Clinical reviews

Purpose: To determine the visual and refractive outcomes of trifocal toric intraocular lens (IOL) implantation in Asian eyes with cataract and astigmatism.

Setting: Asian Eye Institute, Makati City, Philippines.

Design: Prospective study.

Methods: 187 eyes were implanted with the FineVision POD FT IOL and followed for 2 years. The measurements included subjective refraction, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), distance-corrected intermediate visual acuity (DCIVA), uncorrected near visual acuity (UNVA), distance-corrected near visual acuity (DCNVA), defocus curve, photopic and mesopic contrast sensitivity, and rotational stability.

Results: The mean spherical equivalent and cylinder values were, respectively, -0.07 ± 0.34 diopters (D) and -0.48 ± 0.31 D at the 2-year follow-up. At this same follow-up, 69.4% of patients had monocular CDVA and 79.3% had binocular UDVA ≤0.0 logMAR. For intermediate vision, monocular DCIVA reached 74.1%, while binocular UIVA was 86.2% ≤ 0.1 logMAR. Near vision showed 63% for monocular DCNVA and 70.7% for binocular UNVA ≤0.1 logMAR. The mean values at this follow-up were 0.02 ± 0.08, 0.08 ± 0.10, and 0.10 ± 0.12 logMAR for CDVA, DCIVA, and DCNVA, respectively. At the visual acuity threshold of ≤0.20 logMAR, the binocular defocus curve extended up to -3.75 D. Stable contrast sensitivity values were obtained at the different follow-ups. The mean IOL rotation was ≤2 degrees.

Conclusions: The FineVision POD FT IOL yielded good visual outcomes at far, near, and intermediate distances with accurate refractive outcomes and good rotational stability in Asian eyes.

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We studied the recovery of retinal pigment epithelium and retinal function after 80 minutes of pressure-induced ischemia in rabbits. Just before restoring circulation, we gave intravenous mannitol (an osmotic agent and free-radical scavenger), dextromethorphan (an N-methyl-D-aspartate receptor antagonist), or catalase (an antioxidant enzyme). Mannitol has not previously been shown to be protective for retinal or retinal pigment epithelial ischemia. At 24 hours after reperfusion, the electroretinogram b-wave was reduced to 37% of preischemic amplitude in untreated eyes, but it recovered to 67% to 80% after treatment with all three agents. The c-wave was replaced by a negative slow PIII response in control eyes and in seven of 12 catalase-treated eyes, but it recovered by 58% to 82% in the remaining catalase-treated eyes and all the mannitol- and dextromethorphan-treated eyes. Histologic examination confirmed that retinal pigment epithelium as well as retina had been damaged by the ischemia. The effects of mannitol seem of special interest, since the drug has a dual mechanism of action and is clinically available.

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Purpose: To compare the outcomes of combined microbypass stent implantation, cataract extraction, and endocyclophotocoagulation (ECP) with those of implantation of the same microbypass stent with concomitant cataract surgery in patients with open-angle glaucoma (OAG).

Setting: Private Practice, Sioux Falls, South Dakota, USA.

Design: Retrospective consecutive case series.

Methods: Patients from January 2015 to August 2016 were included. The study group comprised eyes that had implantation of a microbypass stent in combination with cataract extraction and ECP. To compare outcomes, a control group of eyes with similar baseline characteristics that had implantation of a stent in combination with cataract surgery was established. Data were collected preoperatively and postoperatively at 1 day, 1 week, and 1, 3, 6, and 12 months. Data included intraocular pressure (IOP) and number of glaucoma medications.

Results: The mean preoperative IOP was 21.49 mm Hg ± 9.56 (SD) in the study group (51 eyes) and 20.66 ± 3.23 mm Hg in the control group (50 eyes). Twelve months postoperatively, the mean IOP reduction was 7.14 mm Hg in the study group and 4.48 mm Hg in the control group and the medication reduction was 38% (0.68) and 63% (1.06), respectively.

Conclusions: Patients who had implantation of the microbypass stent in combination with cataract surgery and ECP had significantly better IOP reduction than those who did not have ECP. The combination procedure was also effective in patients with severe OAG.

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Purpose: To evaluate the clinical outcomes of cataract surgery using novel diffractive trifocal intraocular lenses (IOLs) in Koreans.

