-case conditions than previous-generation hydrophobic acrylic materials. The new polymer had the same hydrophobic properties as the hydrophobic Acrysof IQ SN60WF material; both materials were less hydrophobic than the hydrophobic Sensar AR40e material and more hydrophobic than the hydrophilic Ioflex IOL material. The in vitro bioadhesiveness tests showed that porcine LEC adhesion levels of the new material were intermediate with respect to those of the 2 reference hydrophobic materials.

Conclusions: When equilibrated in aqueous medium, the new-generation hydrophobic acrylic material reached a low water content at equilibrium, making it glistening free. The hydrophobicity and bioadhesiveness of the new raw material were comparable to those of state-of-the-art reference materials; these properties may resist the formation of posterior capsule opacification.

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Purpose: To characterize the fluidics of axial rotating vitreous cutter probe (RT) compared with the standard guillotine (regular blade), when tested in Balanced Salt Solution (Alcon Laboratories, Forth Worth, TX).

Methods: RT and regular blade (RB) cutter probes connected to the same vitrectomy console used a peristaltic pump. The authors measured instantaneous flow through aspiration tubing proximal to the handpiece, fluid velocity, and acceleration at the port by means of particle image velocimetry.

Results: Average flow at aspiration tubing of RT and RB did not vary significantly. Regular blade probes produced higher instantaneous flow fluctuation than RT at any considered cut rate (RB 1,600 6.4 ± 5.3 mL/minute; RB 3,000 11.8 ± 6.3 mL/minute; RT 1,600 0.9 ± 0.7 mL/minute, and RT 3,000 1.8 ± 0.8 mL/minute, respectively. P < 0.001 in all cases). Regular blade also yield significantly higher fluid velocity at cutter port compared with RT (RB 1,600 85.8 ± 70.1 mm/second; RB 3,000 81.6 ± 66.4 mm/second; RT 1,600 71.9 ± 40.3 mm/second; and RT 3,000 32.9 ± 20.8 mm/second. P < 0.001 in all cases). Fluid acceleration at the cutter port was higher when the RB was used (RB 1,600 26.85 ± 30.18 mm/second; RB 3,000 33.76 ± 34.09 mm/second; RT 1,600 24.01 ± 21.94 mm/second; and RT 3,000 16.62 ± 17.87 mm/second. P < 0.001 in all cases).

Conclusion: RT blade design causes less instantaneous flow fluctuation within the aspiration tubing, and also lower fluid velocity and lower acceleration at the cutter port. Fluidics suggests a safer cutting action and a reduced risk of retinal incarceration.

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Purpose: To compare hydrophilic and hydrophobic acrylic materials designed for intraocular lenses in a multiparametric investigation in a liquid environment to highlight their properties in terms of adhesion forces, lens epithelial cell (LEC) adhesion, and tissue response as indicators of the risk for posterior capsule opacification (PCO) development.

Methods: The hydrophobicity and surface adhesion force were assessed using contact-angle and atomic force microscopy measurements. The bioadhesiveness of the disks and the tissue response were determined by in vitro experiments using bovine serum albumin and porcine LECs and by in vivo rabbit subcutaneous implantation, respectively.

Results: Increasing surface hydrophobicity led to a greater surface-adhesion force and greater LEC adhesion. After 1 month, the rabbit subcutaneous implants showed a similar thin layer of fibrous capsule surrounding the disks without extensive inflammation. A layer of rounded cells in contact with disks was detected on the hydrophobic samples only.

Conclusions: Hydrophobic acrylic disks that have been associated with a reduced risk for PCO in clinical studies showed increased tackiness.

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Purpose: To compare the biomechanical and optical properties of 2 new hydrophobic platforms and a series of commercially available foldable intraocular lenses (IOLs).

Methods: Eleven benchmark foldable IOLs (iPure, Podeye, Acrysof SN60WF, Envista MX60, Sensar AR40e, Tecnis ZCB00, Isert 251, AF-1 YA-60BB, Finevision, Acri.Tec 366D, and Ioflex) were tested by standard analytical methods for biomechanical, rheological, and optical investigations under identical conditions.

Results: With 1 exception, IOLs equilibrated in aqueous medium had a lower glass-transition temperature, higher deformability, lower injection forces, and complete recovery of their initial optical properties after injection. Typical hydrophobic acrylic dry-packaged IOLs required higher injection forces with high residual deformation and lost part of their initial optical quality after injection. Hydrophobic acrylic C-loop, double C-loop, and closed quadripod haptics applied optimum compression forces to the capsular bag with negligible optic axial displacement and tilt compared with plate haptics and poly(methyl methacrylate) haptics.

