PURPOSE: To present a case series of a modified three-quarter Descemet's membrane endothelial keratoplasty (3/4-DMEK) technique to treat pseudophakic bullous keratopathy in the presence of a glaucoma drainage device (GDD) tube in the anterior chamber by reducing the risk of donor endothelial damage due to absence of donor endothelial cells overlying the GGD tube area. METHODS: In this prospective case series, four eyes of three patients with stable glaucoma underwent 3/4-DMEK surgery for pseudophakic bullous keratopathy after GDD insertion. The patients were followed up to 24 ± 2.5 months postoperatively. RESULTS: No intraoperative or postoperative complications were noted. The average central endothelial cell density (ECD) was 1093 ± 74 cells/mm2 at 12 months postoperatively, corresponding to an ECD decrease of 58 (±6)% as compared to preoperative values. Average best-corrected visual acuity increased from finger counting before surgery to 20/60 (logMar 0.5) at 12 months after 3/4-DMEK and remained stable up to 24 months postoperatively. All corneas remained clear at the last available follow-up. CONCLUSION: This case series demonstrates the technical feasibility of 3/4-DMEK in eyes with pseudophakic bullous keratopathy in the presence of a GDD tube. The absence of a donor DM and donor cells above the silicone tube excludes direct tube contact with the graft. Longer term studies are needed to show the effect of this modified graft pattern and dimensions on transplant survival.

• MeSH
• Time Factors MeSH
• Glaucoma Drainage Implants * MeSH
• Glaucoma etiology   physiopathology   surgery   MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Graft Survival MeSH
• Prospective Studies MeSH
• Prosthesis Design MeSH
• Pseudophakia complications   MeSH
• Refraction, Ocular MeSH
• Graft Rejection prevention & control   MeSH
• Endothelium, Corneal transplantation   MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Descemet Stripping Endothelial Keratoplasty methods   MeSH
• Visual Acuity * MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

PURPOSE: To compare the efficacy and safety of anterior capsulotomy creation with a new selective laser device (CAPSULaser) with those of manual capsulotomies. SETTING: GEMINI Eye Clinic, Zlin, Czech Republic. DESIGN: Prospective case series. METHODS: Patients were placed in cohorts based on age and cataract grade and randomly allocated to have laser capsulotomy or manual continuous curvilinear capsulorhexis (CCC). The anterior capsule was stained with microfiltered trypan blue 0.4%. The anterior capsulotomy was created with the laser device focused on the anterior capsule through a custom patient interface lens. Intraoperative video analysis with the use of an intraocular ruler and postoperative examinations were used to assess safety and efficacy (accuracy of capsulotomy size, circularity, centration). RESULTS: No intraoperative complications occurred in the laser group or the manual group. All capsulotomies in the laser group were free-floating with no tags or tears. The mean capsulotomy diameter was 5.03 mm overall (range 4.8 to 5.2 mm, laser group; 4.4 to 5.8 mm, manual group). In the laser group, all the capsulotomies were within 0.1 mm ± 0.1 (SD) of the target. The circularity accuracy was greater than 99.0% ± 1.0%; the mean centration of the capsulotomy in relation to the intraocular lens (IOL) was 0.1 ± 0.1 mm. All parameters were statistically significant (P < .01). The IOL-capsulotomy overlap was 360 degrees in all laser cases. CONCLUSIONS: Selective laser capsulotomy using a new proprietary trypan blue formulation was safe and effective in cataract surgery. The sizing, circularity, and centration of the laser capsulotomy were more accurate than those of the manual CCC, resulting in consistent 360-degree IOL coverage.

• MeSH
• Coloring Agents administration & dosage   MeSH
• Capsulorhexis methods   MeSH
• Adult MeSH
• Phacoemulsification * methods   MeSH
• Lens Implantation, Intraocular * MeSH
• Cataract complications   MeSH
• Laser Therapy adverse effects   instrumentation   MeSH
• Middle Aged MeSH
• Humans MeSH
• Anterior Capsule of the Lens surgery   MeSH
• Prospective Studies MeSH
• Pseudophakia physiopathology   MeSH
• Aged MeSH
• Trypan Blue administration & dosage   MeSH
• Treatment Outcome MeSH
• Visual Acuity physiology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

