Viraj A. Vasavada

Contrast sensitivity and glare disability after implantation of AcrySof IQ Natural aspherical intraocular lens: Prospective randomized masked clinical trial

PURPOSE: To evaluate contrast sensitivity and glare disability after implantation of an AcrySof IQ Natural SN60WF aspherical intraocular lens (IOL) (Alcon Laboratories). SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS: One hundred twenty consecutive patients who had phacoemulsification in a prospective triple‐masked trial were randomized to receive an AcrySof SA60AT IOL (40 eyes), AcrySof Natural SN60AT IOL (40 eyes), or AcrySof IQ SN60WF IOL (40 eyes). At 3 months, contrast sensitivity was measured using the CSV‐1000E contrast sensitivity chart test face (Vector Vision) at 3, 6, 12, and 18 cycles per degrees (cpd) under photopic conditions (85 cd/m2) and mesopic conditions (2.7 cd/m2) with 4.0 mm and 6.0 mm fixed central apertures, with and without glare. The Kruskal‐Wallis test was used and a pair‐wise comparison performed. The main outcome measure was the difference in contrast sensitivity between IOLs at each spatial frequency. RESULTS: The best corrected visual acuity was similar between the 3 IOL groups (P = .6). The AcrySof IQ group had significantly higher contrast sensitivity at 18 cpd under photopic conditions (P = .008); at 3, 6, 12, and 18 cpd during mesopic testing with a 4.0 mm aperture without glare (P = .018, P = .011, P = .007, and P = .0001, respectively) and with glare (P = .003, P = .006, P = .005, and P = .004, respectively); and at all spatial frequencies during mesopic testing with a 6.0 mm aperture without glare (P = .018, P = .006, P = .009, and P = .0001, respectively) and with glare (P = .019, P = .002, P = .01, and P = .017, respectively). CONCLUSION: Eyes with the AcrySof IQ SN60WF IOL had significantly higher contrast sensitivity than eyes with an AcrySof SA60AT or AcrySof Natural SN60AT IOL at all spatial frequencies during mesopic testing (with and without glare) with 4.0 and 6.0 mm artificial pupil.

Rotational stability of a toric intraocular lens: influence of axial length and alignment in the capsular bag.

PURPOSE: To evaluate the rotational stability of a toric intraocular lens (IOL) using purpose‐designed software and to determine the influence of axial length (AL) and in‐the‐bag IOL alignment on IOL rotation. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. DESIGN: Prospective observational case series. METHODS: This study enrolled eyes that had AcrySof toric IOL implantation. The AL was measured using optical coherence biometry or immersion A‐scan biometry. Corneal astigmatism was determined by manual keratometry and topography. The IOL alignment was vertical, horizontal, or oblique. Rotational stability was measured using the purpose‐designed software, and the mean absolute difference was determined. The effect of AL and IOL alignment on rotational stability was determined 6 months postoperatively. RESULTS: The study evaluated 168 eyes (168 patients). The mean AL was 23.86 mm ± 1.63 (SD), (range 19.50 to 29.03 mm). The median IOL rotation was 0.3 degree from baseline to 1 week, 1.0 degree from 1 week to 1 month, 0.2 degree from 1 to 3 months, and 0.1 degree from 3 to 6 months. The maximum rotation occurred between 1 week and 1 month. There was a strong correlation between AL and IOL rotation at 6 months (r = 0.93, P<.001). The mean absolute difference at 6 months was not significantly different between the 3 axis placement categories when correlated with the rotation (P=.102, analysis of variance). CONCLUSIONS: Toric IOL rotation was greater in eyes with a longer AL. Alignment of the IOL in the capsular bag had no influence on rotation. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Posterior capsule management in congenital cataract surgery.

