Clinical reviews

Purpose: To assess visual outcomes and patient satisfaction for trifocal and extended depth of focus (EDOF) intraocular lenses (IOLs) compared to monofocal IOLs with and without monovision.

Methods: Consecutive patients underwent bilateral cataract extraction surgery and implantation of either monofocal IOLs, monofocal IOLs using monovision, EDOF IOLs, or trifocal IOLs. Patients with preoperative biometric data, postoperative refraction, and visual acuity who completed a questionnaire regarding satisfaction and side effects were included. Visual outcome, spectacle independence, patient satisfaction, and subjective photic phenomena were assessed.

Results: Each group comprised 50 patients (100 eyes). The mean postoperative uncorrected distance, intermediate, and near visual acuities (logMAR) were: 0.17 ± 0.14 (Snellen 20/30), not applicable, and not applicable for monofocal; 0.08 ± 0.12 (Snellen 20/24), not applicable, and 0.07 ± 0.12 (Snellen 20/23) for monovision; 0.03 ± 0.08 (Snellen 20/21), 0.08 ± 0.12 (Snellen 20/24), and 0.23 ± 0.17 (Snellen 20/34) for EDOF; 0.07 ± 0.09 (Snellen 20/23), 0.08 ± 0.11 (Snellen 20/24), and 0.02 ± 0.06 (Snellen 20/21) for trifocal. Spectacle independence was reported by 36%, 70%, 74%, and 92% of patients, respectively. Postoperative halos and/or glare were experienced by 2%, 6%, 14%, and 38%, respectively, of which 2%, 0%, 6%, and 10%, respectively, were functionally disturbing. A total of 64%, 72%, 78%, and 76%, respectively, would choose the same IOL again.

Conclusions: Patient satisfaction rates were high in all groups. Trifocal IOLs were more effective in improving unaided whole range of vision, but were associated with a higher rate of photic phenomena. The EDOF IOL and monovision provided partial spectacle independence with less photic phenomena.

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Purpose: To assess clinical outcomes and subjective experience after bilateral implantation of a diffractive trifocal intraocular lens (IOL).

Setting: Midland Eye Institute, Solihull, United Kingdom.

Methods: Patients had bilateral implantation of Finevision trifocal IOLs. Uncorrected distance visual acuity, corrected distance visual acuity (CDVA), and manifest refraction were measured 2 months postoperatively. Defocus curves were assessed under photopic and mesopic conditions over a range of +1.50 to −4.00 diopters (D) in 0.50 D steps. Contrast sensitivity function was assessed under photopic conditions. Halometry was used to measure the angular size of monocular and binocular photopic scotomas arising from a glare source. Patient satisfaction with uncorrected near vision was assessed using the Near Activity Visual Questionnaire (NAVQ).

Results: The mean monocular CDVA was 0.08 logMAR ± 0.08 (SD) and the mean binocular CDVA, 0.06 ± 0.08 logMAR. Defocus curve testing showed an extended range of clear vision from +1.00 to −2.50 D defocus, with a significant difference in acuity between photopic conditions and mesopic conditions at −1.50 D defocus only. Photopic contrast sensitivity was significantly better binocularly than monocularly at all spatial frequencies. Halometry showed a glare scotoma of a mean size similar to that in previous studies of multifocal and accommodating IOLs; there were no subjective complaints of dysphotopsia. The mean NAVQ Rasch score for satisfaction with near vision was 15.9 ± 10.7 logits.

Conclusions: The trifocal IOL implanted binocularly produced good distance visual acuity and near and intermediate visual function. Patients were very satisfied with their uncorrected near vision.

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Purpose: To investigate refractive and visual acuity outcomes, patient satisfaction, and spectacle independence at 3 months of 2 diffractive (non-toric) trifocal intraocular lenses (IOLs) in a large series of patients.

Design: Multicenter, retrospective, nonrandomized clinical study.

