Clinical reviews

Purpose: To compare clinical outcomes in a prospective trial of cataract surgery patients bilaterally implanted with two different trifocal intraocular lenses (IOLs) with very similar optical designs but consisting of different IOL materials (hydrophobic and hydrophilic).

Patients and methods: Fifty-one patients (102 eyes) were randomized to receive trifocal IOLs bilaterally - FineVision POD F (hydrophilic) or FineVision POD F GF (hydrophobic) (both PhysIOL, Liége, Belgium). The follow-up period was 3 months. Outcome measurements included uncorrected distance (UDVA), corrected distance (CDVA), distance-corrected intermediate (DCIVA), and distance-corrected near visual acuity (DCNVA), refraction, negative dysphotopsia, optical quality of vision, contrast sensitivity under photopic and mesopic conditions, halometry (discrimination index), and patient-reported outcomes.

Results: At the final study visit, mean (SD) values for binocular UDVA, CDVA, DCIVA (80 cm), and DCNVA (40 cm) were -0.01 (0.06), -0.04 (0.04), 0.09 (0.10), and 0.10 (0.09) logMAR, respectively, for POD F, and 0.01 (0.08), -0.03 (0.03), 0.08 (0.1), and 0.13 (0.11) respectively, for POD F GF. Defocus assessments showed a continuous curve with a functional range of visual acuity (≤0.15 logMAR) from ~30 cm to infinity in both groups. The discrimination index was >0.85 for all patients, and both groups showed similar contrast sensitivity under photopic and mesopic conditions. At 3 months, no patient reported negative dysphotopsia, and high satisfaction rates were observed.

Conclusion: Clinical outcomes showed no significant difference between each lens when measured at 1 month and 3 months after implantation. This equally good clinical performance of hydrophilic and hydrophobic trifocal lenses allows the surgeon to choose the IOL material based on personal preferences or patients' needs.

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• Screening the eye for pupil problems starts with taking a careful medical and ocular history.
• Following a small-pupil management algorithm can guide the surgeon to methodically achieve adequate pupil size while minimizing risks.
• A range of pharmacologic agents and mechanical expansion devices allow each eye to be matched to the appropriate solution for optimal surgical visualization.

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Corneal abrasion is the most common ophthalmologic complication that occurs during general anesthesia for nonocular surgery. Such abrasions can be caused by a variety of mechanisms and can lead to sight-threatening microbial keratitis and permanent scarring. There is no standard mode of protecting the cornea during general anesthesia for nonocular surgery. Methods described in the literature are not entirely effective and may be associated with unwanted side effects. Taping alone provides protection that is equivalent or superior to other interventions and has fewer side effects. Petroleum gel is flammable and is best avoided when electrocautery and open oxygen are to be used around the face. Preservative-free eye ointment is preferred, as preservative can cause corneal epithelial sloughing and conjunctival hyperemia. Recently, the application of Geliperm and bio-occlusive dressings has been advocated. Geliperm may be particularly useful during endonasal surgery when continuous perioperative observation of the eye is required. In this article, the literature on the etiology of perioperative corneal abrasions is reviewed and various protection strategies are compared in order to identify the best methods to prevent corneal abrasions during general anesthesia.

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Purpose: To describe a case with bullous keratopathy and anterior segment inflammation associated with heavy liquids.

Design: Observational case report.

Methods: Review of clinical and histopathologic changes.

Results: A 65-year-old patient underwent a pars plana vitrectomy for a rhegmatogenous retinal detachment. Perfluorodecalin was used as a temporary retinal tamponade. After surgery, bubbles of heavy liquid were noted in the anterior chamber. Fifteen months later, severe corneal edema developed, associated with corneal vascularization and keratic precipitates. Removal of heavy liquid through a paracentesis was attempted but the cornea remained edematous, and a penetrating keratoplasty was performed. In the histopathologic examination inflammatory changes from retention of perfluorodecalin were observed. There was a decompensated cornea with florid bullous keratopathy, inflammatory infiltration with vascularization, and deposition of perfluorodecalin within keratocytes and perivascular macrophages.

Conclusion: Presence of heavy liquids in the anterior chamber may be associated with an intense inflammatory response and corneal decompensation.

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Basal tear production was measured by means of standardized Schirmer strips and 0.5% proparacaine hydrochloride topical anesthesia in 20 patients. Premedication with systemic diazepam (Valium) and atropine sulfate had no effect on basal tear production. General surgical anesthesia resulted in a noticeable depression of basal tear production at 10, 30, and 60 minutes following induction of the anesthesia. It is suggested that prophylactic eye care include both replacement of tears and prevention of mechanical exposure of the cornea during general anesthesia.

