Peter Mojzis

Outcomes of a new diffractive trifocal intraocular lens

Purpose To evaluate refractive and visual parameters related to distance, intermediate, and near vision after cataract surgery and the optical quality of a new diffractive trifocal intraocular lens (IOL). Setting Vissum Instituto Oftalmologico de Alicante, Alicante, Spain. Design Case series. Methods Patients had bilateral refractive lens exchange and multifocal diffractive IOL (AT Lisa tri 839 MP) implantation. A complete ophthalmology examination was performed preoperatively and postoperatively. The follow‐up was 6 months. The main outcome measures were uncorrected distance (UDVA) and corrected distance (CDVA), intermediate, and near visual acuities; keratometry; manifest refraction; and aberrations (total, corneal, internal). Results The study comprised 60 eyes of 30 patients (mean age 57.9 years ± 7.8 [SD]; range 42 to 76 years). There was significant improvement in UDVA, uncorrected intermediate visual acuity, uncorrected near visual acuity, CDVA, and distance‐corrected intermediate and near visual acuity. The postoperative refractive status was within the range of +1.00 to −1.00 diopter. Total internal aberrations decreased significantly (P<.001). Conclusions The trifocal IOL improved near, intermediate, and distance vision in presbyopic patients. The use of 3 foci provided significant intermediate visual results without sacrificing near or distance vision. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Comparative analysis of the visual performance after cataract surgery with implantation of a bifocal or trifocal diffractive IOL.

PURPOSE To evaluate and compare the visual, refractive, contrast sensitivity, and aberrometric outcomes with a diffractive bifocal and trifocal intraocular lens (IOL) of the same material and haptic design. METHODS Sixty eyes of 30 patients undergoing bilateral cataract surgery were enrolled and randomly assigned to one of two groups: the bifocal group, including 30 eyes implanted with the bifocal diffractive IOL AT LISA 801 (Carl Zeiss Meditec, Jena, Germany), and the trifocal group, including eyes implanted with the trifocal diffractive IOL AT LISA tri 839 MP (Carl Zeiss Meditec). Analysis of visual and refractive outcomes, contrast sensitivity, ocular aberrations (OPD-Scan III; Nidek, Inc., Gagamori, Japan), and defocus curve were performed during a 3-month follow-up period. RESULTS No statistically significant differences between groups were found in 3-month postoperative uncorrected and corrected distance visual acuity (P ≥ .21). However, uncorrected, corrected, and distance-corrected near and intermediate visual acuities were significantly better in the trifocal group (P < .01). No significant differences between groups were found in postoperative spherical equivalent (P = .22). In the binocular defocus curve, the visual acuity was significantly better for defocus of -0.50 to -1.50 diopters in the trifocal group (P ≤ .04) and -3.50 to -4.00 diopters in the bifocal group (P ≤ .03). No statistically significant differences were found between groups in most of the postoperative corneal, internal, and ocular aberrations (P ≤ .31), and in contrast sensitivity for most frequencies analyzed (P ≤ .15). CONCLUSIONS Trifocal diffractive IOLs provide significantly better intermediate vision over bifocal IOLs, with equivalent postoperative levels of visual and ocular optical quality.

Comparative analysis of clinical outcomes obtained with a new diffractive multifocal toric intraocular lens implanted through two types of corneal incision.

PURPOSE To analyze and compare the clinical outcomes obtained after cataract surgery with the implantation of a new multifocal toric intraocular lens (IOL) using two different types of corneal incision. METHODS Retrospective study including 64 eyes of 35 patients who underwent surgery with implantation of the AT LISA 909M multifocal toric IOL (Carl Zeiss Meditec) in 2 different ophthalmologic centers using different criteria for corneal incision size: sub-1.8 mm (micro-incision surgery [MICS] group) and 2.2 mm (mini-incision group). Visual, refractive, and corneal topographic outcomes were evaluated during 6-month follow-up. Additionally, refractive astigmatic changes were analyzed using the Alpins vectorial method. RESULTS Significant reductions of refractive sphere and cylinder were observed postoperatively (P<.03), with associated visual improvements for near and distance (P<.01) in both groups. Mean postoperative magnitudes of difference vector, torque, and magnitude of error in the overall sample were 0.52±0.36 diopters (D), 0.36 ± 0.36 D, and 0.08 ± 0.38 D, respectively. A mean overcorrection of 4% in refractive astigmatism was found. Mean angle of error was 0.37± 5.50° and -4.51±13.16° for the MICS and mini-incision groups, respectively (P=.09). Significant positive correlations were found between the magnitudes of torque and difference vector (r=0.78, P<.01) as well as between the magnitude of torque and absolute angle of error (r=0.76, P<.01). CONCLUSIONS Implantation of the AT LISA toric IOL using corneal incisions <2.2 mm provides excellent predictability for astigmatic correction.

