Raúl Montalbán

Corneal aberrations after microincision cataract surgery

PURPOSE: To study the effect of microincision cataract surgery (MICS) on the optical quality of the cornea, characterized in terms of Seidel aberrations. SETTING: Instituto Oftalmológico de Alicante, Vissum, Alicante, Spain. METHODS: This study comprised 25 eyes of 25 patients with nuclear or corticonuclear cataract of grade 2+ to 4+ (Lens Opacities Classification System III). Microincision cataract surgery was performed using low ultrasound power through a 1.6 to 1.8 mm clear corneal incision placed on the axis of the positive corneal meridian. An Acri.Smart 48S intraocular lens (Acri.Tec) was implanted in all eyes. Seidel aberration root‐mean‐square (RMS) values were obtained with a 6.0 mm aperture using the CSO topographer (Costruzione Strumenti Oftalmici) preoperatively and 1 and 3 months postoperatively. RESULTS: The total RMS after MICS decreased slightly from a mean of 2.15 μm ± 2.51 (SD) preoperatively to 1.96 ± 2.01 μm postoperatively; the decrease was not statistically significant (P = 1.00). The difference between the corneal astigmatism from preoperatively (−0.80 ± 0.76 diopter [D]) to postoperatively (−0.63 ± 0.62 D) was not statistically significant (P = 1.00) nor were the differences in Seidel aberrations, coma, or higher‐order aberrations. CONCLUSION: Microincision cataract surgery did not degrade the optical quality of the cornea or induce a modification in corneal astigmatism, including the axis.

Visual Outcomes of a Trifocal Aspheric Diffractive Intraocular Lens With Microincision Cataract Surgery

PURPOSE To evaluate the visual outcomes of patients with a new diffractive trifocal intraocular lens (IOL). METHODS A trifocal diffractive Fine Vision IOL (Physiol, Liege, Belgium) was implanted after microincision cataract surgery (MICS) in 40 eyes of 20 patients with bilateral cataract. The monocular and binocular visual performance and the refractive status were assessed, as well as the defocus curve and contrast sensitivity at 1 and 6 months postoperatively. RESULTS The monocular visual outcomes (logMAR) at 6 months postoperatively were uncorrected distance visual acuity 0.18 ± 0.13, uncorrected near visual acuity 0.26 ± 0.15, and uncorrected intermediate visual acuity 0.20 ± 0.11. With the best distance correction, the visual outcomes were 0.05 ± 0.06 for corrected distance visual acuity, 0.16 ± 0.13 for distance corrected near visual acuity, and 0.17 ± 0.09 for distance corrected intermediate visual acuity. Binocular defocus curve at 6 months shows a wide range of useful vision with 0.19 ± 0.08 (logMAR) at -1.50 diopter defocus. The monocular contrast sensitivity under scotopic conditions (3 cd/m(2)) was within normal range for a population older than 60 years. CONCLUSION The trifocal Fine Vision IOL can restore vision at different distances after cataract surgery, specifically intermediate and near vision.

Intrasubject repeatability in keratoconus-eye measurements obtained with a new Scheimpflug photography–based system

Purpose To evaluate in keratoconus eyes the intrasubject repeatability of anterior and posterior corneal curvature and of other anterior segment anatomic measurements obtained with a new topography system combining Scheimpflug‐photography and Placido‐disk technology. Setting Vissum Corporation, Alicante, Spain. Design Evaluation of technology. Methods All keratoconus eyes had a comprehensive ophthalmologic examination including analysis with the Sirius system. Three consecutive measurements were obtained to assess the intrasubject repeatability of the following parameters: anterior and posterior corneal curvature and shape factor, white‐to‐white (WTW) corneal diameter, central and minimum corneal thickness, and anterior chamber depth (ACD). The within‐subject standard deviation (Sw) and intraclass correlation coefficient (ICC) were calculated. Results This study comprised 61 eyes of 61 patients ranging in age from 14 to 64 years. For anterior and posterior corneal curvatures and power vector components, the Sw was 0.29 mm or less in all cases. The ICC was above 0.990 in all cases except the flattest curvature of the posterior corneal surface at 3.0 mm, which was 0.840 (moderate agreement), and the posterior power vector J0, which was 0.665 (poor agreement), 0.752, and 0.758 (moderate agreement) for 3.0 mm, 5.0 mm, and 7.0 mm, respectively. In shape factor measurements, the Sw was 0.12 or less in all cases and the ICC ranged between 0.989 and 0.999. Pachymetry, ACD, and WTW had ICC values very close to 1. Conclusion The new topography system provided repeatable measurements of corneal shape and other anatomic parameters in eyes with keratoconus. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Intrasubject repeatability of corneal morphology measurements obtained with a new Scheimpflug photography–based system