PURPOSE: To determine the effect of pars plana vitrectomy (PPV) on oxygen saturation in retinal vessels in patients with diabetes and non-diabetes after a 1-year follow-up. METHODS: This was a prospective consecutive interventional case series in 82 eyes in 82 patients. The sample consisted of 25 patients with non-proliferative diabetic retinopathy with macular oedema based on vitreoretinal traction or epiretinal membrane (ERM) and 57 non-diabetic patients with macular hole and ERM. Automatic retinal oximetry (Oxymap Inc.) was used on all patients 24 hr prior to PPV, and it was also used 7 and 52 weeks after PPV (classic 20G or sutureless 23G). We analysed the data according to subgroup diagnosis and lens status. RESULTS: Arterial saturation increased significantly from 96.4 ± 2.9% at baseline to 96.6 ± 3.4% at week 7 and 97.3 ± 3.4% at week 52 (p < 0.0001; Friedman test). Vein saturation also increased significantly from 63.5 ± 7.9% at baseline to 66.1 ± 7.7% and 67.0 ± 7.2% at weeks 7 and 52 (p < 0.0001; Friedman test). The value of the arteriovenous (A-V) difference decreased significantly after vitrectomy from 32.8 ± 7.5% at baseline to 30.5 ± 7.5% and 30.3 ± 7.0% at weeks 7 and 52 (p < 0.0001; Friedman test). The subgroup analysis revealed that in patients with diabetes, there were no statistically significant changes in oxygen saturation in blood vessels or in the A-V difference after PPV. After vitrectomy, retinal vessel diameter reduced by about 3.5% in both groups of patients. Further, the analysis revealed that opacification of the lens leads to a decrease in oxygen saturation in contrast to a clear lens and pseudophakic IOLs. CONCLUSION: Oxygen saturation is higher in the retinal veins and arteries after PPV in patients with non-diabetes, and this lasts for at least 52 weeks. In contrast, in patients with diabetes, there is no increase in oxygen saturation in the retinal vessels after vitrectomy. After vitrectomy, retinal vessel diameter reduced in both groups of patients. Further, the nuclear cataract progression has substantial effect on oximetry results. Patients with nuclear cataract exhibited an increase in saturation in both arteries and veins, but the A-V difference remained the same.

• MeSH
• Diabetic Retinopathy physiopathology   MeSH
• Phacoemulsification MeSH
• Lens Implantation, Intraocular MeSH
• Cataract congenital   physiopathology   MeSH
• Oxygen blood   MeSH
• Middle Aged MeSH
• Humans MeSH
• Macular Edema physiopathology   MeSH
• Retinal Neovascularization physiopathology   MeSH
• Oximetry MeSH
• Prospective Studies MeSH
• Pseudophakia physiopathology   MeSH
• Retinal Vessels physiopathology   MeSH
• Aged MeSH
• Vitrectomy * MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

PURPOSE: To investigate the low mesopic contrast sensitivity function (LMCSF) of patients implanted with different modern optical bifocal and trifocal designs of multifocal intraocular lenses (mfIOLs). METHODS: This prospective, comparative, nonrandomized consecutive case series included 180 eyes that underwent cataract surgery. Six groups of eyes were differentiated: group A, eyes with the diffractive AT LISA tri 839MP; group B, eyes with diffractive FineVision; group C, eyes with the bifocal Lentis Mplus-LS313; group D, eyes with the diffractive bifocal Acri.Lisa 366D; group E, eyes with the diffractive apodized Acrysof ReSTOR SN6AD1; group F, as the control group, implanted with a monofocal spherical intraocular lens. The LMCSF was evaluated with the OPTEC® 6500 device at 3 months postoperatively using a luminance of 3 cd/m2. RESULTS: No significant differences among groups were detected in LMCSF for the spatial frequencies of 1.5, 3.0, 6.0, and 12.0 cpd (1.5 cpd: F = 1.81, p = 0.13; 3.0 cpd: F = 1.14, p = 0.14; 6.0 cpd: F = 1.87, p = 0.11; 12.0 cpd: F = 1.26, p = 0.29), but significant differences were found among groups for the spatial frequency of 18 cpd (F = 2.62, p = 0.03). When comparing the groups in pairs, only statistically significant differences were observed between groups E and F for the spatial frequency of 18.0 cpd (t = 3.27, p = 0.03) with better values for group F. CONCLUSION: No significant differences were observed in LMCSF among the different mfIOLs studied. The third focus of trifocal IOL models did not adversely affect the LMCSF. The ReSTOR SN6AD1 showed the poorest LMCSF for the highest spatial frequency analyzed when compared with the control group.