Methods: This was a retrospective, consecutive, interventional study of cataract surgery using POD FineVision IOL implantation. Complete ophthalmologic examinations were performed preoperatively and postoperatively. Defocus curves were assessed over a range of +1.5 to -4.0 diopters in 0.5-diopter steps at one month postoperatively. Uncorrected distant visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity, corrected distant visual acuity, distant-corrected intermediate visual acuity, and distant-corrected near visual acuity were assessed one month postoperatively, and manifest refraction was performed during every visit.

Results: The study analyzed 31 eyes in 20 patients. There were statistically significant improvements in uncorrected distance visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity, corrected distance visual acuity, distance-corrected intermediate visual acuity, and distance-corrected near visual acuity (p < 0.001). The final postoperative refractive outcomes showed statistically significant myopic shifts compared to the target refraction based on SRK/T, SRK-II, Haigis, and Hoffer Q formulas (p < 0.001).

Conclusions: POD FineVision IOLs provide stable visual restoration with improvements of near and intermediate vision in presbyopic eyes. POD FineVision IOLs show myopic shift in a Korean population; therefore, surgeons should be cautious when selecting IOL power in such patients.

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Proliferative vitreoretinopathy (PVR) is a complication that develops in 5% to 10% of patients who undergo surgery to correct a detached retina. The only treatment option for PVR is surgical intervention, which has a limited success rate that diminishes in patients with recurring PVR. Our recent studies revealed that antioxidants prevented intracellular signaling events that were essential for experimental PVR. The purpose of this study was to test whether N-acetyl-cysteine (NAC), an antioxidant used in a variety of clinical settings, was capable of protecting rabbits from PVR. Vitreous-driven activation of PDGFRα and cellular responses intrinsic to PVR (contraction of collagen gels and cell proliferation) were blocked by concentrations of NAC that were well below the maximum tolerated dose. Furthermore, intravitreal injection of NAC effectively protected rabbits from developing retinal detachment, which is the sight-robbing phase of PVR. Finally, these observations with an animal model appear relevant to clinical PVR because NAC prevented human PVR vitreous-induced contraction of primary RPE cells derived from a human PVR membrane. Our observations demonstrate that antioxidants significantly inhibited experimental PVR, and suggest that antioxidants have the potential to function as a PVR prophylactic in patients undergoing retinal surgery to repair a detached retina.

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Purpose: To compare Nd:YAG capsulotomy rates following implantation of two diffractive trifocal intraocular lenses (IOLs).

Methods: This multi-center retrospective analysis included patients who underwent uncomplicated lens phacoemulsification and were implanted with a diffractive trifocal IOL: FineVision MicroF (PhysIOL, Liège, Belgium) or AT Lisa tri 839MP (Carl Zeiss Meditec, Jena, Germany). All surgeries were performed during the same period. The postoperative follow-up period was at least 1 year. Chi-square and Kaplan-Meier tests analyzed non-parametric estimates for survival/failure functions. The Wilcoxon (Breslow) test compared Nd:YAG capsulotomy rates between the two groups.

Results: Of 5,130 eyes included, 3,387 were implanted with the FineVision MicroF IOL and 1,743 with the AT Lisa tri 839MP IOL. There were no statistical differences in age, axial length, or IOL power between groups. Nd:YAG capsulotomies were necessary in 330 eyes (9%) in the FineVision group and 408 eyes (23%) in the AT Lisa tri group (P < .001). The probability of having Nd:YAG capsulotomy up to 9 months postoperatively was equal for both lenses. Beyond 9 months, the Nd:YAG capsulotomy rate increased significantly more in the AT Lisa tri group, reaching a probability of 35% for eyes with a follow-up of 34 to 44 months, whereas in the FineVision group the probability was 14% after a follow-up of 37 to 47 months. The differences in survival (without Nd:YAG capsulotomy)/failure (with Nd:YAG capsulotomy) functions were significant (P < .001).

Conclusions: Eyes implanted with the FineVision MicroF IOL required significantly fewer Nd:YAG laser capsulotomies than those with the AT Lisa tri 839MP IOL during the first years after implantation. The design of the IOL platforms could account for these differences. 

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Purpose: To evaluate reading performance of a trifocal intra-ocular lens (IOL) at near and intermediate distances using the Salzburg Reading Desk.