PURPOSE: To evaluate in normal healthy eyes the intrasubject repeatability of anterior and posterior corneal curvature measurements and other anatomic anterior segment measurements obtained with a new topography system combining Scheimpflug photography and Placido‐disk technology. SETTING: Vissum Corp., Alicante, Spain. DESIGN: Evaluation of technology. METHODS: All eyes received a comprehensive ophthalmologic examination including anterior segment analysis with the Sirius system. Three consecutive measurements were performed with the device to assess the intrasubject repeatability of the following parameters: anterior and posterior corneal curvature and shape factor, white‐to‐white (WTW) corneal diameter, central and minimum corneal thickness, and anterior chamber depth (ACD). The within‐subject standard deviation (Sw) and intraclass correlation coefficient (ICC) were calculated. RESULTS: This study included 117 eyes of 117 subjects (mean age 42 years; range 7 to 80 years). For anterior and posterior corneal curvatures, the Sw was 0.04 mm or lower and the ICC was higher than 0.990. For shape‐factor measurements, the Sw was below 0.08 in all cases and ICC values ranged between 0.909 and 0.994. Significantly larger Sw values were found for the anterior and posterior shape factor calculated for 8.0 mm compared with 4.5 mm (P<.01). An Sw value below 3 μm was observed for the central and minimum thickness, with ICC values close to 1. The mean Sw for ACD and WTW was below 0.1 mm. CONCLUSION: In healthy eyes, the new topography system provided repeatable measurements of several anterior segment parameters, including anterior and posterior curvature and pachymetry. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Clinical outcomes and postoperative intraocular optical quality with a microincision aberration-free aspheric intraocular lens

PURPOSE: To evaluate the visual outcomes and optical quality with an aspheric intraocular lens (IOL) with no aberration in microincision cataract surgery. SETTING: Vissum‐Instituto de Oftalmológico de Alicante, Alicante, Spain. METHODS: This prospective cohort study included eyes that had cataract surgery with implantation of an Akreos Adapt Advanced Optics MI60 IOL. Surgery was performed using the Millennium phacoemulsification platform. The IOL was implanted through a sub‐1.8 mm incision using the 1.8 Viscoglide cartridge. Visual and refractive outcomes were analyzed during a 12‐month follow‐up. In addition, postoperative ocular optical quality was evaluated using the Optical Quality Analysis System. Postoperative intraocular optical aberrations were calculated by subtracting corneal aberrations from total aberrations. RESULTS: The cohort comprised 25 eyes of 25 patients ranging in age from 52 to 83 years. The mean spherical equivalent was −0.47 diopters ± 0.62 (SD) 3 months postoperatively (P = .72). The mean corrected distance visual acuity improved from 0.54 ± 0.23 logMAR preoperatively to 0.08 ± 0.16 logMAR 3 months postoperatively (P<.01). Optical quality analysis showed a mean spatial frequency at 50% of the modulation transfer function (MTF) of 2.85 ± 0.55 cycles per degree (cpd) and a mean cutoff MTF frequency of 21.50 ± 7.02 cpd. Postoperatively, the mean intraocular spherical aberration was 0.16 ± 0.11 μm and the mean primary coma root mean square, 0.23 ± 0.15 μm. CONCLUSION: Implantation of the aberration‐free aspheric IOL was safe and effective and provided excellent visual and refractive outcomes with good optical performance.