Methods: Patients underwent lens phacoemulsification and were implanted bilaterally with a diffractive trifocal IOL: FineVision Micro F (PhysIOL SA, Liège, Belgium) or AT Lisa tri 839MP (Carl Zeiss AG, Jena, Germany). Surgeries were performed between 2011 and 2015 with at least 3 months of follow-up. Visual and refractive performance, patient satisfaction, and spectacle independence were evaluated.

Results: A total of 10 084 trifocal IOLs were bilaterally implanted (5802 FineVision in 2901 patients and 4282 AT Lisa in 2141 patients). Three-month mean (± standard deviation) acuity: AT Lisa, binocular uncorrected distance visual acuity (UDVA), -0.01 logMAR ± 0.06; monocular distance corrected visual acuity (CDVA), 0.02 logMAR ± 0.06; binocular uncorrected near visual acuity (UNVA) at 40 cm, 0.05 logMAR ± 0.08; binocular uncorrected intermediate visual acuity (UIVA) at 80 cm, -0.05 logMAR ± 0.14; postoperative spherical equivalent, 0.26 D ± 0.47; cylinder -0.34 D ± 0.38; FineVision Micro F, binocular UDVA, 0.01 logMAR ± 0.05; monocular CDVA, 0.03 logMAR ± 0.06; binocular UNVA, 0.05 logMAR ± 0.08; binocular UIVA, -0.05 logMAR ± 0.12; spherical equivalent, 0.34 D ± 0.50; cylinder -0.39 D ± 0.40. The IOLs were equivalent in achieving spectacle independence; 98% were "satisfied" to "very satisfied" with their IOL performance.

Conclusions: In this retrospective study with over 5000 patients, implantation of both trifocal IOL models provided good functional distance, intermediate, and near visual acuity, resulting in high levels of both spectacle independence and patient satisfaction.

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Purpose: To evaluate the visual outcomes of patients with a new diffractive trifocal intraocular lens (IOL).

Methods: A trifocal diffractive Fine Vision IOL (Physiol, Liege, Belgium) was implanted after microincision cataract surgery (MICS) in 40 eyes of 20 patients with bilateral cataract. The monocular and binocular visual performance and the refractive status were assessed, as well as the defocus curve and contrast sensitivity at 1 and 6 months postoperatively.

Results: The monocular visual outcomes (logMAR) at 6 months postoperatively were uncorrected distance visual acuity 0.18 ± 0.13, uncorrected near visual acuity 0.26 ± 0.15, and uncorrected intermediate visual acuity 0.20 ± 0.11. With the best distance correction, the visual outcomes were 0.05 ± 0.06 for corrected distance visual acuity, 0.16 ± 0.13 for distance corrected near visual acuity, and 0.17 ± 0.09 for distance corrected intermediate visual acuity. Binocular defocus curve at 6 months shows a wide range of useful vision with 0.19 ± 0.08 (logMAR) at -1.50 diopter defocus. The monocular contrast sensitivity under scotopic conditions (3 cd/m(2)) was within normal range for a population older than 60 years.

Conclusion: The trifocal Fine Vision IOL can restore vision at different distances after cataract surgery, specifically intermediate and near vision.

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Purpose: To investigate visual outcomes, spectacle independence, and patient satisfaction after trifocal intraocular lens implantation.

Methods: A retrospective study conducted on 5,186 patients who underwent phacoemulsification and were implanted with a diffractive trifocal intraocular lens (FineVision Micro F, PhysIOL SA, Liège, Belgium).

Results: The mean pre-operative keratometry was 43.61±1.55 D, and mean keratometric cylinder was -0.86±0.66 D. At 3 months post-operatively, values changed to 43.59±1.56 and -0.71±0.46 D, respectively. Mean sphere varied from 2.04±2.60 to 0.14±0.38 D, and mean spherical equivalent from 1.64±2.61 to -0.05±0.36 D. More than 60% of the patients achieved better corrected distance visual acuity. The majority had a final residual refractive error (predictability) lower than 1 D (99.1%), with 14.3% needing optical adjustment (bioptics). Posterior capsulotomy was performed in 2.2%, and the lens was replaced in 5 patients. A high percentage of patients were satisfied in terms of vision and spectacle independence at all distances. Although 2% referred to worsening of night vision quality, only 2% were not very satisfied and 20 patients were dissatisfied. The causes were: blurred vision (7 cases), spectacle dependence (10), dysphotopsia (7), and dry eye (4).

