Clinical and Self-Reported Outcomes after Multifocal Intraocular Lens Implantation of Patients with Stable Keratoconus

Trifocal Iol

Abstract Background: Multifocal intraocular lens (IOL) implantation is generally not considered in patients with keratoconus; however, it may provide good optical results in selected patients with stage I and II keratoconus based on two case reports. Aims: To evaluate patient satisfaction and clinical outcomes in this patient population.Methods: This is a retrospective single-center, non-interventional, non-comparison study. All patients with frank keratoconus who had undergone a trifocal IOL implantation between 2016 and 2019 were invited to participate in this study (18 eyes of 9 patients). Postoperatively, refractive outcomes, contrast sensitivity, and ocular aberrations were recorded. A questionnaire was used for determining patient satisfaction and their quality of life. The mean follow-up time was 31.22 ± 6.38 months.Results: Postoperatively the patients’ uncorrected distance visual acuity improved from 1.13 ± 0.93 to 0.10 ± 0.17 (p˂0.001), corrected distance visual acuity went from 0.10 ± 0.11 to 0.05 ± 0.09 (p=0.19), mean refractive spherical equivalent changed from -4.34 ± 4.31 to 0.05 ± 0.51 D (p˂0.001), and manifest astigmatism from 2.44 ± 1.92 to 0.88 ± 1.81 D (p=0.017). A target refraction of less than ± 0.50 D was achieved in 17 eyes (94%) and one eye exhibited a hyperopic MRSE of +2.0 D. Three eyes (17%) lost 1 line of best corrected visual acuity and no patient lost two or more lines. The patients were independent of glasses in 78% for all distances. Conclusions: A trifocal IOL currently gives relatively good, predictable results with most patients feeling satisfied with the results of spectacle independence for all distances.

Clinical Outcomes after Binocular Implantation of a New Trifocal Diffractive Intraocular Lens

10.1155/2015/962891 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 12

Author(s):

Florian T. A. Kretz ◽

Detlev Breyer ◽

Vasilios F. Diakonis ◽

Karsten Klabe ◽

Franziska Henke ◽

...

Keyword(s):

Visual Acuity ◽

Patient Satisfaction ◽

Contrast Sensitivity ◽

Intraocular Lens ◽

Iol Implantation ◽

Refractive Outcomes ◽

Trifocal Iol ◽

Defocus Curve ◽

Near Visual Acuity

Purpose.To evaluate visual, refractive, and contrast sensitivity outcomes, as well as the incidence of pseudophakic photic phenomena and patient satisfaction after bilateral diffractive trifocal intraocular lens (IOL) implantation.Methods. This prospective nonrandomized study included consecutive patients undergoing cataract surgery with bilateral implantation of a diffractive trifocal IOL (AT LISA tri 839MP, Carl Zeiss Meditec). Distance, intermediate, and near visual outcomes were evaluated as well as the defocus curve and the refractive outcomes 3 months after surgery. Photopic and mesopic contrast sensitivity, patient satisfaction, and halo perception were also evaluated.Results.Seventy-six eyes of 38 patients were included; 90% of eyes showed a spherical equivalent within ±0.50 diopters 3 months after surgery. All patients had a binocular uncorrected distance visual acuity of 0.00 LogMAR or better and a binocular uncorrected intermediate visual acuity of 0.10 LogMAR or better, 3 months after surgery. Furthermore, 85% of patients achieved a binocular uncorrected near visual acuity of 0.10 LogMAR or better.Conclusions.Trifocal diffractive IOL implantation seems to provide an effective restoration of visual function for far, intermediate, and near distances, providing high levels of visual quality and patient satisfaction.