Visual outcomes with a single-optic accommodating intraocular lens and a low-addition-power rotational asymmetric multifocal intraocular lens

PURPOSE: To compare the visual outcomes and intraocular optical quality in patients with a low‐addition (add) power multifocal refractive intraocular lens (IOL) with rotational asymmetry and a single‐optic accommodating IOL. SETTING: Vissum Instituto Oftalmológico de Alicante, Miguel Hérnandez University, Alicante, Spain. DESIGN: Prospective comparative nonrandomized consecutive case series. METHODS: Consecutive cataract patients had implantation of a low‐add‐power refractive multifocal IOL with rotational asymmetry (Lentis‐Mplus LS‐312 MF15) (multifocal group) or a single‐optic accommodating IOL (Crystalens HD) (accommodating group). Distance and near visual acuities were evaluated. Ocular optical quality, intraocular aberrations, defocus curve, and contrast sensitivity were evaluated postoperatively. RESULTS: Of the 66 eyes (40 patients; age 61 to 81 years), 31 were in the multifocal group and 35 were in the accommodating group. Postoperatively, both groups had a significant improvement in the uncorrected and corrected distance visual acuities and uncorrected (UNVA) and corrected near (CNVA) near visual acuities (P<.01). Distance‐corrected near visual acuity was significantly better in the multifocal group postoperatively (P≤.04). No significant differences in UNVA and CNVA were detected postoperatively (P≥.09). In the defocus curve, the multifocal group had significantly better visual acuities at several defocus levels. The accommodating group had better contrast sensitivity under photopic conditions at all spatial frequencies (P≤.04). The multifocal group had significantly higher postoperative intraocular tilt (P<.01). CONCLUSIONS: Both IOLs restored distance vision. The refractive multifocal IOL provided better near visual rehabilitation. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Near visual outcomes with single-optic and dual-optic accommodating intraocular lenses

Purpose To compare the visual and ocular optical performance in eyes with a single‐optic or a dual‐optic accommodating intraocular lens (IOL) with particular attention to near‐vision outcomes. Setting Vissum Instituto Oftalmológico de Alicante, Miguel Hérnandez University, Alicante, Spain. Design Prospective consecutive nonrandomized interventional comparative clinical study. Methods Eyes with cataract were divided into 2 groups. Group A had implantation of a single‐optic accommodating IOL (Crystalens HD) and Group B, of a dual‐optic accommodating IOL (Synchrony). Distance and near visual acuities, contrast sensitivity, ocular aberrations, reading performance, and the defocus curve were evaluated over a 6‐month postoperative follow‐up. Results Group A comprised 27 eyes and Group B, 26 eyes. The patient age ranged from 59 to 82 years. Uncorrected and corrected distance visual acuities were significantly better in Group B (P≤.04). There were no significant between‐group differences in near or intermediate visual vision (P≥.13). In the defocus curve, Group B had significantly better visual acuities at several levels of defocus (P≤.04). The ocular Strehl ratio and contrast sensitivity were also significantly better in Group B (P≤.04). Group A had higher postoperative total and higher‐order root‐mean‐square aberrations (P≤.01). The incidence of posterior capsule opacification was significantly higher in Group A (40.7%) than in Group B (11.5%). Conclusions Both IOLs restored distance visual function after cataract surgery with limitations in near visual outcomes. Eyes with the dual‐optic IOL had significantly better ocular optical quality. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Corneal Wavefront-guided LASIK Retreatments for Correction of Highly Aberrated Corneas Following Refractive Surgery

