Search Results (20)

Objective: The aim of this study was to evaluate the clinical outcomes of sutureless scleral-fixated (SSF) Soleko Fil Carlevale intraocular lens (SC-IOL) implants associated with pars plana vitrectomy (PPV) in patients with aphakia secondary to complicated cataract surgery or IOL luxation nationwide. Methods: A multicenter, national, retrospective study of 268 eyes (268 patients) which underwent simultaneous PPV and SC-IOL implantation was conducted. Demographics; ocular data; pre-surgical, surgical and post-surgical details; and refractive results were collected. Intra- and postoperative complications and management details were described. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) and central retinal thickness (CRT) were collected at 1 week and at 1, 3, 6 and 12 months post-surgery. Kaplan–Meier curves were constructed to assess the cumulative probability of postoperative BCVA, IOP levels, macular edema (ME) and corneal decompensation. Results: The cumulative probability of final VA ≤ 0.3 logMAR was 64.4% at 12 months follow-up. The probability of IOP > 21, ≥25 and ≥30 mmHg was 29.8%, 16.9% and 10.1%, respectively, and the cumulative probability of IOP-lowering treatment was 42.3% at 12 months. Glaucoma surgery was required in 3.7% of the eyes (10/268). The cumulative probability of postoperative ME development was 26.6% at 12 months, managed with topical treatment alone (73.5%) and intravitreal injections (26.5%). Corneal transplantation was required in 3.7% of the eyes (10/268). Conclusions: Sutureless scleral-fixated SC-IOL is an adequate therapeutic alternative in the management of aphakia with good visual results and an acceptable safety profile in routine clinical care. Longer-term studies are needed to evaluate its results and complications compared to other therapeutic alternatives. Full article

Objectives: Intraocular lens dislocation is a well-recognized complication of cataract surgery, necessitating secondary interventions such as retropupillary iris-claw IOL implantation. While effective, this procedure requires larger incisions that may induce significant astigmatism. This study aimed to (1) evaluate anterior chamber changes following retropupillary ICIOL implantation and (2) compare surgically induced astigmatism between corneal and scleral incision techniques. Methods: In this prospective cohort study, patients with IOL dislocation underwent 25-gauge pars plana vitrectomy with ICIOL implantation. Anterior chamber depth, volume, and angle configuration were measured across 12 meridians preoperatively, at 1–1.5 months (short-term), and 5–6 months (long-term). Surgically induced astigmatism was compared between the corneal and scleral incision groups. Statistical analysis included Shapiro–Wilk, Mann–Whitney U, and repeated-measures ANOVA tests. Results: This prospective study included 40 patients (22 females, 18 males) with a mean age of 76.3 ± 5.38 years (range 65–86). Significant reductions in ACD and ACV occurred postoperatively (p < 0.05), with partial recovery at long-term follow up. Surgically induced astigmatism was markedly higher with corneal incisions versus scleral approaches (p < 0.01 short term; p < 0.05 long term). Anterior chamber angle changes varied by meridian but stabilized by 6 months. Conclusions: Retropupillary ICIOL implantation induces predictable anterior segment remodeling, with scleral incisions offering superior refractive stability. Surgical planning should prioritize scleral techniques to minimize surgically induced astigmatism while maintaining anatomical efficacy. Future innovations in IOL design may further reduce incision-related complications. Full article

Purpose: To report our experience with Descemet stripping only (DSO) for the treatment of Fuchs endothelial corneal dystrophy. Methods: Thirteen eyes of 9 patients with symptomatic Fuchs endothelial dystrophy underwent a 4 mm central Descemetorhexis without graft implantation between June 2017 and July 2020. All patients had central confluent guttata, undetectable central endothelial cell count by specular microscopy, and healthy peripheral corneal endothelium. In 6 eyes, the procedure was combined with phacoemulsification and intraocular lens implantation. Eight eyes were treated with topical rho-associated protein kinase (Rock) inhibitors and five eyes were treated with hypertonic sodium chloride 5%, post operatively. Results: All eyes completed at least 4 months of post-operative follow-up (mean follow-up 12.0 ± 7.9 mo; 4–29 mo). Mean patient age was 70 ± 6 years. All eyes achieved corneal clearance with an average time for clearance of 7.2 ± 2.4 weeks. Mean endothelial cell count postoperatively was 778 ± 228. Mean central corneal thicknesses pre- and postoperatively were 620 ± 100 and 560 ± 58 μm, respectively. Eleven eyes achieved improvement in visual acuity and in two eyes vision remained unchanged, with mean visual acuity 0.392 to 0.225 logMAR; p = 0.001. Also, all patients reported subjective improvement in the quality of vision. ROCK inhibitors compared to hypertonic sodium chloride 5% did not show statistically significant differences in time for corneal clearance or endothelial cell counts postoperatively but did show a trend towards faster corneal clearance and higher endothelial cell counts postoperatively among the ROCK inhibitors-treated eyes. Conclusions: In patients with Fuchs endothelial dystrophy and visual degradation secondary to central guttata, DSO represents a viable procedure for visual rehabilitation. Full article

A cataract is a disease in which the lens of the eye becomes clouded, causing a partial or complete loss of vision. Phacoemulsification (PHACO) is a modern surgical technique used in cataract surgery. Study findings: This study observed changes in intraocular pressure (IOP) after surgery in 31 dogs (48 eyes) with cataracts that visited a veterinary hospital. The procedure involved a lens extraction by PHACO and the implantation of an intraocular lens (IOL). Postoperative ocular hypertension (POH) was defined as a postoperative IOP of 25 mmHg or higher. To assess changes in IOP, IOP measurements were performed at 1, 2, 3, and 20 h, and at 1, 2, 3, 4, and 8 weeks after surgery. The IOP was found to be significantly higher at 1 (p < 0.05), 2 (p < 0.01), and 3 (p < 0.01) hours postoperatively compared with preoperatively. The IOP measurements were compared by dividing them into three groups according to the observation period. The IOP values were measured for three groups: before cataract surgery (Group A: 13.10 ± 8.29 mmHg), 1 to 3 h after cataract surgery (Group B: 17.84 ± 5.33 mmHg), and 20 h to 8 weeks after surgery (Group C: 13.71 ± 4.78 mmHg). The IOP values from 1 to 3 h after surgery (Group B) were significantly higher compared to both Group A (p < 0.01) and Group C (p < 0.001). Conclusions: It is suggested that POH occurring within 0 to 3 h after cataract surgery should be diagnosed as secondary glaucoma, and treatment should be performed accordingly. Full article

We describe a novel experimental device, the VaMa (Vatavuk and Marić) artificial intraocular lens (IOL) capsule, and a method that enables all IOL types to be implanted in the bag. We present the application of the device and the procedure in patients with aphakia and native capsule damage and without efficient capsular support. The VaMa device and the method facilitate IOL exchange due to refractive errors and, in the case of their invention, the implementation of superior IOLs in the future. The postoperative results after the implantation of the VaMa capsule along with IOLs in three patients are promising, with significant visual improvement and without adverse events 7 to 10 months postoperatively. Full article