Etiology and outcomes of current posterior chamber phakic intraocular lens extraction

Scientific Reports ◽

10.1038/s41598-020-78661-z ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Hideki Hayakawa ◽

Kazutaka Kamiya ◽

Wakako Ando ◽

Masahide Takahashi ◽

Nobuyuki Shoji

Keyword(s):

Visual Acuity ◽

Patient Satisfaction ◽

Intraocular Lens ◽

Posterior Chamber ◽

Phakic Intraocular Lens ◽

Distance Visual Acuity ◽

Lens Extraction ◽

Refractive Outcomes ◽

Surgical Extraction

AbstractThis study was aimed to review the etiology and the outcomes of current posterior chamber phakic intraocular lens (Visian ICL, STAAR Surgical) extraction. This review comprised 770 eyes of 403 consecutive patients undergoing ICL extraction. We evaluated prevalence, etiology, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), predictability, and patient satisfaction. ICL extraction was required in 8 of 770 (1.0%) eyes. The most common reason was the progression of the pre-existing cataract formation in 5 eyes (63%), followed by residual refractive errors in 3 eyes (38%). Of the 7 eyes targeted for emmetropia, 7 (100%) and 6 (86%) achieved UDVAs of 20/40 and 20/20 or better, respectively. Three eyes (38%) showed no change in CDVA, 3 eyes (38%) gained 1 line, 2 eyes (25%) gained 3 or more lines. 88% and 100% were within ± 0.5 and 1.0 diopter (D), respectively, of the targeted correction. Patient satisfaction improved significantly, from 3.0 ± 1.4 preoperatively, to 8.0 ± 2.4 postoperatively. No vision-threatening complications occurred. ICL extraction was required in approximately 1% of ICL-implanted eyes. Visual and refractive outcomes were good, and patient satisfaction was overall high, even in ICL-extracted eyes.

Clinical Outcomes of Sequential Intrastromal Corneal Ring Segments and an Extended Range of Vision Intraocular Lens Implantation in Patients with Keratoconus and Cataract

10.1155/2018/8328134 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

C. Lisa ◽

R. Zaldivar ◽

A. Fernández-Vega Cueto ◽

R. M. Sanchez-Avila ◽

D. Madrid-Costa ◽

...

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Iol Implantation ◽

Distance Visual Acuity ◽

Refractive Outcomes ◽

Intrastromal Corneal Ring ◽

Corrected Distance Visual Acuity ◽

Extended Range ◽

The Mean

Purpose. To evaluate efficacy, safety, and predictability of sequential Ferrara-type intrastromal corneal ring segments (ICRS) and an extended range of vision intraocular lens (IOL) implantation in patients with keratoconus and cataract. Methods. This study comprised patients with keratoconus and cataract that had ICRS implantation followed 6 months later by extended range of vision IOL implantation. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and residual refractive errors, analysed using vector analysis, were recorded preoperatively, 6 months after ICRS implantation, and 6 months after IOL implantation, respectively. Results. The study enrolled 17 eyes (11 patients). The mean UDVA (logMAR scale) was 1.15 ± 0.67 preoperatively, 0.88 ± 0.69 six months after ICRS implantation (P=0.005), and 0.27 ± 0.18 six months after IOL implantation (P<0.0001). The CDVA changed from 0.26 ± 0.15 (logMAR) before surgery to 0.17 ± 0.08 six months after Ferrara-type ICRS implantation (P=0.002) and to 0.07 ± 0.06 six months after IOL implantation (P<0.0001). The spherical equivalent and the refractive cylinder declined steeply after IOL implantation (P<0.001). The magnitude of depth of focus was 2.60 ± 1.02 D. There were no statistically significant differences in visual acuity for a defocus range from +0.50 D to −0.50 D (P>0.1). Conclusion. Sequential Ferrara-type ICRS and an extended range of vision IOL implantation provided good visual and refractive outcomes, being an effective, safe, and predictable procedure for the treatment of selected cases of patients with keratoconus and cataract. In addition, this approach provides an increase of tolerance to defocus.