Conclusions: The implantation of this model provided good visual performance in all distances, as well as high levels of spectacle independence and satisfaction.

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Purpose: To evaluate the subjective and objective visual results after the implantation of a new trifocal diffractive intraocular lens.

Methods: A new trifocal diffractive intraocular lens was designed combining two superimposed diffractive profiles: one with +1.75 diopters (D) addition for intermediate vision and the other with +3.50 D addition for near vision. Fifty eyes of 25 patients that were operated on by one surgeon are included in this study. The uncorrected and best distance-corrected monocular and binocular, near, intermediate, and distance visual acuities, contrast sensitivity, and defocus curves were measured 6 months postoperatively. In addition to the standard clinical follow-up, a questionnaire evaluating individual satisfaction and quality of life was submitted to the patients.

Results: The mean age of patients at the time of surgery was 70 ± 10 years. The mean uncorrected and corrected monocular distance visual acuity (VA) were LogMAR 0.06 ± 0.10 and LogMAR 0.00 ± 0.08, respectively. The outcomes for the binocular uncorrected distance visual acuity were almost the same (LogMAR −0.04 ± 0.09). LogMAR −010 ± 0.15 and 0.02 ± 0.06 were measured for the binocular uncorrected intermediate and near VA, respectively. The distance-corrected visual acuity was maintained in mesopic conditions. The contrast sensitivity was similar to that obtained after implantation of a bifocal intraocular lens and did not decrease in mesopic conditions. The binocular defocus curve confirms good VA even in the intermediate distance range, with a moderate decrease of less than LogMAR 0.2 at −1.5 D, with respect to the best distance VA at 0 D defocus. Patient satisfaction was high. No discrepancy between the objective and subjective outcomes was evidenced.

Conclusion: The introduction of a third focus in diffractive multifocal intraocular lenses improves the intermediate vision with minimal visual discomfort for the patient.

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Purpose: To evaluate refractive and visual outcomes at different distances after implantation of an isofocal optic design intraocular lens (IOL) following cataract surgery.

Methods: This multicentric, retrospective/prospective, open-label, observational study considered 183 eyes of 109 patients who were implanted with the ISOPURE 123 (PhysIOL) IOL. The main outcome measures were refractive error and monocular and binocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), and distance-corrected intermediate visual acuity (DCIVA) at 66 and 80 cm, uncorrected near visual acuity (UNVA), and distance-corrected near visual acuity (DCNVA) at 40 cm. Binocular visual acuity at different vergences (defocus curve) was also measured. Patients were evaluated at least 120 days postoperatively.

Results: A total of 95.7% of the eyes were within ±1.00 diopter (D) and 73.2% of the eyes were within ±0.50 D; the mean postoperative spherical equivalent was -0.12 ± 0.42 D. There were 90.54% and 98.57% of patients presenting a cumulative binocular UDVA and CDVA value of 20/25 or better, respectively; 80.65% and 50.0% of patients presented a binocular DCIVA value of 20/25 or better at 80 and 66 cm, respectively; and 41.94% of patients presented a binocular DCNVA value of 20/40 or better. The through-focus curve showed good visual acuity at far and intermediate distances with a depth of focus value of 1.50 D. No adverse events were reported.

Conclusions: The current study shows that this isofocal optic design IOL provides excellent visual performance for far vision and functional intermediate vision with an extended range of vision. This lens is an effective option for providing functional intermediate vision and correcting aphakia.