• MeSH
• Contrast Sensitivity physiology   MeSH
• Phacoemulsification * MeSH
• Lens Implantation, Intraocular * MeSH
• Middle Aged MeSH
• Humans MeSH
• Lenses, Intraocular * MeSH
• Prospective Studies MeSH
• Prosthesis Design MeSH
• Pseudophakia physiopathology   MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Mesopic Vision physiology   MeSH
• Visual Acuity physiology   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

PURPOSE: Intravitreal implantation of dexamethasone implant (Ozurdex®) is being widely used for the treatment of macular edema (ME) after branch or central retinal vein occlusion, diabetic ME, and persistent ME associated with uveitis or Irvine-Gass syndrome. We describe a complication: migration of the dexamethasone implant into the anterior chamber through basal iridectomy (Ando) in a pseudophakic patient with development of corneal edema and secondary high intraocular pressure. METHODS: This is a case report of migration of Ozurdex® through basal iridectomy in a pseudophakic patient with iris claw lens. CONCLUSIONS: Pseudophakic patients, with a history of vitrectomy, even those with a basal iridectomy (Ando), are at high risk for migration of the Ozurdex® into the anterior chamber and development of corneal edema.

• MeSH
• Dexamethasone administration & dosage   MeSH
• Corneal Edema etiology   MeSH
• Phacoemulsification MeSH
• Glucocorticoids administration & dosage   MeSH
• Lens Implantation, Intraocular MeSH
• Drug Implants adverse effects   MeSH
• Intravitreal Injections MeSH
• Iridectomy * MeSH
• Humans MeSH
• Macular Edema drug therapy   MeSH
• Ocular Hypertension etiology   MeSH
• Anterior Chamber pathology   MeSH
• Pseudophakia etiology   MeSH
• Prosthesis Failure etiology   MeSH
• Aged MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

PURPOSE: To determine the critical value of the angle kappa in connection with a higher risk of photic phenomena for the AcrySof ReSTOR and Tecnis multifocal intra-ocular lens (MIOL) on a standardized pseudophakic eye model. To analyse the impact of biometric value changes on the critical angle kappa. METHODS: Geometrical optic rules applied to a suitable optical model of the pseudophakic eye were used to calculate the critical value of the angle kappa for the Tecnis and three types of the AcrySof ReSTOR MIOLs. The angle kappa was defined as critical if the incident ray passed through the first ring's edge area. The influence of different positive optical corneal power (K), effective lens position (ELP) and axial length (AL) on the critical angle kappa (κc) was investigated. The dependence of κc on one of the parameters was studied for standardized values of the remaining parameters. RESULTS: The highest value of the critical angle kappa was evaluated for the Tecnis MIOL. The increase in ELP and K caused an increase in κc under the given conditions. On the contrary, an increase in AL led to lower values of κc. CONCLUSION: We demonstrated the dependence of the critical angle kappa on the central part of the MIOL and on biometric parameters of the eye, especially on the effective lens position. According to these results, we conclude that shallow anterior chamber depth in connection with a higher angle kappa is an important risk factor for pronounced photic phenomena after implantation of a diffractive MIOL.

• MeSH
• Axial Length, Eye MeSH
• Lens Implantation, Intraocular * MeSH
• Humans MeSH
• Lenses, Intraocular * MeSH
• Optics and Photonics * MeSH
• Pseudophakia physiopathology   MeSH
• Pupil physiology   MeSH
• Cornea physiology   MeSH
• Models, Theoretical * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH

PURPOSE: To evaluate the visual, refractive, contrast-sensitivity, and aberrometric outcomes during a 1-year follow-up after implantation of a trifocal intraocular lens (IOL). SETTING: Premium Clinic, Teplice, Czech Republic. DESIGN: Prospective case series. METHODS: This study included eyes of patients having cataract surgery with implantation of the trifocal IOL model AT Lisa tri 839MP. Distance, intermediate (66 and 80 cm), and near (33 and 40 cm) vision; contrast sensitivity; aberrometric outcomes; and the defocus curve were evaluated during a 12-month follow-up. The level of posterior capsule opacification (PCO) was also evaluated. RESULTS: In 120 eyes (60 patients), 1 month postoperatively, an improvement was observed in all visual parameters (P ≤ .03) except corrected near and intermediate visual acuities (both P ≥ .05). From 1 month to 12 months postoperatively, small but statistically significant changes were observed in uncorrected and corrected distance and near visual acuities (all P ≤ .03) and in uncorrected intermediate visual acuity (P = .01). In the defocus curve, no significant differences were found between visual acuities corresponding to defocus levels of -1.0 diopter (D) and -2.0 D (P = .22). The level of ocular spherical aberration decreased statistically significantly at 6 months (P < .001). Ocular and internal higher-order aberrations increased minimally but significantly from 6 to 12 months postoperatively (P < .001). The mean 12-month PCO score was 0.32 ± 0.44 (SD). Four eyes (3.3%) required neodymium:YAG capsulotomy. CONCLUSION: The trifocal IOL provided complete and stable visual restoration after cataract surgery during a 12-month follow-up, with good levels of visual quality. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

• MeSH
• Aberrometry MeSH
• Contrast Sensitivity physiology   MeSH
• Adult MeSH
• Phacoemulsification * MeSH
• Lens Implantation, Intraocular * MeSH
• Middle Aged MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Lenses, Intraocular * MeSH
• Prospective Studies MeSH
• Prosthesis Design MeSH
• Pseudophakia physiopathology   MeSH
• Refraction, Ocular physiology   MeSH
• Corneal Wavefront Aberration physiopathology   MeSH
• Aged MeSH
• Capsule Opacification diagnosis   MeSH
• Visual Acuity physiology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

PURPOSE: To assess efficacy and patient satisfaction after cataract surgery and implantation of a new accommodative bioanalogic intraocular lens (IOL). METHODS: We evaluated the collected data of 48 patients with bilateral cataract surgery and Wichterle IOL (WIOL) implantation included in the Czech national observational registry. Monocular and binocular uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity, uncorrected near visual acuity (UNVA), best spectacle-corrected visual acuity for distance (CDVA), best spectacle-corrected visual acuity for near (CNVA), distance-corrected near visual acuity (DCNVA), and distance-corrected intermediate visual acuity were evaluated 6 months after surgery. Subjective patient satisfaction was assessed at 3 months postoperatively. RESULTS: The mean monocular UDVA was 0.074 ± 0.108 logMAR, the mean monocular CDVA was 0.047 ± 0.125 logMAR, the mean monocular UNVA was 0.328 ± 0.146 logMAR, the mean monocular DCNVA was 0.339 ± 0.131 logMAR, and the mean monocular CNVA was 0.139 ± 0.107 logMAR. A total of 24 patients (50%) had no problems with any light phenomena. A total of 18 patients were very satisfied (37.5%), 11 were satisfied (22.9%), 15 (31.2%) were rather satisfied, 4 (8.3%) were rather dissatisfied, and 0 were dissatisfied. CONCLUSIONS: The WIOL-continuous focus polyfocal lens offers very good vision at far and intermediate distance comparable with other types of multifocal IOLs, and relatively good near vision, while the incidence of adverse side phenomena is relatively low.

• MeSH
• Accommodation, Ocular physiology   MeSH
• Eyeglasses MeSH
• Phacoemulsification * MeSH
• Lens Implantation, Intraocular * MeSH
• Middle Aged MeSH
• Humans MeSH
• Lenses, Intraocular * MeSH
• Prosthesis Design MeSH
• Pseudophakia physiopathology   MeSH
• Registries * MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Patient Satisfaction MeSH
• Vision, Binocular physiology   MeSH
• Visual Acuity physiology   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH
• Geographicals
• Czech Republic MeSH

