ArticlePDF Available

The refractive outcome of Toric Lentis Mplus implant in cataract surgery

Authors:
Patrick J Chiam
Patrick J Chiam
Patrick J Chiam
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Say Aun Quah at East Cheshire NHS Trust
Say Aun Quah
Download full-text PDF
Read full-text
Download citation

Abstract and Figures

Aim: To evaluate the refractive outcome of Toric Lentis Mplus intraocular lens (IOL) implant. Methods: This is a retrospective case series. Consecutive patients with corneal astigmatism of at least 1.5 D had Toric Lentis Mplus IOL implant during cataract surgery. The exclusion criteria included irregular astigmatism on corneal topography, large scotopic pupil diameter (>6 mm), poor visual potential and significant ocular comorbidity. Postoperative manifest refraction, uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BCVA), uncorrected intermediate visual acuity (UIVA) at 3/4 m and uncorrected near visual acuity (UNVA) were obtained. Results: There were 70 eyes from 49 patients in this study. Patients were refracted at a median of 8.9wk (range 4.0 to 15.5) from the operation date. Sixty-five percent of eyes had 6/7.5 (0.10 logMAR) or better, and 99% 6/12 (0.30 logMAR) or better postoperative UDVA. Eighty-nine percent could read Jaeger (J) 3 (0.28 logMAR) and 95% J5 (0.37 logMAR) at 40 cm. The median magnitude of astigmatism decreased from 1.91 D to 0.49 D (Wilcoxon, P<0.001) after the operation. The range of the cylindrical error was reduced from 1.5-3.95 D (keratometric) preoperatively to 0.00-1.46 D (subjective refraction transposed to corneal plane) postoperatively. Conclusion: Toric Lentis Mplus IOL has good predictability in reducing preexisting corneal astigmatism.
Figures - available via license: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
Content may be subject to copyright.
Available via license: CC BY-NC-ND 4.0
Content may be subject to copyright.
陨灶贼允韵责澡贼澡葬造皂燥造熏灾燥造援 9熏晕燥援 5熏May18, 圆园16 www.ijo.cn
栽藻造押8629原愿圆圆源缘员苑圆 8629-82210956 耘皂葬蚤造押ijopress 岳员远猿援糟燥皂
TherefractiveoutcomeofToricLentisMplusimplantin
cataractsurgery
窑ClinicalResearch窑
1BirminghamandMidlandEyeCentre,CityHospital,
BirminghamBH187QH,UnitedKingdom
2OptegraManchesterEyeHospital,ManchesterM202EY,
UnitedKingdom
Correspondenceto: PatrickJChiam.Birminghamand
MidlandEyeCentre,CityHospital,DudleyRoad,Birmingham
BH187QH,UnitedKingdom.pjtchiam@yahoo.com
Received:2015-09-20Accepted:2015-11-17
Abstract
·AIM:ToevaluatetherefractiveoutcomeofToricLentis
Mplusintraocularlens(IOL)implant.
·METHODS: This is a retrospective case series.
Consecutivepatientswithcornealastigmatismofatleast
1.5DhadToricLentisMplusIOLimplantduringcataract
surgery. The exclusion criteria included irregular
astigmatismoncornealtopography,largescotopicpupil
diameter (>6mm),poorvisualpotentialandsignificant
ocularcomorbidity.Postoperativemanifestrefraction,
uncorrected distance visual acuity (UDVA), best-
correcteddistancevisualacuity (BCVA),uncorrected
intermediate visual acuity at (UIVA) 3/4 m and
uncorrectednearvisualacuity(UNVA)wereobtained.
·RESULTS:Therewere70eyesfrom49patientsinthis
study.Patientswererefractedatamedianof8.9wk
(range4.0to15.5)fromtheoperationdate.Sixty-five
percentofeyeshad6/7.5 (0.10logMAR)orbetter,and
99%6/12 (0.30logMAR)orbetterpostoperativeUDVA.
Eighty-ninepercentcouldreadJaeger(J)3(0.28logMAR)
and95%J5 (0.37logMAR)at40cm.Themedian
magnitudeofastigmatismdecreasedfrom1.91Dto0.49D
(Wilcoxon, <0.001)aftertheoperation.Therangeofthe
cylindrical error was reduced from 1.5-3.95 D
(keratometric)preoperativelyto0.00-1.46D(subjective
refractiontransposedtocornealplane)postoperatively.
·CONCLUSION:ToricLentisMplusIOLhasgood
predictabilityinreducingpreexistingcornealastigmatism.
·KEYWORDS: ToricLentisMplus;multi-focalintraocular
lensimplant;refractiveoutcome
DOI:10.18240/ijo.2016.05.10
ChiamPJ,QuahSA.TherefractiveoutcomeofToricLentisMplus
implantincataractsurgery. 2016;9(5):699-702
INTRODUCTION
Multifocalintraocularlenses(IOLs)werefirstintroduced
inthe1980s [1-2].Meta-analysesofrandomisedcontrol
trialsshowedtheseIOLsimproveuncorrectednearvisual
acuitywithoutcompromisingdistancevisualacuityand
reducespectacledependence [3-5].However,thepresenceof
morethan1diopter(D)astigmatismhasbeenshowntohave
anadverseeffectontheperformanceoftheseIOLs[6-8].Thisis
asignificantissueespeciallycornealastigmatismof1.25D
ormoreisprevalentinupto30%ofeyesthathavecataract
surgery [9-12].ToricIOLhasbeenreportedtoprovidebetter
predictabilityinreducingmoderatecornealastigmatism
comparedtooppositeclearcornealincisionorarcuate
keratotomy[13-14].
Today'spatientsaremoredemanding,andtheyseektotal
visualrehabilitationandspectacleindependence.These
requirements havespurredthedevelopmentoftoric
multifocalIOLs.TheseIOLssimultaneouslycorrectcorneal
astigmatismandthelossofaccommodativeabilityafter
crystallinelensextraction.Theimplantationoftoricmonofocal
IOLsduringphacoemulsificationhasbeenshowntobe
effectiveincorrectingpreexistingcornealastigmatism[15-17].
TheLentisMplusisrefractiverotationalasymmetryIOL
designedtoovercomethedrawbacksofmultifocalIOLsby
providinghighcontrastsensitivityandminimizinghalosand
glare [16].TheLentisMplusIOLconsistsof2radialsectors-
onefordistanceandtheotherfornearvision.Currentlythere
arethreestrengthsofaddition(add)fornear 依3.00D(LS-312
MF30),+2.00D(LS-312MF20)and+1.50D(LS-312MF15).
Eighty-fourpercentofpatientswithbilateralLentisMplus
+3.00Daddimplantshavebeenshowntobespectacle
independentfordistant,intermediateandnearvision [16].A
toricversionofthisIOL(LU-313MF30T)isavailable
howeverthereisnodatapublishedtodate.Thepurposeof
thisstudyistoevaluatetherefractiveoutcomeoftheToric
LentisMplusIOL.
SUBJECTSANDMETHODS
Subjects Thisisaretrospectivecaseserieswith70
consecutiveeyesimplantedwithToricLentisMplusIOL
duringphacoemulsification.Thepatientswereoperated
betweenJanuary2011andDecember2012byasingle
surgeon(QuahSA)atOptegraManchesterEyeHospital,UK.