&NA; Management of the posterior capsule significantly affects the outcome of pediatric cataract surgery. Posterior capsule opacification (PCO) is rapid and virtually inevitable in very young children when adult‐style cataract surgery is performed and the posterior capsule is left intact. In eyes with pediatric cataract, primary posterior capsulotomy and vitrectomy are considered routine surgical steps, especially in younger children. The site of intraocular lens (IOL) fixation and the surgical technique used also affect the prevalence of PCO. The present systematic review evaluates the options available to prevent PCO or ensure a clear central visual axis after pediatric cataract surgery. Newer approaches to posterior capsule management such as pars plicata posterior capsulorhexis, sutureless vitrectomy, sealed‐capsule irrigation, and bag‐in‐the‐lens IOL are discussed. Management of the posterior capsule in the presence of a preexisting posterior capsule defect and posterior capsule plaque and options to treat PCO are also reviewed. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Comparison of posterior capsule opacification with hydrophobic acrylic and hydrophilic acrylic intraocular lenses

PURPOSE: To compare posterior capsule opacification (PCO) 3 years postoperatively in contralateral eyes with a single‐piece hydrophobic acrylic and 1 of 2 single‐piece hydrophilic acrylic intraocular lenses (IOLs) with different configurations. SETTING: Iladevi Cataract and IOL Research Institute, Ahmedabad, India. DESIGN: Prospective randomized clinical trial. METHODS: A hydrophobic Acrysof (hydrophobic group) or a hydrophilic C‐flex (hydrophilic group C) or Akreos Adapt IOL (hydrophilic group A) was randomized for implantation in the fellow eye or vice versa of each patient. The Evaluation of Posterior Capsule Opacification (EPCO) area, EPCO score, and neodymium:YAG (Nd:YAG) capsulotomy rates were compared using digital photographs. RESULTS: The study enrolled 68 patients. Although there was no significant difference at 1 month, the median EPCO score was statistically significantly lower in the hydrophobic group than in hydrophilic group C (P=.00) and hydrophilic group A (P=.000) at 3 years. There were no significant differences in the median EPCO area at 1 month; however, the area was statistically significantly less in the hydrophobic group than in hydrophilic group C and hydrophilic group A at 3 years (both P=.000). Four (12.9%) of 31 eyes in hydrophilic group C and 5 (16%) of 31 eyes in hydrophilic group A required an Nd:YAG capsulotomy; no eye in the hydrophobic group required a capsulotomy (P=.04 and P=.02, respectively). CONCLUSION: Posterior capsule opacification was significantly less with the Acrysof hydrophobic acrylic IOL at 3 years. Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Effect of stromal hydration of clear corneal incisions: Quantifying ingress of trypan blue into the anterior chamber after phacoemulsification

PURPOSE: To use trypan blue as a quantifiable ingress tracer to determine whether stromal hydration reduces ocular surface fluid ingress at the end of phacoemulsification. SETTING: Iladevi Cataract and IOL Research Centre, Memnagar, Ahmedabad, India. METHODS: A prospective randomized study included 80 eyes having phacoemulsification through 2.2 mm incisions. These eyes were divided into 2 equal groups: 1 had stromal hydration (surgery completed by injecting fortified balanced salt solution [BSS Plus] to hydrate the lateral walls and internal entry of incision) and the other had no stromal hydration. One half milliliter of 0.0125% sterile trypan blue was instilled on the ocular surface and allowed to remain for 2 minutes. One‐tenth milliliter of aqueous fluid was aspirated from the anterior chamber, and its optical density was measured using ultraviolet spectrophotometry. Logs of dilution of trypan blue were used for statistical analysis using the nonparametric Mann‐Whitney U test. RESULTS: There was a statistically significant decrease and difference between groups in mean dilution of trypan blue in the aqueous aspirate (P<.001). The mean was 1:11 337 in the stromal hydration group and 1:220 in the no stromal hydration group. Logs of mean dilution of trypan blue had statistically significant lower values in the stromal hydration group than in the no stromal hydration group (3.21 and 2.14, respectively) (P<.001). CONCLUSIONS: Stromal hydration of clear corneal incisions reduced ingress into the anterior chamber of the trypan blue instilled on the ocular surface. Clinically, these findings may have a beneficial effect in reducing the risk for postoperative endophthalmitis.

