Tos Tjm Berendschot

Dissatisfaction after implantation of multifocal intraocular lenses

PURPOSE: To analyze the symptoms, etiology, and treatment of patient dissatisfaction after multifocal intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology, Maastricht University Medical Center, The Netherlands. DESIGN: Case series. METHODS: In this retrospective chart review, the main outcome measures were type of complaints, uncorrected and corrected distance visual acuities, uncorrected and distance‐corrected near visual acuities, refractive state, pupil diameter and wavefront aberrometry measurements, and type of treatment. RESULTS: Seventy‐six eyes of 49 patients were included. Blurred vision (with or without photic phenomenon) was reported in 72 eyes (94.7%) and photic phenomena (with or without blurred vision) in 29 eyes (38.2%). Both symptoms were present in 25 eyes (32.9%). Residual ametropia and astigmatism, posterior capsule opacification, and a large pupil were the 3 most significant etiologies. Sixty‐four eyes (84.2%) were amenable to therapy, with refractive surgery, spectacles, and laser capsulotomy the most frequent treatment modalities. Intraocular lens exchange was performed in 3 cases (4.0%). CONCLUSION: The cause of dissatisfaction after implantation of a multifocal IOL can be identified and effective treatment measures taken in most cases. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Evaluation of the Lenstar LS 900 non-contact biometer.

Background/aims: Evaluation of the reproducibility of the Lenstar LS 900 non-contact biometer, and a comparison with the Visante anterior-segment optical coherence tomography (AS-OCT) and the IOLMaster. Methods: Central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), keratometry (K) values, corneal diameter (CD) and axial length (AL) were obtained in 38 healthy volunteers (76 eyes) to determine the reproducibility of the Lenstar. CCT, ACD, CD, K values and AL measurements measured with the Lenstar were compared with the AS-OCT and IOLMaster. Intraocular lens (IOL) power calculations were done to study the significance of the difference between AL measurements. Results: The reproducibility of the Lenstar was better than 0.9% for CCT, ACD, LT, K values and AL measurements. Although all correlations were highly significant (p<0.001), all comparisons showed a significant difference, except for the comparison of CD measurements using the Lenstar and IOLMaster (p = 0.175). The differences in IOL power calculations for an AL of 20, 25 and 30 mm with a mean difference between Lenstar and IOLMaster AL measurements of 0.03 mm, were 0.13 D, 0.10 D and 0.08 D, respectively. Conclusion: The reproducibility of the Lenstar was excellent. Small but significant differences exist between the Lenstar, Visante OCT and the IOLMaster. Therefore, measurements of the Lenstar, AS-OCT and IOLMaster are not interchangeable. Despite the significant difference between AL measurements, there is no clinically significant difference in the IOL power calculation results.

Evaluation of the comparability and repeatability of four wavefront aberrometers.

PURPOSE To compare total ocular aberrations and corneal aberrations identified with four different aberrometers and to determine the repeatability and interobserver variability. METHODS In this prospective comparative study, 23 healthy subjects underwent bilateral examination with four aberrometers: the Irx3 (Hartmann-Shack; Imagine Eyes, Orsay, France), Keratron (Hartmann-Shack; Optikon, Rome Italy), iTrace (ray-tracing; Tracey Technologies, Houston, TX), and OPD-Scan (Automated Retinoscopy; Nidek, Gamagori, Japan). Six images per eye were obtained. Second-, third- and fourth-order spherical aberrations were exported for 5.0-mm pupils. RESULTS Significant differences in measurements were found for several total ocular aberrations (defocus [2,0], astigmatism [2,2], trefoil [3,-3], trefoil [3,3], and spherical aberration [4,0]) and corneal aberrations (defocus [2,0] and astigmatism [2,2]). The Irx3 showed the highest repeatability in measuring total ocular aberrations, followed by the Keratron, OPD-Scan, and iTrace. The repeatability of the corneal aberration measurements was highest for the iTrace, followed by the Keratron and OPD-Scan. The OPD-Scan showed a lower interobserver variability, compared with the Irx3, Keratron, and iTrace. CONCLUSIONS Total ocular and corneal aberrations are not comparable when measured with different aberrometers. Hartmann-Shack aberrometers showed the best repeatability for total ocular aberrations and iTrace for corneal aberrations. It would be worthwhile in the future to evaluate aberrometers in patients with more aberrant eyes.

Visual outcome and patient satisfaction after multifocal intraocular lens implantation: aspheric versus spherical design.

