Fabrizio Casprini

Prospective randomized study of clinical performance of 3 aspheric and 2 spherical intraocular lenses in 250 eyes.

PURPOSE To compare the quality of vision with aspheric and spherical intraocular lenses (IOLs) in pseudophakic patients. METHODS This prospective, comparative, randomized study included 250 eyes of 125 patients with bilateral cataracts. Patients were randomly assigned to receive either IOLs with a spherical biconvex optic (Acrysof SN6OAT [Alcon] or Sensar AR40e [Advanced Medical Optics, AMO]) or IOLs with an aspheric optic (Acrysof IQ SN6OWF [Alcon], Tecnis Z9000 [AMO], or Sofport L161AO [Bausch & Lomb]). Ophthalmologic examination including best spectacle-corrected visual acuity, pupil size, ocular dominance investigation, contrast sensitivity under mesopic and photopic conditions, and wavefront analysis was performed 2 months postoperatively. RESULTS Aspheric IOLs showed better contrast sensitivity compared to spherical IOLs at spatial frequencies of 6, 12, and 18 cycles per degree (cpd) under photopic conditions and at all spatial frequencies under mesopic conditions. There was no significant difference among the three aspheric IOLs at all spatial frequencies under either photopic or mesopic conditions. Mean total spherical aberration was statistically lower in dominant eyes with aspheric IOLs (0.05 +/- 0.06, 0.11 +/- 0.1, and 0.19 +/- 0.08 pm for the Tecnis Z9000, Acrysof IQ SN6OWF, and Sofport L161AO, respectively) compared with eyes with spherical IOLs (0.62 +/- 0.24 and 0.46 +/- 0.19 microm for the Acrysof SN6OAT and Sensar AR40e, respectively) for a 5-mm pupil diameter. CONCLUSIONS The aspheric IOLs had less wavefront aberrations and performed better under both photopic and mesopic contrast sensitivity compared to the spherical IOLs. These findings confirm it is possible to improve the optical performance of IOLs by modifying the surfaces.

Preliminary results of cataract extraction with implantation of a single-piece AcrySof intraocular lens

Purpose: To evaluate the intraoperative and postoperative performance of the single‐piece AcrySof® SA30AL intraocular lens (IOL) in a series of patients after cataract surgery and IOL implantation. Setting: Department of Ophthalmology and Neurosurgery, University of Siena, Siena, Italy. Methods: In this prospective study, 20 patients who had phacoemulsification and implantation of a single‐piece AcrySof SA30AL lens from March to April 2000 were evaluated. Assessed were control of IOL folding, ease of IOL implantation, IOL centration, intraoperative and postoperative complications, visual acuity, and anterior (ACO) and posterior (PCO) capsule opacification. Results: In all cases, the IOL was easily folded, inserted, and unfolded. It remained well centered in the capsular bag, and there were no intraoperative or postoperative complications. The best corrected visual acuity after surgery was 20/40 or better in all patients. No eye developed ACO or phimosis. One eye had a well‐demarcated, oval area of lens epithelial cell proliferation on the posterior capsule that did not impair visual acuity. Conclusions: Initial results indicate that the single‐piece AcrySof SA30AL IOL has good biocompatibility, haptic flexibility and resistance, and stability in the capsular bag. The incidence of PCO in 1 eye could have been the result of several factors and requires further evaluation. An area of future study is the wide haptic of the lens, which may create a path for cells to proliferate as they travel from the equatorial capsule.

Pseudoexfoliation syndrome: in vivo confocal microscopy analysis

Pseudoexfoliation (PEX) syndrome is a common ocular disease that also affects the cornea. A case of clinical PEX syndrome, studied by in vivo corneal confocal microscopy is reported. The morphological analysis of the confocal images demonstrated hyper‐reflective deposits and several dendritic cells in the basal epithelial layer. A fibrillar subepithelial structure was also found. The endothelial layer showed cell anomalies (polymegathism and pleomorphism) and hyper‐reflective small endothelial deposits. Confocal microscopy is an in vivo imaging method that may provide new information on corneal alterations in PEX, and detect early corneal features.

Long-term results of combined 1-way phacoemulsification, intraocular lens implantation, and trabeculectomy

