Tiago Ferreira

Comparison of visual outcomes of 2 diffractive trifocal intraocular lenses

Purpose To compare the visual outcomes after cataract surgery with bilateral implantation of 1 of 2 diffractive trifocal intraocular lenses (IOLs). Setting Two clinical centers, Lisbon, Portugal. Design Prospective comparative case series. Methods Phacoemulsification with bilateral implantation of a Finevision Micro F IOL (Group 1) or an AT Lisa tri 839 MP IOL (Group 2) was performed. Over a 3‐month follow‐up, the main outcome measures were uncorrected distance visual acuity (UDVA), corrected monocular and binocular distance visual acuity, uncorrected intermediate visual acuity at 80 cm, distance‐corrected intermediate visual acuity (DCIVA), uncorrected near visual acuity at 40 cm, distance‐corrected near visual acuity (DCNVA), spherical equivalent (SE) refraction, defocus curves, contrast sensitivity, presence of dysphotopsia, and use of spectacles. Results Each group comprised 30 eyes (15 patients). The mean values at 3 months were UDVA, 0.03 logMAR ± 0.08 (SD) (Group 1) and 0.08 ± 0.12 (Group 2) (P = .765); DCIVA, 0.04 ± 0.07 logMAR and 0.18 ± 0.18 logMAR, respectively (P = .048); DCNVA, 0.03 ± 0.06 logMAR and 0.11 ± 0.08 logMAR, respectively (P = .032); SE, −0.25 ± 0.30 diopter (D) and −0.02 ± 0.39 D, respectively (P = .087). There was no significant difference in contrast sensitivity or dysphotopic phenomena between groups. Conclusions Both trifocal IOL models provided excellent distance, intermediate, and near visual outcomes. Monocular DCIVA and DCNVA appeared slightly better in Group 1. Predictability of the refractive results and optical performance were excellent, and all patients achieved spectacle independence. Financial Disclosure Neither author has a financial or proprietary interest in any material or method mentioned.

Visual and optical outcomes of a diffractive multifocal toric intraocular lens

Purpose To evaluate the visual and wavefront outcomes after cataract surgery with implantation of a diffractive multifocal toric intraocular lens (IOL). Setting Two clinical centers, Lisbon, Portugal. Design Case series. Methods This study comprised patients with cataract and corneal astigmatism between 0.75 diopter (D) and 2.50 D who had phacoemulsification with implantation of an Acrysof IQ Restor toric IOL. Over a 3‐month follow‐up, the main outcome measures were uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) at 80 cm, uncorrected near visual acuity (UNVA) at 40 cm, spherical equivalent (SE) refraction, residual astigmatism, rotational stability of the IOL, higher‐order aberrations, and the presence of dysphotopic phenomena. Results The study included 38 eyes (19 patients). The mean UDVA was 0.07 logMAR ± 0.10 (SD), the mean UIVA was 0.16 ± 0.10 logMAR, and the mean UNVA was 0.02 ± 0.09 logMAR. Predictability of refractive results was very good, with an SE refraction within ±0.50 D of the attempted spherical correction in 33 eyes (87%). The mean toric IOL axis rotation was 2.97 ± 2.33 degrees. One eye required a second surgery to align the IOL axis. Ocular aberrometry and dysphotopic phenomena results were similar to those published for the nontoric version of the toric IOL. Conclusion Implantation of the diffractive multifocal toric IOL in patients with cataract and corneal astigmatism provided excellent distance, intermediate, and near visual outcomes; predictability of the refractive results; rotational stability; and good optical performance, allowing all patients to achieve complete spectacle independence. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Comparison of the Visual Outcomes and OPD-Scan Results of AMO Tecnis Toric and Alcon Acrysof IQ Toric Intraocular Lenses