ThetenetsoftheDeclarationofHelsinkiwerefollowedfor
allstudyprocedures.Becausethisisaretrospectivestudy
informedconsentwasnotobtainedfromthesubjects.
TheinclusioncriteriaforthetoricIOLimplantwereregular
cornealastigmatismofatleast1.5D.Theexclusioncriteria
includedirregularastigmatismoncornealtopography,large
scotopicpupildiameter(>6mm),poorvisualpotentialand
significantocularcomorbidity maculardiseaseand
glaucoma.
IntraocularLens ToricLentisMplus(modelLU-313
MF30T)isabiconvex1-piecemultifocalacrylicIOLmade
699
withanasphericposteriorsurfacedesign.TheIOLhasan
11.0mmoveralllength,a6.0mmoptic,andasquarehaptic
design with 0-degreeangulation.Thenon-rotational
symmetricmultifocalIOLwitharefractivedesigncombines
anasphericasymmetricdistancevisionzonewithasector-
shapednearvisionzonewitha+3.00Dadd.AllToricLentis
Mpluslensesarecustommadeandorderedusinganonline
toricintraocularlenscalculator(www.lentistoric.com).
SurgicalTechnique Alloperationswereperformedwithout
anycomplications.Marksweremadeonthecorneaunder
topicalanaestheticontheslit-lamppreoperatively.Anarrow
slitbeamwasdirectedatthecentreofthepupilacrossthe
corneahorizontally.Peri-limbalscratchesat30毅andthe
steepestaxisofalignmentweremadewithasterileneedle.A
surgicalmarkerpenwasthenusedtostainthesescratches.
Atthestartoftheoperation5.5mmdiameterwasmarkedon
thecorneatofacilitatethedesireddiameterofcapsulorrhexis.
Phacoemulsificationwasperformedthrougha2.75mmclear
cornealincisionplaced30毅temporallyinallcases.TheIOLs
wereimplantedusingadisposableinjector(viscojectBIO2.2
injector).ThereferencemarksontheopticofIOLwerethen
alignedwiththepremarkedsteepestaxisandthenearsector
oftheIOLopticplacedinferiorly.
Thetargetedsphericalequivalentwaszeroorthefirst
negative(myopic)figure.Postoperativepatientswereadvised
tousetopicalsteroidforamonthandantibioticfora
fortnight.Thefelloweyewasoperatedwithin1molater.
PatientExamination Preoperatively,allpatientsunderwent
acompleteophthalmicevaluationincludingsubjective
refraction,biometrywithIOLMaster500(CarlZeiss),
cornealtopographyandpupillometrywithSchwindSirius
andCombiWavefrontAnalyzer,slitlampexamination,
fundoscopyandapplanationtonometry.Uncorrecteddistance
visualacuity(UDVA),best-correcteddistancevisualacuity
(BCVA),uncorrectedintermediatevisualacuityat(UIVA)
3/4manduncorrectednearvisualacuity(UNVA)were
obtained.
DataandStatisticalAnalysis Thedatawerecollectedin
Microsoft誖OfficeExcel 誖2007spreadsheetandanalyzed
withIBM 誖SPSS 誖Statisticsversion20.Snellenacuities
wereconvertedintologMARforstatisticalcalculations.
Themagnitudeofrefractivechangeinducedbytheclear
cornealmainincisionatthebeginningofthesurgerywas
takenas0.50DandfactoredintothetoricIOLcalculation.
Thepostoperativeastigmatismisthemanifestrefractive
cylindricalerrorobtainedpostoperatively.Thelatterwas
vertexedonthecorneaplaneforcomparisonwith
preoperativekeratometricastigmatism.
Shapiro-Wilktestwasusedtoascertainthedatadistribution
fornormality.PairedStudent's -testandWilcoxonsigned
ranktestwereusedtoanalyseparametricandnon-parametric
data respectively.Thepost-operativeastigmatismwas
determinedwhetheritwasdifferentfromzerousingdioptric
powermatrixtransformation.Whereappropriatetheresults
werereportedasmean依standarddeviation.
Thedifferencevector(DV)isthevectorthatallowsthe
inducedsurgicalastigmatismeffecttointendedsurgical
astigmatismeffect.Thisisanabsolutemeasureofsuccess
andideallyshouldbezero.Themagnitudeoferror(ME)is
thearithmeticdifferencebetweenthemagnitudesofthe
inducedsurgicalastigmatismeffectandintendedsurgical
astigmatismeffect.TheMEispositiveifthereisan
overcorrectionandnegativeforundercorrection.Theangleof
error (AE)istheanglebetweentheinducedsurgical
astigmatismeffectandintendedsurgicalastigmatismeffect
vectors.IfAEispositive,thismeanstheachievedcorrection
iscounterclockwisetotheintendedaxis;ifnegativeitis
clockwisetotheintendedaxis.Theabsoluteangleoferror
(AAE)isthesumoftheabsolutedifferencebetweenthe
intendedandinducedangleofcorrection.Thecorrection
index(CI)wascalculatedastheratiooftheabsolutevalues
ofInducedsurgicalastigmatismeffecttotheIntended
surgicalastigmatismeffect.Anidealcorrectionindexis1.0.
Ifthisisgreaterthan1.0,itmeanstheoperationhascausedan
overcorrection,andiflessthan1.0referstoundercorrection.
RESULTS
Therewere70eyesfrom49patientsinthisstudy.There
were34female(47eyes)patients.Themeanagewas60.2依
7.7year-old(range47to81).Thirty-sevenrightand33left
eyeswereoperated.Therewerenointraoperative
complications.Seveneyeswithamblyopiaanddocumented
visualpotentialofatleast0.30logMARwereincluded.
ThesetofdatadistributedinaGaussianfashionwerepreand
postoperativesphericalequivalentonly(Shapiro-Wilk, =0.21
and =0.18).Therestwasnon-Gaussian.
VisualOutcome Patientswererefractedatamedianof
8.9wk(range4.0to15.5)fromtheoperationdate.Table1
showsthepreoperativeandpostoperativevariousdistance
visualacuities.Sixty-fivepercentofeyeshad6/7.5(0.10
logMAR)orbetter,and99%6/12(0.30logMAR)orbetter
postoperativeUDVA.Eighty-ninepercentcouldreadJaeger
(J)3(0.28logMAR)and95%J5(0.37logMAR)at40cm.
Fifty-sixeyes(80%)hadamanifestastigmaticerrorof0.75D
orless.Intheseeyes,themedianUDVAwas0.10logMAR
(range-0.10to0.30),UIVA0.05(range-0.10to0.20)and
UNVA0.13(range0.00to0.60).Theremainingfourteen
eyeshadastigmaticerrorofmorethan0.75D(maximumwas
1.5D).Inthisgroup,themedianUDVAwas0.23logMAR
(range0.10to0.50),UIVA0.10(range0.10to0.30)and
UNVA0.20(range0.10to0.53).TheWilcoxon valuesfor
eachdistantwas0.0001,0.003and0.008.
