Clinical reviews

This new trifocal continues to have the same unbeaten clinical outcomes proven by the FineVision hydrophilic.

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Purpose: To characterize the fluidics of vitreous cutter port in response to aspiration and blade motion using particle image velocimetry techniques. Diverse surgical scenarios and fluid characteristics were replicated.

Methods: The 23-gauge vitreous cutters were immersed in seeded Balanced Salt Solution (BSS) (Alcon, Forth Worth, TX) or egg albumen, and high-speed video was recorded. Fluid velocity, kinetic energy (KE), and acceleration generated by Venturi and peristaltic pumps were measured in aspiration only (200 and 300 mmHg), low-speed vitrectomy (1,600 cuts per minute; 200 mmHg vacuum), and high-speed vitrectomy (3,000 cuts per minute; 300 mmHg vacuum) modes.

Results: The Venturi pump generated significantly higher KE than peristaltic pump in BSS (P < 0.0001 for each pair), and aspiration only yielded significantly higher KE. Cutting activation generated significant acceleration (P < 0.001), and the peristaltic pump produced higher positive and negative acceleration peaks (P < 0.001) than the Venturi pump. In egg albumen, the peristaltic pump generated significantly more KE than the Venturi pump (P < 0.001) and perturbed a much wider area. Acceleration was higher for the peristaltic pump in low-speed mode (P < 0.001), whereas in high-speed modality, the Venturi pump produced the highest acceleration peaks (P < 0.001).

Conclusion: Pump type and blade motion largely influence velocity, KE, and acceleration. In BSS, the Venturi pump induces higher KE and acceleration, although perturbing fluid less diffusely. In egg albumen, the peristaltic pump perturbed a much wider area and induced a higher KE and acceleration than the Venturi pump, even more so at lower cut rates. As a conclusion, particle image velocimetry allowed precise characterization of fluid velocity in response to cutter activation, suggesting a pragmatic approach to surgical scenarios.

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Purpose: To measure the hydraulic resistance (HR) of vitreous cutters equipped with a Regular guillotine Blade (RB) or double edge blade (DEB) at cut rates comprised between 0 and 12,000 cuts per minute (CPM) and compare it with vitreous fragment size. This was an in vitro experimental study; in vivo HR measure and vitreous sampling.

Methods: HR, defined as aspiration pressure/flow rate, was measured in balanced salt solution (BSS; Alcon, Fort Worth, TX) (in vitro) and during pars plana vitrectomy of 20 consecutive patients aged 18 to 65, undergoing macular surgery. HR was recorded at increasing cut rates (500-6000 CPM for the RB and 500-12,000 CPM for the DEB; 5 mL/min flow). Vitreous samples were withdrawn and analyzed with Western and collagen type II and IX immunostaining to evaluate protein size. The main outcome measures were hydraulic resistance (mm Hg/ml/min [±SD]) and optic density for Western blot and immunostaining.

Results: RB and DEB showed identical HR in BSS between 0 and 3000 CPM. Above 3000 CPM, RB HR steadily increased, and was significantly higher than DEB HR. Vitreous HR was also similar for the two blades between 0 and 1500 CPM. Above 1500 CPM, RB offered a significantly higher resistance. Western blot and immunostaining of vitreous samples did not yield a significant difference in size, regardless of blade type and cut rate.

Conclusions: DEB is more efficient, offering a lower HR than RB over 1500 CPM in human vitreous. There is no viscosity reduction as a function of cut-rate between 1500 and 12,000 CPM, as HR does not vary. Translational relevance: Future vitreous cutters will benefit of a DEB; optimal cut rate needs to be defined, and the simple increase of cut rate does not provide benefits after a certain limit to be assessed.

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Purpose: To analyze the refractive and visual outcomes following cataract surgery and implantation of a new hydrophobic trifocal toric intraocular lens (IOL) in Japanese eyes with different degrees of corneal astigmatism.

Methods: A total of 66 eyes from 39 patients implanted with a FineVision HP Toric IOL (Beaver-Visitec International Inc) were analyzed retrospectively. The main outcome measures considered were refraction, monocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), and distance-corrected intermediate visual acuity (DCIVA) at 80 and 66 cm, uncorrected near visual acuity (UNVA) and distance-corrected near visual acuity (DCNVA) at 40 cm. Eyes were evaluated at three months post-surgery.