Intraoperative performance and postoperative outcomes of microcoaxial phacoemulsification: Observational study

PURPOSE: To evaluate the intraoperative performance and postoperative outcomes after microcoaxial phacoemulsification. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS: A prospective observational case series comprised 84 eyes with age‐related uncomplicated cataract having microcoaxial phacoemulsification through a 2.2 mm clear corneal incision by a standard surgical technique. Phacoemulsification parameters (Infiniti Vision System, Alcon) were microburst width, 30 ms; preset power, 50%; vacuum, 650 mm Hg; aspiration flow rate, 25 cc/minute. A single‐piece Alcon AcrySof intraocular lens was implanted with the C cartridge (Alcon) cartridge. The incision was measured at the end of surgery. Observations included surgical time (from commencement of sculpting to end of epinucleus removal), cumulative dissipated energy (CDE), wound burns, intraoperative complications, postoperative increase in mean central corneal thickness (CCT) at 1 day and 1 month, mean % decrease in endothelial cell density (ECD), absolute mean change in coefficient of variation (cv) 3 months, and uncorrected visual acuity (UCVA) at 1 day. Data were analyzed using a 1‐sample t test with 95% confidence intervals (CIs). RESULTS: The mean follow up was 3 months ± 0.3 (SD). The mean incision size at the end of surgery was 2.3 ± .09 mm; mean surgical time, 4.5 ± 1.5 minutes; and mean CDE, 2.3 ± 2.2 seconds. No wound burns or other intraoperative complications occurred. The postoperative CCT increased by a mean of 16 μm at 1 day (95% CI, 8‐25; P = .66;) and by a mean of 3.14 μm at 1 month (95% CI, 2.26‐4.05; P = .92). The ECD decreased by a mean of 5.8% (95% CI, 6.8‐3.5; P = .82) and the mean coefficient of variation, by 3.3 (95% CI, 4.5‐2.0; P = .65). At 1 day, the UCVA was 20/20 in 29% of cases, 20/20 to 20/40 in 58%, and 20/40 to 20/50 in 12%. CONCLUSION: Microcoaxial phacoemulsification was safely and effectively performed, achieving consistent and satisfactory postoperative outcomes.

Outcomes of cataract surgery and intraocular lens implantation with and without intracameral triamcinolone in pediatric eyes.

PURPOSE: To evaluate whether intracameral triamcinolone has an effect on anterior segment inflammation and visual axis obscuration after pediatric cataract surgery with intraocular (IOL) implantation. SETTING: Iladevi Cataract and IOL Research Institute, Ahmedabad, India. METHODS: This retrospective age‐matched case‐control study comprised consecutive eyes of children having phacoaspiration, posterior capsulectomy, vitrectomy, and IOL implantation. In the study group, eyes received a standardized application of an intracameral preservative‐free triamcinolone acetonide suspension intraoperatively. In the control group, age‐matched consecutive eyes had surgery with a similar technique but without intracameral preservative‐free triamcinolone acetonide. Cell deposits, posterior synechias, visual axis obscuration, and intraocular pressure (IOP) were evaluated 1 month and 12 months postoperatively. RESULTS: The mean patient age at surgery was 9.15 months ± 5.04 (SD) in the study group (41 eyes) and 9.34 ± 5.10 months in the control group (83 eyes) (P = .91). The visual axis was not obscured in any eye in the study group, while 9 eyes (10.8%) in the control group had an obscured axis; the difference between groups was statistically significant (P<.029). Six eyes (7.2%) in the control group required secondary membranectomy with pars plana vitrectomy. There was a statistically significant difference between the 2 groups in posterior synechias and cell deposits (both P<.033) and no significant difference in preoperative or postoperative IOP (P = .29 and P = .50, respectively). CONCLUSION: Pediatric eyes receiving intracameral triamcinolone intraoperatively had significantly less anterior segment inflammation and no visual axis obscuration after cataract surgery with IOL implantation. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Intraoperative performance and postoperative outcomes of endocapsular ring implantation in pediatric eyes