RefractiveOutcome Table2showsthepreoperativeand
postoperativerefractivechanges.Thesphericalequivalent
(SE)beforeandaftertheToricLentisMplusimplantwasnot
statisticallysignificant(pairedStudent's -test, =0.71).The
medianmagnitudeofastigmatismdecreasedfrom1.91Dto
0.49D(Wilcoxon, <0.001)aftertheoperation.Themean
sphericalequivalentpostoperativewas0.00 依0.36Dandthe
rangewas-1.00to+1.00D.
Table3revealsthevectorialanalysisoftheastigmatic
change.TheDVwasnotsignificantlydifferentfromzero( =
0.48).Therewasaslightovercorrection,asindicatedbyaCI
of1.07.
ToricLentisMplusrefractiveoutcome
700
陨灶贼允韵责澡贼澡葬造皂燥造熏灾燥造援 9熏晕燥援 5熏May18, 圆园16 www.ijo.cn
栽藻造押8629原愿圆圆源缘员苑圆 8629-82210956 耘皂葬蚤造押ijopress 岳员远猿援糟燥皂
Forty-eighteyes(69%)hadapostoperativesubjectiverefractive
cylinder(atspectacleplane)ofupto0.50D,and56eyes
(80%)upto0.75D.Twoeyesfromdifferentpatientshada
residualcylinderof1.25Dand1.50D.Theseweretheonly
oneshigherthan1.00D.Therangeofthecylindricalerror
wasreducedfrom1.5-3.95D(keratometric)preoperatively
to0.00-1.46D(subjectiverefractiontransposedtocorneal
plane)postoperatively.Figure1showstheindividualchange
in preoperative keratometric astigmatismcomparedto
postoperativesubjectiverefraction.Thedoubleanglevector
diagramshowedareducedrangeofastigmaticspreadafter
theIOLimplant(Figure2).
PatientSatisfaction AllpatientsweresatisfiedwiththeIOL
implantandwouldrecommendtheproceduretoafriend.
Theseincludedthetwopatientswithresidualpostoperative
astigmatismof1.25Dandmore.Theirpreoperative
astigmatismswere2and3Drespectively.Despitethe
photopicphenomenonwasnotformallyevaluated,nopatients
complainedofseveresymptomsrequiringexplantation.
DISCUSSION
OurresultsshowthatToricLentisMplusIOLhasgood
predictabilityinreducingtheamountofpreexistingcorneal
astigmatismwhichiscrucialinallowingthemaximum
multifocalutility.Preoperativelythemediankeratometric
astigmatismwas1.91D,andthiswasreducedtoamedianof
0.49Dinthepostoperativesubjectiverefractiveastigmatism.
Currently,thepublishedliteratureonthevisualoutcomeof
ToricLentisMplusislimited.Inourstudy,69%ofeyeshada
subjectivemanifestastigmatismof0.50Dorless;and80.0%
had0.75Dorlessaftertheoperation.Thisiscomparableto
theonlypublisheddataonToricLentisMplusbyVenterand
Pelouskova[18] where65%ofeyeshadarefractiveastigmatism
of0.50Dorlessdespitetheirrangeofpreoperative
astigmatismwasslightlywider.Themeanpreoperative
keratometricastigmatisminourstudywasonly2.2D,while
thestudyaforementionedwas3.0D.Inothertypesoftoric
multifocal IOLstudies withcomparable preoperative
astigmatism,themeanpostoperativerefractivecylinderswere
foundtobe0.40依0.25Dand0.71依0.42D
[19-20].Anotherseries
withhigherpreoperativeastigmatismof3.4依1.17Drevealed
a3-monthpostoperativeresultof0.80依0.42D
[21].
Vectoranalysisoftheoverallastigmaticchangeshowsthat
theToricLentisMplushasexcellentpredictabilityin
correctingastigmatismasshownbythesmallindicesofME,
AE,AAEandCI.Ourstudycouldnodemonstrateaclear
relationshipbetweentheamountofpreoperativeastigmatism
withtheresidualpostoperativeastigmatismasshownby
Figure1.Alargerstudyisrequiredforthis.
Table 1 Preoperative and postoperative visual acuity and refractive error
Visual Acuity Preoperative
(logMAR)
Postoperative
(logMAR) P
Median UDVA
0.90 0.10
Range -0.10 to 1.70 -0.1 to 0.5
Mean UDVA 0.76 0.10
<0.001a
Median BCVA
0.10 0.00
Range -0.10 to 0.60 -0.10 to 0.30
Mean BCVA 0.10 0.03
0.001a
Median UIVA 0.35 0.10
Range 0.00 to 0.40 -0.10 to 0.30
Mean UIVA 0.28 0.06
0.002a
Median UNVA
0.63 0.13
Range 0.10 to 0.90 0.00 to 0.60
Mean UNVA 0.55 0.18
<0.001a
aWilcoxon signed rank test.
Table 2 Preoperative and postoperative refractive changes
Refractive error Preoperative (D)
Postoperative (D) P
Spherical equivalent
Mean±SD -0.27±5.05 0.00±0.36 0.71a
Range -10.00 to +9.13
-1.00 to +1.00
Astigmatism (Keratometric) (Subjective refraction
at corneal plane)
Vector 1.41 at 89.5° 0.18 at 28.7°
Median magnitude
1.91 0.49 <0.001b
Range 1.5 to 3.95 0.00 to 1.46
aPaired student’s t-test; bWilcoxon signed rank test.
Figure2Double-anglevectorialdiagramforpositivecylinder
(D)preandpostoperation.
Figure1Changeinpreoperativekeratometricastigmatism
versuspostoperativesubjectiverefractiveastigmatism.
Table 3 Preoperative and postoperative astigmatism analysis
Parameters Astigmatism
Intended surgical astigmatism effect 1.41 D at 179.5°
Induced surgical astigmatism effect 1.51 D at 2.4°
Difference vector 0.18 D at 28.7°a
Magnitude of error (D) 0.10±0.36
Angle of error 2.8°±4.5°
Absolute angle of error 3.7°±5.2°
Correction index 1.07
aNot significantly different from zero; P=0.48 (dioptric power matrix
transformation).
sx
±
701
TheUDVAinourstudywas0.10logMARwhichwas
slightlyworsebutwithinoneSnellenlineofVenterand
Pelouskova's [18] resultof0.03.Oneofthereasonsmightbe
duetotheinclusionof7amblyopiceyesalbeittheirbest
recordedvisualpotentialwasatleast0.3logMARorbetter.
Excludingtheseeyes,ourUDVAimprovedto0.09logMAR.
OurfindingsonUNVAwas0.18logMARwhichwasalmost
thesameasVenterandPelouskova's [18] findingof0.17.Ina
largeseriesnon-ToricLentisMplusdata,themeanUDVA
was0.05logMARandUNVA0.21[22].
Patientsfoundwithresidualobjectiveastigmatismofmore
than0.75Daremorelikelytobedissatisfiedwiththeir
vision [23-24].Ourresultsshowedacuitiesatalldistanceswere
statisticallysignificantlyworsewhentheastigmatismwas
morethan0.75D.Thisshowstheimportanceofresidual
astigmatismtobecorrectedbelowthislevel.It'snotinthe
remitofthisstudytodiscusstheoptionsavailabletoenhance
therefractiveerrorinthesecases.