PURPOSE To compare the visual outcomes and wavefront analyses of patients who underwent cataract surgery with the implantation of a Tecnis toric intraocular lens (IOL) (Abbott Medical Optics) with those patients who received an Acrysof IQ toric IOL (Alcon Laboratories Inc). METHODS The study included 40 eyes from 26 patients with regular corneal astigmatism between 1.00 and 3.00 diopters (D) who were undergoing phacoemulsification with implantation of a toric IOL. Patients were randomized into two groups (20 eyes in each group): one group received the Tecnis toric IOL (Tecnis group) and one group received the Acrysof IQ toric IOL (Acrysof group). Over a 2-month follow-up period, the main outcome measures were uncorrected (UDVA) and corrected distance visual acuity (CDVA), spherical equivalent refraction, residual astigmatism, rotational stability of the IOL, and higher order aberrations, measured with a dynamic retinoscopy aberrometer. RESULTS At 2-month follow-up, UDVA, CDVA, spherical equivalent refraction, and residual astigmatism showed no statistically significant between-group differences (P=.834, P=.178, P=.447, and P=.166, respectively). No eye had IOL rotation >10°. The toric IOL axis misalignment was similar in both groups (3.15°±2.62° in the Tecnis group and 3.25°±2.04° in the Acrysof group, P=.265). No statistically significant between-group differences were noted for all ocular aberrometry values, except for spherical aberration, which was higher in the Acrysof group (P=.029). CONCLUSIONS Both studied IOLs promoted good postoperative UDVA, CDVA, and refractive results. Rotational stability was excellent for both IOLs. Postoperative spherical aberration was higher for the Acrysof toric IOL; however, this difference did not seem to affect overall visual quality.

Clinical outcomes and surgeon assessment after implantation of a new diffractive multifocal toric intraocular lens.

Purpose To evaluate the clinical outcome in eyes with significant corneal astigmatism after cataract surgery with implantation of a new diffractive multifocal toric intraocular lens (IOL). Methods Prospective, non-randomised multicentre clinical study including 57 eyes of 38 consecutive patients with an age between 37 and 84 years that underwent cataract surgery with implantation of the toric multifocal IOL Tecnis ZMT (Abbott Medical Optics, Santa Ana, California, USA). Changes in uncorrected and corrected logMAR distance, intermediate and near visual acuity ((uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), corrected near visual acuity) and manifest refraction were evaluated during a 2–4 month follow-up. Additionally, patients were asked about photic phenomena and spectacle dependence. The surgeons subjectively assessed various aspects of the surgery. Results A significant improvement in CDVA was observed postoperatively (p<0.01), with a significant reduction in manifest cylinder (p<0.01). Mean postoperative binocular UDVA and UNVA were 0.04±0.10 and 0.06±0.12, respectively. Monocular UDVA and UNVA was 0.20 or better in 85.4% and 87.0% of eyes, respectively. Mean binocular logMAR UIVA was 0.21±0.20. Only 10.5% of patients required postoperative correction for near or intermediate distance. The incidence of moderate to severe photic phenomena was limited. Surgeons defined the IOL implantation in most cases as easy or very easy, with a satisfaction rate with the procedure of 84%. Conclusions The implantation of the multifocal toric IOL is a safe procedure that provides a very good visual rehabilitation in eyes with corneal astigmatism.

Endothelial distance after phakic iris-fixated intraocular lens implantation: a new safety reference.

Purpose To evaluate the distance between the endothelial surface of the cornea to the anterior edge of an Artiflex® phakic intraocular lens (IOL) implant to improve the safety profile of this implant. Methods This is a retrospective clinical case series of 45 patients who had Artiflex phakic IOL implantation (Artiflex p-IOL) with a follow-up period of 3 years. A Pentacam HR imaging system was used to measure the distance from various points of the anterior edge of the Artiflex IOL to the endothelial surface of the cornea, which we called endothelial–IOL (E–IOL) distance, in 45 eyes. The E–IOL distances were assessed at 1, 3, 6, 12, 24, and 36 months. Corresponding correlations of central endothelial distance to temporal and nasal edges and center of the IOL anterior surface were tabulated. Results Mean follow-up was 21.39±11.28 months. A statistically significant reduction of the E–IOL distance was observed over the follow-up period (P<0.05), with the mean annual reduction being 24.70 μm. A strong positive correlation between the E–IOL distance of the edges of the IOL and the central distance was observed (correlation coefficients nasal/central: month 1, 0.905; month 36, 0.806; temporal/central: month 1, 0.906; month 36, 0.806; P<0.001). Moderate negative correlations were found between the spherical equivalent power of the implanted IOL and the E–IOL distance (correlation coefficients −0.271 to −0.412, P>0.05). For an E–IOL distance of the IOL edge >1500 μm, the distance from the endothelium to the central point of the p-IOL optic should be a minimum of 1,700 μm to improve the safety profile for Artiflex p-IOL implantation and reduce the potential complication of accelerated endothelial cell loss. Conclusion After Artiflex IOL implantation, the mean annual reduction of the E–IOL distance was 25 μm. A negative correlation existed between the spherical equivalent power of the implanted IOL and the postoperative E–IOL distance. The minimum E–IOL distance from the center of the IOL to minimize the risk of endothelial cell loss was 1.7 mm. This distance, as is the 1.5 mm initially proposed by Baikoff, is a postoperative value. We cannot make that assumption for the preoperative evaluation, as the morphometry of the anterior chamber changes with the implant.