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Purpose: To evaluate clinical outcomes obtained after cataract surgery involving the implantation of a trifocal hydrophobic intraocular lens (IOL) and to determine if pupil size and the corneal aberrometric profile correlate to visual acuity at different distances.
Methods: 49 patients (98 eyes) underwent bilateral cataract surgery with the placement of FineVision HP IOLs for presbyopia and were assessed at 1- and 3- to 6-months post-surgery. Postoperatively, refraction, monocular and binocular uncorrected and corrected distance visual acuity (UDVA and CDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA) and the binocular defocus curve were measured. Pupil size and corneal aberrations (higher-order and low-order aberrations; HOA and LOA) were also measured using a Scheimpflug 3D camera.
Results: Sphere, cylinder and spherical equivalent decreased significantly after surgery (p< 0.05) and CDVA had improved significantly 1-month post-surgery (p=0.007). The sphere, cylinder, spherical equivalent and CDVA values remained stable at the 3- to 6-month follow-up (p> 0.05). Binocular UDVA was 0 logMAR or better for 79.2% of patients and binocular UNVA was 0.1 logMAR or better for 91.7%. The binocular defocus curve showed average maximum visual acuity values at – 0.07± 0.06 logMAR, 0.01± 0.06 logMAR, and 0.01± 0.06 logMAR, for far, intermediate and near distances, respectively. Neither the UDVA nor UNVA values correlated with patient pupil diameter (UDVA: r=0.035, p=0.744; UNVA: r=− 0.073, p=0.492). Neither the UDVA nor UNVA values correlated with patient HOA or LOA (UDVA versus HOA: r=0.016, p=0.872; UDVA versus LOA: r=0.032, p=0.759; UNVA versus HOA: r=0.056, p=0.582; UNVA versus LOA: r=0.059, p=0.568).
Conclusion: This study shows that the FineVision HP IOL provides excellent refractive and visual outcomes at different distances. Pupil size does not correlate with UDVA and UNVA and quality of vision does not seem to correlate with the corneal aberrometric profile.

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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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The visualization of transparent perfluorocarbon liquid (PFCL) using triamcinolone acetonide is described. Intravitreal injection of triamcinolone acetonide enabled visualization of residual PFCL intraoperatively. In addition, it was shown that triamcinolone acetonide could visualize PFCL in an in vitro preparation of balanced salt solution. This in vitro experiment confirmed that triamcinolone acetonide also could be adsorbed by PFCL outside the vitreous. Triamcinolone acetonide was helpful to visualize transparent PFCL both in vivo and in vitro, and may be useful at the end of vitrectomy to completely remove residual PFCL from the eye.

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Aim: To determine the efficacy and safety of perfluorocarbon liquid as a short term postoperative tamponade in patients with retinal detachment from giant retinal tears.

Method: A retrospective consecutive case series of patients with retinal detachment from giant retinal tears who underwent vitrectomy using perfluorocarbon liquid as a short term postoperative internal tamponade. The perfluorocarbon liquid was removed 5-14 days (mean 7.5 days) later and replaced by gas or silicone oil. Scleral buckling was performed in some cases with proliferative vitreoretinopathy. The crystalline lens was removed if there was interference with the surgical view or if it was subluxated. The success rate of retinal reattachment, visual outcome, and postoperative complications were assessed.

Results: A total of 62 eyes of 61 patients with a follow up of 8-69 months (mean 24.5 months) were included. All retinas were attached intraoperatively. 14 eyes (22.6%) developed re-detachment and additional operations were performed in 13 eyes. At final visit, 58 eyes (93.5%) had retinas that remained attached with visual acuity 6/12 or better in 27 eyes (46.5%). The visual acuity improved in 34 eyes (54.8%) with 28 eyes (45.2%) improving at least two Snellen lines, it was unchanged in 20 eyes (32.3%), and was worse in eight eyes (12.9%). Three patients developed glaucoma that was controlled medically. There was no retained perfluorocarbon liquid in any eyes.

Conclusion: Perfluorocarbon liquid appears safe and effective to use as a short term postoperative tamponade in management of retinal detachment from giant retinal tears.

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Objectives: Does phaco–ECP reduce intraocular pressure? Is phaco–ECP safe?

Design: Retrospective case note review of all patients undergoing phaco–ECP between June 2008 and June 2009. All glaucoma subtypes were included.