Outcomes of refractive error correction in pseudophakic patients using a sulcus piggyback intraocular lens

European Journal of Ophthalmology ◽

10.1177/1120672120903560 ◽

2020 ◽

pp. 112067212090356

Author(s):

Eliya Levinger ◽

Michael Mimouni ◽

Yaron Finkelman ◽

Yossi Yatziv ◽

Jonathan Shahar ◽

...

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Intraocular Lens ◽

Refractive Error ◽

Spherical Equivalent ◽

Distance Visual Acuity ◽

Refractive Outcomes ◽

Corrected Distance Visual Acuity

Purpose: The purpose of this study was to assess the results of a sulcus intraocular lens (Sulcoflex) for pseudophakic refractive errors following phacoemulsification cataract surgery. Methods: This retrospective clinical observational cohort study included consecutive eyes in which a Sulcoflex was implanted. Uncorrected distance visual acuity and corrected distance visual acuity as well as refractive outcomes were assessed. The minimum follow-up time required for inclusion was 3 months. Results: In total, 15 eyes ( n = 15) were evaluated. The mean follow-up was 14 months (range: 3–18 months). The Sulcoflex aspheric (653L) was implanted in 13 eyes and the Sulcoflex toric (653T) in two eyes. The preoperative mean logMAR (Snellen) uncorrected distance visual acuity and corrected distance visual acuity were 0.88 (20/150) and 0.27 (20/40), respectively. The postoperative mean logMAR (Snellen) corrected distance visual acuity was 0.15 (20/30). The preoperative mean spherical equivalent was −0.22 ± 5.95 D and the postoperative mean spherical equivalent was −1.59 ± 1.45 D. There was a significant and strong correlation ( r = 0.64, p < 0.001) between the attempted and the achieved spherical equivalent. Conclusion: The Sulcoflex is a safe and viable option for patients with residual refractive error following cataract surgery.

Implantable collamer lens for the correction of post-keratoplasty myopia and astigmatism

International Eye Research ◽

10.18240/ier.2020.02.09 ◽

2020 ◽

Vol 1 (2) ◽

pp. 113-116

Author(s):

Nasser A Alsabaani ◽

◽

Salem Almalki ◽

Keyword(s):

Visual Acuity ◽

Contact Lenses ◽

Posterior Chamber ◽

Implantable Collamer Lens ◽

Distance Visual Acuity ◽

Refractive Outcomes ◽

Single Center Study ◽

Corrected Distance Visual Acuity ◽

Corneal Refractive Surgery

AIM: To evaluate the safety, refractive outcomes and vision after phakic posterior chamber implantable collamer lens (ICL) after keratoplasty (KP). METHODS: This retrospective single center study evaluated 32 (35 eyes) patients who received an ICL for myopia and/or astigmatism after keratoplasty. Patients underwent ICL surgery if they were unable to wear glasses or contact lenses and excimer laser surgery was contraindicated. Data were collected on uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction and complications. Data were analyzed for the preoperative and last postoperative visits (16.7±13mo) (P<0.05). RESULTS: Preoperatively, spherical equivalent (SE) ranged from -4.00 to -20.00 D and cylinder from -2.00 to -9.00 D. The mean SE decreased statistically significantly from -11.41±3.62 D preoperatively to -1.95±1.78 D postoperatively (P<0.0001). Mean UDVA increased statistically significantly from 20/400 preoperatively to 20/25 postoperatively (P<0.0001). There was a mean improvement in postoperative CDVA of 1.5 lines compared to preoperatively, 37% of eyes had an increase of 2 or more lines. One eye (2.8%) lost ≥1 line of CDVA. There were no intraoperative or postoperative complications. CONCLUSION: Posterior chamber phakic intraocular lens implantation is a safe and effective treatment for post-keratoplasty myopia and astigmatism in patients unable to wear spectacles or contact lenses and where corneal refractive surgery is contraindicated.