Results: Sixty-five eyes (98.48%) were within ±0.50D of spherical equivalent, and all were within ±1.00D (mean: 0.00±0.21D). Moreover, 63 eyes (95.45%) had ≤0.50D of residual astigmatism, and all had ≤1.00D (mean: –0.08±0.23D). Similarly, 58 (87.88%) and 60 eyes (90.91%) had ≥20/20 UDVA and CDVA, respectively, with 65 (98.48%) and 66 eyes (100%) achieving ≥20/25 UDVA and CDVA, respectively. In addition, 28 (42.42%) and 23 eyes (34.85%) had ≥20/25 DCIVA at 80 and 66 cm, respectively, with 49 (74.24%) and 52 eyes (78.79%) achieving ≥20/32 DCIVA at 80 and 66 cm, respectively. Finally, 39 (59.09%) and 40 eyes (60.61%) had ≥20/20 UNVA and DCNVA, respectively, with 58 (87.88%) and 59 eyes (89.39%) achieving ≥20/25 UNVA and DCNVA, respectively.

Conclusion: Our study shows that implantation of the new hydrophobic FineVision HP Toric IOL results in accurate refractive outcomes, with good visual acuity at different distances, in Japanese eyes.

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Purpose: To compare the in vitro optical quality of multifocal apodized intraocular lenses (IOLs) at different focal points. Setting: University of Valencia, Valencia, Spain.

Design: Experimental study. Methods: The Acrysof Restor +3.0 diopter (D) multifocal IOL with 2 main foci (bifocal IOL) and the Finevision multifocal IOL with 3 main foci (trifocal IOL) were evaluated. The optical quality was quantified using the modulation transfer function (MTF) at 7 focal points and for 3.0 mm and 4.5 mm apertures. The through-focus MTF at 10 focal points of the IOLs was also recorded.

Results: For the 0.0 D and -2.5 D focal points, the bifocal IOL showed the highest MTF values for pupil sizes as well as for the -3.0 D focal point for a 3.0 mm aperture. For the -1.5 D and -3.5 D focal points, the trifocal IOL provided better MTF values, whereas for -2.0 D and -4.0 D both IOLs provided comparable results for both apertures. The through-focus MTF curves showed 3 and 2 peaks for the trifocal IOL and the bifocal IOL, respectively. With the bifocal IOL, better peak values were obtained at the 0.0 D, -2.0 D, -2.5 D, and -3.0 D focal points, while the trifocal IOL yielded better peak values at the -1.5 D and -3.5 D focal points.

Conclusion: The bifocal IOL is likely to provide a greater range of vision from distance to near than the trifocal IOL; however, at the intermediate focal point (-1.5 D), the trifocal IOL will probably yield better optical quality. Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned.

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Purpose: To measure the longitudinal chromatic aberration (LCA) by both psychophysical methods and in vivo double-pass retinal imaging in patients bilaterally implanted with trifocal diffractive intraocular lenses (IOLs).

Methods: Measurements were performed with a polychromatic adaptive optics system provided with a supercontinuum laser, a Hartmann-Shack wavefront sensor, a deformable mirror, a motorized Badal system, a pupil monitoring system, a double-pass retinal imaging channel, and a psychophysical channel with monochromatically illuminated stimuli. Ten patients (20 eyes) bilaterally implanted with hydrophilic trifocal diffractive IOLs (POD F [FINeVision]; PhysIOL, Liege, Belgium) participated in the study. Measurements were performed in both eyes at three different viewing distances (0.00, +1.75, and +3.50 diopters [D]). Subjective best focus of monochromatic stimuli at five wavelengths (480 to 700 nm) was obtained using the Badal system. Best focused images of through-focus double-pass image series were obtained at three wavelengths (480 to 700 nm). LCA was computed from chromatic difference of focus curves (objective and subjective) as the difference between 480 and 700 nm at near, intermediate, and far.