PURPOSE To analyze the results of 1-way phacoemulsification and posterior chamber intraocular lens (IOL) implantation combined with trabeculectomy. SETTING Department of Ophthalmology and Neurosurgery, University of Siena, Siena, Italy. METHODS This retrospective study comprised 42 eyes of 36 patients with glaucoma and cataract who had phacoemulsification with posterior chamber IOL implantation combined with trabeculectomy. The mean follow-up of 28.24 months +/- 10.99 (SD) (range 11 to 52 months) included measurement of intraocular pressure (IOP), visual acuity, visual field, endothelial cell loss, and notation of complications. RESULTS There was a statistically significant postoperative improvement in visual acuity (P < .001). Mean preoperative best corrected visual acuity (BCVA) was 20/200 (range 20/30 to hand movements). Mean 1 year postoperative BCVA was 20/30 (range 20/20 to 20/60). The preoperative mean IOP of 24.06 mm Hg decreased to 15.36 mm Hg at 1 year (P < .001). All 42 eyes had a postoperative IOP of less than 21.00 mm Hg. Mean central cornea endothelial cell density preoperatively was 2238 +/- 396 cells/mm2 (range 1697 to 2906 cells/mm2) and postoperatively, 2005 +/- 397 cells/mm2 (range 1302 to 2801 cells/mm2). Early postoperative complications consisted of a choroidal detachment in 2 patients (4.76%). Three and 4 days after surgery, respectively, 2 patients (4.76%) had surgery to remove viscoelastic substance under the IOL. Late complications included posterior synechias in 3 eyes (7.14%). One year after surgery, because of a significant decrease in vision, a neodymium:YAG laser posterior capsulotomy was necessary in 2 eyes, 1 with an acrylic IOL (3.70%) and 1 with a silicone lens (9.09%). CONCLUSION Combined phacoemulsification, posterior chamber IOL implantation, and trabeculectomy was safe and effective in patients with coexisting glaucoma and cataract.

Phacoemulsification without intraocular lens implantation in patients with high myopia: Long-term results

Purpose: To estimate the cumulative incidence of postoperative retinal detachment (RD), rhegmatogenous retinal lesions requiring argon laser treatments, anterior (ACO) and posterior (PCO) capsule opacification, and neodymium:YAG (Nd:YAG) laser capsulotomy in patients with high myopia who had phacoemulsification without intraocular lens (IOL) implantation. Setting: Department of Ophthalmology and Neurosurgery, University of Siena, Siena, Italy. Methods: Seventy‐three eyes of 57 patients with high myopia who had phacoemulsification without IOL implantation from 1993 to 1996 were retrospectively reviewed. The mean postoperative follow‐up was 62.3 months and the mean axial length, 30.22 mm (range 29.10 to 33.70 mm). The incidence of RD and preoperative and postoperative prophylactic argon laser photocoagulation for rhegmatogenous retinal lesions were assessed. Between 1997 and 2000, ACO was evaluated subjectively and PCO was evaluated using the EPCO photographic image‐analysis system. The incidence of Nd:YAG laser capsulotomy was noted. Results: Argon laser photocoagulation was performed in 8 eyes (10.9%) preoperatively and 3 eyes (4.1%) postoperatively. One RD (1.3%) was observed 26 months after surgery; no preoperative or postoperative prophylactic argon laser photocoagulation or Nd:YAG laser capsulotomy was performed in this eye. At 1 year, 49 eyes (67.1%) had mild ACO and 24 (32.8%) had anterior capsule fibrosis. The data did not change during subsequent follow‐up visits. At 6 years, the mean PCO grade was 1.109 (range 0.972 to 2.931); an Nd:YAG laser capsulotomy was performed in 12 eyes (16.4%). Conclusions: Compared with other studies that evaluated the outcomes of highly myopic patients who had cataract surgery with posterior chamber IOL implantation, our patients, who did not have IOL implantation, had a lower incidence of postoperative rhegmatogenous retinal lesions requiring argon laser treatments and a similar incidence of postoperative RD and visually significant PCO.

Confocal microscopy identification of keratoconus associated with posterior polymorphous corneal dystrophy

We present a case of keratoconus in which the association with posterior polymorphous corneal dystrophy was established by confocal microscopy. Confocal microscopy enable us to assess the differential diagnosis between posterior corneal dystrophies, essential for a prognosis and therapeutic decision.