Bioptics for high hyperopia with combined multifocal intraocular lens implantation and excimer ablation in young patients

European Journal of Ophthalmology ◽

10.1177/1120672118797281 ◽

2018 ◽

Vol 29 (4) ◽

pp. 426-430 ◽

Cited By ~ 1

Author(s):

Omer Trivizki ◽

David Smadja ◽

Michael Mimouni ◽

Samuel Levinger ◽

Eliya Levinger

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Laser In Situ Keratomileusis ◽

Intraocular Lens Implantation ◽

Multifocal Intraocular Lens ◽

Distance Visual Acuity ◽

Lens Implantation ◽

Near Visual Acuity ◽

High Hyperopia

Purpose:To analyze the visual and refractive outcome of the bioptics procedure combining multifocal intraocular lens implantation and excimer laser surgery in young patients with high hyperopic eyes not suitable for a single surgical procedure.Methods:This retrospective case series included 10 eyes of five patients (age range 18–30 years) with high hyperopia (spherical equivalent +8.51 ± 0.85 diopters (D)). They had been treated with serial multifocal intraocular lens implantation followed 6 weeks later by laser in situ keratomileusis for residual hyperopia. Uncorrected distance visual acuity, uncorrected near visual acuity, corrected distance visual acuity, corrected near visual acuity, and manifest refraction were evaluated before surgeries, after multifocal intraocular lens implantation, and 3 months post laser in situ keratomileusis.Results:No patients were lost to follow-up (6 months). The mean spherical equivalent decreased to +2.05 ± 1.33 D after multifocal intraocular lens implantation and to −0.10 ± 0.58 D after the laser in situ keratomileusis procedure. Success of the procedures was determined by uncorrected visual acuity. LogMAR uncorrected distance visual acuity improved by a total of more than six lines from 1.05 ± 0.18 LogMAR to 0.46 ± 0.12 LogMAR post multifocal intraocular lens implantation and to 0.15 ± 0.06 LogMAR after both surgeries. The LogMAR uncorrected near visual acuity increased by 0.81 ± 0.82 LogMAR after lens implantation due to loss of accommodation, and all eyes reached a LogMAR of 0 at 1 month postoperatively following laser in situ keratomileusis.Conclusions:A bioptics approach involving multifocal intraocular lens followed 6 weeks later by a laser in situ keratomileusis procedure for the correction of very high hyperopia enabled the resolution of the residual refractive error in young very high hyperopic patients.

Optimal Keratoplasty for the Correction of Presbyopia and Hypermetropia

10.1155/2017/7545687 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6

Author(s):

Daniele Veritti ◽

Valentina Sarao ◽

Paolo Lanzetta

Keyword(s):

Visual Acuity ◽

Patient Satisfaction ◽

Postoperative Complications ◽

Safety And Efficacy ◽

Distance Visual Acuity ◽

Ophthalmologic Examination ◽

Near Visual Acuity ◽

Better Than

Purpose.To evaluate prospectively the safety and efficacy of optimal keratoplasty for the correction of hyperopia and presbyopia.Methods. Consecutive patients undergoing bilateral optimal keratoplasty for refractive presbyopic and hypermetropic corrections were enrolled. Each patient received a complete ophthalmologic examination at baseline, 1 hour, 1 day, 1 week, 1 month, 3 months, and 6 months after treatment.Results. The study included 40 consecutive eyes of 20 patients. All patients reached the 6-month follow-up. No serious intra- or postoperative complications were recorded. Monocular and binocular uncorrected near visual acuities improved significantly during the follow-up (p<0.001). Binocular uncorrected distance visual acuity in presbyopic patients improved from 0.28 logMAR to a maximum of 0.04 logMAR (from 20/38 to 20/22 Snellen equivalent) the day after the treatment and remained significantly better than baseline until the end of the follow-up. A significant improvement of patient satisfaction for near (p<0.001) and distance (p=0.007) activities was seen the day after treatment and was maintained throughout the follow-up.Conclusions.Optimal keratoplasty is a safe, noninvasive, rapid, pain-free, office-based procedure. It offers low to moderate hyperopes and presbyopes an improvement in uncorrected near visual acuity while maintaining or improving their distance visual acuity.