Setting: International Vision Correction Research Centre and David J. Apple Laboratory, University Eye Clinic, Heidelberg, Germany.

Design: Prospective, nonrandomized clinical study.

Methods: Follow-up examinations at a minimum of 3 months postoperatively included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, uncorrected (UIVA) and distance-corrected (DCIVA)) intermediate as well as uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity. Uncorrected and distance-corrected reading acuity at 40 cm for near, 80 cm for intermediate distance, and at the patient's preferred near and intermediate distances were evaluated with the reading desk.

Results: In this study, 22 eyes of 11 patients having cataract surgery with implantation of the trifocal Finevision IOL were evaluated. Postoperative monocular Snellen median values were 20/21.44 (range 20/52.61 to 20/14.49) for UDVA, 20/20.47 (range 20/38.11 to 20/16.64) for UIVA, and 20/26.39 (range 20/43.76 to 20/18.24) for UNVA. Subjective intermediate distance at the binocular uncorrected examination on the reading desk was 64.2 cm (range 51.9 to 80.0) with a reading acuity of 0.10 logMAR (range 0.32 to 0.00). Subjective near distance at the uncorrected binocular reading desk examination was 36.5 cm (30.8 to 41.2) with a near reading acuity of 0.06 logMAR (range 0.23 to -0.01). The preferred distances differed significantly from the fixed ones of 40 and 80 cm. The preferred intermediate distance was almost consistent, with the intermediate addition of 1.75 D corresponding to 57.1 cm.

Conclusion: The visual and reading function of the trifocal IOL was better at the patient's preferred near and intermediate distances.

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Purpose: To evaluate and compare the accuracy of 2 toric intraocular lens (IOL) calculators with or without a new regression formula.

Setting: Ein-Tal Eye Center, Tel-Aviv, Israel, and the Lions Eye Institute, Nedlands, Western Australia, Australia.

Design: Retrospective case series.

Methods: A new regression formula (Abulafia-Koch) was developed to calculate the estimated total corneal astigmatism based on standard keratometry measurements. The error in the predicted residual astigmatism was calculated by the Alcon and Holladay toric IOL calculators with and without adjustments by the Abulafia-Koch formula. These results were compared with those of the Barrett toric calculator.

Results: Data from 78 eyes were evaluated to validate the Abulafia-Koch formula. The centroid errors in predicted residual astigmatism were against-the-rule with the Alcon (0.55 diopter [D]) and Holladay (0.54 D) toric calculators and decreased to 0.05 D (P < .001 [x-axis], P = .776 [y-axis]) and 0.04 D (P < .001 [x-axis], P = .726 [y-axis]) with adjustments by the Abulafia-Koch formula. The Alcon and the Holladay toric calculators had a higher proportion of eyes within ±0.50 D of the predicted residual astigmatism with the Abulafia-Koch formula (76.9% and 78.2%, respectively) than without it (both 30.8%). There were no significant differences between the results of the Abulafia-Koch-modified Alcon and the Holladay toric calculators and those of the Barrett toric calculator.

Conclusion: Adjustment of commercial toric IOL calculators by the Abulafia-Koch formula significantly improved the prediction of postoperative astigmatic outcome.

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Purpose: To evaluate objective and subjective results after bilateral implantation of a diffractive trifocal intraocular lens (IOL) in a Mexican population.

Methods: Prospective, interventional case series involved 15 cataract surgery patients who underwent bilateral implantation of the trifocal Micro F lens FineVision IOL (PhysIOL, Liège, Belgium). Objective analysis involved assessment of monocular uncorrected distance (UDVA), near (UNVA) at 30 and 40 cm, and intermediate visual acuity (UIVA) at 50, 60, and 70 cm, preoperatively, and at postoperative months 1, 3, and 6. Higher-order aberrations were assessed via aberrometry. Contrast sensitivity was determined via modulation transfer function. Subjective outcomes were assessed using the National Eye Institute Visual Functioning Questionnaire-25 (VFQ-25).