Results: The average subjective LCA was 0.82 ± 0.05 D for far, 0.27 ± 0.15 D for intermediate, and 0.15 ± 0.15 D for near. The average objective LCA was 0.72 ± 0.10 D for far, 0.19 ± 0.15 D for intermediate, and 0.07 ± 0.17 D for near.

Conclusions: Objective LCA was lower than subjective LCA, which was in agreement with previous studies on patients with phakic and monofocal IOLs. In vivo measurements of LCA enable understanding of the relative contribution of refractive and diffractive LCA and will eventually optimize IOL designs to improve polychromatic image quality.

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Purpose: To measure the longitudinal chromatic aberration in vivo using psychophysical and wavefront-sensing methods in patients with bilateral implantation of monofocal intraocular lenses (IOLs) of similar aspheric design but different materials (hydrophobic Podeye and hydrophilic Poday).

Setting: Instituto de Optica, Consejo Superior de Investigaciones Cientificas, Madrid, Spain.

Design: Prospective observational study.

Methods: Measurements were performed with the use of psychophysical (480 to 700 nm) and wavefront-sensing (480 to 950 nm) methods using a custom-developed adaptive optics system. Chromatic difference-of-focus curves were obtained from best-focus data at each wavelength, and the longitudinal chromatic aberration was obtained from the slope of linear regressions to those curves.

Results: The longitudinal chromatic aberration from psychophysical measurements was 1.37 diopters (D) ± 0.08 (SD) (hydrophobic) and 1.21 ± 0.08 D (hydrophilic). From wavefront-sensing, the longitudinal chromatic aberration was 0.88 ± 0.07 D and 0.73 ± 0.09 D, respectively. At 480 to 950 nm, the longitudinal chromatic aberration was 1.27 ± 0.09 D (hydrophobic) and 1.02 ± 0.13 D (hydrophilic). The longitudinal chromatic aberration was consistently higher in eyes with the hydrophobic IOL than in eyes with the hydrophilic IOL (a difference of 0.16 D and 0.15 D, respectively). Similar to findings in young phakic eyes, the longitudinal chromatic aberration from the psychophysical method was consistently higher than from wavefront-sensing, by 0.48 D (35.41%) for the hydrophobic IOL and 0.48 D (39.43%) for the hydrophilic IOL.

Conclusion: Longitudinal chromatic aberrations were smaller with hydrophilic IOLs than with hydrophobic IOLs of the same design.

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Purpose: To evaluate changes in angle κ after the implantation of a trifocal intraocular lens (IOL) and to assess the postoperative outcomes of patients with different angle κ values.

Setting: IOA Madrid Innova Ocular, Madrid, Spain.

Design: Prospective trial.

Methods: Sixty-three eyes from 63 patients who had bilateral implantation of a diffractive trifocal IOL (POD F, PhysIOL) were included. Pupil offset was used as the best estimate of angle κ and was measured using Pentacam (Oculus) preoperatively and at 3 months postoperatively. Postoperative refractive outcomes (sphere, cylinder, and manifest refraction spherical equivalent) and visual outcomes at far, intermediate, and near distance were assessed and compared between eyes with small pupil offset and eyes with large pupil offset. Quality of vision was assessed using a subjective questionnaire.

Results: There was a significant decrease in pupil offset values postoperatively (mean: 0.197 ± 0.12 mm) compared with those preoperatively (mean: 0.239 ± 0.12 mm), with a mean decrease of -0.042 mm (P = .0002). The same significant decrease was found for both right and left eyes, when analyzed separately. No statistically significant difference was found in any of the refractive and visual acuity outcomes between eyes with small pupil offset and eyes with large pupil offset. The majority of patients (14 of 16) complaining of significant halos had eyes with small pupil offset.

Conclusions: Large pupil offset did not negatively affect visual and refractive outcomes. The tolerance to larger pupil offset might be due to the IOL optical design, with the first diffractive ring being larger than other commonly used multifocal IOLs. More studies comparing various diffractive IOL models would be useful to confirm such hypothesis.

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Purpose: To study the agreement between manifest refraction and objective refraction measured with two autorefractor models and an aberrometer in eyes implanted with a trifocal diffractive intraocular lens (IOL).

Setting: IOA Madrid Innova Ocular, Madrid, Spain.