PURPOSE: To study the intraoperative performance and postoperative outcomes of Cionni modified capsule tension ring (CTR) and intraocular lens (IOL) implantation in the capsular bag in pediatric eyes with ectopia lentis. SETTING: John A. Moran Eye Center, Salt Lake City, Utah, USA. METHODS: Thirty‐five eyes (22 children) with ectopia lentis and visually significant cataract that had lens aspiration and in‐the‐bag implantation of single‐piece AcrySof IOL and Cionni CTR were included. Single‐ and double‐eyelet CTRs were used. The rings were sutured to the sclera using 9‐0 or 10‐0 polypropylene (Prolene) sutures. Preoperative and postoperative best corrected visual acuity (BCVA), intraoperative performance, IOL centration, and complications were studied. RESULTS: The mean patient age was 8.2 years ± 5.1 (SD) and the median follow‐up, 28 months. A double‐eyelet CTR was implanted in 12 eyes and a single‐eyelet CTR, in 23 eyes. The mean BCVA at the final follow‐up (0.37 ± 0.25 logMAR, 33 eyes) was significantly better than preoperatively (0.78 ± 0.42 logMAR, 28 eyes) (P = .003). At the last examination, the BCVA was 20/40 or better in 16 eyes (45.7%). Three eyes (8.5%) required resuturing for IOL decentration. Nineteen eyes (54.3%) had a secondary procedure for posterior capsule opacification. Other complications included anterior capsule opacification (2.85%), cystoid macular edema (5.71%), chronic uveitis (5.71%), and vitreous prolapse (2.85%). CONCLUSION: Implantation of the Cionni CTR and single‐piece AcrySof IOL in the capsular bag in pediatric eyes with subluxated lenses was safe and effective and led to a stable IOL with few significant complications.

Comparative quantification of ingress of trypan blue into the anterior chamber after microcoaxial, standard coaxial, and bimanual phacoemulsification: randomized clinical trial.

PURPOSE: To compare ocular surface fluid ingress into the anterior chamber at the end of microcoaxial, standard coaxial, and bimanual phacoemulsification using trypan blue as the quantifying tracer. SETTING: Iladevi Cataract and IOL Research Centre, Ahmedabad, India. METHODS: This prospective randomized observational study comprised 180 consecutive patients who had microcoaxial, standard coaxial, or bimanual phacoemulsification. Trypan blue was applied over the conjunctival surface, and the amount of ingress was assessed after cortex removal (time point 1) and at the end of the surgery after intraocular lens insertion and stromal hydration (time point 2). Logs of dilution were used for statistical analysis. RESULTS: At time point 1, a statistically significant difference was observed in the ingress of trypan blue in the aqueous aspirate. The bimanual group had the highest ingress and the microcoaxial group, the lowest. The amount of ingress in the standard coaxial group fell between the other 2 groups (P<.001). At time point 2, there was no statistically significant difference between the microcoaxial group and the standard coaxial group (P = 1.00); however, in the bimanual group, trypan blue ingress was statistically significantly higher than in the other 2 groups (P<.001). CONCLUSION: At both time points, trypan blue ingress was statistically significantly higher in the bimanual group than in the standard coaxial and microcoaxial groups. At time point 2, there was no statistically significant difference between the standard coaxial and microcoaxial groups.

Comparison of 2 moxifloxacin regimens for preoperative prophylaxis: Prospective randomized triple-masked trial: Part 2: Residual conjunctival flora

PURPOSE: To determine whether a regimen of topical moxifloxacin hydrochloride ophthalmic solution 0.5% (Vigamox) administered on the day of cataract surgery reduces conjunctival bacterial flora. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS: Seventy‐four patients were prospectively randomized to receive Vigamox 4 times 1 day before surgery plus 1 drop 2 hours preoperatively (Group 1) and 74 patients, to receive Vigamox 2 hours before surgery and every 15 minutes in the first hour only (Group 2). Conjunctival swabs from the upper and lower lid margins and lower fornix were taken before and after Vigamox instillation. Aliquots were spread on chocolate blood, anaerobic basal, and nutrient agars. The number of bacterial colony‐forming units (CFU) on the plates was counted with a grid technique and expressed as log values. The total number of CFU per eye and mean percentage reduction in CFU after instillation were calculated. Bacterial species were identified using biochemical and biophysical reactions. Wilcoxon signed ranked and Mann‐Whitney tests and multiple linear regression were applied. RESULTS: In Group 1, the median colony count decreased from 1284.00 CFU ± 643.18 (SD) before Vigamox instillation to 65.00 ± 72.61 CFU after instillation (93.12% reduction) (P<.001) and in Group 2, from 1634.00 ± 769.27 CFU to 75.00 ± 81.23 CFU (93.28% reduction) (P<.001). The percentage reduction after instillation was similar between the 2 groups (P = .09). CONCLUSION: Both Vigamox regimens reduced the number of CFU of conjunctival flora, indicating that instillation beginning on the day of surgery is effective.