SciCombinator

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Concept: Intraocular lens

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To describe the differences in treatment costs for infants randomized to contact lens correction versus primary intraocular lens (IOL) implantation after unilateral cataract surgery in the Infant Aphakia Treatment Study (IATS).

Concepts: Cornea, Ophthalmology, Lens, Contact lens, Intraocular lens, Phacoemulsification, Cataract, Aphakia

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Purpose: To evaluate the outcome, intraoperative and postoperative complications of refractive lens exchange (RLE) by phacoemulsification with posterior chamber intraocular lens (IOL) implantation combined with simultaneous pars plana vitrectomy (PPV) in the management of high myopia. Methods: This prospective study consisted of 45 eyes of 26 patients with preoperative myopia greater than -12.5 dpt. Clear lens phacoemulsification with IOL implantation surgery was combined with PPV. Main outcome measures were best-corrected visual acuity (BCVA), stability of the spherical equivalent (SE) and complications at follow-up. Results: The combined procedure of clear lens phacoemulsification combined with PPV has a favorable outcome with acceptable SE predictability and improvement in BCVA. The postoperative BCVA was 0.67 ± 0.21 compared to 0.15 ± 0.10 preoperatively (p < 0.001). The mean postoperative SE was -1.6 ± 0.9 dpt, showing a significant difference when compared with a mean value of -20.0 ± 5.2 dpt before the operation (p < 0.001). During the follow-up, all IOLs were placed stably in the bag with no capsular tear occurring and only 1 case (2.2%) developed retinal detachment. Conclusion: RLE and implantation of an IOL combined with simultaneous PPV is a reasonable refractive surgery option for middle-aged patients with high myopia.

Concepts: Retina, Ophthalmology, Vitrectomy, Myopia, Lens, Presbyopia, Contact lens, Intraocular lens

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Background:  To assess outcomes of the iris claw intraocular lens implanted in the retropupillary position for correction of aphakia without adequate capsular support. Design:  Retrospective study of patients consulted at two private practices and a tertiary public hospital clinic in Brisbane, Queensland. Samples:  Thirty-two consecutive patients who underwent posterior chamber insertion of the iris claw intraocular lens alone or in combination with other procedure/s by the same consultant ophthalmologist (GL). Methods:  Lens power was calculated using an A-constant of 117.0. Main Outcome Measures:  Clinical examination. Results:  Thirty-four eyes in 32 patients (23 male, 9 female) were included in the study. Indications for surgery were pseudophakic bullous keratopathy (n = 14), aphakia from previous lens extraction/lensectomy (n = 9), subluxation of intraocular lens (n = 7), cataract extraction (n = 2), explantation of anterior chamber intraocular lens due to uveitis (n = 1) and for Baerveldt tube insertion (n = 1). Follow-up duration ranged from 1 to 68 months. Of the 26 eyes followed for at least 6 months, the final vision improved in 69% (n = 18), remained unchanged in 8% (n = 2) and worsened in 23% (n = 6). Final visual acuity was 6/12 or better in 58% (n = 15). Complications included iris trauma/defect (n = 8), pupil irregularity/ovalization (n = 6), microhyphaema (n = 2) and lens decentration (n = 2). Conclusion:  Implantation of the iris claw intraocular lens in the retropupillary position is a useful technique for correction of aphakic eyes with sufficient iris support, avoiding the corneal complications of an anterior chamber intraocular lens and the surgical challenge of a sutured posterior chamber intraocular lens.

Concepts: Eye, Visual acuity, Cornea, Ophthalmology, Lens, Intraocular lens, Cataract, Aphakia

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PURPOSE: To measure the effect of spherical aberration correction by aspheric intraocular lenses (IOLs) based on pupil diameter, and to determine the minimum pupil diameter for each aspheric IOL. DESIGN: Retrospective cross-sectional study. METHODS: Eight-six patients (169 eyes) who were implanted with a HOYA AF-1 NY-60 or Tecnis ZCB00 1-piece IOL were enrolled. Ocular, corneal, and internal spherical aberrations were measured at the 1-month postoperative visit using the Wavefront Analyzer KR-1W. Minimum pupil diameter, which is required for each aspheric IOL to be effective, was calculated using a regression equation. RESULTS: The mean value of internal spherical aberration of the Tecnis ZCB00 group (-0.09 ± 0.094 μm) was lower than that of the HOYA NY-60 group (-0.05 ± 0.072 μm) (P = .005). The original negative spherical aberrations of the HOYA NY-60 (-0.18 μm) were measured at a pupil diameter of 5.6 mm, and for the Tecnis ZCB00 (-0.27 μm) at a pupil diameter of 6.1 mm. The aspheric IOL efficiency dropped to 0% when the pupil diameter was 3.47 mm for the Tecnis ZCB00 group and 3.71 mm for the HOYA NY-60 group. CONCLUSIONS: When the pupil diameters of patients are smaller than 3.4 mm for the Tecnis ZCB00 and 3.7 mm for the HOYA NY-60, the spherical aberration correction using these aspheric IOLs seems to be ineffective. Approximately 10% of the eyes showed smaller pupil size than the minimum effective diameter under mesopic conditions.