Design: Prospective comparative cohort study.

Methods: An autorefractor keratometer (KR-8800), based on a Scheiner double pinhole, and a 3-dimension wavefront topography aberrometer system (OPD-Scan III), based on the scanning-slit retinoscopy principle, were used to obtain objective refraction readings. In addition, lower-order Zernike coefficients (Z) were used to calculate objective refraction. A set of 7 different results was obtained in power vector notation (spherical equivalent [SE], Jackson cross-cylinder, axes at 180 degrees and 90 degrees [J0] and Jackson cross-cylinder, axes at 45 degrees and 135 degrees [J45]) for 7 different methods: manifest refraction, autorefraction obtained with the autorefractor keratometer, WF-P (Z-based objective refraction for the photopic pupil), WF-M (Z-based objective refraction for the mesopic pupil), WF-4 (Z-based objective refraction for a 4.0 mm pupil), OPD-C (autorefraction measured with the 3-dimension wavefront topography aberrometer system under photopic conditions), and OPD-M (autorefraction measured with the 3-dimension wavefront topography aberrometer system under mesopic conditions).

Results: The study comprised 102 eyes from 51 cataract patients who underwent binocular implantation of a diffractive trifocal IOL (FineVision POD F). All 6 objective methods yielded more negative SE values than manifest refraction (P < .001). As for the astigmatism components (J0 and J45), only autorefraction (P = .003) and OPD-M (P < .001) differed significantly from manifest refraction. The best and worst correlation for the SE component were intraclass correlation coefficient (ICC) = 0.70 (for WF-M) and ICC = 0.48 (for WF-4).

Conclusion: Objective methods tend to yield more negative sphere values than manifest refraction.

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Introduction: Les membranes épirétiniennes idiopathiques semblent liées au décollement postérieur du vitré. La vitrectomie postérieure et le pelage en sont le traitement de choix. Le bleu tryptan colore les membranes épirétiniennes et à un moindre degré, la limitante interne, ce qui permet leur ablation sélective et complète, facilitant ainsi le geste chirurgical. Une étude prospective est menée évaluant, d’une part l’intérêt d’une coloration sélective associée au geste chirurgical, et d’autre part l’incidence des complications postopératoires et l’influence sur le pronostic visuel final.

Matériel et méthodes: Quatorze patients présentant une membrane épirétinienne idiopathique unilatérale sont opérés par un seul et même chirurgien. Une vitrectomie complète puis un échange fluide-air permet l’injection de 0,2 ml de bleu Trypan 0,15 % non dilué en regard de la membrane et la réalisation de son pelage. L’acuité visuelle pré-opératoire, les complications postopératoires, ainsi que le statut oculaire à la fin du suivi sont analysés. Toutes les membranes sont étudiées en microscopie électronique. Un examen angiographique systématique est pratiqué avant et après chirurgie.

Résultats: Les résultats préliminaires montrent une ablation complète et facilitée des membranes. La coloration est rapide et facile à exécuter. Le colorant ne présente pas d’effet toxique à court terme. Les résultats fonctionnels à 3 mois montrent une amélioration de la fonction visuelle et une disparition des métamorphopsies.

Conclusion: La technique de coloration des membranes épirétiniennes idiopathiques au bleu tryptan est, à l’heure actuelle, une bonne alternative à l’utilisation du vert d’indocyanine.

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Purpose: To assess the efficacy of novel vitreous cutter blades compared with the regular guillotine by means of particle image velocimetry. Tested blades included a regular blade (RB) and newer designs where a circular (hole blade [HB]) or a slit aperture (slit blade [SB]) had been opened proximal to the cutting edge. Methods: Twenty-three–gauge probes were immersed in BSS or egg albumen, and high-speed video (1,000 frames per second) was recorded. Duty cycle, flow rate, and acceleration generated by Venturi and peristaltic pumps were measured under cutter settings simulating “low-speed” vitrectomy (1600 cuts per minute, 200 mmHg vacuum) and “high speed” vitrectomy (3000 cuts per minute, 300 mmHg vacuum. Results: The SB and HB had a significantly more favorable duty cycle than that of the RB (P < 0.01) and higher BSS flow rate regardless of the aspiration. The SB flow rate in albumen was significantly higher than that of the HB and RB only over 1,000 cuts per minute using a peristaltic pump and at any cut rate with Venturi pump (P < 0.001). The SB also yielded the lowest fluid acceleration than both the HB and SB (P < 0.001 in all cases). Conclusion: The HB and SB proved to be significantly more efficient than the RB, with better duty cycle and higher flow rate. The SB generated significantly less fluid acceleration than any other tested blade, regardless of the fluid viscosity and pump technology. The SB design is significantly more efficient and possibly safer than both HB and RB.