Trifocal diffractive intraocular lens implantation in patients after previous corneal refractive laser surgery for myopia

10.21203/rs.3.rs-27965/v1 ◽

2020 ◽

Author(s):

Qiu-Mei Li ◽

Feng Wang ◽

Shao-Wei Li ◽

Knut Stieger ◽

Zhe-Ming Wu ◽

...

Keyword(s):

Visual Acuity ◽

Excimer Laser ◽

Full Range ◽

Subjective Quality ◽

Laser In Situ Keratomileusis ◽

Power Calculation ◽

Iol Implantation ◽

Refractive Outcomes ◽

Trifocal Iol

Abstract Background: With the difficulties in IOL power calculation and the potential side effects occurring postoperatively, multifocal IOL implantation after previous corneal refractive surgery are rarely reported especially for the trifocal IOL. Herein we report the clinical observation of trifocal IOL implantation in patients with previous myopia excimer laser correction. In this study, a multi-formula average method was performed for the IOLs power calculation to improve the accuracy. Visual and refractive outcomes were analyzed, and the subjective quality of patients’ life was evaluated by questionnaires survey.Methods: This retrospective case series included patients with previous myopia excimer laser correction who underwent femtosecond laser assisted phacoemulsification and trifocal IOL (AT LISA tri 839 MP) implantation. Follow-up was done at 1-day, 1-month and 3-month to assess the visual outcomes. Outcome measures were uncorrected distance, intermediate and near visual acuity (UDVA, UIVA, UNVA), manifest refraction, defocus curve, and subjective quality of vision.Results: 16 patients (14 eyes with previous laser in situ keratomileusis and 7 eyes with previous photorefractive keratectomy) were included. Mean postoperative spherical equivalent (SE) at 3-month was −0.56 D ± 0.49 SD, wherein, 48% of eyes were within ±0.50 D of emmetropia, and 91% were within ±1.0 D. Mean monocular UDVA, UIVA and UNVA (logMAR) at last visit were 0.02 ± 0.07, 0.10 ± 0.10, and 0.15 ± 0.11 respectively. Three patients (19%) reported halos and glare in postoperative 3 months, two of them needed to use spectacles to improve the intermediate visual acuity. Fifteen patients (94%) reported a satisfaction score of ≥3.5 out of 4.0, and thirteen patients (81%) did not need spectacles at all distances. Mean composite score of the VF-14 questionnaire was 95.00 ± 7.29 out of 100.Conclusions: Trifocal IOL implantation after myopia excimer laser correction could safely achieve a full range of adequate vision and accurate refractive outcomes.

Trifocal diffractive intraocular lens implantation in patients after previous corneal refractive laser surgery for myopia

10.21203/rs.3.rs-27965/v2 ◽

2020 ◽

Author(s):

Qiu-Mei Li ◽

Feng Wang ◽

Zhe-Ming Wu ◽

Zhen Liu ◽

Chuan Zhan ◽

...

Keyword(s):