Conclusions: The combination of the C-loop haptic and the bioadhesive glistening-free material, which absorbs a predetermined amount of water, allowed for a biomechanically stable IOL. The same material used in association with a double C-loop haptic design facilitated the perioperative manipulation and placement of the IOL in a smaller capsular bag without impairing the other biomechanical properties of a single C-loop design.

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Purpose: To assess the biomechanical stability of three different marketed intraocular lenses (IOLs) with different haptic designs (four-loop IOL [Micro F FineVision model] and double C-loop IOL [POD F and POD FT models], all manufactured by PhysIOL), in silico (computer simulation) and in vivo (in the context of lens surgery).

Methods: An in silico simulation investigation was performed using finite element modeling (FEM) software to reproduce the compression test defined by the International Organization for Standardization and in vivo implantation in patients in the context of lens surgery was evaluated 1 day and 3 months postoperatively. IOL decentration and rotation were tested. In addition, the stress and strains were analyzed with the finite element method.

Results: In the in silico evaluation, the compression force for the POD F IOL was slightly lower than for the POD FT IOL and Micro F IOL for all compression diameters. The axial displacement was maximum for the POD FT IOL and the tilt, rotation, and lateral decentration were substantially lower than the acceptable tolerance limits established in ISO 11979-2. In the in vivo evaluation, a total of 45 eyes from 45 patients were selected, 15 eyes for each IOL model under assessment. Statistically significant differences were found between the Micro F and POD F IOLs for lateral decentration in x-direction (in absolute value) at 3 months postoperatively (P = .03).

Conclusions: Although statistically significant differences have been found when comparing the displacement, tilt, and rotation between the different lenses, these differences cannot be considered clinically relevant, which would suggest that all three IOL models yield excellent stability in those terms. FEM appears to be a powerful tool for numerical studies of the biomechanical properties of IOLs.

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Purpose: To compare capsular bag stability and posterior capsule opacification (PCO) of a plate-haptic intraocular lens (IOL) and a standard three-piece open-loop-haptic IOL of the same acrylic material.

Methods: In this randomised bilateral patient-masked and examiner-masked study, each patient received a microincision cataract surgery IOL (MICS IOL; Acri.Smart 46S=CT SHERIS 209M) in one eye and a small incision cataract surgery IOL (SICS IOL; AcriLyc 53N = CT 53N, both Carl Zeiss Meditec AG, Germany) as a control in the contralateral eye. Follow-up examinations were performed 1 h, 1 week, 1 month, 1 year and 3 years postoperatively. Anterior chamber depth (ACD) was measured and retroillumination images were performed at all postoperative follow-ups. Furthermore, uncorrected and corrected distance visual acuity, autorefraction and subjective refraction were assessed.

Results: In total, 50 eyes of 25 patients were included. The ACD difference between the MICS IOL and the SICS IOL was not significant at any time point (p>0.05). Distance-corrected visual acuity at the 3-year follow-up was similar and not significantly different between the groups (p=0.48). Mean AQUA score in the MICS IOL group and in the SICS IOL group at the 3-year follow-up was 2.3 (SD ±2.3) and 2.1 (SD ±2.2), respectively (p=0.79).

Conclusions: The investigated hydrophilic acrylic plate-haptic MICS IOL with a hydrophobic surface showed comparable results concerning capsular bag stability and PCO rates up to 3 years compared with a SICS IOL of the same material.

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Background: Capsulorrhexis may be hazardous in the absence of the red fundus reflex. Anterior capsule trypan blue staining enabled to perform the capsulorrhexis and safe phacoemulsification.

Material and methods: Twenty patients with mature cataract were enrolled in the study and opereted on after injection of trypan blue in the anterior chamber.

Results: Circular capsulorrhexis was performed in all cases followed by phacoemulsification and in-the-bag IOL implantation. In two cases hard nuclei required a manual extracapsular technique. No operative complications, and no residual of coloration was noted the day after the operation. With a follow-up of 2 to 12 months, no complications appeared (cornea, capsulorrhexis, IOP).

Conclusion: In mature cataracts, with no red fundus reflex, capsulorrhexis can be done by anterior capsule staining.

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Purpose: To evaluate the efficacy of combination pars plana vitrectomy, endoscopic peripheral panretinal photocoagulation, and endocyclophotocoagulation (ECP) as compared with standard care in patients with neovascular glaucoma.