Comparison of AcrySof MA30BA and Sensar AR40 acrylic intraocular lenses

Purpose: To compare differences in anterior (ACO) and posterior (PCO) capsule opacification and subjective glare between 2 acrylic intraocular lenses (IOLs): AcrySof® MA30BA (Alcon) and Sensar® AR40 (Allergan). Setting: Department of Ophthalmology and Neurosurgery, University of Siena, Siena, Italy. Methods: This retrospective study comprised 100 cataract patients who had phacoemulsification and IOL implantation. Fifty eyes of 50 patients received an MA30BA and 50 eyes of 50 patients, an AR40. The mean postoperative follow‐up was 25 months (range 20 to 31 months) and 22 months (range 19 to 29 months), respectively. Examiners subjectively evaluated ACO, and a photographic image‐analysis system was used to assess PCO. All patients received a questionnaire to evaluate the incidence of subjective photic phenomena. Results: In the MA30BA group, 60% had no ACO, 19% had mild ACO, and 21% had anterior capsule fibrosis. In the AR40 group, 55% had no ACO, 27% had mild ACO, and 18% had anterior capsule fibrosis. In the MA30BA group, the mean PCO score measured by image‐analysis was 0.043 (range 0.000 to 0.084) at 1 year and 0.125 (range 0.000 to 0.197) at 2 years and in the AR40 group, 0.071 (range 0.000 to 0.157) and 0.230 (range 0.091 to 0.628), respectively. Although the ACO percentages and the PCO scores at 1 year were not statistically different between the 2 groups (P > .05), the MA30BA group had statistically less PCO at 2 years (P < .05). In the MA30BA group, 36 patients had trouble reading in a dim environment, 25 had difficulty driving at night, 25 were mildly bothered by the lights of other vehicles, and 17 saw halos when looking at the lights of other vehicles and 17, when looking at lights at night. In the AR40 group, 7 patients had trouble reading in a dim environment and 11 had difficulty driving at night. At 6 months, the AR40 group had a statistically significantly lower incidence of photic phenomena than the MA30BA group (P < .05). In the MA30BA group 1 year after surgery, 13 patients had trouble reading in a dim environment and 12 had difficulty driving at night. In the AR40 group, 5 patients had trouble reading in a dim environment and 8 had difficulty driving at night. One year after surgery, the difference between the 2 groups in photic phenomena was not statistically significant (P > .05). Conclusions: The findings indicate that the AcrySof MA30BA has a lower incidence of PCO than the Sensar AR40. The AR40 IOL induced less glare; however, the glare phenomena did not disturb those with an MA30BA lens and the symptoms decreased by 1 year after surgery. These results suggest that both optic design and haptic material influence postoperative clinical results.

Histology of anterior capsule fibrosis following phacoemulsification

Purpose: To determine the histology and immunohistochemistry of anterior capsule fibrosis. Setting: Department of Ophthalmology and Neurosurgery and Institute of Pathology, University of Siena, Siena, Italy. Methods: Tissue sections from 3 patients with anterior capsule fibrosis after phacoemulsification and intraocular lens implantation were examined histologically. Results: The proliferating tissue was devoid of vessels and composed of dense fibrous tissue and numerous activated fibroblasts with contractile capacity (myofibroblasts). No TGF‐&bgr;, which is the most important cytokine in modulating myofibroblasts, was present in the fibrotic tissue. Conclusion: The absence of the cytokine TGF‐&bgr; and inflammatory cells in the proliferating tissue confirms the unique character of the reparative activity within the eye.

Contrast sensitivity evaluation of aspheric and spherical intraocular lenses 2 years after implantation.

PURPOSE To compare the quality of vision with aspheric and spherical intraocular lenses (IOLs) in pseudophakic patients after long-term follow-up. METHODS Two hundred eyes of 100 patients with bilateral cataracts were randomly assigned to receive spherical (Acrysof SN60AT [Alcon Laboratories Inc] or Sensar AR40e [Advanced Medical Optics Inc]) or aspheric IOLs (Acrysof SN60WF [Alcon] or Tecnis Z9000 [Advanced Medical Optics]). Ophthalmologic examination, including best spectacle-corrected visual acuity (BSCVA), pupil size, ocular dominance, contrast sensitivity under mesopic and photopic conditions, and wavefront analysis, was performed 2 months and 1 and 2 years after surgery. RESULTS No statistically significant differences among the four groups in terms of age, pupil diameter, postoperative BSCVA, comeal spherical aberration, and posterior capsular opacification were noted. At all followup examinations, contrast sensitivity results showed no significant differences between the two aspheric IOLs at all spatial frequencies. Under photopic conditions, significant differences (P<.05) between spherical and aspheric IOLs were detected for spatial frequencies of 12 and 18 cycles per degree (cpd) at 2 months and 2 years and 12 cpd at 1 year. Under mesopic conditions, significant differences (P<.05) were detected between spherical and aspheric IOLs for all spatial frequencies at 2 months; all spatial frequencies except 18 cpd at 1 year; and spatial frequencies of 3, 12, and 18 cpd at 2 years. In addition, aspheric IOLs had statistical reductions in total spherical aberration at all follow-up examinations (P<.01). CONCLUSIONS This study confirms that implantation of a modified aspheric IOL improves functional visual performance at 2 years postoperative.

Trypan blue staining of the anterior capsule: the one-drop technique.

Capsule staining is usually a two- or three-stage procedure in which trypan blue is injected under air, a viscoelastic device, viscoelastic mixed with dye, or compartmentalized viscoelastic and balanced salt solution. In these techniques, the consequent irrigation of the anterior chamber with balanced salt solution may lead to a less stable anterior chamber, a decrease of pupil diameter, and damage of the corneal endothelium. A modification of current injection techniques for staining the anterior capsule under a dispersive viscoelastic device with 1 drop of trypan blue by an ordinary 27-gauge anterior chamber cannula is described.