PURPOSE: To evaluate visual outcomes and patient satisfaction after implantation of an aspheric apodized diffractive intraocular lens (IOL) or a spherical apodized diffractive IOL in cataract surgery. SETTING: Maastricht University Medical Center, The Netherlands. DESIGN: Nonrandomized clinical trial. METHODS: This prospective nonrandomized study with a 6‐month follow‐up compared the results of cataract surgery with implantation of an aspheric AcrySof ReSTOR SN6AD3 IOL and a spherical AcrySof ReSTOR SN60D3 IOL. Main outcome measures were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, uncorrected (UNVA) and distance‐corrected (DCNVA) near visual acuities, straylight levels, incidence of glare and halos, and contrast sensitivity levels. RESULTS: The mean UDVA was 0.14 ± 0.15 logMAR in the aspheric group (47 eyes) and 0.14 logMAR ± 0.17 (SD) in the spherical group (45 eyes) and the mean CDVA, −0.01 ± 0.06 logMAR and 0.02 ± 0.10 logMAR, respectively. The mean UNVA was Jaeger (J) 1 in 83.0% of patients in the aspheric group and 55.5% of patients in the spherical IOL group (P = .003). The DCNVA was J1 in 95.7% and 71.1%, respectively (P = .001). There were no significant differences between the 2 groups in contrast sensitivity levels, intraocular straylight levels, incidence of night‐vision symptoms, or subjective rating of vision. CONCLUSIONS: Patients with the aspheric multifocal IOL had significantly better near vision than patients with the multifocal spherical IOL. The UDVA, CDVA, intraocular straylight, night‐vision symptoms, and contrast sensitivity were similar between the 2 groups. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Persistent subfoveal fluid and increased preoperative foveal thickness impair visual outcome after macula-off retinal detachment repair.

Purpose: To investigate the influence of subfoveal fluid and foveal thickness on visual outcome in patients who underwent reattachment surgery for rhegmatogenous retinal detachment (RRD). Methods: This prospective study included 53 patients who were undergoing successful scleral buckling surgery for primary RRD. A thorough ophthalmologic examination including best-corrected visual acuity, slit-lamp biomicroscopy, binocular indirect ophthalmoscopy, and optical coherence tomography scanning was performed preoperatively and during all subsequent follow-up visits at 1, 3, 6, 9, 12, and 24 months postoperatively. Results: Preoperative foveal thickness was significantly higher in the macula-off group (n = 38) compared with the macula-on group (n = 15) (P < 0.0001), whereas postoperative measurements were normal in both the groups. Linear mixed-model analysis revealed that persistent subfoveal fluid (P = 0.0004) was an independent predictor of a worse visual outcome after scleral buckling surgery for primary macula-off RRD, although the effect on visual outcome was small (0.1 logarithm of the minimal angle of resolution units). Moreover, increased preoperative foveal thickness was associated with a worse visual prognosis in macula-off RRD (P = 0.010). Conclusion: Persistent subfoveal fluid and increased preoperative foveal thickness were associated with a worse visual prognosis in macula-off RRD patients, albeit the effect of persistent subfoveal fluid was small and temporary.

Risk factors for redetachment and worse visual outcome after silicone oil removal in eyes with complicated retinal detachment

Purpose The goal of this study was to identify risk factors for redetachment and/or a worse visual outcome after silicone oil removal (SOR) for complicated retinal detachment. Methods The authors retrospectively analyzed 287 consecutive eyes with SOR between January 1999 and December 2003. Results Anatomic success after SOR was achieved in 81% of the eyes. The overall anatomic success at the end of follow-up was 94%. Postoperative ocular hypertension was found in 8% of the eyes, hypotony in 6% of the eyes, and keratopathy in 29% of the eyes. After SOR 43% of the eyes had an improvement in visual acuity of at least two Snellen lines. After multivariate analysis, male sex, the presence of preoperative rubeosis, and proliferative diabetic retinopathy (PDR) were found to be risk factors for recurrent retinal detachment. Male sex, preoperative visual acuity of <0.1 Snellen lines, PDR, the performance of three more operations, any size of retinectomy, and hypotony were found to be associated with a poor visual outcome of Snellen visual acuity <0.1. Conclusions Retinal detachment after SOR in the current unselected series of eyes occurred in approximately 20%, which is comparable to the Silicone Oil Study reports, published approximately 20 years ago. However, preoperative selection was then made, and less than 50% of the silicone oil-filled eyes had SOR. The higher overall anatomic success in the current study may be due to improved vitreoretinal surgical techniques.