Methods: This age-matched case-controlled retrospective series of 54 eyes compared the clinical outcomes between a consecutive series of combination pars plana vitrectomy/panretinal photocoagulation/ECP (n = 27) versus the current standard of care (n = 27) for patients with neovascular glaucoma. "Standard" treatments for patients with neovascular glaucoma include panretinal photocoagulation, intravitreal bevacizumab, filtration surgery, pars plana vitrectomy, and Ahmed valve placement.

Results: After 1 year, mean intraocular pressure reduced from 40.7 ± 12.40 mmHg preoperatively to 12.3 ± 4.84 mmHg (P < 0.001) in the ECP group and from 34.7 ± 12.38 mmHg to 23.2 ± 12.34 mmHg in the control group (P = 0.002). Compared with controls, the mean drop in intraocular pressure in the ECP group was significantly greater at all postoperative visits. Logarithm of the minimal angle of resolution visual acuity outcomes were similar in both groups. There were 2 cases (7.4%) of postoperative phthisis bulbi in each group.

Conclusion: Endoscopic pars plana vitrectomy, panretinal photocoagulation, and ECP seem to control intraocular pressure to a greater extent than standard glaucoma treatments in patients with neovascular glaucoma. In this aged-matched comparative case series, there was no significant difference between the two treatments' effects on visual acuity.

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Purpose: The aim of the study was to evaluate the visual outcomes, aberrometric results, and subjective and objective optical qualities 12 months after implantation of a new monofocal intraocular lens (Physiol IsoPure 1.2.3) in comparison with a standard monofocal intraocular lens (Tecnis PCB00).

Materials and methods: Cataract patients without ocular comorbidities had bilateral implantation of the IsoPure IOL or the PCB00 IOL. One month after eye surgery, the visual acuity and monocular defocus curve were assessed. Twelve months after surgery, the visual acuity, binocular defocus curve, contrast sensitivity, and subjective/objective optical quality were assessed. Furthermore, wavefront analysis was performed. The primary endpoint was the best distance correct/uncorrected visual acuity at intermediate and far distances. The secondary endpoint was an aberration evaluation of the IOLs and contrast sensitivity.

Results: The study comprised a total of 42 patients (84 eyes). Monocular and binocular uncorrected and corrected distance were similar between groups, and uncorrected intermediate visual acuity was significantly higher in the IsoPure group. There was no difference in contrast sensitivity and subjective and objective optical qualities. The optical aberrations at 3.0 and 5.0 mm aperture diameters were similar in both groups.

Conclusion: The IsoPure IOL, based on greater depth of focus than the aspheric monofocal IOL, may offer a good option for the distance and intermediate vision without increasing optical aberrations and any photic phenomena.

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Purpose: To assess visual acuity, binocular defocus curve, spectacle independence, and photic phenomena after bilateral same-day cataract surgery with implantation of an extended depth-of-focus intraocular lens (IOL) with mini-monovision.

Methods: Single-center retrospective study including 124 eyes from 62 patients who underwent bilateral implantation of an isofocal EDOF lens [Isopure® (BVI)] with mini-monovision (-0.50 D). Refraction, visual acuity at different distances, binocular defocus curves, spectacle independence, and subjective ratings of picture-referenced photic phenomena were assessed one to two months postoperatively.

Results: The mean postoperative refractive spherical equivalent was -0.15±0.41D in the dominant eyes and -0.46±0.35D in the mini-monovision eyes (p<0.01). Overall, 98.4% and 87.7% of the eyes were within ±1.00D and ±0.50D of the target refraction, respectively. Postoperative monocular corrected distance visual acuity was -0.04±0.07 logMAR. Binocular uncorrected visual acuity was -0.02±0.07, 0.13±0.11and 0.40±0.20 logMAR for far, intermediate and near, respectively. At the visual acuity threshold of 0.20 logMAR (or better) the defocus curve ranged from -1.6D to +0.9D. Reported spectacle-independence was 96% for far distance, 95% for intermediate, and 34% for near. Five percent of patients reported halos, 16% starburst, and 16% glare. Only 7% of all patients considered them bothersome.

Conclusion: In patients undergoing same-day bilateral cataract surgery, an isofocal EDOF lens provided an extended range of functional vision, up to 63 cm, resulting in useful uncorrected near vision, good uncorrected intermediate vision, and excellent uncorrected distance vision. Subjective patient satisfaction in terms of spectacle independence and photic phenomena was high.

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