Concepts: Optics, Arithmetic mean, Lens, Intraocular lens, Pupil, Aspheric lens, Spherical aberration, Schmidt corrector plate

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PURPOSE: To compare the outcomes of 2 intraocular lenses (IOLs) for the treatment of age-related cataracts. DESIGN: Prospective, randomized trial. PARTICIPANTS: Patients with age-related cataracts were recruited and randomized to receive phacoemulsification and implantation of either the AcrySof SA60AT lens (Alcon, Inc, Fort Worth, TX) or the low-cost Tecsoft Flex lens (Fred Hollows Foundation, Tilganga, Nepal). A total of 300 patients were available for description and analysis (148 in the AcrySof group and 152 in the Tecsoft group). METHODS: Patients underwent phacoemulsification and implantation of the AcrySof SA60AT lens or the Tecsoft Flex lens. They were followed up and examined at baseline, 1 week, 1 month, 6 months, and 12 months after cataract surgery. MAIN OUTCOME MEASURES: Uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BDVA), incidence of posterior capsule opacification (PCO), Visual Function Index questionnaire results, and safety of the implanted IOLs. RESULTS: No significant difference (P>0.05) was found in UDVA and BDVA after surgery between the 2 groups. The equivalence test of the 95% confidence intervals showed that both lenses had an equal improvement of UDVA and BDVA as well as similar rates of PCO after cataract surgery. There was no significant difference between the 2 groups with regard to visual functioning or the incidence of adverse surgical events during (P>0.05) or after (P>0.05) the surgery. CONCLUSIONS: The Tecsoft Flex IOL is a low-cost suitable alternative that is similar to the AcrySof IOL in terms of safety and visual outcomes. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Concepts: Visual acuity, Ophthalmology, Lens, Intraocular lens, Phacoemulsification, Cataract, Binary relation, Fred Hollows

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Purpose. To report the efficacy and ocular tolerance of a new tamponade made with ether and silicone oil (HeavySil [HSIL]) for the treatment of retinal detachment (RD) complicated by inferior proliferative vitreous retinopathy (PVR).
Methods. Prospective noncomparative interventional study on 31 consecutive eyes that underwent pars plana vitrectomy and were treated with HSIL as an intraocular tamponade. All patients presented with at least one retinal break and grade B-C PVR located between 4 and 8 o'clock. The main endpoint criteria were retinal reattachment after the removal of HSIL and complications arisen from the use of this tamponade.
Results. Primary anatomic success was achieved in 27 out of 31 cases. Mean visual acuity improved from logMAR 1.4 (SD 0.7) to logMAR 1.1 (SD 0.6) (p=0.02).
The main complications reported were cataract formation (5 out of 7 phakic eyes cases), clinically visible emulsification (6 cases), and difficulty of oil removal in 3 cases. Severe intraocular inflammation with HSIL in situ was found in only one case.
Conclusions. HeavySil, a saturated solution of ether with silicone oil, is a safe and effective tamponade agent for the treatment of complicated RD. The most common complications are cataract formation and oil emulsification.

Concepts: Retina, Visual acuity, Ophthalmology, Vitrectomy, Diabetic retinopathy, Retinal detachment, Intraocular lens, Vision loss

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BACKGROUND: Cataracts are a common and significant cause of visual impairment globally. We aimed to evaluate uncorrected distance visual acuity (UDVA) as an outcome in treating astigmatic cataract patients to assist clinicians or ophthalmologists in their decision making process regarding available interventions. RESULTS: The systematic review identified 11 studies which reported UCVA. All 11 studies reported UDVA. Four brands of toric intraocular lenses (IOLs) were reported in these studies. All studies identified in the literature search reported improvements in UDVA following surgical implant of a toric IOL. The largest improvements in VA were reported using the Human Optics MicroSil toric IOL (0.74 LogMAR, UDVA) and the smallest improvements were also reported using the Human Optics MicroSil toric IOL (0.23 LogMAR, UDVA) in a different study. CONCLUSIONS: The results of this systematic review showed the aggregate of studies reporting a beneficial increase in UDVA with the use of toric IOLs in cataract patients with astigmatism.

Concepts: Decision making, Visual acuity, Ophthalmology, Presbyopia, Intraocular lens, Eye surgery, Cataract

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BACKGROUND: To assess the efficacy, clinical outcomes, visual acuity (VA), incidence of adverse effects, and complications of peripheral iris fixation of 3-piece acrylic IOLs in eyes lacking capsular support. Thirteen patients who underwent implantation and peripheral iris fixation of a 3-piece foldable acrylic PC IOL for aphakia in the absence of capsular support were followed after surgery. Clinical outcomes and macular SD-OCT (Cirrus OCT; Carl Zeiss Meditec, Germany) were analyzed. FINDINGS: The final CDVA was 20/40 or better in 8 eyes (62%), 20/60 or better in 12 eyes (92%), and one case of 20/80 due to corneal astigmatism and mild persistent edema. No intraoperative complications were reported. There were seven cases of medically controlled ocular hypertension after surgery due to the presence of viscoelastic in the AC. There were no cases of cystoid macular edema, chronic iridocyclitis, IOL subluxation, pigment dispersion, or glaucoma. Macular edema did not develop in any case by means of SD-OCT. CONCLUSIONS: We think that this technique for iris suture fixation provides safe and effective results. Patients had substantial improvements in UDVA and CDVA. This surgical strategy may be individualized however; age, cornea status, angle structures, iris anatomy, and glaucoma are important considerations in selecting candidates for an appropriate IOL fixation method.

Concepts: Eye, Cornea, Ophthalmology, Lens, Contact lens, Intraocular lens, Carl Zeiss

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To compare preoperative methods for calculating intraocular lens (IOL) power versus the intraoperative wavefront aberrometer in eyes with a history of refractive surgery.

Concepts: Optics, Cornea, Lens, Presbyopia, Intraocular lens

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To establish a corneal correction equation for the Shammas post-hyperopic laser in situ keratomileusis (LASIK) (Shammas-PHL) formula and to evaluate its accuracy in cases with and without available pre-LASIK data.

Concepts: Laser, Eye, Cornea, Refractive surgery, Lens, LASIK, Intraocular lens, Dioptre