José A. Buil

Comparison of the results of first and second cataract eye surgery.

OBJECTIVE To compare the outcomes of second eye cataract surgery with those of first eye surgery. In particular, to evaluate changes in visual acuity (VA), visual function, and health status after the first and second eye surgeries. DESIGN A cohort (case series) analysis of patients recruited in a clinical trial. PARTICIPANTS A total of 403 consecutive patients with indication of noncombined first eye or second eye cataract surgery were recruited in 3 public hospitals in Barcelona, Spain. First eye surgery patients are compared to second eye surgery patients. INTERVENTION Patients were evaluated both before surgery and 4 months after surgery by a standardized telephone interview and clinical examination. MAIN OUTCOME MEASURES Visual acuity, visual function index (VF-14), a 14-item instrument designed to measure visual function, and the Sickness Impact Profile (SIP), a generic measure of health status. RESULTS Full data were obtained from 315 (78%) patients: 249 who underwent first eye surgery only and 66 different patients who underwent second eye surgery. Significant improvement was found in both groups of patients for best-corrected VA in the operated eye (4.4 Snellen lines, P < 0.001; 4.2 Snellen lines, P < 0.001, respectively), VA in the better eye (2.8 Snellen lines, P < 0.001; 1.4 Snellen lines, P < 0.001), and visual function (26.3 Snellen lines, P < 0.001; 17.0 Snellen lines; P < 0.001). Four months after the operation, the VF-14 of the second eye group was slightly better (93.4 vs. 88.5; P = 0.09; score range: 0, worst, to 100, best). Psycho-social SIP scores improved in both groups (4.8, P < 0.001; 3.1, P = 0.016). Physical SIP score improved only in the first eye surgery group (1.8, P = 0.003) but not in the second eye surgery group (-1.0, P = 0.338; score range: 0, best, to 100, worst). CONCLUSIONS The results of our study suggest that patients undergoing second eye cataract surgery show significant improvements in VA, visual function, and psycho-social health status. However, global and physical health status does not change after second eye cataract surgery.

Visual Acuity, Contrast Sensitivity, Subjective Quality of Vision, and Quality of Life with 4 Different Multifocal IOLs:

Purpose This prospective, randomized, double-masked, clinical trial was designed to evaluate visual acuity, contrast sensitivity, subjective quality of vision, and quality of life in 47 patients symmetrically, and randomly, implanted with 4 different IOL designs (SN6AD1, SN60D3, ReZoom NXG1, and Tecnis ZMA00), 3 months after cataract intervention. Methods Binocular corrected and uncorrected distance visual acuity, binocular distance corrected (BCNVA) and uncorrected (UCNVA) near visual acuity, binocular distance corrected (BCIVA) and uncorrected (UCIVA) intermediate visual acuity, photopic, mesopic, and mesopic with glare contrast sensitivity, quality of vision, and quality of life were evaluated. Results Statistically and clinically significant differences were found in BCNVA and UCNVA at 33 cm between high and low add power IOLs, while diffractive SN6AD1 lenses achieved better UCNVA at 40 cm than refractive ReZoom IOLs. Asphericity and low add power were found to improve BCIVA. Contrast sensitivity was similarly compromised in all IOL models, although diffractive optics and aspheric profiles performed better in mesopic conditions. All IOL types received similar overall satisfaction and quality of life scores. Whereas ReZoom patients depended on their spectacles for near tasks, intermediate vision was spectacle independent. Photic phenomena were present in all IOLs, albeit more frequent in ReZoom IOLs. Conclusions The present results, which reflect IOL characteristics in optics, profile, and add power, may contribute to help surgeons decide on the type of IOL most suitable for each patient, especially those with high visual demands at near and intermediate distances.

Endoscope-assisted transscleral suture fixation of intraocular lenses

Abstract We describe a new method for placing transscleral sutures when fixating posterior chamber intraocular lenses to the sulcus. An intraccular microendoscope with an 18 gauge probe is used for direct sulcus observation and needle position assessment. The straight needle of a 10‐0 polypropylene suture and the tip of the probe are placed in a 16 gauge silicone rubber tube to hold them together. Fixing the needle to the endoscope allows a direct view of its tip and requires only one hand. The other hand is used to grasp the tip of the needle when it comes out under the scleral flap after passing through the sulcus. Assessment of needle position with an endoscope avoids surgically induced iris root or ciliary body damage. Fixing the needle to the endoscope simplifies the surgical technique.

