Christina Leydolt

Meta-analysis of accommodating intraocular lenses

&NA; Accommodating intraocular lenses (IOLs) based on the concept of optic shift were introduced to restore accommodation after cataract surgery. Currently, 3 types of accommodating IOLs are commercially available: 1CU (HumanOptics), BioComFold (Morcher), and AT‐45 Crystalens (eyeonics, Inc.). We present a meta‐analysis of the peer‐reviewed data from studies of these IOLs that use optic‐shift measurements and visual acuity as the main outcome measures. In the 6 randomized controlled studies, 5 of which studied the 1CU IOL, the visual acuity results showed moderate to no improvement in near visual acuity compared with control IOLs and a statistically significant but small and inter‐patient variable anterior shift of the IOL optic after pilocarpine stimulation. More clinical trials with randomized, controlled, and patient‐ and examiner‐masked study designs that follow the guidelines of evidence‐based medicine are needed to prove a benefit of accommodating focus‐shift IOLs.

Effect of anterior capsule polishing on the posterior capsule opacification-inhibiting properties of a sharp-edged, 3-piece, silicone intraocular lens: three- and 5-year results of a randomized trial.

PURPOSE: To evaluate the long‐term effects of anterior capsule polishing on regeneratory posterior capsule opacification (PCO), anterior capsule opacification (ACO), and fibrotic PCO with a silicone intraocular lens (IOL) with sharp optic edges. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: This prospective bilateral randomized patient‐ and examiner‐masked clinical trial comprised 130 eyes of 65 patients with bilateral age‐related cataract. All eyes had implantation of a 3‐piece silicone IOL with a truncated, sharp‐edged optic (CeeOn Edge 911A, Advanced Medical Optics). In 1 eye, the anterior capsule was extensively polished using an aspiration curette after phacoemulsification and cortex aspiration. Regenerative PCO was quantified objectively, while ACO and fibrotic PCO were graded subjectively 1, 2, 3, and 5 years postoperatively. RESULTS: The mean ACO score was significantly lower in the eyes in which the anterior capsule had been polished (1 year, P<.02; 2 years, P<.03; 3 years, P<.01; 5 years, P<.01). The mean difference in regeneratory PCO and fibrotic PCO scores between the 2 groups was not statistically significant. CONCLUSIONS: Three years after cataract surgery, eyes in which the anterior capsule had been polished had significantly less ACO. However, polishing did not lower PCO intensity when a sharp‐edged CeeOn 911A IOL was implanted in the bag. Although results indicate that anterior capsule polishing may enhance the development of regeneratory PCO, this trend did not reach statistical significance.

Effect of intravitreal bevacizumab (Avastin®) in neovascular age-related macular degeneration using a treatment regimen based on optical coherence tomography: 6- and 12-month results

Purpose:  To study the effect of intravitreal bevacizumab therapy on visual and anatomical outcomes in patients with neovascular age‐related macular degeneration (AMD) within a follow‐up period of 6 and 12 months.

Posterior Capsule Opacification with the iMics1 NY-60 and AcrySof SN60WF 1-Piece Hydrophobic Acrylic Intraocular Lenses: 3-Year Results of a Randomized Trial

PURPOSE To compare the intensity of posterior capsule opacification (PCO) 3 years after implantation of 2 different 1-piece foldable hydrophobic acrylic intraocular lenses (IOLs). DESIGN Randomized, prospective, patient- and examiner-masked clinical trial with intraindividual comparison. METHODS One hundred patients with bilateral age-related cataract (200 eyes) had standard cataract surgery with implantation of an iMics1 NY-60 IOL (Hoya Corp) in one eye and an AcrySof SN60WF IOL (Alcon Laboratories) in the other eye. Follow-up examinations were performed at 1 week and 3 years. Digital retroillumination images were obtained of each eye. The main outcome measure was PCO score (scale, 0 to 10) assessed subjectively at the slit lamp and objectively using automated image analysis software (Automated Quantification of After-Cataract) 3 years after surgery. RESULTS The objective PCO score (mean ± standard deviation) was 3.0 ± 2.0 for the iMics1 NY-60 IOL and 1.9 ± 1.4 for the AcrySof SN60WF IOL (P < .001). Three years after surgery, 35.6% of patients underwent a neodymium:yttrium-aluminum-garnet capsulotomy in the iMics1 NY-60 eye and 13.7% underwent a capsulotomy in the AcrySof SN60WF eye (P = .001). There was no statistically significant difference in best-corrected visual acuity, rhexis-IOL overlap, capsular folds, or anterior capsule opacification. Glistening formations were found in no iMics1 NY-60 IOLs, but in 97% of the AcrySof SN60WF IOLs. CONCLUSIONS Comparison of 2 sharp-edged single-piece IOLs of similar design and hydrophobic acrylic material indicated a statistically significant difference in PCO and neodymium:yttrium-aluminum-garnet capsulotomy rate 3 years after surgery.