Visual Acuity ◽

Excimer Laser ◽

Subjective Quality ◽

Laser In Situ Keratomileusis ◽

Power Calculation ◽

Iol Implantation ◽

Refractive Outcomes ◽

Trifocal Iol ◽

Near Visual Acuity

Abstract Background: With the difficulties in IOL power calculation and the potential side effects occurring postoperatively, multifocal IOL implantation after previous corneal refractive surgery are rarely reported especially for the trifocal IOL. Herein we report the clinical observation of trifocal IOL implantation in patients with previous myopia excimer laser correction. In this study, a multi-formula average method was performed for the IOLs power calculation to improve the accuracy. Visual and refractive outcomes were analyzed, and the subjective quality of patients’ life was evaluated by questionnaires survey.Methods: This retrospective case series included patients with previous myopia excimer laser correction who underwent femtosecond laser assisted phacoemulsification and trifocal IOL (AT LISA tri 839 MP) implantation. Follow-up was done at 1-day, 1-month and 3-month to assess the visual outcomes. Outcome measures were uncorrected distance, intermediate and near visual acuity (UDVA, UIVA, UNVA), manifest refraction, defocus curve, and subjective quality of vision.Results: 21 Eyes from sixteen patients (14 eyes with previous laser in situ keratomileusis and 7 eyes with previous photorefractive keratectomy) were included. Mean postoperative spherical equivalent (SE) at 3-month was −0.56 D ± 0.49 SD, wherein, 10 eyes (47.6%) were within ± 0.50 D of the desired emmetropia and 19 eyes (90.5%) were within ± 1.0 D. Mean monocular UDVA, UIVA and UNVA (logMAR) at last visit were 0.02 ± 0.07, 0.10 ± 0.10, and 0.15 ± 0.11 respectively. Three patients (19%) reported halos and glare in postoperative 3 months, two of them needed to use spectacles to improve the intermediate visual acuity. Fifteen patients (94%) reported a satisfaction score of ≥3.5 out of 4.0, without any difficulty in daily activity. Thirteen patients (81%) did not need spectacles at all distances, while the other 3 patients (19%) used spectacles for near-distance related visual activity. Mean composite score of the VF-14 questionnaire was 95.00 ± 7.29 out of 100.Conclusions: Trifocal IOL implantation after myopia excimer laser correction could restore good distance, intermediate visual acuity and acceptable near visual acuity, and provide accurate refractive outcomes as well as high spectacles independence rate.

Visual and Refractive Outcomes following Bilateral Implantation of Extended Range of Vision Intraocular Lens with Micromonovision

10.1155/2018/7321794 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 11

Author(s):

Sri Ganesh ◽

Sheetal Brar ◽

Archana Pawar ◽

Kirti J. Relekar

Keyword(s):

Visual Acuity ◽

Contrast Sensitivity ◽

Intraocular Lens ◽

Reading Acuity ◽

Good Tolerance ◽

Iol Implantation ◽

Refractive Outcomes ◽

Intermediate Vision ◽

Defocus Curve ◽

Near Visual Acuity

Purpose. To evaluate the outcomes following bilateral ERV intraocular lens implantation with micromonovision.Methods. 25 subjects underwent bilateral Tecnis Symfony IOL implantation with micromonovision. The dominant eye was targeted for emmetropia and the nondominant eye for myopia of −0.75 D. Uncorrected and corrected distance (UDVA, CDVA), intermediate (UIVA, CIVA), and near visual acuity (UNVA, DCNVA); reading performance; defocus curve; and contrast sensitivity were studied. Follow-ups were conducted at 1 week and 1 and 6 months postoperatively.Results. At 6 months postoperatively, the mean binocular UDVA, CDVA, UNVA, and DCNVA were −0.036 ± 0.09, −0.108 ± 0.07, 0.152 ± 0.11, and 0.216 ± 0.10 logMAR, respectively. Binocular UIVA and DCIVA were 0.048 ± 0.09 and 0.104 ± 0.08 logMAR, respectively, at 60 cm and −0.044 ± 0.09 and 0.012 ± 0.09 logMAR, respectively, at 80 cm. All patients had ≥0.2 logMAR UDVA and UNVA. Reading acuity and reading speeds showed improvement over time. Between defocus range of −2.50 and +1.00 D, the visual acuity remained ≥0.2 logMAR. Contrast sensitivity scores were within the normal range. 4 patients used reading glasses for very fine print.Conclusion. Bilateral ERV IOL implantation leads to excellent outcomes for far and intermediate vision, satisfactory outcomes for near vision, and good tolerance to micromonovision at the end of the 6 months. This trial is registered withCTRI/2015/10/006246.