Themeanpostoperativesphericalequivalentinourstudywas
excellentat0.00依0.36D.Alargestudyofnon-ToricLentis
Mplus,withafollow-upofmorethan5000eyesat3-month
foundaSEof-0.02 依0.60Dwhichiscomparableour
findings [22].ThisshowsthepredictabilityofToricLentis
Mplusiscomparabletothenon-ToricLentisMplus.
OurstudyfoundtheToricLentisMplusLU-313MF30Thas
similarvisualacuitiesatdistanceandnearcomparedtothe
non-toricversionofthesameIOL.Eyeswithnooraresidual
astigmatismoflessthan0.75Dhasthebestacuityoutcome.
Therefractiveoutcomesconfirmthecorrectionofastigmatism
bythisIOLhasagoodpredictabilityinmajorityofcases.
ACKNOWLEDGEMENTS
ChiamPJanalysedandwrotethemanuscript,QuahSA
conceivedthestudyidea,collectedthedataandprovided
criticalreview.
ThestudywasperformedattheOptegraManchesterEye
Hospital,UnitedKingdom.
ConflictsofInterest:ChiamPJ, None; QuahSA, None.
REFERENCES
1HansenTE,CorydonL,KragS,ThimK.Newmultifocalintraocularlens
design. 1990;16:(1)38-41.
2LeylandM,ZinicolaE.Multifocalversusmonofocalintraocularlensesin
cataractsurgery;asystematicreview. 2003;110(9):
1789-1798.
3LeylandM,PringleE.Multifocalversusmonofocalintraocularlenses
aftercataractextraction. 2006;(4):CD003169.
4StathamM,ApelA,StephensenD.ComparisonoftheAcrySofSA60
sphericalintraocularlensandtheAcrySofToricSN60T3intraocularlens
outcomesinpatientswithlowamountsofcornealastigmatism.
2009;37(8):775-779.
5AlioJL,AgdeppaMC,PongoVC,ElKadyB.Microincisioncataract
surgerywithtoricintraocularlensimplantationforcorrectingmoderateand
highastigmatism:pilotstudy. 2010;36(1):44-52.
6HayashiK,ManabeS,YoshidaM,HayashiH.Effectofastigmatismon
visualacuityineyeswithadiffractivemultifocalintraocularlens.
2010;36(8):1323-1329.
7RavalicoG,ParentinF,BaccaraF.Effectofastigmatismonmultifocal
intraocularlenses. 1999;25(6):804-807.
8HayashiK,HayashiH,NakaoF,HayashiF.Influenceofastigmatismon
multifocalandmonofocalintraocularlenses. 2000;130
(4):477-482.
9Ferrer-BlascoT,Mont
佴
s-Mic
佼
R,Peixoto-de-MatosSC,Gonz
佗
lez-
M
佴
ijomeJM,Cervi
觡
oA.Prevalenceofcornealastigmatismbeforecataract
surgery. 2009;35(1):70-75.
10HofferKJ.Biometryof7,500cataractouseyes. 1980;
90(3):360-368.
11HoffmannPC,H
俟
tzWW.Analysisofbiometryandprevalencedatafor
cornealastigmatismin23,239eyes. 2010;36(9):
1479-1485.
12HollandE,LaneS,HornJD,ErnestP,ArleoR,MillerKM.TheAcrySof
toricintraocularlensinsubjectswithcataractsandcornealastigmatism;a
randomized,subject-masked,parallelgroup,1-yearstudy.
2010;117(11):2104-2111.
13MendicuteJ,IrigoyenC,RuizM,IllarramendiI,Ferrer-BlascoT,
Mont
佴
s-Mic
佼
R.Toricintraocularlensversusoppositeclearcorneal
incisionstocorrectastigmatismineyeshavingcataractsurgery.
2009;35(3):451-418.
14TitiyalJS,KhatikM,SharmaN,SehraSV,MaharanaPK,GhatakU,
AgarwalT,KhokharS,ChawlaB.Toricintraocularlensimplantation
versusastigmatickeratotomytocorrectastigmatismduring
phacoemulsification. 2014;40(5):741-747.
15AhmedII,RochaG,SlomovicAR,ClimenhagaH,GohillJ,Gr
佴
goireA
MaJ,CanadianToricStudyGroup.Visualfunctionandpatientexperience
afterbilateralimplantationoftoricintraocularlenses.
2010;36(4):609-616.
16MendicuteJ,IrigoyenC,RuizM,IllarramendiI,Ferrer-BlascoT,
Mont
佴
s-Mic
佼
R.Toricintraocularlensversusoppositeclearcorneal
incisionstocorrectastigmatismineyeshavingcataractsurgery.
2009;35(3):451-458.
17Mu
觡
ozG,Albarr
佗
n-DiegoC,Ferrer-BlascoT,SaklaHF,Garc
侏
a-
L
佗
zaroS.Visualfunctionafterbilateralimplantationofanewzonal
refractiveasphericmultifocalintraocularlens.
2011;37(11):2043-2052.
18VenterJ,PelouskovaM.Outcomesandcomplicationsofamultifocal
toricintraocularlenswithasurface-embeddednearsection.
2013;39(6):859-866.
19MojzisP,Pi
觡
eroDP,CtvrteckovaV,RydlovaI.Analysisofinternal
astigmatismandhigherorderaberrationsineyesimplantedwithanew
diffractivemultifocaltoricintraocularlens.
2013;251(1):341-348.
20VisserN,NuijtsRMMA,deVriesNE,BauerNJC.Visualoutcomesand
patientsatisfactionaftercataractsurgerywithtoricmultifocalintraocular
lensimplantation. 2011;37(11):2034-2042.
21Ali
佼
JL,Pi
觡
eroDP,Tom
佗
sJ,PlazaAB.Vectoranalysisofastigmatic
changesaftercataractsurgerywithimplantationofanewtoricmultifocal
intraocularlens. 2011;37(7):1217-1229.
22VenterJA,PelouskovaM,CollinsBM,SchallhornSC,HannanSJ.
Visualoutcomesandpatientsatisfactionin9366eyesusingarefractive
segmentedmultifocalintraocularlens. 2013;39
(10):1477-1484.
23deVriesNE,WebersCA,TouwslagerWR,BauerNJ,deBrabanderJ,
BerendschotTT,NuijtsRMDissatisfactionafterimplantationofmultifocal
intraocularlenses. 2011;37(5):859-865.
24WoodwardMA,RandlemanJB,StultingRD.Dissatisfactionafter
multifocalintraocularlensimplantation. 2009;35
(6):992-997.
ToricLentisMplusrefractiveoutcome
702
... These regions do not need to be concentric disc portions: some designs include wedged regions, as with the Lentis Mplus IOL (Oculentis GmbH, Berlin, Germany; see Table 1, row E6). 23 These optical systems are dependent on pupil dynamics and sensitive to postoperative decentration, as well as the risk of causing photic phenomenon such as halos and glare. Reducing the power of the addition enables the conception of zonal refractive EDoF lenses such as the Lentis Comfort (Oculentis GmbH; see Table 1, row B2), which is designed to allow for activities further away than the reading distance. ...
