F. T. A. Kretz

Clinical outcomes and surgeon assessment after implantation of a new diffractive multifocal toric intraocular lens.

Purpose To evaluate the clinical outcome in eyes with significant corneal astigmatism after cataract surgery with implantation of a new diffractive multifocal toric intraocular lens (IOL). Methods Prospective, non-randomised multicentre clinical study including 57 eyes of 38 consecutive patients with an age between 37 and 84 years that underwent cataract surgery with implantation of the toric multifocal IOL Tecnis ZMT (Abbott Medical Optics, Santa Ana, California, USA). Changes in uncorrected and corrected logMAR distance, intermediate and near visual acuity ((uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), corrected near visual acuity) and manifest refraction were evaluated during a 2–4 month follow-up. Additionally, patients were asked about photic phenomena and spectacle dependence. The surgeons subjectively assessed various aspects of the surgery. Results A significant improvement in CDVA was observed postoperatively (p<0.01), with a significant reduction in manifest cylinder (p<0.01). Mean postoperative binocular UDVA and UNVA were 0.04±0.10 and 0.06±0.12, respectively. Monocular UDVA and UNVA was 0.20 or better in 85.4% and 87.0% of eyes, respectively. Mean binocular logMAR UIVA was 0.21±0.20. Only 10.5% of patients required postoperative correction for near or intermediate distance. The incidence of moderate to severe photic phenomena was limited. Surgeons defined the IOL implantation in most cases as easy or very easy, with a satisfaction rate with the procedure of 84%. Conclusions The implantation of the multifocal toric IOL is a safe procedure that provides a very good visual rehabilitation in eyes with corneal astigmatism.

Clinical evaluation of a new pupil independent diffractive multifocal intraocular lens with a +2.75 D near addition: a European multicentre study

Purpose To evaluate the clinical outcomes after cataract surgery with implantation of a new diffractive multifocal intraocular lens (IOL) with a lower near addition (+2.75 D.). Methods 143 eyes of 85 patients aged between 40 years and 83 years that underwent cataract surgery with implantation of the multifocal IOL (MIOL) Tecnis ZKB00 (Abbott Medical Optics,Santa Ana, California, USA) were evaluated. Changes in uncorrected (uncorrected distance visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity) and corrected (corrected distance visual acuity, corrected near visual acuity) logMAR distance, intermediate visual acuity and near visual acuity, as well as manifest refraction were evaluated during a 3-month follow-up. Additionally, patients were asked about photic phenomena and spectacle dependence. Results Postoperative spherical equivalent was within ±0.50 D and ±1.00 D of emmetropia in 78.1% and 98.4% of eyes, respectively. Postoperative mean monocular uncorrected distance visual acuity, uncorrected near visual acuity and uncorrected intermediate visual acuity was 0.20 LogMAR or better in 73.7%, 81.1% and 83.9% of eyes, respectively. All eyes achieved monocular corrected distance visual acuity of 0.30 LogMAR or better. A total of 100% of patients referred to be at least moderately happy with the outcomes of the surgery. Only 15.3% of patients required the use of spectacles for some daily activities postoperatively. Conclusions The introduction of low add MIOLs follows a trend to increase intermediate visual acuity. In this study a near add of +2.75 D still reaches satisfying near results and leads to high patient satisfaction for intermediate visual acuity.

Bilateral implantation of toric multifocal additive intraocular lenses in pseudophakic eyes

UNLABELLED A 41-year-old patient presented with hyperopia, astigmatism, and presbyopia for refractive treatment 6 years following cataract surgery. A toric multifocal additive intraocular lens with a near addition of +3.5 diopters (D) for sulcus implantation was chosen and implanted uneventfully. Follow-up examinations were performed from the first day until 9 months after surgery. A predictable refractive correction was seen, with a residual error of +0.125 D (spherical equivalent) in the right eye and emmetropia in the left eye. Monocular uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity (UNVA) (40 cm) improved to 0.1 logMAR. It could not be improved further with near-add spectacles. Binocular UDVA and UNVA were 0.0 logMAR and 0.1 logMAR (80 cm), respectively. Both additive IOLs remained centered and on axis during the follow-up period. Spectacle independence was achieved, as was high patient satisfaction. FINANCIAL DISCLOSURE The International Vision Correction Research Centre received research grants related to this publication from the following companies: Dr. Schmidt Intraocularlinsen GmbH, Rayner Intraocular Lenses, Ltd., and Carl Zeiss Meditec AG. No author has a financial or proprietary interest in any material or method mentioned.

Clinical Outcomes After Implantation of a Trifocal Toric Intraocular Lens.

PURPOSE To evaluate the visual, refractive, and contrast sensitivity outcomes, as well as the level of photic phenomena, after cataract surgery with implantation of a trifocal diffractive toric intraocular lens (IOL). METHODS This prospective study included 56 eyes with corneal astigmatism of 1.00 diopters (D) or greater of 28 patients (age: 23 to 78 years) undergoing cataract surgery with implantation of the trifocal toric IOL AT LISA tri toric 939MP (Carl Zeiss Meditec, Jena, Germany). Monocular and binocular visual outcomes, refractive changes, contrast sensitivity, and photic phenomena perception (Halo & Glare Simulator; Eyeland-Design Network GmbH, Vreden, Germany) were evaluated at 3 months postoperatively. RESULTS Mean 3-month postoperative monocular uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuities were 0.13±0.15, 0.08±0.15, and 0.13±0.18 logMAR, respectively. Binocular postoperative CDVA, DCIVA, and DCNVA values were 0.10 logMAR or better in all cases. A total of 88.2%, 88.2%, and 95.5% of eyes achieved binocular UDVA, UIVA, and UNVA values of 0.20 logMAR or better, respectively. Postoperative refractive cylinder was 0.50 D or less and 1.00 D or less in 78.6% and 98.2% of eyes, respectively. Photopic contrast sensitivity was significantly better than mesopic values for the spatial frequencies of 6 (P=.007), 12 (P=.005), and 18 cycles/degree (P=.011). Mean size and intensity of halos were 50.67±15.69 and 54.89±17.86, respectively. Mean glare size and intensity were 39.67±3.51 and 44.67±15.01, respectively. CONCLUSIONS The evaluated trifocal diffractive toric IOL provides an effective restoration of the distance, intermediate, and near vision after cataract surgery with good levels of visual quality and minimal photic phenomena.

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

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.

Proteomics of vitreous in neovascular age-related macular degeneration.

Neovascular age-related macular degeneration (nAMD) has been described as a predominantly inflammatory and proangiogenic retino-choroidal disease. Vitreous humor (VH) is the adjacent and accessible compartment which, due to the vicinity to the retina, might best represent changes of protein-based mediators of nAMD. The aim of this clinical-experimental study was to analyze the nAMD associated VH proteome of previously untreated patients whilst taking different groups of nAMD into account, based on their clinical presentation (clinical diagnosis groups). Electrophoresis coupled online to mass spectrometry (CE-MS) as well as liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) were used to analyze VH of 108 nAMD patients and 24 controls with idiopathic floaters. A total of 101 different proteins with at least two unique peptides could be identified. Using a stringent statistical analysis with implementation of the closed test principle, we were able to identify four proteins that may be involved in the pathophysiology of nAMD: Clusterin, opticin, pigment epithelium-derived factor and prostaglandin-H2 d-isomerase. Using independent samples, ROC-Area under the curve was determined proving the validity of the results: Clusterin 0.747, opticin 0.656, pigment epithelium-derived factor 0.514, prostaglandin-H2 d-isomerase 0.712. In addition, validation through ELISA measurements was performed. The identified proteins may serve as potential biomarkers or even targets of therapy for nAMD.

Visual Outcomes, Patient Satisfaction and Spectacle Independence with a Trifocal Diffractive Intraocular Lens

Purpose To evaluate visual outcomes following implantation of a trifocal diffractive intraocular lens (IOL) and to analyze their correlation with patient satisfaction and ease of performing daily tasks. Methods This was a prospective study enrolling 100 eyes of 50 patients undergoing cataract surgery with implantation of trifocal IOL AT LISA tri 839MP. Visual and refractive outcomes were evaluated during a 3-month follow-up. Postoperatively, a questionnaire was used to evaluate patient satisfaction with regard to surgical outcome, spectacle independence, perception of photic phenomena, and ease of performing some vision-related activities. Results A total of 91%, 87%, and 79% of eyes achieved a monocular uncorrected distance, near, and intermediate visual acuity of 0.1 logarithm of the minimum angle of resolution or better, respectively. After the surgery, 96% of the patients could perform their daily activities without problems. The mean spectacle independence scores for reading, doing computer work, and for distance were 10.33 ± 12.47, 5.71 ± 11.90, and 3.92 ± 9.77, respectively (scale: 0 = no spectacles needed; 40 = spectacles always needed). No correlation was found between spectacle independence and visual outcome (-0.101 ≤ r ≤ 0.244, p ≥ 0.087). Mean scores (0 = no symptoms; 40 = strong symptoms) for glare at night, ghost images, and halos were 15.15 ± 12.02, 4.49 ± 7.92, and 13.34 ± 10.82, respectively. No correlation was found between photic phenomena and visual outcome (-0.199 ≤ r ≤ 0.209, p ≥ 0.150). A total of 80% of patients reported satisfaction with the surgery outcome, and 86% would recommend the surgery to friends and family. Conclusions Implantation of the AT LISA tri 839MP IOL after cataract surgery provides effective visual restoration associated with a minimal level of photic phenomena, a positive impact on the performance of vision-related daily activities, and a high level of postoperative patient satisfaction.