Reproducibility of anterior chamber angle analyses with the swept-source optical coherence tomography in young, healthy Caucasians

PURPOSE To assess the reproducibility of iridocorneal angle (ICA) analysis in young, healthy Caucasian subjects using swept-source optical coherence tomography (SS-OCT) by determining variability and interobserver agreement between expert and nonexpert observers. METHODS Thirty-one healthy volunteers (nonexperts) acquired three consecutive SS-OCT images of the right eyes of their peer nonexperts. Images were analyzed by 31 nonexperts and additionally by three experts, whereby the angle opening distance (AOD) and the trabecular iris space area (TISA) at 500 and 750 μm were calculated. A random intercept model was used to determine the amount of variation between observers. In addition, the intra-observer variability between nonexperts and experts was calculated by determining the coefficient of variation (CV). RESULTS A significant difference was found in the expert analysis for the nasal and temporal angle in the AOD500 (P = 0.002), AOD750 (P < 0.01), and TISA750 (P < 0.01), and the values AOD500 (P = 0.025), AOD750 (P = 0.012), and TISA500 (P = 0.010) were significantly larger if nonexperts analyzed SS-OCT images. The CV was only significant larger for nonexperts for AOD500 (11.1% vs. 8.7%, P < 0.01). CONCLUSIONS This study demonstrated high reproducibility of angle analysis in young, healthy Caucasian subjects using SS-OCT. Nevertheless, nonexperts obtained significant larger values compared with experts, implying that training is a necessary requirement before analyzing SS-OCT images in ophthalmic practice.

Antiangiogenic isoforms of vascular endothelial growth factor predominate in subretinal fluid of patients with rhegmatogenous retinal detachment and proliferative vitreoretinopathy.

Background: In proliferative vitreoretinopathy (PVR), a nonangiogenic eye disease that is characterized by the formation of mainly avascular membranes, vascular endothelial growth factor (VEGF) levels are found to be upregulated. Recently, it was discovered that VEGF is alternatively spliced to form the angiogenic (VEGFxxx) and antiangiogenic (VEGFxxxb) family of isoforms. Previous studies on expression of VEGF in PVR samples have not distinguished between the two families of isoforms. Methods: We measured total VEGF and VEGFxxxb levels in subretinal fluid of patients with PVR (n = 10) and in patients with uncomplicated rhegmatogenous retinal detachment (n = 27) using enzyme-linked immunosorbent assay. Results: We found total VEGF levels to be 2- to 3-fold elevated in the PVR group as compared with the rhegmatogenous retinal detachment group (P = 0.047). Antiangiogenic VEGFxxxb isoforms predominated (>60% of total VEGF) in the majority of rhegmatogenous retinal detachment and PVR samples investigated, although a wide variability of isoform ratios was observed within both groups. Conclusion: The absence of an increased ratio of VEGFxxx to VEGFxxxb in patients with PVR as compared with patients with uncomplicated rhegmatogenous retinal detachment may explain a lack of blood vessels in PVR membranes. Elevated VEGF levels indicate that this cytokine may play a role in the pathogenesis of PVR that is not related to angiogenesis.

Diplopia was not predictable and not associated with buckle position after scleral buckling surgery for retinal detachment.

Purpose: The possibility of postoperative binocular diplopia is seen as an important drawback of conventional scleral buckling surgery for rhegmatogenous retinal detachment. The goal of this study was to evaluate the occurrence and pattern of binocular diplopia after scleral buckle procedures in patients with rhegmatogenous retinal detachment. Methods: In a retrospective study of 1,030 patients with primary rhegmatogenous retinal detachment who were treated by scleral buckle surgery between January 2001 and July 2008, the postoperative occurrence of binocular diplopia was retrieved from the medical charts. Results: Secondary strabismus developed in 39 subjects (3.8%) after scleral buckle surgery during a mean follow-up of 6.4 ± 6.3 months. Twenty-eight patients (2.7%) developed strabismus because of a mechanical restriction of one of the muscles. No association was found between the position of the buckle, that is, the muscle affected, and the incidence of diplopia. A moderate significant association was found when two muscles were affected with a higher incidence of diplopia. This was, however, not found for three or more muscles. In 28 of 39 patients, binocular single vision was restored at the end of the follow-up period. In the majority, this was accomplished with conventional prism treatment. Conclusion: Strabismus caused by a restriction of the muscles in scleral buckle surgery was not predictable based upon the buckle position. Patients with a minimal restriction of the muscles after scleral buckle surgery can often be well treated with prisms.

Iris-fixated anterior chamber phakic intraocular lens for myopia moves posteriorly with mydriasis.

PURPOSE To elucidate the physiological characteristics of eyes implanted with iris-fixated anterior chamber phakic intraocular lenses (pIOLs), which are increasingly being used for the correction of higher myopic and hyperopic refractive errors. METHODS In a case series of 20 patients (39 eyes), the position of the pIOL to the natural lens and the cornea was evaluated under photopic (135 lux) and low mesopic (< 1 lux) circumstances with anterior segment optical coherence tomography. RESULTS The distance between the pIOL and the natural lens decreased, and congruently, the distance from the pIOL to the corneal endothelium increased under low mesopic circumstances. CONCLUSIONS The distance between the pIOL and the corneal endothelium increases when the pupil dilates under dark circumstances, contributing to the already excellent safety data available on pIOL implantation.