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Purpose: To theoretically and experimentally assess a new aspheric diffractive trifocal intraocular lens (IOL).

Methods: The theoretical profile of the IOL was designed using software simulation and validated by optical calculation software tools that enabled complete theoretical characterization. These data resulted in a new aspheric diffractive trifocal IOL. The IOL theoretically allows improved intermediate vision without impairing near and far vision and favors distance vision in mesopic conditions without increasing halos or glare perception under dim light or large pupil conditions. The theoretical findings were compared with those of in vitro testing on the optical bench.

Results: There was good agreement between the theoretical profile and achieved IOL profile. The simulated and achieved light distribution and focus distribution showed good concordance. The FineVision aspheric trifocal IOL provided intermediate addition at 1.75 diopters.

Conclusion: The combination of 2 diffractive profiles to achieve far, intermediate, and near correction is validated. Further clinical investigations are required to validate these principles.

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The purpose of this review is to summarize the clinical rotational stability outcomes reported in patients following implantation of the POD platform with double C-loop haptics. A literature search in PubMed (US National Library of Medicine) was carried out to find publications, both prospective and retrospective, which report rotational stability outcomes in patients who were implanted with this platform after cataract or refractive lens exchange surgeries. This platform is used in different commercially available intraocular lenses (IOLs), both monofocal and trifocal, made of hydrophilic or hydrophobic material. 19 clinical peer-reviewed studies published between 2013 and 2024 were included in this review. The data reported in the clinical publications was analyzed in detail, focusing on rotational stability (mean rotation values and ranges, and percentage of eyes with some degrees of rotation), measurement methods and rotation follow-up period. Our review encompassed a total of 1428 eyes implanted with the POD platform analyzed at different follow-up periods, up to a maximum of 26 months. The mean rotation across all the studies was 2.61 °.The analysis carried out in this review leads us to conclude that the POD platform provides good rotational stability when used with different IOL models based on monofocal or trifocal designs and made using hydrophilic or hydrophobic material.

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Purpose

To compare the staining properties of Monoblue inner limiting membrane (ILM) View and Monoblue DUAL View (study products) vital stains during vitrectomy surgery to those of ILM Blue or Membrane Blue Dual (control products).

Methods

In this study, 105 patients were included in the Ophthalmic Clinic of the University Hospitals Leuven from September 2021 to April 2022. For prospective data collection in this study, patients were randomized between a control group (ILM Blue or Membrane Blue Dual, manufactured and commercialized by DORC®) and a study group (Monoblue ILM View or Monoblue DUAL View, manufactured and commercialized by Arcadophta®-BVI®). For retrospective data collection, patients were divided into similar surgery groups. Efficacy was analyzed using a binary subjective evaluation of the visualization of stained membranes during vitrectomy. The rate and severity of potential adverse events related to the study products were tracked, allowing both treatment groups to be compared with the corresponding control groups (ILM Blue and Membrane Blue Dual).

Results

Based on the results and findings, none of the comparisons (primary outcomes) were statistically significant, showing similar efficacy of the dyes used. The study products were found to be safe in this study since no serious adverse events were reported.

Conclusions

The present findings indicate that the Monoblue ILM View and Monoblue DUAL View dyes can safely be used during vitrectomy to stain the ILM and/or epiretinal membrane (ERM) when removal is needed.

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Aim: To report on the efficacy of combined endoscopic cyclophotocoagulation (ECP) and phacoemulsification cataract extraction (PCE) with intraocular lens placement for reduction of intraocular pressure (IOP) and medication burden in glaucoma.

Methods: A retrospective case review of 91 eyes (73 patients) with glaucoma and cataract that underwent combined PCE/ECP surgery was performed. Baseline demographic and ocular characteristics were recorded, as well as intraocular pressure, number of glaucoma medications, and visual acuity postoperatively with 12-month follow-up. Treatment failure was defined as less than 20% reduction in IOP from baseline on two consecutive visits (at 1, 3, 6, or 12mo postoperatively), IOP ≥21 mm Hg or ≤5 mm Hg on two consecutive visits, or additional glaucoma surgery performed within 12mo after PCE/ECP.

Results: Overall, mean medicated IOP was reduced from 16.65 mm Hg at baseline to 13.38 mm Hg at 12mo (P<0.0001). Mean number of glaucoma medications was reduced from 1.88 medications at baseline to 1.48 medications at 12mo (P=0.0003). At 3mo postoperatively, the success rate was 73.6% (95%CI: 63.3, 81.5), 57.1% at 6mo (95% CI: 46.3, 66.6), and 49.7% at 12mo (95%CI: 38.9, 59.6). Patient demographic characteristics were not associated with treatment success. The only ocular characteristic associated with treatment success was a higher baseline IOP.