Results: At postoperative month 6, mean monocular UDVA was 0.06 ± 0.11 logMAR, and UNVA was 0.03 ± 0.04 logMAR at 30 cm and 0.05 ± 0.08 logMAR at 40 cm. Mean UIVA at 50, 60, and 70 cm was 0.12 ± 0.06, 0.13 ± 0.08, and 0.04 ± 0.08 logMAR, respectively. Spherical equivalent at postoperative month 3 was 0.23 ± 0.4 diopters (D). Aberrometry revealed a mean RMS of 0.18 microm and PSF of 0.19 (Strehl ratio). VFQ-25 questionnaire results showed a mean score of 93.64 ± 4.19 points (maximum 100 points). Vision during distance and near activities was reported as "excellent." Adverse events were reported as occurring "never to occasionally."

Conclusion: Implantation of a diffractive trifocal IOL in a Mexican population appears safe and effective, both objectively and subjectively. Good uncorrected visual acuity outcomes were achieved at far, near, and intermediate distances. Overall patient satisfaction was excellent.

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Purpose: Unexplained visual field loss after pars plana vitrectomy (PPV) has been reported in up to 14% of all uncomplicated cases with signs varying from visual field defect and disc pallor, to optic atrophy, loss of vision, and phthisis bulbi. Among the postulated pathogenic mechanism is ocular hypoperfusion due to insufficient blood pressure (NBP) and/or elevated IOP, or to their mismatch. The purpose of this study is to assess if, to what extent, and for how long the intraoperative simultaneous variation of IOP and NBP causes mean ocular perfusion pressure (MOPP) to drop below values considered safe, during PPV.

Methods: An IOP sensor placed in the infusion cannula recorded 6 readings per second, while arm systolic and diastolic NBP were taken every 5 minutes throughout surgery and deemed stable in between readings. Supine MOPP was calculated as (115/130) mean arterial pressure − IOP. Surgical monitor video overlay displayed all data in real time and saved them for analysis.

Results: Average IOP significantly increased during surgery, while NBP decreased, compared to baseline. As a result, intraoperative MOPP decreased an average 37.1% compared to baseline (range, 13.8%–58.6%; P < 0.05). Of 18 patients, 16 (88.8%) had a significant intraoperative MOPP decrease; 15/18 (83.3%) spent more than 20%, and 5/18 (27.7%) more than 50% of the entire surgery below 30 mm Hg MOPP. Surgical maneuvers, such as phacoemulsification, silicone oil removal, and fluid injection, were associated with significant MOPP decrease, while peeling and vitrectomy were not.

Conclusions.: The MOPP may decrease significantly in course of PPV, acutely and for longer time. Surgical maneuvers, including silicone oil removal and combined phacoemulsification, pose a higher risk for MOPP reduction. Discretion should be exercised while administering deep sedation, since it may further lower MOPP through undue blood pressure reduction.

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Purpose: To report the intraocular pressure (IOP) lowering effect of endoscopic cyclophotocoagulation (ECP) treatment through 1 versus 2 corneal incisions.

Methods: This is a retrospective consecutive case review of combined ECP and phacoemulsification (PE). Group 1 included patients undergoing PE-ECP through 1 clear cornea incision and group 2 involved PE followed by ECP through 2 incisions. The 1 versus 2 site selection was performed in a nonrandomized fashion at the time of surgery. Data including age, sex, preoperative diagnosis, number of preoperative and postoperative glaucoma medications, complications, treatment failures, and IOP were collected and analyzed using analysis of variance and t tests where appropriate.

Results: Group 1 included 15 patients and group 2 included 25 patients. Age of patients in group 1 (66.07+/-17.73) and group 2 (73.48+/-11.31) were similar (P=0.11). Visual acuity in group 1 ranged from 20/40 to 20/400 and from 20/40 to counting fingers in group 2. The preoperative diagnoses were similar between the 2 groups. Preoperative IOP was 23.60+/-3.89 in group 1 and 24.48+/-8.99 in group 2 (P=0.72). IOP decreased in group 1 from 23.60+/-3.89 to 17.93+/-4.38 (P=0.0008) and in group 2 from 24.48+/-8.99 to 13.88+/-3.22 (P=0.00001) with 3 months of follow-up. IOP at 3 months was significantly lower in group 2 compared with group 1 (P=0.002). Six-month IOP data for group 1 (16.00+/-2.77) and group 2 (13.00+/-3.09) remained statistically significant in favor of 2-site PE-ECP (P=0.04). Glaucoma medication use decreased more in group 2 (2.56+/-0.71 to 0.52+/-0.59) versus group 1 (2.47+/-0.74 to 1.93+/-0.88) (P=0.00001).