Background: The aim of this study was to evaluate visual outcomes and patient satisfaction after bilateral implantation of a new hydrophobic acrylic intraocular lens called Clareon (Alcon) using the mini-monovision technique. Methods: A single-center, prospective, nonrandomized study was conducted in Tandil (Buenos Aires, Argentina), including patients scheduled for cataract surgery. To achieve mini-monovision, the spherical equivalent was calculated between −0.25 and +0.25 D for the dominant eye, and between −0.75 and −1.00 D for the non-dominant eye. The main outcomes were uncorrected distance visual acuity (UDVA) and uncorrected intermediate visual acuity (UIVA) evaluated at 66 cm. A secondary outcome, patient satisfaction, was assessed using the CatQuest-9SF questionnaire. Results: The mean binocular UDVA was 0.01 ± 0.05 logMAR three months after surgery, while the mean binocular UIVA was 0.20 ± 0.06 logMAR. The postoperative mean spherical equivalent in the dominant eye was −0.27 ± 0.12, and in the non-dominant eye was −0.87 ± 0.25. Before surgery, the CatQuest-9SF questionnaire revealed that 83.33% of patients were dissatisfied with their vision during daily activities. Over 50% reported significant difficulties with reading newspapers, sewing, and reading TV subtitles. Additionally, 66.6% struggled with recognizing faces, 50% with seeing product prices, and 50% with walking on uneven ground. Post-surgery, most patients experienced improved vision for daily tasks, with no reports of high dissatisfaction or significant difficulties. Patients were quite satisfied with their vision for hobbies and TV subtitles, and very satisfied (90%) with seeing supermarket prices. Conclusions: patients implanted with a new enhanced monofocal IOL using the mini-monovision technique showed improved distance and intermediate visual acuity, reduced need for glasses, and expressed a high degree of satisfaction. Full article

Objectives: This study compared long-term surgical outcomes of the scleral flap versus scleral pocket technique for sutureless intrascleral one-piece intraocular lens (IOL) fixation. Methods: A retrospective comparative study was conducted at a single center, involving consecutive patients undergoing sutureless intrascleral one-piece IOL implantation, between January 2020 and May 2022. Eyes were divided into two groups based on the surgical technique: group 1 underwent scleral flap (n = 64), and group 2 received scleral pocket technique (n = 59). Visual acuity, refractive outcomes, and complications were assessed over a minimum 24-month follow-up period. Results: Both groups showed improvements in best-corrected visual acuity (BCVA), increasing from 0.84 ± 0.56 logMAR at baseline to 0.39 ± 0.23 logMAR (p = 0.042) at 24 months in group 1 and from 0.91 ± 0.63 logMAR at baseline to 0.45 ± 0.38 logMAR (p = 0.039) at 24 months in group 2. No significant differences in BCVA were observed between the groups at baseline (p = 0.991), 12 (p = 0.496) and 24 months (p = 0.557). Mean spherical equivalent (−0.73 ± 1.32 D in group 1 and −0.92 ± 0.99 D in group 2, p = 0.447), refractive prediction error (−0.21 ± 1.1 D in group 1 and −0.35 ± 1.8 D in group 2, p = 0.377), and surgically induced astigmatism (0.74 ± 0.89 D in group 1 and 0.85 ± 0.76 in group 2, p = 0.651) were comparable between the two groups. An IOL tilt of 5.5 ± 1.8 and 5.8 ± 2.0 degrees (p = 0.867) and an IOL decentration of 0.41 ± 0.21 mm and 0.29 ± 0.11 mm (p = 0.955) were obtained, respectively, in group 1 and group 2 at 24 months. Mean endothelial cell density remained stable at 24 months in both groups (p = 0.832 in group 1 and p = 0.443 in group 2), and it was 1747.20 ± 588.03 cells/mm² in group 1 and 1883.71 ± 621.29 cells/mm² in group 2 (p = 0.327) at baseline, 1545.36 ± 442.3 cells/mm² in group 1 and 1417.44 ± 623.40 cells/mm² in group 2 (p = 0.483) at 24 months. No cases of endophthalmitis were observed. Conclusions: The scleral pocket technique for sutureless intrascleral one-piece IOL fixation is comparable to the traditional scleral flap technique in terms of long-term visual outcomes and safety. The scleral pocket technique offers a simplified approach and a viable option even for less experienced surgeons. Full article