Comparison of far and near contrast sensitivity in patients symmetrically implanted with multifocal and monofocal IOLs.

Purpose A prospective, randomized, double-masked, clinical trial was designed to evaluate distance and near contrast sensitivity (CS) in patients symmetrically, and randomly, implanted with 4 different multifocal intraocular lens (MIOL) designs (ReSTOR SN6AD1, ReSTOR SN60D3, ReZoom NXG, and Tecnis ZMA00) and a monofocal control group (Tecnis ZA9003), 6 months after cataract intervention. Methods Photopic, mesopic, and mesopic with glare distance CS, as well as photopic near CS, was evaluated with the CSV-1000 CS test and the Vistech VCTS 6000 system, respectively, in a group of 180 patients attending the ophthalmology department of Sant Pau Hospital, Barcelona, for cataract intervention and lens implantation. Results Statistically and clinically significant differences were found between the monofocal and multifocal lens groups at all spatial frequencies and illumination conditions, both during distance and near CS evaluation (all p<0.05), with the monofocal lens offering the best performance in all cases. Contrast sensitivity was similarly compromised in all MIOL models at distance, although MIOLs with diffractive optics and aspheric profiles showed a non–statistically significant trend to perform better in mesopic conditions. Near CS was lower for refractive, distance dominant lens designs, particularly at medium to high spatial frequencies. Conclusions The present results, which reflect intraocular lens (IOL) characteristics in optics, profile, and add power, may contribute to help surgeons decide on the type of IOL most suitable for each patient by taking into consideration the individual needs for critical distance and near vision, both in terms of visual acuity and contrast sensitivity.

Acute-Onset Endophthalmitis Caused by Alloiococcus otitidis following a Dexamethasone Intravitreal Implant.

Purpose: To report the first case of acute endophthalmitis caused by Alloiococcus otitidis after a dexamethasone intravitreal implant. Methods: A 74-year-old female was treated with intravitreal Ozurdex® in her left eye for central retinal vein occlusion (CRVO). Best-corrected visual acuity (BCVA) in the eye was 4/20. Intravitreal injection was uneventful. At 48 h after injection, she developed ocular pain and visual acuity had dropped to light perception. Endophthalmitis associated with intravitreal injection was suspected. Results: The patient did not show a favorable clinical response following systemic, intravitreal, and topical fortified antibiotics. We then performed a vitreous biopsy and removed the Ozurdex implant by pars plana vitrectomy. A vitreous culture was positive for A. otitidis. At the 2-month follow up, no inflammation was observed, but due to CRVO and probably aggravated by endophthalmitis, the fundus showed macular fibrosis. The final BCVA was finger counting at 30 cm in her left eye. Conclusions: In cases of an intravitreal implant associated with endophthalmitis, we recommend removal of the device because it may act as a permanent reservoir of organisms if it remains in the vitreous cavity.

Halo and Through-Focus Performance of Four Diffractive Multifocal Intraocular Lenses

PURPOSE. To compare, as a function of pupil size, the through-focus performance and halo features of four diffractive intraocular lenses (IOLs). METHODS. Three diffractive bifocal IOLs (ReSTOR þ2.5 D SV25T0, Tecnis þ2.75 D ZKB00, and AT LISA þ3.75 D 809M) and a diffractive trifocal IOL (AT LISA tri þ3.33 D, þ1.66 D 839MP) were tested in vitro in a modified International Organization for Standardization eye model. The modulation transfer function (MTF) at the IOLs’ foci was obtained with pupils ranging from 2.0 to 5.0 mm. Through-focus MTF curves (at 50 cycles/mm) were compared among all the IOLs. The halo formation and characteristics were obtained from image analysis. RESULTS. The multifocal IOLs studied in this work showed, at their foci, secondary out-of-focus images, which originate halos and whose characteristics depend on the lens design and pupil size. The smallest halo occurred for the distance focus of the SV25T0. The distance and near foci of the SV25T0 yielded, respectively, the best and lowest optical quality among the studied IOLs. The distance focus of the ZKB00, AT LISA, and AT LISA tri were of similar quality, but the near focus of the ZKB00 outperformed the near foci of the rest of the IOLs. The IOLs’ optical performance gradually deteriorates as pupil increases. CONCLUSIONS. Differences in the design of the diffractive IOLs translate into differences in optical quality at their foci, through-focus performance, and halo features, which can offer further information to surgeons when selecting which IOL to implant.

Intraocular lens dislocation after whole-body vibration

We present 2 cases of intraocular lens (IOL) dislocation that appeared shortly after the patients exercised on a vibration platform. The first patient was a 71-year-old woman who presented with lens subluxation in her right eye and a complete posterior IOL dislocation in her left eye. The second case was a 62-year-old woman who presented with unilateral IOL dislocation within the capsular bag in her right eye. Timing from IOL implantation to dislocation was approximately 6 years and 4 years, respectively. Pars plana vitrectomy with removal of the dislocated IOL was performed in both patients. Whole-body vibration training has become increasingly popular as a form of exercise training. It reportedly may provide benefits in physical function and in some diseases, especially in older people. However, evidence-based protocols ensuring safety and efficacy in this population are lacking. We discuss vibration as a cause of late IOL dislocation.

An aggressive primary orbital natural killer/T-cell lymphoma case: poor response to chemotherapy.

Natural killer/T-cell lymphoma (NKTCL) and its presentation with extranodal orbital involvement as a single lesion are extremely rare. The aim of this article was to describe the presentation, diagnosis, and systemic treatment of a primary orbital NKTCL. A 67-year-old Caucasian woman presented with left exophthalmos, pain, periorbital swelling, and limited extrinsic ocular motility. Orbital cellulitis was suspected, but finally orbital biopsy was performed due to no response to initial antibiotic and anti-inflammatory standard treatment. The pathologic diagnosis was NKTCL. Systemic evaluations were negative. CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy was initiated, but after 2 cycles of treatment, tumoral progression was observed. SMILE (dexamethasone, methotrexate, ifosfamide, L-asparaginase, etoposide) rescue chemotherapy was then administered. Lymphoma progression was inevitable. She died 10 months later. Although more nasal NKTCL cases have been described, the nonnasal primary orbital NKTCL is an uncommon neoplasm with high mortality rate, despite the recent use of more potent chemotherapy regimens.

Haemorrhage of a cavernous haemangioma of the optic disc in pregnancy.

A healthy 29-year-old woman presented at 20 weeks’ gestation with a 3-week history of a paracentral scotoma in her right eye. Visual acuity was 20/20 in both eyes. Fundus examination of the right eye showed a mass of numerous, grape-like, aneurysms filled with dark blood along the optic disc. White fibroglial tissue covered the surface. A triangular haemorrhage was observed in the macular area, under the internal limiting membrane, and stopping just at the …

Stereo-Acuity in Patients Implanted with Multifocal Intraocular Lenses: Is the Choice of Stereotest Relevant?

Abstract Purpose: A randomized and double-blinded study design was implemented to assess the stereo-acuity in patients symmetrically implanted with four types of multifocal intraocular lenses (MIOLs), compared to a monofocal lens (control group). In addition, the influence of the type of test employed for the evaluation of stereo-acuity was explored. Materials and Methods: Six months after cataract intervention, stereo-acuity was measured with the Titmus and TNO stereotests in 143 patients implanted with one of the following MIOL lens types: hybrid spherical SN60D3, hybrid aspheric SN6AD1, diffractive aspheric ZMA00 and refractive spherical NXG1. A control group implanted with the monofocal aspheric ZA9003 (in which stereo-acuity was measured with a near addition) was also included in the study. Results: Statistically significant better stereo-acuity was found in the monofocal group with both stereotests (except for the SN60D3 group with the Titmus test) (all p < 0.001). No significant differences in stereo-acuity between MIOLs were found using the Titmus test. However, with the TNO, patients implanted with hybrid diffractive MIOLs exhibited statistically significant worse stereo-acuity than those with the refractive design (SN60D3, p < 0.001; SN6AD1, p = 0.006). Conclusions: Patients implanted with MIOLs have worse stereo-acuity than those implanted with monofocal IOLs due to the decrease in retinal image contrast originating in the simultaneous presence of two images. A wavelength-based stereotest such as the TNO induces large differences in image contrast between fellow eyes implanted with diffractive-based MIOLs, which may result in an underestimation of the real stereo-acuity of the patient.