Javier Mendicute

Foldable toric intraocular lens for astigmatism correction in cataract patients

PURPOSE: To evaluate the results of AcrySof toric intraocular lens (IOL) (Alcon) implantation to correct preexisting astigmatism in patients having cataract surgery. SETTING: Ophthalmology Service, Donostia Hospital, San Sebastián, Spain. METHODS: This prospective observational study included 30 eyes of 15 consecutive patients with more than 1.00 diopter (D) of preexisting corneal astigmatism having cataract surgery. Bilateral implantation of the AcrySof toric IOL was performed after phacoemulsification. The uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), residual refractive sphere, residual keratometric and refractive cylinders, and toric IOL axis were measured. RESULTS: The UCVA was 20/40 or better in 93.3% of eyes and 20/25 or better in 66.6%. All eyes achieved 20/25 or better BCVA. The mean refractive cylinder decreased significantly after surgery from −2.34 D ± 1.28 (SD) to −0.72 ± 0.43 D (P<.01). Vector analysis of attempted versus achieved correction showed that 100% of eyes were within ±1.00 D and 80% and 93.9% were within ±0.50 D for J0 and J45, respectively. The mean toric IOL axis rotation was 3.63 ± 3.11 degrees, with rotation less than 10 degrees in 96.7% of eyes. CONCLUSIONS: The results indicate that phacoemulsification and posterior chamber AcrySof toric IOL implantation is an effective option to correct preexisting astigmatism in cataract surgery. The AcrySof toric IOL showed good rotational stability.

Toric intraocular lens versus opposite clear corneal incisions to correct astigmatism in eyes having cataract surgery

PURPOSE: To compare toric intraocular lens (IOL) implantation with paired opposite clear corneal incisions (OCCIs) for astigmatism correction in patients having cataract surgery. SETTING: Ophthalmology Service, Donostia Hospital, San Sebastián, Spain. METHODS: This randomized prospective clinical study comprised eyes with more than 1.00 diopter (D) of preexisting corneal astigmatism. One group had AcrySof toric IOL implantation and the other, paired 2.75 mm/3.20 mm OCCIs in the steep axis with spherical IOL implantation. Uncorrected (UCVA) and best corrected (BCVA) visual acuity, refraction, corneal and total higher‐order aberrations (HOAs), photopic and mesopic contrast sensitivity, and toric IOL axis were measured 3 months postoperatively. RESULTS: Forty eyes (40 patients) were evaluated. In the toric group, 95% of eyes achieved 20/40 or better UCVA and 70%, 20/25 or better. In the OCCI group, 80% of eyes achieved 20/40 or better UCVA and 50%, 20/25 or better. All eyes achieved 20/25 or better BCVA. Mean refractive cylinder decreased significantly from preoperatively to postoperatively (−1.75 ± 0.71 to −0.62 ± 0.46 D, toric group; −1.61 ± 0.67 to −0.97 ± 0.51 D, OCCI group) (P<.01). In the toric group, 95% and 100% of eyes were within ±0.50 D for J0 and J45, respectively. In the OCCI group, the percentages were 70% and 100%, respectively. No significant differences in HOA were found between groups (P>.1). Contrast sensitivity was similar except at the highest spatial frequency, being better in the toric group (P<.01). CONCLUSION: Toric IOL implantation achieved a slight enhanced effect over OCCIs in treating preexisting astigmatism.

Keratomycosis after cataract surgery

Purpose: To evaluate cases and results of keratomycosis that developed after cataract surgery. Setting: Hospital de Guipúzcoa, San Sebastián, Spain. Methods: This retrospective study comprised 8 patients who developed keratomycosis soon after cataract surgery. Results: Culture analysis revealed 7 cases of Aspergillus fumigatus and 1 of Aspergillus flavus. After medical treatment with antifungal agents, 6 cases resolved and 2 required evisceration. Conclusions: The presence of fungi in corneal ulcers that develop after cataract surgery should be considered. Initiation of early treatment determines the prognosis. Among the therapeutic options, collagen shields soaked in amphotericin B may be effective.

Evaluation of visual outcomes and patient satisfaction after implantation of a diffractive trifocal intraocular lens.