MULTIFOCAL AND EDOF INTRAOCULAR LENSES IN 2020
Article
  • Sep 2020
Ophthalmic surgeons are being overwhelmed by the influx of multifocal intraocular lens options in recent years, with close to one hundred intraocular lenses currently on the market in 2020. This practical and technical update on a representative group of established as well as newly launched multifocal intraocular lenses on the market, focuses on multifocal intraocular lenses including Extended depth of focus lenses. We also describe the optical basis of lens platforms used and thorough pre-operative planning to aid decision making. This will allow the surgeon the knowledge base to deliver the required relative customized spectacle independence with the least photic phenomenon and loss of contrast possible, whilst achieving high individual patient satisfaction. Data of reviewed lenses displayed in tabular format includes mean monocular uncorrected distance, intermediate and near visual acuities (LogMAR), with standard deviation and range where available. The range of vision targeted, pupil dependence, toric availability as well as type of optical platform is provided as a practical guide to demystify existing terminology on the market that may create interest around a 'new' design that is actually not novel at all. Halos and glare experienced, levels of patient satisfaction and spectacle independence achieved are also summarized. Surgeons have a wide range of multifocal intraocular lens options available to them on the market. A comprehensive patient selection, examination, combined with knowledge of most recent options and adequate patient counselling including neuroadaptation, can avoid dissatisfaction. Many recently available intraocular lenses are awaiting formal results but the methods by which we label and compare these types of intraocular lenses must also be standardized.
View
... D in patients seeking spectacle independence after cataract surgery especially with multifocal IOLs. [50][51][52] The experts agreed that, whether manual or femtosecond assisted, the following intraoperative techniques are currently being used to correct astigmatism during cataract surgery: 1) creating clear corneal incision (CCI) on the steepest meridian, 2) paired opposite clear corneal incisions (POCCIs) on the steepest meridian, 3) corneal relaxing incisions, and 4) toric IOL implantation. It is important to recognize that these treatment options correct regular astigmatism; as such, it is important to do thorough preoperative work-up to identify and rule out the presence of corneal conditions that cause irregular or asymmetric astigmatism. ...
Consensus on the management of astigmatism in cataract surgery
Article
Full-text available
  • Feb 2019
  • Clin Ophthalmol
This project was aimed at achieving consensus on the management of astigmatism during cataract surgery by ophthalmologists from Latin America using modified Delphi technique. Relevant peer-reviewed literature was identified, and 21 clinical research questions associated with the definition, classification, measurement, and treatment of astigmatism during cataract surgery were formulated. Twenty participants were divided into seven groups, and each group was assigned three questions to which they had to respond in written form, after thoroughly reviewing the literature. The assigned questions with corresponding responses by each group were discussed with other participants in round 4 – presentation of findings. The consensus was achieved if approval was obtained from at least 80% of participants. The present paper provides several agreements and recommendations for management of astigmatism during cataract surgery, which could potentially minimize the variability in practice patterns and help ophthalmologists adopt optimal practices for cataract patients with astigmatism and improve patient satisfaction.
View
... One limitation of the study is that the results have been obtained with a specific autorefractor model, but we have observed (unpublished data) the same results with other autorefractors as well. Other possible limitation lies in the fact that we have only evaluated spherical IOLs, whereas the Lentis MPlus multifocal IOL has a toric platform [18] , and further studies must confirm our results with the toric geometry. Although retinoscopy is superior to AR in the general population [19] , we found it a difficult technique in eyes implanted with the Lentis Mplus multifocal IOL (any of the Mplus models) because of the presence of two opposite retinoscopy shadows, especially in small pupils. ...
Validity of automated refraction after segmented refractive multifocal intraocular lens implantation
Article
Full-text available
  • Nov 2017
Aim: To evaluate the clinical utility of automated refraction (AR) and keratometry (KR) compared with subjective or manifest refraction (MR) after cataract or refractive lens exchange surgery with implantation of Lentis Mplus X (Oculentis GmbH) refractive multifocal intraocular lens (IOL). Methods: Eighty-six eyes implanted with the Lentis Mplus X multifocal IOL were included. MR was performed in all patients followed by three consecutive AR measurements using the Topcon KR-8000 autorefractor. Assessment of repeatability of consecutive AR before and after dilation with phenylephrine 10%, and comparison of the AR and KR with MR using vector analysis were performed at 3mo follow-up. Results: Analysis showed excellent repeatability of the AR measurements. Linear regression of AR versus MR showed good correlation for sphere and spherical equivalent, whereas the correlation for astigmatism was low. The mean difference AR-MR was -1.28±0.29 diopters (D) for sphere. Astigmatism showed better correlation between KR and MR. Conclusion: We suggest AR sphere plus 1.25 D and the KR cylinder as the starting point for MR in eyes with a Lentis Mplus X multifocal IOL. If AR measurements are equal to MR, decentration of the IOL should be suspected.
View
... Some studies have reported worse photopic and mesopic contrast sensitivities compared to other IOLs [45], while others found the lens comparable to most other trifocals in low mesopic contrast sensitivity outcomes [46]. The lens design seems to provide better visual outcomes in eyes with pupil diameters >3 mm [47••], and positioning of the near add did not influence objective or subjective visual function parameters [48], making it a more forgiving lens (similar positive outcomes have been reported for its toric version [49]). ...
Refractive IOL Pipeline: Innovations, Predictions, and Needs
Article
Full-text available
  • Sep 2017
Purpose of Review The aim of this paper is to provide an overview of published literature evaluating new refractive intraocular lenses (IOLs). Recent Findings Six categories of refractive IOLs are either currently commercialized in various regions (notably Europe) or under investigation for the treatment of presbyopia. No single category has emerged as a clear market leader, re-emphasizing the need for surgeons to individualize their treatment approaches. Summary The newest refractive IOLs provide good outcomes with minimal complications. However, the categories studied each have their own strengths and weaknesses. Despite advancements, there are still significant opportunities to meet the unmet refractive needs through additional research and development in intraocular lenses.
View
Viskoelastik Materyaller
Chapter
  • Oct 2022
Cerrahi Öncesi Değerlendirme Neslihan BAYRAKTAR BİLEN Preoperatif Göz İçi Lens Hesaplama Eser ÇATAL Katarakt ve Tipleri Mehmet Akif EROL Viskoelastik Materyaller Onur ÖZALP Kesi Tipleri, Kapsüloreksis ve Hidroprosedürler Mehmet İÇÖZ, Şule Gökçek GÜRTÜRK İÇÖZ FAKO Cerrahisinde Sıvı Dinamikleri ve Enerji Modülasyonu Mehmet ATAKAN Nükleus Kırma Yöntemleri ve İrrigasyon-Aspirasyon Ömer TAKEŞ Torik İntraoküler Lens İmplantasyonu Mehmet Şirin TÜRKOĞLU Zor Olgularda Katarakt Cerrahisi Sezer HACIAĞAOĞLU Glokom Hastalarında Katarakt Cerrahisi Sinem KARABULUT Şaşılık Hastalarında Katarak Cerrahisi Müjdat KARABULUT Retina Hastalıklarında Katarakt Cerrahisi Erdoğan YAŞAR, Mustafa Değer BİLGEÇ Monofokal Lens Cerrahisi ve Monovizyon Murat ERDAĞ Presbiopi Düzeltici Göz İçi Lensler Eyüp ÖZCAN Cerrahi Komplikasyonlar ve Yönetimi Cem SUNDU Katarakt Cerrahisinde Medikal Tedavi Ayşe Güzin TAŞLIPINAR UZEL
View
Toric intraocular lenses: Expanding indications and preoperative and surgical considerations to improve outcomes
Article
Full-text available
  • Jan 2022
  • Indian J Ophthalmol
Since the introduction of the first toric intraocular lens (IOLs) in the early 1990s, these lenses have become the preferred choice for surgeons across the globe to correct corneal astigmatism during cataract surgery. These lenses allow patients to enjoy distortion-free distance vision with excellent outcomes. They also have their own set of challenges. Inappropriate keratometry measurement, underestimating the posterior corneal astigmatism, intraoperative IOL misalignment, postoperative rotation of these lenses, and IOL decentration after YAG-laser capsulotomy may result in residual cylindrical errors and poor uncorrected visual acuity resulting in patient dissatisfaction. This review provides a broad overview of a few important considerations, which include appropriate patient selection, precise biometry, understanding the design and science behind these lenses, knowledge of intraoperative surgical technique with emphasis on how to achieve proper alignment manually and with image-recognition devices, and successful management of postoperative complications.