Conclusions: Two-site PE-ECP may result in statistically significant IOP lowering and less dependence on glaucoma medications compared with single site PE-ECP.

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Purpose: This study aimed to evaluate one-year clinical outcomes in cataract patients with pre-existing corneal astigmatism implanted with a biconvex aspheric toric monofocal intraocular lens (IOL) with a double C-loop haptic-design.
Methods: One hundred and eighteen patients (236 eyes) with corneal astigmatism (≥ 0.75D) were implanted bilaterally with the PODEYE toric IOL and assessed up to 1-year after surgery. Postoperative evaluation included monocular and binocular uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), under both photopic and mesopic lighting conditions, refraction, photopic and mesopic contrast sensitivity (with and without glare), and rotational stability.
Results: At the last postoperative visit, 74.6% and 95.8% of eyes were within ± 0.50D and ± 1.00D of the target refraction, respectively. About 78.0% and 97.5% of eyes showed a postoperative refractive cylinder of ≤ 0.50D and ≤ 1.00D, respectively. The mean manifest spherical equivalent value was 0.16± 0.40D, and the mean refractive cylinder value was − 0.42± 0.33D. 97.5% and 100% of patients had a binocular UDVA and CDVA of ≥ 20/32, respectively. The mean binocular UDVA and CDVA were 0.01± 0.09 and − 0.03± 0.07 logMAR, respectively. Under mesopic conditions, 79.5% and 89.8% of patients showed a binocular UDVA and CDVA of ≥ 20/32, respectively. The mean binocular UDVA and CDVA were 0.15± 0.11 and 0.10± 0.10 logMAR, respectively. Binocular contrast sensitivity function both under photopic and mesopic conditions was good. The mean absolute IOL rotation was 2.52± 2.59 degrees with 98.56% of eyes having a rotation of less than 10 degrees.
Conclusion: Bilateral implantation of an aspheric toric monofocal IOL with a double C-loop haptic design in cataract patients with corneal astigmatism provides good visual and refractive outcomes up to 1-year post-surgery.

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Purpose: To evaluate the potential efficacy of ophthalmic laser microendoscope photocoagulation of the ciliary processes in the management of intractable neovascular glaucoma.

Methods: Ten patients with intractable neovascular glaucoma underwent ophthalmic laser microendoscope ciliary process ablation via a pars plana incision. The device and surgical technique are discussed.

Results: Preoperative intraocular pressure (IOP) ranged from 36 mmHg to 62 mmHg (mean, 43.6 mmHg). Postoperative final IOP ranged from 3 mmHg to 27 mmHg (mean, 15.3 mmHg). This represents an absolute decrease of 28.3 mmHg (65%). Postoperatively, 9 eyes had an IOP of less than 21 mmHg, although 3 of these eyes required medication. One eye attained a final IOP of 27 mmHg. All eyes were treated once. Nine patients were treated with carbonic anhydrase inhibitors preoperatively, and six patients were able to discontinue this medication postoperatively. Phthisis was not observed, but hypotony evolved in two eyes with chronic retinal detachment. Follow-up ranged from 6 to 11 months (mean, 8.8 months).

Conclusion: This new therapeutic modality, which combines endoscopic visualization of the ciliary processes with diode laser photocoagulation, can be effective in the management of intractable neovascular glaucoma.

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Background: To compare the in vitro optical quality of two new trifocal intraocular lenses at different focal points as a function of pupil size.

Methods: Two intraocular lenses having different design approaches were evaluated: the AT LISA tri 839MP with a trifocal diffractive design, and the FineVision, which combines two distinct apodized bifocal diffractive profiles resulting in three foci. A PMTF optical bench was used to assess the intraocular lenses' performance, and as optical quality metrics, the through-focus modulation transfer function was selected; that is, it was measured at 10 focal points and for four different apertures (2.0, 3.0, 3.75 and 4.5 mm).

Results: For both lenses, the through-focus curve showed three peaks, corresponding to far, intermediate and near focal point. At the 0.0 D focal point, the FineVision yielded better results for larger pupils. At the −1.5 D focal point, both lenses performed worse for larger pupils. At the −3.0 D, the FineVision provided better results for all apertures. However, at the −3.5 D focal point, it was the AT LISA tri 839MP that outperformed the FineVision for larger pupils.