Implantation of a diffractive trifocal intraocular lens: One-year follow-up

Purpose To evaluate the visual, refractive, contrast‐sensitivity, and aberrometric outcomes during a 1‐year follow‐up after implantation of a trifocal intraocular lens (IOL). Setting Premium Clinic, Teplice, Czech Republic. Design Prospective case series. Methods This study included eyes of patients having cataract surgery with implantation of the trifocal IOL model AT Lisa tri 839MP. Distance, intermediate (66 and 80 cm), and near (33 and 40 cm) vision; contrast sensitivity; aberrometric outcomes; and the defocus curve were evaluated during a 12‐month follow‐up. The level of posterior capsule opacification (PCO) was also evaluated. Results In 120 eyes (60 patients), 1 month postoperatively, an improvement was observed in all visual parameters (P ≤ .03) except corrected near and intermediate visual acuities (both P ≥ .05). From 1 month to 12 months postoperatively, small but statistically significant changes were observed in uncorrected and corrected distance and near visual acuities (all P ≤ .03) and in uncorrected intermediate visual acuity (P = .01). In the defocus curve, no significant differences were found between visual acuities corresponding to defocus levels of −1.0 diopter (D) and −2.0 D (P = .22). The level of ocular spherical aberration decreased statistically significantly at 6 months (P < .001). Ocular and internal higher‐order aberrations increased minimally but significantly from 6 to 12 months postoperatively (P < .001). The mean 12‐month PCO score was 0.32 ± 0.44 (SD). Four eyes (3.3%) required neodymium:YAG capsulotomy. Conclusion The trifocal IOL provided complete and stable visual restoration after cataract surgery during a 12‐month follow‐up, with good levels of visual quality. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Impact of low mesopic contrast sensitivity outcomes in different types of modern multifocal intraocular lenses.

Purpose To investigate the low mesopic contrast sensitivity function (LMCSF) of patients implanted with different modern optical bifocal and trifocal designs of multifocal intraocular lenses (mfIOLs). Methods This prospective, comparative, nonrandomized consecutive case series included 180 eyes that underwent cataract surgery. Six groups of eyes were differentiated: group A, eyes with the diffractive AT LISA tri 839MP; group B, eyes with diffractive FineVision; group C, eyes with the bifocal Lentis Mplus-LS313; group D, eyes with the diffractive bifocal Acri.Lisa 366D; group E, eyes with the diffractive apodized Acrysof ReSTOR SN6AD1; group F, as the control group, implanted with a monofocal spherical intraocular lens. The LMCSF was evaluated with the OPTEC® 6500 device at 3 months postoperatively using a luminance of 3 cd/m2. Results No significant differences among groups were detected in LMCSF for the spatial frequencies of 1.5, 3.0, 6.0, and 12.0 cpd (1.5 cpd: F = 1.81, p = 0.13; 3.0 cpd: F = 1.14, p = 0.14; 6.0 cpd: F = 1.87, p = 0.11; 12.0 cpd: F = 1.26, p = 0.29), but significant differences were found among groups for the spatial frequency of 18 cpd (F = 2.62, p = 0.03). When comparing the groups in pairs, only statistically significant differences were observed between groups E and F for the spatial frequency of 18.0 cpd (t = 3.27, p = 0.03) with better values for group F. Conclusion No significant differences were observed in LMCSF among the different mfIOLs studied. The third focus of trifocal IOL models did not adversely affect the LMCSF. The ReSTOR SN6AD1 showed the poorest LMCSF for the highest spatial frequency analyzed when compared with the control group.

Visual outcomes of a new toric trifocal diffractive intraocular lens

Purpose To evaluate the visual, refractive, contrast sensitivity, and aberrometric outcomes as well as the patient quality of life and photic phenomena disturbances after cataract surgery with implantation of a new trifocal toric intraocular lens (IOL). Settings Premium Clinic, Regional Hospital in Havlickuv Brod, Czech Republic, and Vissum and Universidad Miguel Hernández, Alicante, Spain. Design Prospective consecutive series of cases. Methods The study involved eyes with corneal astigmatism of 1.25 D or more that were having cataract surgery with implantation of the trifocal toric IOL AT Lisa tri toric 939MP (Carl Zeiss Meditec). Visual outcomes and astigmatic changes analyzed by Alpins vector analysis were evaluated at 3 months postoperatively. Contrast sensitivity, quality of life, and photic phenomena were also evaluated. Results The study involved a total of 30 eyes of 16 patients, age 37 to 64 years. A significant improvement with surgery was observed in uncorrected distance, intermediate, and near visual acuity (P ≤ .01). A significant decrease in the refractive cylinder was observed postoperatively (P < .01), with all eyes showing a postoperative astigmatism below 1.00 D. The difference between targeted and surgically induced astigmatism was small (0.06 ± 0.30 D) but statistically significant (P = .04). The mean magnitude of angle of error was 5.80 ± 8.47 degrees. The low levels of higher‐order aberrations found postoperatively were consistent with the good levels of contrast sensitivity achieved. Regarding quality of life, low to moderate levels of difficulty in performing various types of vision‐related tasks were found. Conclusions The trifocal toric IOL evaluated provides effective restoration of visual function after cataract surgery, with associated high levels of visual acuities and quality of life. Financial Disclosure The authors have no proprietary or commercial interest in the medical devices that are involved in this manuscript.