View
Comparison of Nd:YAG Laser Capsulotomy Rates Between Refractive Segmented Multifocal and Multifocal Toric Intraocular Lenses
Article
  • Oct 2020
  • AM J OPHTHALMOL
Purpose To investigate the early incidence of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy according to intraocular lens (IOL) type (non-toric vs. toric) and surgical techniques (femtosecond laser-assisted cataract surgery vs. conventional phacoemulsification) in eyes with refractive multifocal IOLs. Design Retrospective case-control study. Methods Nine hundred thirteen eyes from 483 patients implanted with Lentis Mplus LS-313 MF20 (771 eyes) or Lentis Mplus Toric LU-313 MF20T (149 eyes) IOLs (Oculentis GmbH, Berlin, Germany) were enrolled. We compared the incidence of Nd:YAG laser capsulotomy between the non-toric and toric groups. In addition, the incidence of Nd:YAG laser capsulotomy was also evaluated according to the surgical technique used. Results The overall incidence of Nd:YAG laser capsulotomy was 10.2% (93/913 eyes). The Nd:YAG laser capsulotomy rate was significantly higher in the toric group (20/149; 16.4%) than in the non-toric group (60/771; 9.0%; P = 0.007). Out of 913 enrolled eyes, 448 eyes (49.1%) underwent femtosecond laser-assisted cataract surgery and 465 eyes (50.9%) underwent conventional phacoemulsification cataract surgery. There was no significant difference in the incidence of Nd:YAG laser capsulotomy between eyes with femtosecond laser-assisted cataract surgery and eyes with conventional phacoemulsification cataract surgery. Conclusion Patients with refractive multifocal toric IOLs had higher early incidence rates of Nd:YAG laser capsulotomy when compared to those with refractive multifocal non-toric IOLs. Furthermore, femtosecond laser-assisted cataract surgery could not reduce the early incidence of Nd:YAG laser capsulotomy in this study.
View
Toric Lentis Mplus intraocular lens opacification: A case report
Article
Full-text available
  • Mar 2020
Purpose To present the case of a patient with Toric Lentis Mplus intraocular lens (IOL) (Oculentis, Berlin, Germany) opacification after vitrectomy and his follow-up. Observations A 44-year-old man with high myopia and right optic neuritis history complained of visual impairment due to cataract in the right eye. We performed uneventful phacoemulsification and implanted a Toric Lentis Mplus IOL in his right eye. Six months later, he came to us with a retinal detachment in the nasal area of the right eye. We performed a 25-gauge vitrectomy with gas tamponade and endolaser treatment. Ten months after the vitrectomy, he complained of blurred vision in the right eye again. On slit-lamp examination, we observed a wide opacification localized to the anterior surface of the IOL. We explanted the IOL from the right eye and replaced it with a Clareon IOL (Alcon, Fort Worth, TX). The explanted IOL was examined under light microscopy and scanning electron microscopy. Conclusions and importance We described a case of postoperative opacification of Toric Lentis Mplus IOL after vitrectomy. We found calcium aggregate deposits on the anterior surface of the IOL. Given the higher frequency of fundus disease observed in patients with high myopia, hydrophilic acrylic IOLs should be used with caution in patients with high myopia and in young patients. To our knowledge, this is the first report of Toric Lentis Mplus IOL opacification after the 2017 Field Safety Notice by Oculentis in response to the Food and Drug Administration's recall.
View
How much astigmatism to treat in cataract surgery
Article
  • Nov 2019
Purpose of review: Astigmatism correction in cataract surgery is a common surgical challenge. Although there are numerous approaches to its treatment during cataract surgery, there remains a lack of consensus on what level of postoperative astigmatism to target. We examine the literature to determine the effect of astigmatism on visual function and provide a recommendation on how much to treat in cataract surgery. Recent findings: Distance visual acuity decreases as myopic, hyperopic, or mixed astigmatism increases. Near visual acuity decreases with hyperopic astigmatism but improves with myopic astigmatism. The effect of astigmatism is generally independent of axis; however, against-the-rule (ATR) astigmatism with mild myopia may benefit reading. A progressive ATR shift occurs with age whether or not an individual undergoes cataract surgery. In the presence of higher order aberrations, correction of astigmatism below 0.5 D shows minimal practical benefit. Presbyopia-correcting intraocular lenses (IOLs) are sensitive to astigmatism but achieve distance visual acuities similar to monofocal IOLs and reach their full near and/or intermediate potential when residual astigmatism 0.5 D or less. Summary: In cataract surgery, we recommend correction to 0.5 D or less of postoperative residual astigmatism to achieve optimum visual function and patient satisfaction following cataract surgery.
View
Analysis of internal astigmatism and higher order aberrations in eyes implanted with a new diffractive multifocal toric intraocular lens
Article
Full-text available
  • May 2012
  • GRAEF ARCH CLIN EXP
Background To evaluate the intraocular lens (IOL) position by analyzing the postoperative axis of internal astigmatism as well as the higher-order aberration (HOA) profile after cataract surgery following the implantation of a diffractive multifocal toric IOL Methods Prospective study including 51 eyes with corneal astigmatism of 1.25D or higher of 29 patients with ages ranging between 20 and 61 years old. All cases underwent uneventful cataract surgery with implantation of the AT LISA 909 M toric IOL (Zeiss). Visual, refractive and corneal topograpy changes were evaluated during a 12-month follow-up. In addition, the axis of internal astigmatism as well as ocular, corneal, and internal HOA (5-mm pupil) were evaluated postoperatively by means of an integrated aberrometer (OPD Scan II, Nidek). Results A significant improvement in uncorrected distance and near visual acuities (p < 0.01) was found, which was consistent with a significant correction of manifest astigmatism (p < 0.01). No significant changes were observed in corneal astigmatism (p = 0.32). With regard to IOL alignment, the difference between the axes of postoperative internal and preoperative corneal astigmatisms was close to perpendicularity (12 months, 87.16° ± 7.14), without significant changes during the first 6 months (p ≥ 0.46). Small but significant changes were detected afterwards (p = 0.01). Additionally, this angular difference correlated with the postoperative magnitude of manifest cylinder (r = 0.31, p = 0.03). Minimal contribution of intraocular optics to the global magnitude of HOA was observed. Conclusions The diffractive multifocal toric IOL evaluated is able to provide a predictable astigmatic correction with apparent excellent levels of optical quality during the first year after implantation.