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Purpose: To show the visual and refractive outcomes in Asian eyes with cataract when bilaterally implanted with either a hydrophobic FineVision POD F GF or a hydrophilic FineVision POD F intraocular lens (IOL).
Methods: Forty-six patients were randomized to receive POD F GF or POD F IOLs. Visual and refractive outcomes were assessed up to 24 months post-surgery. Measurements included uncorrected-distance visual acuity, corrected-distance visual acuity (CDVA), distance-corrected intermediate visual acuity (DCIVA), distance-corrected near visual acuity (DCNVA), refraction, defocus curve, photopic and mesopic contrast sensitivity, and patient-reported outcomes.
Results: Mean spherical equivalent was close to emmetropia for both groups and stable across postoperative visits. Overall, 97.73% and 100% of eyes in the POD F GF IOL group and 95.65% and 100%, of eyes in the POD F IOL group were within ± 1.00D of the target refraction at 12 and 24 months, respectively. All patients showed a CDVA of ≥ 20/25 at 12- and 24-months post-surgery. In both groups, 24 months post-surgery 91% of patients presented a DCIVA of ≥ 20/25 and 83.3% of patients had a DCNVA of ≥ 20/25. Defocus curve showed continuous visual acuity, being 20/32 or better in both groups over a 4.00D range between 1.00D and − 3.00/-3.50D. Both groups showed good contrast sensitivity values for photopic and mesopic conditions. Overall, 86.4%, 86.4%, and 72.7% of patients implanted with the POD F GF IOL reported not wearing glasses at all for distance, intermediate, and near vision, respectively. These values were 81.8%, 86.4%, and 90.9% for patients implanted with the POD F IOL. Both groups of patients reported similar satisfaction percentages (100% very satisfied/satisfied) and would recommend the procedure (100% definitively yes/probably yes).
Conclusion: This study demonstrates good visual and refractive outcomes for both the FineVision POD F GF and the FineVision POD F IOLs when implanted in Asian eyes.

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Purpose: To show clinical outcomes after bilateral implantation of either a hydrophobic FineVision POD F GF or a hydro-philic FineVision POD F intraocular lens (IOL) (Beaver-Visitec International, Inc).

Methods: A total of 110 patients with cataract were randomized to receive either POD F GF or POD F IOLs and followed up for 2 years. The measurements included refraction, monocular and binocular uncorrected and corrected distance (UDVA and CDVA), intermediate (UIVA and DCIVA), and near (UNVA and DCNVA) visual acuities, defocus curve, photopic and mesopic contrast sensitivity, photic phenomena, and patient-reported outcomes.

Results: The mean spherical equivalent was similar in both groups and stable across visits (< 0.25 diopters [D]). At 2 years, 81.8% and 90.5% of eyes were within ±0.50 D in the POD F GF and POD F IOL groups, respectively (100% for ±1.00 D in both groups). At 2 years, 100% and 90.5% of the patients presented a binocular CDVA of 20/25 or better; 93.9% and 85.7% of patients a DCIVA of 20/25 or better and 87.5% and 70% of patients a DCNVA of 20/25 or better, for the POD F GF and POD F IOL groups, respectively. The defocus curve showed continuous visual acuity, being 20/32 or better in both groups over a 4.50 D range. Both groups presented good contrast sensitivity for photopic and mesopic conditions, and the size and intensity of halo and glare phenomena were similar between the two. Both groups also included a high percentage of patients who reported that they had stopped wearing glasses and greater than 80% satisfaction and recommendation levels.

Conclusions: This study showed comparable long-term visual and refractive outcomes of both IOL models after cataract surgery.

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