Purpose To evaluate clinical outcomes after the implantation of a diffractive trifocal intraocular lens (IOL). Setting Nine European ophthalmology centers. Design Prospective noncomparative interventional multicenter study. Methods The trifocal diffractive AT LISA tri 839MP IOL was implanted in eyes with bilateral cataract. Monocular and binocular visual performance was assessed as was the level of perceived photic phenomena, patient satisfaction, and spectacle dependence 1 month and 3 months postoperatively. Results The IOL was implanted in 208 eyes of 104 patients. The mean binocular uncorrected distance visual acuity improved from 0.44 logMAR ± 0.30 (SD) to 0.02 ± 0.10 logMAR and 0.03 ± 0.09 logMAR at 1 month and 3 months, respectively (P < .01). The mean binocular uncorrected intermediate visual acuity (80 cm) improved from 0.51 ± 0.30 logMAR to 0.09 ± 0.13 logMAR and 0.10 ± 0.15 logMAR at 1 month and 3 months, respectively (P < .01). The mean binocular uncorrected near visual acuity improved from 0.67 ± 0.31 logMAR to 0.16 ± 0.14 logMAR and 0.15 ± 0.14 logMAR, respectively (P < .01). Among the more frequently perceived photic phenomena were halos; however, approximately 75% of patients were not bothered by them. More than 90% of patients were satisfied with the outcome. Spectacle independence at all distances was higher than 90%. Conclusion This IOL provided excellent visual outcomes and high refractive predictability at all distances, including intermediate, leading to high levels of patient satisfaction and spectacle independence. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Vector analysis of astigmatism correction after toric intraocular lens implantation

Purpose To determine astigmatic changes by vector analysis and postoperative refractive and visual outcomes after implantation of the monofocal aspheric bitoric AT Torbi 709M toric intraocular lens (IOL). Setting Three centers in Salzburg, Austria, and Alicante and San Sebastián, Spain. Design Prospective interventional case series. Methods Preoperative and postoperative visual acuity, subjective and objective refractions, and corneal radii using a topographer were examined in all patients. All patients had postoperative examinations within the first week and at 6 to 12 weeks. Astigmatic changes were evaluated using the Alpins vector method based on 3 fundamental vectors as follows: target induced astigmatism (TIA), surgically induced astigmatism (SIA), and difference vector. The various relationships between these 3 vectors were calculated, providing an extensive description of the astigmatic correction achieved. Results Eighty‐eight eyes (71 patients) were included. Postoperatively, refractive cylinder was reduced significantly (P < .001), concurrent with visual improvement. The mean magnitude of the SIA vector (2.54 diopters [D] ± 1.21 [SD]) was slightly higher than the mean magnitude of the TIA vector (2.37 ± 1.15 D) at the last follow‐up. The mean difference vector was 0.46 ± 0.46 D, the mean magnitude of error was 0.16 ± 0.46 D, and the mean correction index was 1.09 ± 0.21, all indicating minimal overcorrection at 3 months that remained stable during the follow‐up. Conclusion Implantation of the toric IOL was safe and effective for the treatment of eyes with cataract in combination with preexisting regular corneal astigmatism over a short‐term follow‐up. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Bilateral implantation of+2.5 D multifocal intraocular lens and contralateral implantation of+2.5 D and+3.0 D multifocal intraocular lenses: Clinical outcomes

Purpose To assess the clinical visual outcomes of bilateral implantation of Restor +2.5 diopter (D) multifocal intraocular lenses (IOLs) and contralateral implantation of a Restor +2.5 D multifocal IOL in the dominant eye and Restor +3.0 D multifocal IOL in the fellow eye. Setting Multicenter study at 8 investigative sites. Design Prospective randomized parallel‐group patient‐masked 2‐arm study. Methods This study comprised adults requiring bilateral cataract extraction followed by multifocal IOL implantation. The primary endpoint was corrected intermediate visual acuity (CIVA) at 60 cm, and the secondary endpoint was corrected near visual acuity (CNVA) at 40 cm. Both endpoints were measured 3 months after implantation with a noninferiority margin of &Dgr; = 0.1 logMAR. Results In total, 103 patients completed the study (53 bilateral, 50 contralateral). At 3 months, the mean CIVA at 60 cm was 0.13 logMAR and 0.10 logMAR in the bilateral group and contralateral group, respectively (difference 0.04 logMAR), achieving noninferiority. Noninferiority was not attained for CNVA at 40 cm; mean values at 3 months for bilateral and contralateral implantation were 0.26 logMAR and 0.11 logMAR, respectively (difference 0.15 logMAR). Binocular defocus curves suggested similar performance in distance vision between the 2 groups. Treatment‐emergent ocular adverse events rates were similar between the groups. Conclusion Bilateral implantation of the +2.5 D multifocal IOL resulted in similar distance as contralateral implantation of the +2.5 D multifocal IOL and +3.0 D multifocal IOL for intermediate vision (60 cm), while noninferiority was not achieved for near distances (40 cm).

Increased aquaporin 1 and 5 membrane expression in the lens epithelium of cataract patients.

In this work we have analyzed the expression levels of the main aquaporins (AQPs) expressed in human lens epithelial cells (HLECs) using 112 samples from patients treated with cataract surgery and 36 samples from individuals treated with refractive surgery, with transparent lenses as controls. Aquaporin-1 (AQP1) is the main AQP, representing 64.1% of total AQPs in HLECs, with aquaporin-5 (AQP5) representing 35.9% in controls. A similar proportion of each AQP in cataract was found. Although no differences were found at the mRNA level compared to controls, a significant 1.65-fold increase (p=0.001) in AQP1protein expression was observed in HLECs from cataract patients, with the highest differences being found for nuclear cataracts (2.1-fold increase; p<0.001). A similar trend was found for AQP5 (1.47-fold increase), although the difference was not significant (p=0.161). Moreover we have shown increased membrane AQP5 protein expression in HLECs of patients with cataracts. No association of AQP1 or AQP5 expression levels with age or sex was observed in either group. Our results suggest regulation of AQP1 and AQP5 at the post-translational level and support previous observations on the implication of AQP1 and 5 in maintenance of lens transparency in animal models. Our results likely reflect a compensatory response of the crystalline lens to delay cataract formation by increasing the water removal rate.

Anterior capsule opacification after femtosecond laser-assisted cataract surgery: Clinical classification versus Scheimpflug device densitometry values.

Purpose To compare the clinical classification of anterior capsule opacification (ACO) after femtosecond laser–assisted cataract surgery with the mean density values of ACO provided by rotating Scheimpflug device (Pentacam HR) densitometry software and to determine which densitometry method correlates best with the clinical classification. Setting Ophthalmology Department, Donostia University Hospital, Donostia‐San Sebastian, Spain. Design Prospective comparative study. Methods Femtosecond laser–assisted cataract surgery was performed using the Victus platform between June 2014 and March 2015. Inclusion criteria were age between 55 years and 85 years, a pupil diameter larger than 6.0 mm in full mydriasis, no intraoperative complications, a curvilinear anterior capsulotomy without tears, and an intraocular lens in the correct intracapsular position at the end surgery. The ACO was measured by a clinical classification ranging from 0 to 4. In addition, ACO density was measured with the Scheimpflug device using 3 densitometry methods (area, linear, and peak). Results The study comprised 32 eyes of 32 patients. Area and linear densitometry values provided by the Scheimpflug device had a strong correlation with the values obtained by clinical classification, whereas peak densitometry values had a very weak correlation at 6 months (area densitometry: Spearman &rgr; = 0.78; P < .0005; linear densitometry: &rgr; = 0.73; P < .0005; peak densitometry &rgr; = 0.21; P = .2). Conclusion The Scheimpflug device provided an objective measurement of ACO after cataract surgery. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned.

Objective optical quality analysis using double-pass technique in pterygium surgery.

Purpose: To analyze objective optical quality changes after pterygium surgical excision using the Optical Quality Analysis System. Methods: Forty eyes with primary pterygium suitable for surgical treatment were included. Uncorrected distance visual acuity, corrected distance visual acuity (CDVA), objective scattering index (OSI), and cutoff frequency of the modulation transfer function (MTFcutoff) were recorded preoperatively and at 1 and 6 months postoperatively. Slit-lamp measurement of pterygium size was performed to classify them: small in group 1 and medium size/large in group 2. A paired comparative study of all data that included preoperative with 1-month results (comparison A), preoperative with 6-month results (comparison B), and 1 month with sixth-month results (comparison C) was performed. Results: In global analysis, uncorrected distance visual acuity and OSI showed significant changes in comparison A, all parameters in comparison B, and CDVA, OSI, and MTFcutoff in comparison C. When subdividing into groups, in group 1, there was significant improvement between preoperative uncorrected distance visual acuity value and those at 1 and 6 months. Significant improvement in CDVA, OSI, and MTFcutoff values were observed in comparisons B and C. In group 2, MTFcutoff values significantly improved in comparisons B and C. The comparison of mean values between each group at each evaluation showed a lower value for MTFcutoff at 1 month after surgery. A comparative analysis of the evolution between both groups based on pterygium size did not reveal significant differences. Conclusions: Pterygium can undermine visual quality, and its excision provides significant improvement even at 6 months after surgery. Optical Quality Analysis System proved useful for postoperative outcomes.