PURPOSE To investigate the safety and efficacy of customized corneal wavefront-guided retreatment in symptomatic patients with highly aberrated corneas following LASIK. METHODS This prospective study included 75 eyes of 59 patients with significant visual symptoms who underwent LASIK for the correction of residual refractive error. Ablation profiles were calculated using CSO corneal topography and ESIRIS/Schwind laser platform. Eyes were divided into two groups: those with significant night vision symptoms (37 eyes; night symptoms group) and those with decentration, irregular ablation profile, and flap complications (38 eyes; corneal complications group). Corneal topography and aberrations, visual acuity, point spread function (PSF), refractive outcome, and subjective symptoms were evaluated preoperatively, and 1, 3, and 6 months postoperatively. RESULTS Mean uncorrected visual acuity was 20/32 preoperatively and 20/25 at 6 months postoperatively in the night symptoms group and 20/40 preoperatively and 20/30 at 6 months postoperatively in the corneal complications group. Mean best spectacle-corrected visual acuity was 20/25 both preoperatively and 6 months postoperatively in both groups (t test, P = .219 and P = .149 for the night symptoms and corneal complications groups, respectively). Safety index was 1.1 in both groups, and efficacy index was 0.93 and 0.92, respectively. Statistically significant improvement of total corneal higher order aberrations, tilt, and improvement of spherical aberrations and coma were observed, with corresponding improvement of PSF. CONCLUSIONS Corneal wavefront-guided LASIK retreatment with CSO topography, ORK-W software, and ESIRIS/Schwind laser platform is safe and effective for treating symptomatic patients affected by corneal higher order aberrations or corneal irregularities following LASIK surgery.

Correlation of Anterior and Posterior Corneal Shape in Keratoconus

Purpose: To evaluate the correlation of the mean curvature and shape factors of both corneal surfaces for different corneal diameters measured with the Scheimpflug photography–based system in keratoconus eyes. Methods: A total of 61 keratoconus eyes of 61 subjects, aged 14 to 64 years, were included in this study. All eyes received a comprehensive ophthalmologic examination including anterior segment and corneal analysis with the Sirius system (CSO): anterior and posterior mean corneal radius for 3, 5, and 7 mm (aKM, pKM), anterior and posterior mean shape factor for 4.5 and 8 mm (ap, pp), central and minimal corneal thickness, and anterior chamber depth. Results: Mean aKM/pKM ratio around 1.20 (range, 0.95–1.48) was found for all corneal diameters (P = 0.24). Weak but significant correlations of this ratio with pachymetric parameters were found (r between −0.28 and −0.34, P < 0.04). The correlation coefficient between aKM and pKM was ≥0.92 for all corneal diameters. A strong and significant correlation was also found between ap and pp (r ≥ 0.86, P < 0.01). The multiple regression analysis revealed that central pKM was significantly correlated with aKM, central corneal thickness, anterior chamber depth, and spherical equivalent (R2 ≥ 0.88, P < 0.01) and that 8 mm pp was significantly correlated with 8 mm ap and age (R2 = 0.89, P < 0.01). Conclusions: Central posterior corneal curvature and shape factor in the keratoconus eye can be consistently predicted from the anterior corneal curvature and shape factor, respectively, in combination with other anatomical and ocular parameters.

Implantable Collamer Lens for Myopia: Assessment 12 Years After Implantation.

PURPOSE To evaluate the long-term refractive and visual stability and the risks related to the implantation of Implantable Collamer Lens (ICL; STAAR Surgical, Monrovia, CA) phakic intraocular lens (PIOL) for myopia. METHODS This retrospective, consecutive, cumulative clinical study was performed in a group of 144 eyes implanted with ICL PIOL for myopia. Only the cases with clinical data available 12 years after the implantation were included in the series. Corrected distance visual acuity (CDVA), uncorrected distance visual acuity, spherical equivalent, refractive astigmatism, endothelial cell density, ICL vaulting, and postoperative complications were analyzed. RESULTS Mean spherical equivalent refraction was -16.90±4.26 diopters (D) preoperatively and -1.77±1.93 D 12 years postoperatively. Mean CDVA at the first and last visit were 0.31±0.19 logMAR and 0.22±0.22 logMAR, respectively (Mann-Whitney U test, P<.001). Twelve years postoperatively, 8.9% of eyes had lost more than two lines of CDVA. The incidence of clinically relevant cataracts (13.88%) was significantly linked to the use of the V3 model ICL (chi-square test, P=.007). During the follow-up period, a significant reduction in PIOL vaulting was observed (Kruskal-Wallis test, P<.05), and the mean endothelial cell density decreased by 19.75%. CONCLUSIONS The ICL PIOL provided good refractive outcomes and stability in the long term. The incidence of cataracts is low when the latest models of this PIOL are used.