Combined Intracorneal Ring Segments and Iris-Fixated Phakic Intraocular Lens for Keratoconus Refractive and Visual Improvement

PURPOSE To evaluate the efficacy and safety of keratoconus refractive and visual improvement by combined intracorneal ring segments (ICRS; Intacs/Intacs SK, Addition Technology Inc., Des Moines, IL) and phakic intraocular lens (PIOL; Artisan/Artiflex Toric IOL, Ophtec BV, Groningen, Holland) implantation. METHODS This study comprised patients who had ICRS implantation followed by PIOL implantation 6 or more months later for the correction of keratoconus. Over a 12-month follow-up after PIOL implantation, the main outcome measures were uncorrected and corrected distance visual acuity (UDVA and CDVA), spherical equivalent refraction, and central endothelial cell density. Efficacy and safety indexes were calculated. RESULTS The study included 21 eyes of 16 patients. The mean UDVA 12 months after ICRS and PIOL implantation increased from 2.0 ± 0 to 0.25 ± 0.22 logMAR (Snellen 20/2000 to 20/35) (P < .001). The mean CDVA increased from 0.31 ± 0.13 to 0.13 ± 0.13 log-MAR (Snellen 20/40 to 20/25) (P = .039). Predictability of refractive results was good, with spherical equivalent refraction within ±0.50 diopter of the attempted correction in 13 eyes (61.9%) and within ±1.00 diopter in 19 eyes (90.5%). Mean central endothelial cell density decreased from 2,513 ± 245 cells/mm(2) preoperatively to 2,312 ± 263 cells/mm(2) (P = .402). The efficacy index was 1.06 and the safety index was 1.40. CONCLUSIONS Keratoconus visual and refractive improvement by the sequential implantation of Intacs ICRS and Artisan/Artiflex Toric IOL is a safe and predictable procedure.

Combined corneal collagen crosslinking and secondary intraocular lens implantation for keratectasia after radial keratotomy

We describe a case of corneal ectasia in a patient with previous radial keratotomy (RK). The uncorrected distance visual acuity (UDVA) was 20/400, the corrected visual acuity (CDVA) 20/50, and the spherical equivalent (SE) -5.125 diopters (D). Corneal topography revealed inferior corneal ectasia with corneal astigmatism of 9.2 D. Six months after corneal collagen crosslinking (CXL), the UDVA improved to 20/200, the CDVA to 20/40, and the SE to -4.625 D. Corneal astigmatism was reduced to 8.7 D. An add-on IOL was implanted to correct the residual cylindrical refractive error (-9.25 × 60; Torica-sPB IOL, Humanoptics), after which the UDVA improved to 20/32, the CDVA to 20/30, and the SE to -0.50 D. This case is the first to document the efficacy of CXL in corneal ectasia as a complication of primary RK in a nonkeratoconic or a keratoconus-suspect eye with an add-on IOL used to correct the residual refractive error.

Correlation between cataract grading by Scheimpflug imaging and phaco time in phacoemulsification using peristaltic and venturi pumps.

Purpose To study the correlation among cataract grading system by Scheimpflug imaging (Oculus Pentacam® Nucleus Grading System [PNS]), effective phaco time (EPT), and surgical time (ST) using peristaltic and venturi pumps on the Whitestar Signature Phaco System (Abbott Medical Optics, Inc., Santa Ana, California, USA). Methods Patients scheduled to have bimanual microincision phacoemulsification by the same surgeon (T.F.) had Pentacam® Scheimpflug assessment using PNS and were randomly distributed into 2 groups. In group 1, surgery was performed using peristaltic pump, and in group 2, using venturi pump. Parameters assessed in both groups included EPT and ST. Results Sixty eyes that had uneventful clear cornea phacoemulsification with implantation of foldable intraocular lens (IOL) were evaluated, 30 in each group. The EPT was statistically superior with higher nuclear density grades for both groups 1 and 2 (group 1 Spearman R = 0.739, p<0.001; group 2 Spearman R = 0.924, p<0.001). The ST statistically increased with nucleus density for both groups 1 and 2 (group 1 Spearman R = 0.620, p<0.001; group 2 Spearman R = 0.643, p<0.001). Group 2 presented statistically significant reduction on median ST compared with group 1 for nucleus grading 2, 3, 4, and 5. Conclusions The PNS is an objective and reproducible method of grading nuclear cataract density and had a correlation with EPT. Peristaltic and venturi pumps in Signature Phaco System were similar in EPT but venturi pump reduced the median ST in nucleus with higher PNS, without repercussion on complications or anterior chamber stability.