Different techniques for artificial iris implantation with or without an intraocular lens, depending on lens status, are described in the literature. We describe a surgical technique for a custom-made artificial iris and toric-intraocular lens intrascleral flange fixation. We modified the “Backpack” artificial iris implantation surgical technique to facilitate an accurate alignment of the toric-intraocular lens in a patient with aphakia, aniridia, and high asymmetric astigmatism secondary to blunt trauma. Two months after the surgery, uncorrected visual acuity was 20/30, corrected to 20/25 with a refraction of −2.00 in the diopter sphere with no residual astigmatism. The artificial iris implant and toric-intraocular lens were well-centered. The patient was satisfied with the visual and cosmetic outcomes. This procedure, however, is not complication-free as our patient developed uveitis and increased intraocular pressure during the postoperative period, which was treated successfully. Full article

To demonstrate the results of ray tracing higher- and lower-order aberrations in pseudophakic eyes with rotationally asymmetrical segment multifocal lenses, total high- and low-order aberrations, measured by root mean square value (RMS), refraction, uncorrected distance and uncorrected near visual acuity (UCDVA and UCNVA), and tear break-up time, were measured at scotopic size in 42 eyes of patients implanted with bifocal refractive Mplus15/Mplus30 IOL with +1.5 dpt near addition (42 eyes of patients implanted with Mplus15)/+3.0 dpt near addition (91 eyes of patients implanted with Mplus30), and 107 eyes of control group. No significant differences were noticed between the examined groups concerning UCDVA, UCNVA, and tear break-up time (p < 0.001). Coma and total high-order aberrations were significantly higher for the Mplus30 lens in comparison to the Mplus15 lens and the control group (Coma, Trefoil p < 0.001, Secondary Astigmatism p = 0.002). The spherical aberrations were significantly higher in the lower-addition lens (p = 0.016) in comparison to the control group and to the higher-addition lens group (p < 0.001). Both intraocular lens models were successful at reaching refractive aim, good distance, and near function with the lower higher-order aberrations for the low-addition lens. Full article

This study reports the outcomes of a secondary IOL implantation technique in patients that suffered from rhegmatogenous retinal detachment combined with a cataract, which included reopening the capsular bag, enabling secondary intracapsular intraocular lens (IOL) implantation. We included consecutive cases with rhegmatogenous retinal detachment (RRD) treated with vitrectomy and silicone oil tamponade, and subsequent secondary IOL implantation during silicone oil removal between September 2019 and June 2022. Demographics, pre- and postoperative clinical data, and complications were collected. Visual and refractive outcomes and IOL position were evaluated. Thirty eyes were included and followed up for a mean of 24.2 ± 5.06 months. Compared with the preoperative values, no significant changes were observed in the intraocular pressure (p = 0.170) and endothelial cell density (p = 0.336); however, the best-corrected visual acuity (Snellen: 20/83 vs. 20/38; logMAR: 0.66 ± 0.23 vs. 0.37 ± 0.32; p < 0.001) and spherical equivalent (p < 0.001) improved significantly. The mean prediction error (ME) was −0.45 ± 0.68 D (−1.9–0.54 D), and the mean absolute prediction error (MAE) was 0.62 ± 0.52 D (0.01–1.9 D). The macula-on subgroup demonstrated significantly better refractive outcomes than the macula-off subgroup (ME, p = 0.046; MAE, p = 0.008). The IOL was well positioned, with a mean horizontal and vertical tilt and decentration of 0.53 ± 0.49° and 0.21 ± 0.16 mm, and 0.54 ± 0.45° and 0.22 ± 0.16 mm, respectively. Secondary intracapsular IOL implantation provided a good and stable IOL position and satisfactory refractive outcomes, and is a feasible treatment option for patients with RRD. Full article

Aim: To determine the clinical risk factors that may increase the occurrence of intraocular lens (IOL) calcification in patients who had undergone pars plana vitrectomy (PPV). Methods: The medical records of 14 patients who underwent IOL explantation due to clinically significant IOL opacification after PPV were reviewed. The date of primary cataract surgery, technique and implanted IOL characteristics; the time, cause and technique of PPV; tamponade used; additional surgeries; the time of IOL calcification and explantation; and IOL explantation technique were investigated. Results: PPV had been performed as a combined procedure with cataract surgery in eight eyes and solely in six pseudophakic eyes. The IOL material was hydrophilic in six eyes, hydrophilic with a hydrophobic surface in seven eyes and undetermined in one eye. The endotamponades used during primary PPV were C2F6 in eight eyes, C3F8 in one eye, air in two eyes and silicone oil in three eyes. Two of three eyes underwent subsequent silicone oil removal and gas tamponade exchange. Gas in the anterior chamber was detected in six eyes after PPV or silicone oil removal. The mean interval between PPV and IOL opacification was 20.5 ± 18.6 months. The mean BCVA in logMAR was 0.43 ± 0.42 after PPV, which significantly decreased to 0.67 ± 0.68 before IOL explantation for IOL opacification (p = 0.007) and increased to 0.48 ± 0.59 after the IOL exchange (p = 0.015). Conclusions: PPV with endotamponades in pseudophakic eyes, particularly gas, seems to increase the risk for secondary IOL calcification, especially in hydrophilic IOLs. IOL exchange seems to solve this problem when clinically significant vision loss occurs. Full article

Presbyopia correction through implantation of a trifocal intraocular lens (IOL) is a modality offered to both cataract and refractive-lens exchange patients. To maximize postoperative satisfaction, IOL selection needs to be made based on patients’ requirements aligned with the available technology. Five Trifocal IOLs were assessed in this study, and their differentiating features were identified: Triumf POD L GF, AT Lisa Tri, Tecnis Synergy, AcrySof IQ PanOptix, and Acriva Trinova Pro C. The optical quality was assessed using the modulation-transfer-function principle. Simulated defocus curves were derived from a non-linear formula. Far-focus simulated visual acuity (simVA) was 0.03 logMAR or better for all the studied IOLs, showing minimal differences. However, each IOL’s intermediate focus position differed across a range from 61 cm to 80 cm; and for the near focus, it was 36 cm to 44 cm. Triumf demonstrated improved intermediate point at the expense of the near focus resulting in a lower predicted near VA. PanOptix exhibited the shortest range of vision without a clear distinction between intermediate and near-point. The remaining lenses presented three foci of comparable optical quality and, thus, simVA performance. Each model, however, revealed a different aperture-change response. Trinova function improved at intermediate but was worse at near for larger pupils. The opposite was observed for AT Lisa. Synergy’s optical quality change was predominantly associated with lower pupil diameter. In conclusion, the trifocal IOLs can be differentiated according to their secondary-foci position, light-energy distribution, and pupil-size-related behavior. The observed differences may translate directly into a clinical effect showing that the trifocal IOLs vary in their ability to deliver optimal vision at different distances, with some providing improved intermediate while others favor reading distance. The knowledge gained through this objective testing can support IOL selection, postoperative patient counselling and increase the chance of spectacle independence after surgery. Full article

Purpose. To revise the current literature on FIL SSF (Carlevale) intraocular lens, previously known as Carlevale lens, and to compare their outcomes with those from other secondary IOL implants. Methods. We performed a peer review of the literature regarding FIL SSF IOLs until April 2021 and analyzed the results only of articles with a minimum of 25 cases and a follow-up of at least 6 months. The searches yielded 36 citations, 11 of which were abstracts of meeting presentations that were not included in the analysis because of their limited data. The authors reviewed 25 abstracts and selected six articles of possible clinical relevance to review in full text. Of these, four were considered to be sufficiently clinically relevant. Particularly, we extrapolated data regarding the pre- and postoperative best corrected visual acuities (BCVA) and the complications related to the procedure. The complication rates were then compared with those from a recently published Ophthalmic Technology Assessment by the American Academy of Ophthalmology (AAO) on secondary IOL implants. Results. Four studies with a total of 333 cases were included for results analysis. The BCVA improved in all cases after surgery, as expected. Cystoid macular edema (CME) and increased intraocular pressure were the most common complications, with an incidence of up to 7.4% and 16.5%, respectively. Other IOL types from the AAO report included anterior chamber IOLs, iris fixation IOLs, sutured iris fixation IOLs, sutured scleral fixation IOLs, and sutureless scleral fixation IOLs. There was no statistically significant difference in the rates of postoperative CME (p = 0.20), and vitreous hemorrhage (p = 0.89) between other secondary implants and the FIL SSF IOL, whereas the rate of retinal detachment was significantly less with FIL SSF IOLs (p = 0.04). Conclusion. The results of our study suggest the implantation of FIL SSF IOLs is an effective and safe surgical strategy in cases where there is a lack of capsular support. In fact, their outcomes seem to be comparable to those obtained with the other available secondary IOL implants. According to published literature, the FIL SSF (Carlevale) IOL provides favorable functional results with a low rate of postoperative complications. Full article

Purpose: To compare the refractive results between sutureless scleral fixation intraocular lens (IOLs) (Carlevale, Soleko) and suture-free scleral fixation three-piece IOLs (Sensar AR40, Johnson & Johnson) for secondary implantation in patients with IOL dislocation or aphakia. Methods: This is a monocentric retrospective study on 28 patients (28 eyes) with sutureless scleral fixation Carlevale IOL and 25 patients (25 eyes) with suture-free scleral fixation three-piece IOL. Best-corrected visual acuity (BCVA) evaluation, refractive measures and IOL tilt evaluation with anterior segment optical coherence tomography were conducted at one, three, six and twelve months after surgery. Point Spread Function (PSF) was measured using a total ocular aberrometer. Results: BCVA in both groups improved since the postoperative visit at 1 month and reached a stable value at 3 months At month 12, mean BCVA was 0.23 logMAR in group one and 0.32 logMAR in group two. Mean IOL tilt angle at 12 months was 2.76° ± 1.87 in group one and 2.51° ± 1.80 in group two. PSF at 12 months was 0.18 ± 0.09 in group one and 0.15 ± 0.05 in group two. There were no statistically significant differences (p > 0.05) for all comparisons. The post-operative complications were similar within the two groups. Conclusions: Our results show that secondary IOL implantation has similar visual and surgical outcomes when a sutureless Carlevale lens scleral fixation and a suture-free scleral fixation three-piece IOL are used. Full article

Purpose: To report the visual outcomes of different techniques for iris pupilloplasty in eyes after traumatic and iatrogenic damage. Methods: 70 consecutive eyes with posttraumatic (80%) and postoperative (20%) iris damage were included. According to the preoperative diagnosis, the eyes were divided into three groups: mydriasis (50%), partial iris defects (24%), and iridodialysis (26%). Multiple techniques were performed: the Siepser slip-knot technique, the “lasso” technique, and suturing to the sclera. These techniques were combined in some cases. Results: The best improvement of visual acuity was found for the Siepser slip-knot technique with a median of 0.7 (SD ± 0.83) before surgery and 0.52 logMAR (SD ± 0.65) after surgery with regard to the surgical technique, and for mydriasis with a median of 0.7 (SD ± 0.75) before surgery and 0.52 logMAR (SD ± 0.49) after surgery with regard to preoperative diagnosis. Pupilloplasty was combined with additional surgery (corneal suturing, secondary intraocular lens implantation, anterior or pars plana vitrectomy) in 80% of cases. Apart from corneal suturing, all additional procedures ensured improvement in visual acuity. Conclusions: The slip-knot technique was the only suturing technique that resulted in a significant improvement in visual acuity. Other surgical procedures are usually needed in the majority of cases that undergo pupilloplasty, and they also give visual gain. Full article