Conclusion: Combined PCE/ECP surgery is an effective surgical option for the reduction of IOP and medication burden in glaucoma patients. Patients with higher baseline IOP levels are most likely to benefit from this procedure.

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Purpose: To evaluate the efficacy and safety of endoscopic cyclophotocoagulation (ECP) in the treatment of uncontrolled glaucoma with a prior aqueous tube shunt.

Methods: A prospective, nonrandomized, interventional clinical trial with up to 2 years of follow up included 25 eyes of 25 consecutive glaucoma patients with a previous tube shunt and uncontrolled intraocular pressure (IOP) despite medical therapy. Patients had IOP greater than 21 mm Hg on maximal medications or IOP ≤21 mm Hg but intolerant to medications or using an oral carbonic anhydrase inhibitor. Application of ECP over 360 degrees was performed and subjects were followed for 6 months minimum. Main outcome measures were mean reduction in IOP and medications at 12 months. Success was defined as reduction in IOP of 3 mm Hg and discontinuation of nontolerated glaucoma medications. A failure was defined as continued uncontrolled IOP, vision loss to no light perception, or additional medications or glaucoma surgery required.

Results: At 12 months, the mean IOP dropped from 24.02 to 15.36 mm Hg. The mean of the differences was -7.77 mm Hg (-30.8%). The mean number of medications was 3.2 before laser and 1.5 at 12 months (P<0.001). The success rate at 12 months (n=18) was 88% and remained at that level until the end of the follow-up period of 2 years (n=11, P<0.00005). There were no serious complications.

Conclusions: ECP seems to be a safe and effective treatment in patients with uncontrolled IOP with a prior aqueous tube shunt, and is a reasonable option in this group of refractory glaucoma patients.

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Purpose: To report clinical outcomes after pars plana endoscopic cyclophotocoagulation of the ciliary processes and pars plana (ECP-plus), a novel treatment for refractory glaucoma.

Design: Retrospective, noncomparative interventional case series.

Setting: multicenter tertiary referral academic and clinical practice.

Study population: fifty-three eyes of 53 consecutive subjects undergoing ECP-plus who had uncontrolled intraocular pressure (IOP) despite prior glaucoma surgeries and maximally tolerated medical therapy.

Observation procedure: retrospective analysis of clinical data after ECP-plus and pars plana vitrectomy.

Main outcome measures: primary outcome was IOP at 6 and 12 months. Secondary outcomes were number of glaucoma medications and postoperative complications.

Results: Diagnoses were primary open-angle glaucoma (32%), chronic angle-closure glaucoma (26%), and secondary open-angle glaucoma (OAG, 42%); 50/53 of subjects had 6 months' and 28/53 had 12 months' follow-up data. Preoperative IOP was 27.9±7.5 mm Hg (mean±SD). Postoperative IOP at 6 mo was 10.2±5.6 and at 12 mo was 10.7±5.2 lower than preoperative levels (all P<0.0001). Cumulative treatment success was 81% at 6 mo and 78% at 12 mo. Number of medications fell from 3.4±1.2 pretreatment to 0.8±1.0 at 1 to 6 mo and 0.7±1.2 at 12 mo postoperatively (all P<0.0001). Complications in the initial postoperative period (<3 mo) were hypotony (3/53, 6%), fibrinous uveitis (2/53, 4%), and cystoid macular edema without hypotony (CME; 4/53, 6%). Complications beyond 6 mo occurred in 8/50 (16%) subjects as hypotony (4/50, 8%), choroidal detachment (4/50, 3 with IOP<5 and 1 with IOP≥5; 8%), CME without hypotony (3/50, 6%), and failed corneal graft (1/50, 2%).

Conclusions: The mean IOP was lowered by at least 61% after ECP-plus and IOP lowering was sustained over the follow-up period. Fewer glaucoma medications were needed. Complication rates were comparable with or slightly higher than anterior endoscopic cyclophotocoagulation and acceptable given the refractory nature of disease being treated.

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Purpose: To compare the outcomes of combined endoscopic cyclophotocoagulation (ECP) and phacoemulsification cataract extraction versus cataract extraction alone in eyes with medically controlled open-angle glaucoma (OAG) and visually significant cataract. Setting: Clinical practices of glaucoma specialists and comprehensive ophthalmologists. Design: Prospective nonrandomized matched-control study.

Methods: Consecutive patients with medically controlled OAG and visually significant cataracts were treated with ECP and cataract extraction (study group) or cataract extraction alone (control group). The groups were matched in age and baseline intraocular pressure (IOP). The main outcome measures were the change in IOP and number of glaucoma medications. Secondary measures included visual acuity and postoperative complications.

Results: In the study group (n = 80) the mean IOP decreased (baseline: 18.1 mm Hg ± 3.0 [SD]; 1 year: 16.0 ± 2.8 mm Hg; 2 years: 16.0 ± 3.3 mm Hg). The number of glaucoma medications decreased from 1.5 ± 0.8 to 0.4 ± 0.7 (1 year and 2 years). In the control group (n = 80), the mean IOP was 18.1 ± 3.0 mm Hg (baseline), 17.5 ± 3.6 mm Hg (1 year), and 17.3 ± 3.2 mm Hg (2 years). The mean number of glaucoma medications was 2.4 ± 1.0, 1.8 ± 1.2, and 2.0 ± 1.0, respectively. The difference in IOP and medication reduction between the 2 groups was statistically significant at all timepoints. Visual acuity outcomes and complication rates were similar between the 2 groups.

Conclusion: Combined ECP and cataract extraction resulted in lower IOP and a greater reduction in glaucoma medications than cataract extraction alone in medically controlled OAG patients with visually significant cataract.

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Laser endoscopy is an exciting development that affords ophthalmologists new opportunities in the management of retinal disease, oculoplastics, and glaucoma. This report elucidates the technology and its application in the treatment of glaucoma, as well as highlighting the differences between conventional glaucoma therapy and endoscopic laser management.

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Purpose: To evaluate the safety and efficacy of endoscopic cyclophotocoagulation in the treatment of refractory glaucomas.

Methods: The preoperative and postoperative courses of 68 eyes of 68 patients who underwent endoscopic cyclophotocoagulation at our institution were retrospectively reviewed. Study patients had diverse forms of glaucoma, and most had failed maximal medical therapy as well as failed filtration or transscleral cyclodestructive procedures, or both. Endoscopic cyclophotocoagulation treatment encompassed 180 to 360 degrees of the ciliary body circumference and was performed through a limbal incision (56 eyes, 12 of which underwent concurrent cataract extraction) or pars plana incision (12 eyes). A second laser treatment was required in five eyes (7%).

Results: During the mean follow-up period of 12.9 months, mean +/- SD intraocular pressure decreased from 27.7 +/- 10.3 mm Hg preoperatively to 17.0 +/- 6.7 mm Hg at the final postoperative visit (P < .0001), for a mean reduction of 10.7 mm Hg and a mean percent decrease of 34%. Sixty-one eyes (90%) achieved an intraocular pressure < or = 21 mm Hg. Using this definition of success, Kaplan-Meier analysis predicted a successful outcome in 94% of patients after 1 year and 82% after 2 years. The mean number of glaucoma medications used by each patient was reduced from 3.0 +/- 1.3 preoperatively to 2.0 +/- 1.3 postoperatively (P < .0001). Best-corrected visual acuity was stable or improved in 64 eyes (94%), with four (6%) losing 2 or more lines of Snellen acuity. No case of hypotony (intraocular pressure < 5 mm Hg) or phthisis was observed.

Conclusion: These early results suggest that endoscopic cyclophotocoagulation is a safe and effective therapeutic modality for refractory glaucomas.

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The purpose of this study was to compare the visual performance and optical quality between three new enhanced monofocal intraocular lenses (IOLs). This retrospective study included patients affected by cataracts with corneal astigmatism less than 0.75 D and no ocular comorbidities who underwent cataract surgery with bilateral implantation of Tecnis Eyhance ICB00 (Johnson & Johnson Vision Care, Inc., Jacksonville, FL, USA), Vivinex Impress XY1-EM (Hoya Surgical Optics, Singapore) or IsoPure 123 (PhysIOL, Liege, Belgium) IOLs. Three months postoperatively, monocular and binocular uncorrected and corrected distant, and intermediate and near visual acuities were measured. Binocular defocus curve, photopic contrast sensitivity, Point Spread Function (PSF), low order aberrations (LOAs), high order aberrations (HOAs), objective scatter index (OSI), halo and glare perception were also evaluated. This study included a total of 72 eyes from 36 patients. Visual acuity outcomes, PSF, LOAs, HOAs and OSI were similar between groups. There were no statistically significant differences in terms of photopic contrast sensitivity, halo or glare perception. In patients without ocular comorbidities, the Eyhance ICB00 IOL, the Vivinex Impress IOL and the Isopure IOL—even though based on different optical properties—provided similar results in terms of visual acuity, contrast sensitivity and intraocular aberrations, with no influence on photic phenomena.