Setting: Single District General Hospital Ophthalmology Department within the UK.

Participants: 58 participants case notes reviewed. Mean age 79.0 years (SD ±9.8).

Interventions: All patients received combined cataract surgery and endoscopic cyclophotocoagulation.

Outcome measures: Follow-up was 1 day, 1 week, 1, 3, 6, 12, 18 and 24 months for intraocular pressure (IOP) measurement. Number of medications, visual acuity and presence of complications were also assessed.

Results: Of the 58 cases performed, 56 case notes (97%) were available for analysis. Mean age 79.0 years (SD ±9.8). Mean pre-procedural IOP was 21.54 mm Hg (95% CI 19.86 to 23.22, n=56). Mean IOP was 14.43 mm Hg (95% CI 13.65 to 15.21, n=53) at 18 months and 14.44 mm Hg (95% CI 13.63 to 15.25, n=41) at 24 months. The mean drop from baseline to 18 and 24 months was 7.1 mm Hg. Statistically significant decrease in IOP was demonstrated at all time points (p<0.001). Mean medication usage was 1.97 agents (95% CI 1.69 to 2.25) at baseline, 1.96 agents (95% CI 1.70 to 2.22) at 18 months and 2.07 agents (95% CI 1.76 to 2.38) at 24 months. No statistically significant change throughout.

Conclusions: This study confirms the safety of phaco–ECP. In this case series, the IOP-lowering effect was significant at all time points; however, the effect of cataract surgery alone was not controlled. A randomised controlled trial is required to draw efficacy conclusions. The authors proposed endoscopic cyclophotocoagulation's main role is to optimise control of low-risk glaucoma of low-risk patients at the time of cataract surgery. However, the authors do not propose that phaco–ECP is a substitute for filtration surgery in high-risk eyes or when low target pressures (<14 mm Hg) are indicated.

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목적: 최근 소개된 회절 삼중초점 인공수정체의 단기간의 안전성과 유효성을 평가하기 위하여 회절 이중초점 인공수정체와 수술 후 3개월까지의 임상 결과를 비교해 보고자 하였다.

대상과 방법: 회절 이중초점 인공수정체(TECNISⓇ 1 ZLB00, Abbott Medical Optics Inc., Santa Ana, CA, USA) 및 회절 삼중초점 인공수정체(FineVisionⓇ POD F, PhysIOL SA, Liege, Belgium) 삽입술을 시행받은 각 21안, 17안을 대상으로 수술 후 1주, 1개월, 3개월간의 원거리, 중간거리, 근거리(4 m, 50 cm, 33 cm) 나안시력, 원거리 교정시력, 구면렌즈대응치를 측정하였다. 수술 후 1개월 뒤 Optec 6500Ⓡ (Stereo Optical Co. Inc., Chicago, IL, USA)를 이용한 대비감도를 비교하였으며, 수술 후 3개월 뒤 iTraceⓇ (Tracey Technologies, Houston, TX, USA)를 이용한 내부 수차를 비교하였다. 수술 후 눈부심과 달무리 증상에 대하여 설문하였으며, 안경의 필요 유무에 대하여 조사하였다.

결과: 수술 후 1주 뒤, 이중초점 인공수정체군보다 삼중초점 인공수정체군에서 근거리 나안시력(33 cm)이 유의하게 높았으며, 수술 후 1개월, 3개월 뒤에는 중간거리 나안시력(50 cm)이 유의하게 높았다. 두 군 간 구면렌즈대응치, 대비감도, 내부수차의 유의한 차이는 없었다. 수술 후 눈부심 및 달무리 증상은 삼중초점 인공수정체군에서 조금 더 적게 나타났으나 유의한 차이를 보이지는 않았으며, 안경 착용의 필요성도 두 군 간 유의한 차이가 없었다.

결론: 회절 삼중초점 인공수정체는 회절 이중초점 인공수정체보다 우수한 중간거리 시력을 보여, 백내장수술 후 환자의 다양한 거리에서의 시력 호전에 효과적일 것으로 기대된다.

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