Randomized Clinical Trial to Compare Micropulse Photocoagulation Versus Half-dose Verteporfin Photodynamic Therapy in the Treatment of Central Serous Chorioretinopathy

BACKGROUND AND OBJECTIVE To evaluate subthreshold diode-laser micropulse (SDM) versus half-dose verteporfin photodynamic therapy (hd-PDT) in central serous chorioretinopathy (CSC). PATIENTS AND METHODS 62 eyes of 62 patients were prospectively followed for changes in fluorescein angiography (FA), fundus autofluorescence (FAF), central macular thickness (CMT), best-corrected visual acuity (BCVA), and contrast visual acuity (CVA) after SDM (n=20) or hdPDT (n=24). CSC observation served as control group (n=18). RESULTS Both treatment groups (60% SDM vs. 66.7% hdPDT) showed significant improvement in reduction of leakage activity compared to the control group (37.5%) at 16 weeks. CMT decreased by 69.7 µm (SDM), 109.8 µm (hdPDT), and 89 µm (control). BCVA improved by +6.7 (SDM group), +8.5 (hdPDT), and +1.5 ETDRS letters (control). CVA was best improved in the hdPDT group. No secondary RPE alterations could be detected by FAF after any intervention. CONCLUSION In comparison to the control group, hdPDT and SDM resulted in reduced leakage activity in FA and enhanced photopic and scotopic visual acuity in patients with CSC.

Proteomic Analysis of Vitreous Humor in Retinal Vein Occlusion

Purpose To analyze the protein profile of human vitreous of untreated patients with retinal vein occlusion (RVO). Methods Sixty-eight vitreous humor (VH) samples (44 from patients with treatment naïve RVO, 24 controls with idiopathic floaters) were analyzed in this clinical-experimental study using capillary electrophoresis coupled to mass spectrometer and tandem mass spectrometry. To define potential candidate protein markers of RVO, proteomic analysis was performed on RVO patients (n = 30) and compared with controls (n = 16). To determine validity of potential biomarker candidates in RVO, receiver operating characteristic (ROC) was performed by using proteome data of independent RVO (n = 14) and control samples (n = 8). Results Ninety-four different proteins (736 tryptic peptides) could be identified. Sixteen proteins were found to be significant when comparing RVO and control samples (P = 1.43E-05 to 4.48E-02). Five proteins (Clusterin, Complement C3, Ig lambda-like polypeptide 5 (IGLL5), Opticin and Vitronectin), remained significant after using correction for multiple testing. These five proteins were also detected significant when comparing subgroups of RVO (central RVO, hemi-central RVO, branch RVO) to controls. Using independent samples ROC-Area under the curve was determined proving the validity of the results: Clusterin 0.884, Complement C3 0.955, IGLL5 1.000, Opticin 0.741, Vitronectin 0.786. In addition, validation through ELISA measurements was performed. Conclusion The results of the study reveal that the proteomic composition of VH differed significantly between the patients with RVO and the controls. The proteins identified may serve as potential biomarkers for pathogenesis induced by RVO.

Intermediate and Near Visual Acuity of an Aspheric, Bifocal, Diffractive Multifocal Intraocular Lens With +3.25 D Near Addition

PURPOSE To evaluate the clinical outcomes after cataract surgery with implantation of a new diffractive multifocal intraocular lens with a lower near addition. METHODS A prospective multicenter clinical study including 44 eyes of 44 patients (age range: 43 to 82 years) that underwent cataract surgery with implantation of the Tecnis ZLB00 multifocal intraocular lens (Abbott Medical Optics, Santa Ana, CA). Changes in uncorrected and corrected distance, intermediate, and near visual acuity, and manifest refraction were evaluated during a 3-month follow-up. Additionally, patients were asked about photic phenomena and spectacle dependence. RESULTS Postoperative spherical equivalent was within 0.50 and ± 1.00 diopters of emmetropia in 91.2% and 100% of eyes, respectively. Postoperative monocular uncorrected distance, near, and intermediate visual acuities were 0.10 logMAR (20/25 Snellen) or better in 82.5%, 86.5%, and 68.8% of eyes, respectively. All eyes achieved monocular corrected distance and near visual acuity of 0.10 logMAR (20/25 Snellen) or better. All patients reported to be satisfied with the outcomes of the surgery. Only 6 patients (13.6%) required the use of spectacles for some daily activities postoperatively, and 8 patients (18.2%) reported mild perception of halos. CONCLUSIONS The introduction of low addition multifocal intraocular lenses follows a trend to increase intermediate visual acuity. Still, a near addition of +3.25 diopters reached satisfying near results and led to high patient satisfaction.