Conclusions: The two trifocal intraocular lenses under analysis have modulation transfer function peaks that correspond to the far, intermediate and near focal points. For larger pupil sizes, the FineVision seems to provide better results at far focal points, while the AT LISA tri 839MP not only provides better results at the intermediate and near focal points, but is also less pupil size-dependent.

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Purpose: To examine and assess the halos generated in distance vision by multifocal intraocular lenses (IOLs) using both in vitro objective and in vivo subjective methods.

Setting: The objective method was carried out in the optics laboratory of the Applied Optics and Image Processing Group (Universitat Politècnica de Catalunya -Barcelona). The psychophysical and subjective methods were carried out in the Instituto de Oftalmología Avanzada Madrid Innova Ocular.

Design: Optical bench results and prospective evaluation of consecutive cases.

Methods: The IOLs examined were TECNIS^®one-piece bifocals with addition powers of +4.00 D, +3.25 D, and +2.75 D and the trifocals AT-LISA-tri^® and FineVision^®. In the objective assessment, we examined halos around the far focus images of a pinhole formed by each IOL in an optical bench. For the in vivo study, we recruited 100 patients who had been bilaterally implanted one month earlier with the IOLs under study. Participants were subjected to psychophysical halometry (Halo v1.0) on the eye with better, distance-corrected, visual acuity and were required to subjectively grade halos by responding to the question "How much do halos bother you?"

Results: The objective method revealed that the halo size increased with addition power and that the two trifocals gave rise to a double-halo pattern. Scores in the halometry also indicated a direct relationship between the halo size and addition power. The subjective results indicated fewer complaints about halos associated with the trifocal than bifocal IOLs.

Conclusions: The addition power of the tested IOLs affected both laboratory-measured and patient-perceived halos. Trifocal lenses generated fewer complaints about halos. Precise: Multifocal intraocular lenses (MIOLs) give rise to halos observed by patients under conditions of dim lighting. This study compares laboratory characterized halos generated by five MIOLs with patient-perceived halos.

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Purpose: To evaluate the safety and efficacy of perfluorocarbon-perfused vitrectomy (PCPV) as a novel technique in obtaining a large undiluted vitreous biopsy.

Design: Cross-sectional interventional study.

Methods: Patients with undiagnosed posterior uveitis scheduled for vitreous biopsy underwent PCPV. A syringe containing 5 ml of perfluorocarbon liquid (PCL) was connected to the infusion line. Aspiration of the central and superior vitreous was initiated with simultaneous infusion of the PCL.

Results: Twenty eyes of 20 patients were included in this study. The mean +/- SD amount of PCL used in each eye was 4.50 +/- 0.69 ml. The volume of vitreous sample obtained in each eye was 2.25 +/- 0.413 ml. No complications occurred.

Conclusions: PCPV is a safe and effective method for obtaining large undiluted vitreous biopsy.

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Purpose: To examine the efficacy and safety of combined phacoemulsification and endoscopic cyclophotocoagulation (phaco-ECP) compared to phacoemulsification alone in patients with primary open-angle glaucoma (POAG).

Methods: We performed a retrospective notes review of 99 consecutive clinical records of patients with POAG from 2 London eye departments. A total of 69 patients who underwent phaco-ECP and 30 sex- and age-matched control patients who underwent cataract surgery alone were included. Data on intraocular pressure (IOP), visual acuity (VA), number of ocular hypotensive medications, and postoperative complications were collected over 12 months. The primary outcome measure was defined as an IOP within normal limits (<21 mm Hg) and at least a 20% reduction in IOP from baseline.

Results: Mean IOP was significantly decreased in both groups after 1 year (p<0.001 from baseline). The success rate was significantly higher in the phaco-ECP group (69.6%) than in the phaco group (40%) after 1 year (p = 0.004). Reduction in mean IOP and number of medications was also greater in the phaco-ECP group after 1 year (IOP reduction: 4.5 ± 5.13 mm Hg vs 1.83 ± 3.61 mm Hg; p = 0.007; number of medications reduction: 0.73 ± 0.71 vs 0.23 ± 0.56; p = 0.001). Both groups achieved a similar improvement in VA. There was a higher incidence of minor and self-limiting complications in the phaco-ECP group (p<0.047).

Conclusions: Phaco-ECP resulted in a greater reduction in IOP and number of medications than phacoemulsification alone in POAG.

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Due to differences in expansile properties and duration, perfluorethane gas may offer advantages over other gases presently used for pneumatic retinopexy. Seventeen eyes with retinal detachments with single retinal breaks or groups of breaks no greater than 1 clock hour in extent were prospectively treated with perfluoroethane gas injection and retinocryopexy and followed up for a minimum of 6 months. Twelve eyes (71%) were attached with one procedure, and five eyes (29%) were attached with two or three procedures. Post-operative proliferative vitreoretinopathy occurred in two eyes (12%), new or missed breaks in three eyes (18%), and premacular fibroplasia in one (6%) eye. No eyes had an apparent progression of cataracts. Seven (88%) of eight eyes with preoperative macular detachments had improved visual acuity after surgery. All nine eyes (100%) with preoperative macular attachment had the same or improved visual acuity after surgery. The efficacy of perfluoroethane appears similar to that of other perfluorocarbon gases.

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Purpose: To evaluate the visual outcomes, the incidence of glistenings and posterior capsule opacification in a series of consecutive eyes with a new blue light-filtering hydrophobic acrylic intraocular lens (IOL) SETTING: Service d'ophtalmologie, clinique Beausoleil, avenue de Lodève, Montpellier.

Design: Retrospective, cross-sectional study.

Methods: This study included a series of 66 eyes that underwent routine cataract surgery with PODEye (PhysIOL SA, Liège, Belgium) monofocal IOL implantation between May 2011 and November 2011. These eyes were compared for glistenings with patients implanted with Acrysof material IOL (Alcon, Fort Worth, USA) who had a routine postoperative examination between January 2015 and August 2015. The safety of the IOL was assessed by visual acuity outcomes, as well as rotational stability, centration and postoperative medication. The incidence and severity of glistenings were evaluated with the slit lamp. Glistenings and PCO were graded subjectively (0=absent; 1=moderate; 2=dense). Follow-up was 3 years.

Results: The mean visual acuity after PODEye implantation was 0.98±0.05 (n=50) in decimal notation at 1 year, 0.98±0.06 at 1 week, (n=66), 1.00±0.01 at 3 weeks (n=64) and 0.99±0.02 at 3 months (n=59). The IOL displayed stable positioning in all axes. Glistenings of grade 2 were absent in the G-Free/PODEye group, whereas they were significantly present in the Acrysof group. One out of 43 eyes at 3-year follow-up underwent YAG capulotomy at 37 months. Sixty-six percent of eyes had no PCO (grade 0) at 3 years.

Conclusions: The PODEye IOL was safe and stable. Glistenings grade 2 or more were not found with this blue light-filtering hydrophobic acrylic IOL. PCO occurrence was low at three years.

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Purpose: To assess the efficacy of five calculators for toric intraocular lenses (IOL).

Methods: Retrospective comparative case series in cataract patients undergoing implantation of trifocal toric IOLs (PhysIOL FineVision POD FT). Inclusion criteria were age-related cataract and a corneal astigmatism between 0.90D and 4.50D. Refractive astigmatism predictability of five different toric calculators or calculation methods were compared. Furthermore, two groups were differentiated according to the type of astigmatism. The mean absolute error and the centroid errors in the predicted residual astigmatism from each calculator were evaluated.

Results: Fifty-one eyes of 43 patients were included in the study. For the standard toric calculator using anterior keratometry values only, the centroid prediction error was 0.39D±0.41@166º, which was reduced by the application of the PhysIOL toric calculator that includes the Abulafia-Koch regression formula and adjustment for the effective lens position (0.05D±0.34@167º), and also by the application of the Barrett toric calculator (0.07D±0.28@160º). Regarding the techniques that directly evaluate posterior corneal surface, the Holladay toric calculator, using total corneal power provided by a color-LED topographer, generated better results (0.10D±0.44@156º) than those using Scheimpflug camera data (0.23D±0.56@158º). Similar results were found for both types of astigmatism.

Conclusion: The PhysIOL and the Barrett toric calculators taking into account the posterior corneal astigmatism by mathematical models, yielded lower astigmatic prediction errors compared to a standard toric calculator based on anterior keratometry data only. When total corneal power measurements were used, prediction errors were lower with color-LED than with Scheimpflug based topography.

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