Comparison of Clinical Results Between a 4-point Scleral Fixation of Intraocular Lenses Using Gore-tex Suture and a 2-point Fixation Using Prolene Suture

Purpose: To compare clinical outcomes between a 4-point scleral fixation of intraocular lenses (IOLs) using Gore-Tex suture or a 2-point scleral fixation using Prolene sutureMethods: In this multicenter, retrospective cohort study, patients were enrolled who had undergone a pars plana vitrectomy and either a 4-point scleral fixation using Gore-Tex suture or a 2-point scleral fixation using Prolene suture. Preoperative biometrics, postoperative refractive outcomes, and postoperative surgical complication rates were evaluated.Results: Thirty-seven eyes underwent scleral fixation with Gore-Tex suture, while 44 eyes underwent scleral fixation with Prolene suture. Postoperative best corrected visual acuity was 0.20 (± 0.34) in the Gore-Tex group and 0.21 (± 0.28) in the Prolene group (logMAR, 20/32 on the Snellen scale) (p = 0.691). No significant difference was found in the average prediction error between the Gore-Tex (-0.13 ± 0.68 D) and Prolene (-0.21 ± 1.27 D) groups (p = 0.077). The postoperative complication rate was lower in the Gore-Tex group (17%) than in the Prolene group (41%) (p = 0.023).Conclusion: A 4-point scleral fixation using Gore-Tex suture may be a good alternative to a conventional scleral fixation using Prolene suture for IOL implantations in eyes without capsular support, with a lower risk of postoperative complications.

Phacoemulsification and calculation of intraocular lenses in patients given keratorefractive surgery. Part 2

Effective rehabilitation of patients with cataracts who underwent keratorefractive surgeries requires that the optical power of the IOL be calculated correctly to avoid hyperopic error. The purpose of the 2nd part of the research (for the 1st part, see ROJ, 2021; 14 (2): 55–58) is to present the results of cataract phacoemulsification in patients subjected to keratorefractive surgery based on the author’s algorithm for calculating the optical power of the IOL. Material and methods. The algorithm used optical biometry with an IOL-Master device. The main technique of improving the accuracy of IOL calculation after keratorefractive operations has been to introduce amendments to standard IOL calculation formulas. This work proposes an alternative, which consists in using the Hoffer Q formula, as it is more consistent with changes in the anterior segment of the myopic eye after keratorefractive surgery than other basic. The main distinguishing feature of the Hoffer Q formula is that the corneal refraction is not converted into the radius of curvature but is applied directly as the optical power of a “thin lens”. Results. The empirical customized correction was +1.0 D with regard to the estimated planned postoperative refraction (for patients with initial myopia from -3 to -9 D). The use of the “thin lens” principle made it possible to extrapolate this formula and apply it after LASIK surgery and after radial keratotomy. Conclusion. The proposed technique of IOL calculation was implemented for cataract phacoemulsification in over 200 patients who underwent keratorefractive surgeries. No cases of hyperopic shift of postoperative refraction were noted. The deviation from the planned myopic refraction did not exceed 1.0 D.

Vitreoretinal Surgery in the Treatment of Dislocations of Intraocular Lens and Nucleus-Lens Particules into the Vitreous Cavity

Drops of lens nucleus/cortex particles into the vitreous cavity or dislocations of intraocular lenses (IOLs) are one of the serious complications of cataract surgery with an increasing relative frequency with the increase in the number of cataract surgeries. In addition, spontaneous and traumatic dislocations are other common case groups that should be treated. In this article, the vitreous dislocations of nucleus/cortex residues or IOL dislocations are discussed with different vitreoretinal surgical techniques.

Comparison of Patient Outcomes following Implantation of Trifocal and Extended Depth of Focus Intraocular Lenses: A Systematic Review and Meta-Analysis

Purpose. The purpose is to compare the outcomes of implantation of trifocal intraocular lenses (TIOLs) and extended depth of focus (EDOF) intraocular lenses (IOLs). Methods. A comprehensive search of PubMed, Cochrane Library, EMBASE, and ClinicalTrial.gov was conducted in March 2020 to identify relevant studies. A meta-analysis of the results was performed. Patients implanted with EDOF IOLs or TIOLs in previous studies were included. The primary outcomes of the study were uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), and defocus curve. Results. TIOLs and EDOF IOLs provided comparable binocular UDVA (MD = -0.01, 95% CI: -0.04, 0.03, logMAR). However, EDOF IOLs provided better UIVA (MD: -0.08, 95% CI: -0.14, -0.01, logMAR) and worse UNVA (MD: 0.10, 95% CI: 0.06, 0.14, logMAR) than TIOLs. Fewer patients achieved spectacle independence after implantation of EDOF IOLs (RR: 0.74, 95% CI: 0.63, 0.87) than after implantation of TIOLs, especially for near vision (RR = 0.82, 95% CI: 0.68, 0.99). There was no statistically significant difference in contrast sensitivity (CS) under photopic or mesopic conditions with both IOLs. Patient satisfaction after implantation of both IOLs was high. Conclusion. EDOF IOLs and TIOLs provide comparable distance vision. However, EDOF IOLs provide better intermediate vision and worse near vision than TIOLs. The advantages of EDOF IOLs over TIOLs in terms of CS, aberrations, and visual disturbance are not significant. Patients are satisfied with both types of IOLs.

Congenital Cataract Surgery: A Retrospective Analysis of 62 Patients in a Developing Country

Purpose. This study was aimed at describing our experience in congenital cataract surgery in a developing Country. Methods. A retrospective study was conducted in Amman, Jordan. The patients who were diagnosed with congenital cataract and underwent the surgery were included in the study. It was decided to use an intraocular lens if the corneal diameter was more than 10 millimeters. Results. The findings revealed that around 13 of the patients did not have any visual axis opacification, indicating that they were aphakic. Visual axis opacification was seen in 8 out of the total sample of participants. Eleven patients with obvious opacification of the visual axis were found to be pseudophakic after at least two procedures and were thus cleared. It was necessary to do a second surgery to rectify the visual axis opacification induced by pseudophakia, which was putting the patient’s ability to recuperate at danger. Three of them (or 12 percent) exhibited visual axis opacification, which is a rare occurrence. The intraocular lenses used in the remaining 24 patients were constructed of hydrophilic plastic. Conclusion. Patients are less prone to have visual axis opacification while implanted by hydrophobic intraocular lenses is something they should consider.

One-year post-operative comparison of visual function and patient satisfaction with trifocal and extended depth of focus intraocular lenses

Purpose To evaluate visual performance with trifocal and extended depth of focus IOL at 1 year post-operatively. Setting BMI Southend Hospital. Design Cohort study. Methods An age-matched cohort of forty subjects bilaterally implanted with the AT LISA 839MP trifocal IOL (20 patients, 40 eyes) and the Tecnis Symfony extended depth of focus IOL (20 patients, 40 eyes) were assessed at 3–6 months and 12–18 months post-operatively. Primary outcome measures were distance (6 m), intermediate (70 cm), near visual acuity (40 cm), and analysis of defocus profiles. Secondary outcomes included contrast sensitivity, Radner reading performance, quality of vision and assessment of halos. Results Distance visual acuity (VA) and defocus areas were similar ( p = 0.07). No significant difference in intermediate VA was noted but the intermediate area of focus was greater in the EDoF (0.31 ± 0.12 LogMAR*m−1) compared to the trifocal (0.22 ± 0.08LogMAR*m−1) ( p = 0.02). However, all near metrics were significantly better in the trifocal group. 80% of trifocal subjects were spectacle independent compared to 50% EDoF subjects. Quality of vision questionnaire found no significant differences between groups, however halo scores were greater at 3–6 months in the trifocal group ( p < 0.01) but no differences were noted at 12–18 months. Conclusions Near vision is significantly better for the trifocal, thus greater levels of spectacle independence. The range of intermediate vision was greater for the EDoF but no difference in intermediate VA. In the early period, differences in contrast sensitivity and halo size/intensity were noted, however, by one-year these measures were not significantly different.