Opacification of a hydrophilic acrylic intraocular lens with a hydrophobic surface after air injection in Descemet-stripping automated endothelial keratoplasty in a patient with Fuchs dystrophy

A 71-year-old woman with Fuchs endothelial dystrophy in the right eye had uneventful phacoemulsification cataract surgery with implantation of a single-piece intraocular lens (IOL) (CT47S) in January 2012. Because of corneal problems and vision loss, uneventful Descemet-stripping automated endothelial keratoplasty (DSAEK) was performed in May 2013. Four months later, a new corneal lamella (repeat DSAEK) was implanted with reinjection of an air bubble into the anterior chamber. Six months after the initial DSAEK, the patient complained of blurred vision. On examination, the cornea was transparent but the IOL presented opacification in the central area. The opacified IOL was explanted and analyzed by light microscopy, which showed the presence of thin granular deposits distributed in an overall round pattern that stained positive for calcium. The opacification of hydrophilic acrylic IOLs is a complication that can occur after uneventful endothelial keratoplasty, especially when rebubbling is necessary.

Safety of hydroimplantation: a foldable intraocular lens implantation without the use of an ophthalmic viscosurgical device.

Purpose To compare the safety of a single-piece, foldable intraocular lens (IOL) hydroimplantation with that of a standard implantation using an ophthalmic viscosurgical device (OVD). Methods One hundred consecutive patients with bilateral age-related cataract surgery were enrolled into a prospective double-blind study. Each patients first eye was randomly assigned to a standard implantation technique with an OVD or the hydroimplantation technique, while the fellow eye received the opposite technique. The main outcomes measured were endothelial cell loss, postoperative changes of intraocular pressure (IOP), and the frequency of complications. Results The reduction of endothelial cell density 1 month and 6 months after the surgery was 9.76% ± 13.5%, 10.7% ± 12.6%, respectively, in group A (OVD) and 9.07% ± 12.7%, 9.13% ± 13.7%, respectively, in group B (hydroimplantation). The differences were not statistically significant. The mean IOP 2 hours after surgery was 10.19 ± 6.78 mm Hg in group A and 9.92 ± 7.01 mm Hg in group B. Twenty-four hours and 1 month after surgery, the mean IOP was 14.52 ± 5.59 mm Hg and 13.21 ± 3.5 mm Hg, respectively, in group A, and 15.45 ± 5.77 mm Hg and 13.1 ± 3.44 mm Hg, respectively, in group B. The differences between groups A and B were not statistically significant. Conclusions The hydroimplantation technique is a safe technique for single-piece foldable IOL implantation. There was no increase in intraoperative and postoperative complications compared with the standard implantation technique using an OVD.

Late opacification of a hydrophilic acrylic intraocular lens in Europe

Purpose To describe the clinical and microscopic findings in 2 different patients of 2 cases of late opacification of the hydrophilic acrylic intraocular lens (IOL) Ioflex. Methods Two eyes of 2 patients (73 and 74 years old) had an uneventful phacoemulsification surgery with implantation of the Ioflex IOL (power +21.5 D). At 5 years after surgery, a dense IOL opacification was detected in both cases with significant visual degradation. The IOLs were explanted and analyzed by microscopy. Results In both cases, a satisfactory visual recovery was achieved (corrected distance visual acuity of 6/9 and 6/12). Microscopic examination of the explanted IOLs revealed multiple small granules on the surface/subsurface of the lens. Although histochemical or surface analyses were not performed, the aspect appears consistent with a process of calcification of this lens design. Other findings included few surface contaminants, such as fibers, crystals that may correspond to dry viscoelastic and/or salt solutions, as well as pigments and dust-like deposits. Conclusions Opacification of the posterior chamber hydrophilic acrylic IOL Ioflex probably related to calcification can appear several years after its implantation and requires IOL exchange due to the significant visual loss induced. More studies are required to understand the causes of this complication.

Management of late postoperative capsular block syndrome with accumulation of Propionibacterium acnes.

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