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The complexity of the vitreoretinal structure and the delicacy of its tissues pose unique challenges during retinal detachment repair, macular hole closure, epiretinal membrane (ERM) removal, and other retinal procedures. Adequate and reproducible tissue staining is a vital tool to enhance visualization through improved tissue contrast, facilitate precise surgical maneuvers, and ultimately improve postoperative outcomes.

CONCLUSION

The proper use of tissue-staining dyes in vitreoretinal surgery minimizes the risk of intra- and postoperative complications by enhancing visualization of specific tissues and structures and facilitating precise surgical maneuvers. Monoblue DUAL View helps surgeons navigate the complexities of the vitreoretinal structures with greater accuracy and confidence, prioritizing patient safety, procedural efficacy, and surgical precision.

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But: Le but de cette étude est de déterminer l’efficacité et la sécurité de l’implant intraoculaire de chambre postérieure Ankoris pour la correction de l’astigmatisme cornéen lors de la chirurgie de la cataracte.

Matériel et méthode: Dans cette étude rétrospective, 52 yeux parmi les 64 premiers cas consécutifs implantés avec Ankoris entraient dans les critères d’inclusion. L’analyse rétrospective de ces cas consistait essentiellement en la détermination de l’amélioration de l’acuité visuelle et de la réfraction postopératoire. L’analyse de la correction de l’astigmatisme proprement dite a été faite par la méthode d’Alpins. La stabilité rotatoire de l’implant a été relevée par la différence de l’orientation de l’implant dans l’œil à 1 jour et à 3 mois.

Résultats: L’indice de sécurité qui est le quotient de la meilleure acuité visuelle postopératoire par la meilleure acuité visuelle préopératoire était supérieur à 1 dans tous les cas et valait en moyenne 1,96. Le rapport de l’acuité visuelle postopératoire non corrigée par l’acuité visuelle préopératoire corrigée, indice d’efficacité, était de 1,72. L’astigmatisme postopératoire final était de −0,40±0,28 D. Le pourcentage d’astigmatisme corrigé était de 99,3 %. Le vecteur erreur était de 0,1 D avec une orientation quasiment nulle. La rotation moyenne était de 2,16±1,95°.

Conclusion: L’implant Ankoris a présenté, sur cette cohorte relativement large, tous les éléments permettant de conclure que l’implant est à même de corriger l’astigmatisme cornéen au cours de la chirurgie de la cataracte.

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Purpose: To evaluate the effect of angles kappa and alpha on the visual outcomes after implantation of isofocal intraocular lens (IOL) during cataract surgery.
Methods: This prospective study involved 66 eyes undergoing cataract surgery with Isopure IOLs. Exclusion criteria comprised irregular corneal astigmatism exceeding 1.0D, and ocular co-morbidities affecting visual outcomes post-surgery. Evaluation parameters included postoperative refraction, uncorrected and corrected-distance visual acuity (UDVA, CDVA), uncorrected intermediate visual acuity (UIVA), and distance-corrected intermediate visual acuity (DCIVA) at 80 cm. Additionally, postoperative angles alpha, kappa, and wavefront aberrations at a 3-mm pupil using ray tracing were assessed post-surgery at least 60 days later.
Results: Patients had a mean age of 64.48 ± 9.92 years. Mean postoperative manifest refraction spherical equivalent (MRSE) was − 0.21 ± 0.27 D. Mean UDVA and CDVA were LogMAR 0.06 ± 0.04 and 0.02 ± 0.06, respectively. Mean UIVA LogMAR 0.32 ± 0.08 while mean DCIVA was LogMAR 0.29 ± 0.08. Postoperative angles kappa and alpha were 0.39 ± 0.14 mm and 0.45 ± 0.15 mm, respectively. Mean postoperative ocular RMS higher-order aberrations (HOAs) 0.23 ± 0.08. Spherical aberration, coma, and trefoil averaged 0.05 ± 0.07, 0.12 ± 0.03, and 0.07 ± 0.03, respectively. No significant correlations were observed between postoperative angle kappa and alpha with UDVA, CDVA, or HOAs. A non-significant weak positive correlation was noted between angle kappa and UIVA/DCIVA, while no correlation was found between angle alpha and UIVA/DCIVA.
Conclusion: No substantial correlations were found between various postoperative angles kappa and alpha values and postoperative visual acuity metrics (UDVA, CDVA, UIVA, and DCIVA) or higher order ocular aberrations (including, spherical aberration, coma, and trefoil with a 3.0 mm diameter) in pseudophakic eyes implanted with isofocal intraocular lenses (IOLs).

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