View
Multifocal versus monofocal intraocular lenses after cataract extraction
Chapter
  • Oct 2006
Background: Good unaided distance visual acuity is now a realistic expectation following cataract surgery and intraocular lens (IOL) implantation. Near vision however still requires additional refractive power usually in the form of reading glasses. Multiple optic (multifocal) IOLs are available which claim to allow good vision at a range of distances. It is unclear whether this benefit outweighs the optical compromises inherent in multifocal IOLs. Objectives: The objective of this review was to assess the effects of multifocal IOLs, including effects on visual acuity, subjective visual satisfaction, spectacle dependence, glare and contrast sensitivity, compared to standard monofocal lenses. Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which includes the Eyes and Vision Group Trials Register) on The Cochrane Library (2006, Issue 3), MEDLINE (1966 to July 2006), EMBASE (1980 to July 2006), NRR (2006, Issue 3) and PUBMED searched on 25 July 2006, limit: 90 days (entry date). We searched the reference lists of relevant articles and contacted investigators of included studies and manufacturers of multifocal intraocular lenses for information about additional published and unpublished studies. Selection criteria: All randomised controlled trials comparing a multifocal IOL of any type with a monofocal IOL as control were included. Both unilateral and bilateral implantation trials were included. Data collection and analysis: Data were collected and trial quality was assessed. Where possible, statistical summary measures were calculated otherwise data were tabulated. Main results: Ten trials were identified, and a further three are pending review. There was significant variability between the trials in which outcomes were reported. Unaided distance acuity was similar in multifocal and monofocal IOLs (standardised mean difference (SMD) 0.03, 95% Confidence Interval (CI) -0.13 to 0.19). There was no statistical difference between multifocal IOLs and monofocals with respect to the proportion of participants achieving 6/6 best corrected visual acuity (Peto odds ratio (OR) 1.05, 95% CI 0.67 to 1.63). Unaided near vision was improved with the multifocal IOLs. Total freedom from use of glasses was achieved more frequently with multifocal than monofocal IOLs (OR for spectacle dependence 0.17, 95% CI 0.12 to 0.24). Adverse effects included reduced contrast sensitivity and the subjective experience of haloes around lights. Authors' conclusions: Multifocal IOLs are effective at improving near vision relative to monofocal IOLs. Whether that improvement outweighs the adverse effects of multifocal IOLs will vary between patients. Motivation to achieve spectacle independence is likely to be the deciding factor.
View
Toric intraocular lens implantation versus astigmatic keratotomy to correct astigmatism during phacoemulsification
Article
  • May 2014
  • J CATARACT REFR SURG
Purpose To compare toric intraocular lens (IOL) implantation and astigmatic keratotomy (AK) in correction of astigmatism during phacoemulsification. Setting Tertiary care hospital. Design Prospective randomized trial. Methods Consecutive patients with visually significant cataract and moderate astigmatism (1.25 to 3.00 diopters [D]) were randomized into 2 groups. Temporal clear corneal 2.75 mm phacoemulsification with toric IOL implantation was performed in the toric IOL group and with 30-degree coupled AK at the 7.0 mm optic zone in the keratotomy group. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, keratometry, topography, central corneal thickness, and endothelial cell density were evaluated preoperatively and 1 day, 1 week, and 1 and 3 months postoperatively. Results The study enrolled 34 eyes (34 patients), 17 in each group. There was no difference in UDVA or CDVA between the 2 groups at any follow-up visit. The mean preoperative and postoperative refractive cylinder was 2.00 D ± 0.49 (SD) and 0.33 ± 0.17 D, respectively, in the toric IOL group and 1.95 ± 0.47 D and 0.57 ± 0.41 D, respectively, in the keratotomy group (P=.10). The mean residual astigmatism at 3 months was 0.44 ± 1.89 @ 160 in the toric IOL group and 0.77 ± 1.92 @ 174 in the keratotomy group (P=.61). All eyes in the toric IOL group and 14 eyes (84%) in the keratotomy group achieved a residual refractive cylinder of 1.00 D or less (P=.17). Conclusion Toric IOL implantation was comparable to AK in eyes with moderate astigmatism having phacoemulsification. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
View
Visual outcomes and patient satisfaction in 9366 eyes using a refractive segmented multifocal intraocular lens
Article
  • Jul 2013
  • J CATARACT REFR SURG
To report the effectiveness, patient satisfaction, and complication rate with a zonal refractive intraocular lens (IOL) in a high volume of patients. Private clinic, London, United Kingdom. Case series. Retrospective data of patients with binocular Lentis Mplus IOLs were analyzed. The main outcome measures were uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), corrected distance visual acuity, manifest refraction, patient satisfaction, and complications. One-month, 3-month, and 6-month data were analyzed. The study comprised 9366 eyes of 4683 patients. The mean spherical equivalent changed from +1.73 diopters (D) ± 3.37 (SD) preoperatively to -0.02 ± 0.60 D at 3 months and +0.03 ± 0.60 D at 6 months. Ninety-five percent of patients achieved a binocular UDVA of 6/7.5 (0.1 logMAR) or better 3 months postoperatively. The mean binocular UNVA was 0.155 ± 0.144 logMAR and 0.159 ± 0.143 logMAR at 3 months and 6 months, respectively. Severe dysphotopsia requiring an IOL exchange occurred in 55 eyes. Patient satisfaction was high, with 97.5% of patients willing to recommend the procedure. The zonal refractive IOL provided excellent distance and near visual acuity. The postoperative complication rate was clinically acceptable, and patient satisfaction high. Dr. Schallhorn is a consultant to Abbott Medical Optics, Inc. No author has a financial or proprietary interest in any material or method mentioned.
View
Outcomes and complications of a multifocal toric intraocular lens with a surface-embedded near section
Article
  • Jun 2013
  • J CATARACT REFR SURG
Purpose: To evaluate the refractive outcomes and rotational stability after implantation of a multifocal toric intraocular lens (IOL) with a surface-embedded near section. Setting: Private center, London, United Kingdom. Design: Case series. Methods: This study evaluated eyes with more than 1.50 diopters (D) of preexisting corneal astigmatism. After phacoemulsification, Lentis Mplus toric IOLs were implanted in all cases. The main outcome measures were refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, uncorrected near visual acuity (UNVA), keratometry, and IOL position. Three-month postoperative data are presented. Results: The study enrolled 89 eyes (58 patients). The mean monocular postoperative UDVA and UNVA were 0.03 logMAR ± 0.11 (SD) and 0.17 ± 0.14 logMAR, respectively. The mean refractive cylinder decreased from 2.90 ± 1.31 D preoperatively to 0.50 ± 0.39 D postoperatively (P<.001). The mean difference between the planned axis of implantation and the actual axis postoperatively was 2.53 ± 2.27 degrees. Conclusion: The multifocal toric IOL with a surface-embedded near section effectively corrected preexisting corneal astigmatism. The IOL was stable in the capsular bag, there were no visually significant complications, and there was no significant rotation out to 3 months postoperatively. Financial disclosure: Neither author has a financial or proprietary interest in any material or method mentioned.