PURPOSE: To evaluate the visual, refractive, contrast sensitivity, and aberrometric outcomes as well as the patient quality of life and photic phenomena disturbances after cataract surgery with implantation of a new trifocal toric intraocular lens (IOL). SETTINGS: Premium Clinic, Regional Hospital in Havlickuv Brod, Czech Republic, and Vissum and Universidad Miguel Hernández, Alicante, Spain. DESIGN: Prospective consecutive series of cases. METHODS: The study involved eyes with corneal astigmatism of 1.25 D or more that were having cataract surgery with implantation of the trifocal toric IOL AT Lisa tri toric 939MP (Carl Zeiss Meditec). Visual outcomes and astigmatic changes analyzed by Alpins vector analysis were evaluated at 3 months postoperatively. Contrast sensitivity, quality of life, and photic phenomena were also evaluated. RESULTS: The study involved a total of 30 eyes of 16 patients, age 37 to 64 years. A significant improvement with surgery was observed in uncorrected distance, intermediate, and near visual acuity (P ≤ .01). A significant decrease in the refractive cylinder was observed postoperatively (P < .01), with all eyes showing a postoperative astigmatism below 1.00 D. The difference between targeted and surgically induced astigmatism was small (0.06 ± 0.30 D) but statistically significant (P = .04). The mean magnitude of angle of error was 5.80 ± 8.47 degrees. The low levels of higher-order aberrations found postoperatively were consistent with the good levels of contrast sensitivity achieved. Regarding quality of life, low to moderate levels of difficulty in performing various types of vision-related tasks were found. CONCLUSIONS: The trifocal toric IOL evaluated provides effective restoration of visual function after cataract surgery, with associated high levels of visual acuities and quality of life. FINANCIAL DISCLOSURE: The authors have no proprietary or commercial interest in the medical devices that are involved in this manuscript.

• MeSH
• Contrast Sensitivity physiology   MeSH
• Adult MeSH
• Phacoemulsification * MeSH
• Lens Implantation, Intraocular * MeSH
• Quality of Life MeSH
• Middle Aged MeSH
• Humans MeSH
• Lenses, Intraocular * MeSH
• Prospective Studies MeSH
• Prosthesis Design MeSH
• Surveys and Questionnaires MeSH
• Pseudophakia physiopathology   MeSH
• Refraction, Ocular physiology   MeSH
• Corneal Wavefront Aberration physiopathology   MeSH
• Patient Satisfaction MeSH
• Visual Acuity physiology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

PURPOSE: To evaluate refractive and visual parameters related to distance, intermediate, and near vision after cataract surgery and the optical quality of a new diffractive trifocal intraocular lens (IOL). SETTING: Vissum Instituto Oftalmologico de Alicante, Alicante, Spain. DESIGN: Case series. METHODS: Patients had bilateral refractive lens exchange and multifocal diffractive IOL (AT Lisa tri 839 MP) implantation. A complete ophthalmology examination was performed preoperatively and postoperatively. The follow-up was 6 months. The main outcome measures were uncorrected distance (UDVA) and corrected distance (CDVA), intermediate, and near visual acuities; keratometry; manifest refraction; and aberrations (total, corneal, internal). RESULTS: The study comprised 60 eyes of 30 patients (mean age 57.9 years ± 7.8 [SD]; range 42 to 76 years). There was significant improvement in UDVA, uncorrected intermediate visual acuity, uncorrected near visual acuity, CDVA, and distance-corrected intermediate and near visual acuity. The postoperative refractive status was within the range of +1.00 to -1.00 diopter. Total internal aberrations decreased significantly (P<.001). CONCLUSIONS: The trifocal IOL improved near, intermediate, and distance vision in presbyopic patients. The use of 3 foci provided significant intermediate visual results without sacrificing near or distance vision.

• MeSH
• Aberrometry MeSH
• Contrast Sensitivity physiology   MeSH
• Adult MeSH
• Phacoemulsification * MeSH
• Lens Implantation, Intraocular * MeSH
• Middle Aged MeSH
• Humans MeSH
• Lenses, Intraocular * MeSH
• Depth Perception physiology   MeSH
• Prosthesis Design MeSH
• Pseudophakia physiopathology   MeSH
• Refraction, Ocular physiology   MeSH
• Corneal Topography MeSH
• Aged MeSH
• Patient Satisfaction MeSH
• Treatment Outcome MeSH
• Visual Acuity physiology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH