Mitsutaka Soda

Effect of decentration on the optical performance in multifocal intraocular lenses.

Aims: To evaluate the influence of decentration on optical performance in multifocal intraocular lenses (IOLs) using eye models. Methods: This study evaluated 4 types of multifocal IOLs (ReSTOR SA60D3, Alcon; TECNIS Multifocal ZM900, AMO; ReZoom, AMO; SFX-MV1, Hoya). The evaluations were based on measurements of the near and far modulation transfer function (MTF) and visualized actual near images (newspaper) using eye models with the IOL horizontally displaced 0, 0.25, 0.5, 0.75 and 1.0 mm from the center. Results: For the diffractive ReSTOR the near MTF decreased with increasing decentration. The near images (newspaper characters) became difficult to distinguish at a decentration of 1.0 mm. For the diffractive ZM900, the near and far MTFs gradually decreased with increasing decentration. For the refractive ReZoom and SFX-MV1, we observed almost no change in the near MTF from a decentration of 0–1.0 mm. However, the far MTF clearly decreased starting at a decentration of 1.0 mm for ReZoom and 0.75 mm for SFX-MV1. Conclusion: The MTFs and near images are affected to a different extent depending on the design of multifocal IOLs; clinically relevant effects are not to be expected up to a decentration of 0.75 mm.

Cytotoxicity of five fluoroquinolone and two nonsteroidal anti-inflammatory benzalkonium chloride-free ophthalmic solutions in four corneoconjunctival cell lines

Purpose: Epithelial disorders after eye surgery can result in visual deterioration and patient discomfort. Such disorders may be caused by drug toxicity. In the present study, we evaluated the toxicity of ophthalmic solutions, with or without benzalkonium chloride (BAK) as the preservative, used for postoperative care. Methods: A range of commercially available antibiotic and anti-inflammatory ophthalmic solutions used postoperatively (ie, levofloxacin, moxifloxacin, gatifloxacin, norfloxacin, tosufloxacin, dibekacin, cefmenoxime, diclofenac, bromfenac, pranoprofen, betamethasone, and fluoromethorone) were assessed in three corneal cell lines and one conjunctival cell line. All antibiotic solutions were BAK free. Cell viability was determined with the 3-(4,5-dimethyl-2 thiazoyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay after cells had been exposed to the drugs for 48 h. The effects of preservatives on cell viability were also determined. Toxicity was compared using the cell viability score (CVS). Results: Based on results of the MTT assay and CVS, the order of cell viability after exposure to the antibiotic solutions was cefmenoxime ≥ tosufloxicin ≥ dibekacin ≥ levofloxacin ≥ norfloxacin = gatifloxacin = moxifloxacin. For the anti-inflammatory solutions, the order of cell viability was betamethasone ≥ betamethasone + fradiomycin > preservative-free diclofenac ≥ preservative-free bromfenac >> 0.02% fluoromethorone ≥ 0.1% fluoromethorone = diclofenac + preservative = bromfenac + preservative = pranoprofen. The anti-inflammatory drugs were more toxic than the antibiotics. The toxicity of antibiotic drugs against ocular surface cells was dependent on the pharmaceutical components of the solution, whereas that of the anti-inflammatory drugs was dependent on both the pharmaceutical components and the preservatives. Conclusion: Postoperative drug-induced epitheliopathy may be caused primarily by anti-inflammatory drugs. CVS is useful in comparing the cytotoxicity of different drugs.

Modified capsule expander implantation to reposition and fixate the capsular bag in eyes with subluxated cataractous lenses and phacodonesis: intermediate-term results.

Purpose To report the intermediate‐term results of capsule stabilization for scleral fixation with implantation of the Yaguchi hook, a modified capsule expander stabilization hook. Setting Department of Ophthalmology, School of Medicine, University of Showa, Fujigaoka Rehabilitation Hospital, Yokohama, Japan. Design Retrospective case series. Methods Patients with zonular dialysis and phacodonesis were followed postoperatively for at least 2 years. All eyes had phacoemulsification and aspiration using an ordinary capsule expander and in‐the‐bag implantation of an intraocular lens (IOL). Capsule expanders were removed after the residual cortex was removed, and the capsular bag was fixated to the scleral wall via the ciliary sulcus using the modified capsule expander stabilization hook. Preoperative findings, intraoperative complications, and postoperative courses were examined. Results The mean age of the 11 patients (11 eyes) was 72.2 years ± 10.5 (SD); 5 patients were men. The mean postoperative follow‐up was 48.6 ± 13.6 months. The zonular dialysis range was 90 to 180 degrees in 1 eye, 180 degrees in 4 eyes, and 180 to 270 degrees in 1 eye. In 5 eyes, severe phacodonesis was observed without obvious zonular dialysis. In all eyes, the capsular bag and IOL were well centered without severe intraoperative or postoperative complications. Conclusion The modified capsule expander stabilization hook provided good centration and stabilization of the capsule–IOL complex in eyes with severely weak zonular fibers. Financial Disclosure Dr. Yaguchi, who is the inventor of the modified capsule expander, has received financial support from Handaya, Tokyo, Japan. No other author has a financial or proprietary interest in any material or method mentioned.

Phacoemulsification without hydrodissection: Semi-crater and split technique

&NA; We present a semi‐crater sculpting and split technique for simple nucleus removal and hydrodissection‐free phacoemulsification. In this technique, the crater sculpting is done in half the nucleus only and emulsified before nucleus rotation. The remaining half of the nucleus is freed from the capsule and then rotated to the opposite side of the phaco tip and emulsified. This technique can be easily performed without hydrodissection because emulsifying half the nucleus creates a free space. It was used in 19 198 eyes between 2000 and 2013 and enabled stable phacoemulsification, regardless of the surgeon’s experience. The technique prevents hydrodissection‐related complications, such as posterior capsule rupture caused by high intraocular pressure changes, and reduces the stress on the zonule during nucleus rotation. Financial Disclosure Neither author has a financial or proprietary interest in any material or method mentioned.