View
Visual function after bilateral implantation of a new zonal refractive aspheric multifocal intraocular lens
Article
  • Nov 2011
  • J CATARACT REFR SURG
To evaluate visual function after bilateral implantation of a zonal refractive aspheric multifocal intraocular lens (IOL). Private practice surgery center, Valencia, Spain. Cohort study. Consecutive eyes with cataract had bilateral implantation of Lentis Mplus LS-312 multifocal IOLs. Distance, intermediate, and near visual acuities; contrast sensitivity; defocus curves; and a quality-of-vision questionnaire, including presence of halos or dysphotopsia, were evaluated 6 months postoperatively. A control group of age-matched monofocal pseudophakic patients was included to compare contrast sensitivity function. In the multifocal group, the mean binocular corrected distance visual acuity (logMAR) was -0.04 ± 0.07 at 6 m, 0.11 ± 0.10 at 1 m, and 0.06 ± 0.07 at 40 cm. The defocus curve showed little intermediate vision drop off. Photopic contrast sensitivity for distance was similar to the monofocal IOL contrast sensitivity function, while photopic contrast sensitivity for near and mesopic contrast sensitivity for distance with or without glare was reduced at high frequencies. The mean patient satisfaction was 8.09 ± 1.30 (scale 0 to 10); 84.4% of patients were completely independent of spectacles. Moderate halos, glare, and night-vision problems were reported by 6.2%, 12.5%, and 15.6% of patients, respectively. The new-generation multifocal IOL provided adequate distance, intermediate, and, to a lesser extent, near vision with high rates of spectacle freedom. Halos occurred, and other photic phenomena should be expected in a small percentage of patients. No author has a financial or proprietary interest in any material or method mentioned.
View
Visual outcomes and patient satisfaction after cataract surgery with toric multifocal intraocular lens implantation
Article
  • Sep 2011
  • J CATARACT REFR SURG
To evaluate visual outcomes and patient satisfaction after toric multifocal intraocular lens (IOL) implantation in patients with cataract and corneal astigmatism. University Eye Clinic Maastricht, The Netherlands. Cohort study. Patients with cataract, corneal astigmatism, and a motivation for spectacle independency had cataract surgery with implantation of a toric diffractive multifocal IOL (AT Lisa). Three months postoperatively, the uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuities; corrected distance, intermediate, and near visual acuities; residual refractive astigmatism; defocus curve; contrast sensitivity; and patient satisfaction were evaluated. Forty-five eyes of 25 patients were enrolled. Postoperatively, the mean UDVA was 0.04 logMAR ± 0.15 (SD) and 98% of eyes achieved a UDVA of 20/40 or better. The mean UNVA was 0.20 ± 0.16 logMAR and the mean UIVA (at 60 cm), 0.40 ± 0.16 logMAR. Residual refractive astigmatism of -1.00 diopter or less was achieved in approximately 90% of eyes. Contrast sensitivity levels were high. Approximately 50% of patients reported moderate glare, halos, and starburst symptoms. Spectacle independency for distance and near vision was achieved by 95% of patients and 79% of patients, respectively. Toric IOL implantation in patients with cataract and corneal astigmatism provided good distance and near visual outcomes and acceptable intermediate visual outcomes, allowing patients with considerable amounts of corneal astigmatism to achieve spectacle independence at distance and near. No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.
View
Vector analysis of astigmatic changes after cataract surgery with implantation of a new toric multifocal intraocular lens
Article
  • Jul 2011
  • J CATARACT REFR SURG
To analyze the astigmatic changes after cataract surgery with the implantation of a new toric multifocal intraocular lens (IOL) using the Alpins vector method. Vissum-Instituto de Oftalmológico de Alicante, Alicante, Spain. Prospective case series. After cataract surgery with implantation of an AT Lisa 909M toric multifocal IOL, the visual, refractive, corneal topographic, internal astigmatism, defocus curves, and contrast sensitivity outcomes were evaluated over 6 months. Refractive astigmatic changes (target astigmatism [TIA]; surgically induced astigmatism [SIA]; difference vector; magnitude of error; flattening effect; torque) were analyzed using the Alpins vectorial method. The study enrolled 23 eyes (12 patients). Postoperatively, there was a significant reduction in refractive cylinder (P < .01) with an associated visual improvement for near (P = .03) and distance (P=.01). The magnitude of SIA vector was significantly larger than the TIA 3 months postoperatively (P = .03). The mean magnitude of the difference vector was 0.67 diopter (D) ± 0.51 (SD) at 6 months. The mean magnitude of error remained positive and close to zero over the entire follow-up (P ≥ .19). The mean magnitude of torque vector was 0.49 ± 0.54 D at 6 months. Significant positive correlation was found between the magnitude of torque and the difference vector (r ≥ 0.70, P<.01). The new toric IOL restored distance and near visual function with excellent predictability in eyes with moderate to high corneal astigmatism having cataract surgery.
View
Dissatisfaction after implantation of multifocal intraocular lenses
Article
  • Mar 2011
  • J CATARACT REFR SURG
To analyze the symptoms, etiology, and treatment of patient dissatisfaction after multifocal intraocular lens (IOL) implantation. Department of Ophthalmology, Maastricht University Medical Center, The Netherlands. Case series. 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. 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%). The cause of dissatisfaction after implantation of a multifocal IOL can be identified and effective treatment measures taken in most cases.
View
Effect of astigmatism on visual acuity in eyes with a diffractive multifocal intraocular lens
Article
  • Aug 2010
  • J CATARACT REFR SURG
To examine the effect of astigmatism on visual acuity at various distances in eyes with a diffractive multifocal intraocular lens (IOL). Hayashi Eye Hospital, Fukuoka, Japan. In this study, eyes had implantation of a diffractive multifocal IOL with a +3.00 diopter (D) addition (add) (AcrySof ReSTOR SN6AD1), a diffractive multifocal IOL with a +4.00 D add (AcrySof ReSTOR SN6AD3), or a monofocal IOL (AcrySof SN60WF). Astigmatism was simulated by adding cylindrical lenses of various diopters (0.00, 0.50, 1.00, 1.50, 2.00), after which distance-corrected acuity was measured at various distances. At most distances, the mean visual acuity in the multifocal IOL groups decreased in proportion to the added astigmatism. With astigmatism of 0.00 D and 0.50 D, distance-corrected near visual acuity (DCNVA) in the +4.00 D group and distance-corrected intermediate visual acuity (DCIVA) and DCNVA in the +3.00 D group were significantly better than in the monofocal group; the corrected distance visual acuity (CDVA) was similar. The DCNVA with astigmatism of 1.00 D was better in 2 multifocal groups; however, with astigmatism of 1.50 D and 2.00 D, the CDVA and DCIVA at 0.5m in the multifocal groups were significantly worse than in the monofocal group, although the DCNVA was similar. With astigmatism of 1.00 D or greater, the mean CDVA and DCNVA in the multifocal groups reached useful levels (20/40). The presence of astigmatism in eyes with a diffractive multifocal IOL compromised all distance visual acuities, suggesting the need to correct astigmatism of greater than 1.00 D. No author has a financial or proprietary interest in any material or method mentioned.
View