Posterior capsule opacification and neodymium:YAG rates with 2 single-piece hydrophobic acrylic intraocular lenses: Three-year results

Purpose To compare the incidence and intensity of posterior capsule opacification (PCO) between 2 similar 1‐piece foldable hydrophobic acrylic intraocular lenses (IOLs) over 3 years. Setting Department of Ophthalmology, Medical University Vienna, Vienna, Austria. Design Randomized prospective patient‐ and examiner‐masked clinical trial with intraindividual comparison. Methods Patients with bilateral age‐related cataract had cataract surgery and implantation of a Tecnis ZCB00 continuous‐optic‐edge IOL in 1 eye and an Acrysof SA60AT interrupted‐optic‐edge IOL in the other eye. Postoperative examinations were performed at 6 months and 3 years. Digital retroillumination images were taken of each eye. The amount of PCO (score 0 to 10) was assessed subjectively at the slitlamp and objectively using automated image‐analysis software. Results The study comprised 54 patients (108 eyes). The mean objective PCO score was 1.3 ± 1.7 (SD) for the continuous‐optic‐edge IOLs and 0.9 ± 1.3 for the interrupted‐optic‐edge IOLs (P=.10). Three years postoperatively, a neodymium:YAG (Nd:YAG) capsulotomy was performed in 26.1% of eyes with the continuous‐optic‐edge IOL and 21.7% with the interrupted‐optic‐edge IOL (P=.56). There was no significant difference in corrected distance visual acuity, capsulorhexis–IOL overlap, capsule folds, or anterior capsule opacification 3 years after surgery. Conclusions Both IOLs had comparable PCO and Nd:YAG rates 3 years postoperatively. The optimized barrier function of the continuous‐optic‐edge IOL and the material properties of the interrupted‐optic‐edge IOL seemingly outbalanced the effect on lens epithelial cell migration and proliferation beneath the optic. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Comparison of partial coherence interferometers : ACMaster versus laboratory prototype

PURPOSE To evaluate anterior segment biometry using the ACMaster (Carl Zeiss Meditec AG, Jena, Germany) in regard to precision of measurement and clinical performance compared to the original laboratory prototype of the partial coherence interferometry technique. METHODS Ten phakic (20 eyes) and 27 pseudophakic (44 eyes) patients were included in this study. Anterior segment biometry of phakic and pseudophakic study eyes was performed using the ACMaster and the laboratory prototype of the partial coherence interferometry technique. The ACMaster is a commercially available device based on the partial coherence interferometry technique, which provides high precision anterior segment measurements in a quick and user-friendly fashion. Examination included measurement of central corneal thickness, anterior chamber depth, and lens thickness, the latter only in the phakic eyes. RESULTS The consistency of anterior segment measurements performed with both units was excellent in phakic as well as in pseudophakic eyes. In pseudophakic eyes, the measurement of anterior chamber thickness and lens thickness with the ACMaster produced several (typical) measurement artifacts in some cases, which partially aggravated the identification of the A-scan peak representing the anterior intraocular lens surface. CONCLUSIONS The ACMaster is a user-friendly device that enables axial anterior segment biometry using the partial coherence interferometry technique with a reproducibility similar to that of the original laboratory prototype.

Posterior capsule opacification and neodymium:YAG laser capsulotomy rates with 2 microincision intraocular lenses: Four-year results

Purpose To compare the development of posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) capsulotomy rates between 2 microincision intraocular lenses (IOLs) 4 years after surgery. Setting Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Design Prospective randomized clinical trial. Methods Patients randomly received a Y‐60H 3‐piece hydrophobic IOL (hydrophobic group) in 1 eye and an MI60 1‐piece hydrophilic IOL (hydrophilic group) in the contralateral eye during simultaneous bilateral cataract surgery. Eyes were examined 1 week, 20 months, and 4 years postoperatively. Digital retroilluminated images of each eye were evaluated using Automated Quantification of After‐Cataract software. The Nd:YAG laser capsulotomy rate was recorded. Results Sixty patients were enrolled. Objective PCO was significantly higher in the hydrophobic group than in the hydrophilic group before capsulotomy 2 years after cataract surgery (mean score 2.1 ± 1.8 (SD) versus 1.2 ± 1.4) (P =.031). At the 4‐year follow‐up, the hydrophobic group had a statistically significantly higher Nd:YAG rate than the hydrophilic group (77% versus 50%) (P =.012). Conclusion Comparison of 2 microincision IOLs indicated a statistically significant difference in PCO and Nd:YAG capsulotomy rates, with very high Nd:YAG rates 4 years after surgery. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

RETREATMENT WITH ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY BASED ON CHANGES IN VISUAL ACUITY AFTER INITIAL STABILIZATION OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: 3-Year Follow-up Results.

Purpose: To evaluate the 3-year therapeutic benefit of intravitreal bevacizumab in neovascular related macular degeneration (nAMD) in a standard clinical setting involving 3 initial injections and a pro re nata regimen as recommended in the PRONTO study. Methods: In this interventional clinical study, 181 eyes of 160 consecutive patients with active neovascular related macular degeneration meeting recommended criteria for inclusion and protocol criteria for anti–vascular endothelial growth factor therapy undergoing intravitreal bevacizumab monotherapy were observed. Data of treatment-naive eyes (Group 1, n = 114) were analyzed separately from eyes that had undergone previous photodynamic therapy plus intravitreal triamcinolone (Group 2, n = 67). Re-treatment criteria were based on clinical outcome following the official European label regimen. After 1 year of continuous service at an academic referral center, follow-up was performed in private practices in collaboration with the referral center. Main outcome parameters were best-corrected visual acuity and central retinal thickness. Results: After 3 years, best-corrected visual acuity decreased in the overall population (0.23 ± 0.16 to 0.16 ± 0.21. P = 0.002) and in both groups compared with baseline (0.24 ± 0.21 to 0.17 ± 0.21, Group 1, P = 0.03; 0.22 ± 0.19 to 0.16 ± 0.21, Group 2, P > 0.05), whereas central retinal thickness increased in the overall population (291 ± 92 to 319 ± 110 &mgr;m, P = 0.01) and in both groups (291 ± 96 to 325 ± 117 &mgr;m, Group 1, P > 0.05; 290 ± 83 to 308 ± 96 &mgr;m, Group 2, P > 0.05) because of chronic cystic degeneration changes of the macula. Mean treatment rate was 5.1 ± 3.9 (Group 1) versus 3.7 ± 2.7 (Group 2, P = 0.01). Five cases of severe intraocular inflammation after intravitreal bevacizumab were documented. Discussion: While the functional and morphological benefits persisted for the first year after intravitreal bevacizumab treatment, after this time both functional and morphologic results were disappointing during long-term follow-up with visual acuity loss as the main retreatment criterion. After stabilization of the disease, a monthly follow-up of optical coherence tomography and re-treatment based on morphologic, clinical, and vision outcomes may increase the efficacy in patients with neovascular related macular degeneration under anti–vascular endothelial growth factor treatment.

Posterior capsular opacification and Nd:YAG capsulotomy rates with the iMics Y‐60H and Micro AY intra‐ocular lenses: 3‐year results of a randomized clinical trial

To compare the incidence and intensity of posterior capsular opacification (PCO) and neodymium:yttrium‐aluminium‐garnet (Nd:YAG) capsulotomy rates between two microincision intra‐ocular lenses (IOLs) 3 years after surgery.

Determination of Personalized IOL-Constants for the Haigis Formula under Consideration of Measurement Precision.

The capabilities of a weighted least squares approach for the optimization of the intraocular lens (IOL) constants for the Haigis formula are studied in comparison to an ordinary least squares approach. The weights are set to the inverse variances of the effective optical anterior chamber depth. The effect of random measurement noise is simulated 100000 times using data from N = 69 cataract patients and the measurement uncertainty of two different biometers. A second, independent data set (N = 33) is used to show the differences that can be expected between both methods. The weighted least squares formalism reduces the effect of measurement error on the final constants. In more than 64% it will result in a better approximation, if the measurement errors are estimated correctly. The IOL constants can be calculated with higher precision using the weighted least squares method.