Visual Performance and Rotational Stability of a Multifocal Toric Intraocular Lens.

PURPOSE To evaluate the visual results, refractive predictability, rotational stability, and spectacle independence of patients who had cataract surgery with implantation of a diffractive multifocal toric intraocular lens (IOL) (Tecnis Multifocal Toric ZMT 150-400; Abbott Medical Optics, Santa Ana, CA). METHODS This prospective study included 60 eyes of 30 patients with cataract and regular corneal astigmatism who had phacoemulsification with bilateral implantation of a Tecnis Multifocal Toric IOL. Over a 6-month follow-up period, the main outcome measures were uncorrected and corrected monocular and binocular distance (UDVA and DCVA), intermediate at 80 cm (UIVA and DCIVA), and near at 40 cm (UNVA and DCNVA) visual acuities, spherical equivalent (SE) refraction, residual astigmatism, rotational stability, defocus curves, contrast sensitivity, presence of photic phenomena, and use of spectacles. RESULTS Results at 6 months showed mean UDVA of 0.07 ± 0.1 logMAR (range: 0.3 to 0.0 logMAR), mean UIVA of 0.18 ± 0.09 logMAR (range: 0.3 to -0.1 log-MAR, and mean UNVA of 0.03 ± 0.09 logMAR (range: 0.2 to -0.1 logMAR). Refractive predictability was excellent with a mean SE of 0.05 ± 0.47 diopters (D) (range: -0.75 to +1.00 D) and a mean refractive cylinder of -0.44 ± 0.49 D (range: -1.25 to 0.00). Mean rotation was 3.18° ± 3.28°. Photic phenomena were moderate or severe in 30% of patients. All patients were spectacle independent at the 6-month follow-up visit at all distances in this case series. CONCLUSIONS The implantation of the Tecnis multifocal toric IOL in patients with cataract and corneal astigmatism provided excellent distance and near visual acuities with good intermediate visual acuity. Predictability of refractive results, rotational stability, and optical performance were excellent, allowing all patients in this series to achieve spectacle independence. [J Refract Surg. 2016;32(7):444-450.].

Clinical results with a supplementary toric intraocular lens for the correction of astigmatism in pseudophakic patients

Purpose To evaluate the visual outcomes of pseudophakic patients who underwent supplementary toric intraocular lens (IOL) implantation to correct astigmatic refractive errors. Methods Pseudophakic patients referred for the implantation of a supplementary toric IOL (Sulcoflex Toric 653T) were evaluated. Uncorrected and corrected distance visual acuities (UDVA and CDVA, respectively), spherical equivalent (SE) refraction, rotational stability, higher order aberrations (HOA), and photopic glare and no-glare contrast sensitivity (CSV-1000, VectorVision) were evaluated. Results A total of 10 eyes of 10 patients were included. The mean age was 56.42 ± 5.9 years (range 45-65 years). Mean follow-up was 6.99 ± 5.1 months (6-18 months). Postoperatively, UDVA improved to 0.10 ± 0.12 (0.3 to −0.1) (p = 0.004) and CDVA to 0.07 ± 0.12 (0.3 to −0.1) (p = 0.021). Mean SE was −0.30 ± 0.56 D (-1.00 to +0.75) (p = 0.001). Mean toric IOL axis rotation at 6-month follow-up was 3.0° ± 2.45° (0-6). Ocular aberrometry values decreased after surgery (for average HOA root mean square, p = 0.008). Photopic contrast sensitivity (for all spatial frequencies) showed a trend for improvement after surgery; however, this was not borne out from the analysis (p>0.05). Conclusions The implantation of the Sulcoflex Toric IOL to correct astigmatism in pseudophakic patients provided excellent visual outcomes, predictability of refractive results, rotational stability, and optical performance. The implantation of this IOL is a safe and effective technique to correct pseudophakic cylindrical refractive errors and reduce spectacle dependence in these patients.