Efficacy and Safety Analysis of the New Aspheric Hydrophobic Acrylic Monofocal IOL Implantation at Short-Term Follow-Up

Aim. To evaluate the results of implantation of a new hydrophobic acrylic monofocal IOL in an automated preloaded delivery system in the short-term follow-up period.Patients and methods. The prospective study included 89 patients (114 eyes) after bilateral or monolateral Clareon IOL implantation with a mean follow-up of 2.1 ± 0.4 (1–4) months. The age range was 53 to 87 (71.1 ± 5.2) years. A corneal incision of 1.8 mm was used in all cases. For implantation using the AutonoMe® system , the incision was enlarged by 0.2 mm for implantation IOL 26 D and higher. IOL optical power was calculated using the SRK/T formula; retrospective analysis was performed using the Hoffer Q, Haigis, Holladay II, Olsen, Barrett Universal II, and Kane formulas.Results. In all studied periods (1 day, 1 week and 1 month) there was statistically significant (p < 0.05) increase both of NCDVA (from 0.13 ± 0.02 in the preoperative period to 0.81 ± 0.07 in 1 month after surgical intervention), and BCDVA (from 0.32 ± 0.15 before surgery to 0.94 ± 0.11 after surgery). When assessing the percentage of eyes with an BCDVA of 0.9 or higher, a statistically significant (p < 0.05) difference was shown in all studied periods. The lowest MAE was shown for the Barrett Universal II (0.292), SRK/T (0.312) Kane (0.301), and Olsen (0.325) formulas. For the Hoffer Q and Holladay 2 formulas, MAE values were significantly higher (p < 0.05). The highest frequency of achieving the target refraction of ± 0.25 D was shown for the Barrett Universal II and Kane formulas (68 and 69 %, respectively), and the lowest for the Hoffer Q and Holladay 2 formulas (28 and 35 %, respectively). The primary endpoint of the study (BCDVA = 1.0) was achieved in 95.6 % (n = 109), with a deviation in BCVA of ± 0.1 noted in 4 eyes (3.5 %). No glistening was detected in the follow-up period up to 4 months.Conclusion. The paper presents an analysis of the first experience with the implantation of new Clareon monofocal IOLs in Russian Federation. The results of implantation of a new hydrophobic acrylic monofocal IOL in an automated preloaded delivery system showed a good clinical and functional effect, a high frequency of achieving the target result and the absence of significant side effects. The Kane, Barrett Universal II, and SRK/T formulas, using the Verion diagnostic navigation system, are recommended for calculating the optical power of the new IOL.

Comparative analysis of postoperative results of cataract surgery using monofocal IOLs

One of the most common surgical interventions in ophthalmology today is lens replacement surgery. But there is still no consensus on whether the choice of a monofocal IOL affects the postoperative functional outcome.The aim: to conduct a comparative analysis of values of visual acuity without correction in the early postoperative period after cataract surgery using monofocal IOLs.Material and methods. The study included data of 2643 eyes operated for cataract, into which one of the monofocal IOLs, included in the top ten most frequently implanted IOLs in the Orenburg Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, was implanted for the period 2019–2021. Statistical analysis was performed using the program Statistica 13.0.Results. The performed analysis of variance showed that the established differences between the compared groups are statistically signifi cant (p < 0.05). However, the subgroup analysis showed that there were statistically signifi cant differences between pairs such as Tecnis and Hydro-4; Tecnis and Rayner. In all other cases, statistically signifi cant uncorrected visual activity (UCVA) values after surgery were not established. It has also been reliably established that the presence of subluxation of the lens affects the value of UCVA after surgery.Conclusion. The results of the performed analysis in general indicate that the value of UCVA in patients in the early postoperative period after the performed surgical intervention does not depend on the manufacturer of the used IOL.

Profile of a new extended range-of-vision IOL: a laboratory study

Purpose To evaluate the surface profile of a new-generation extended range-of-vision intraocular lens (IOL) and to compare it with that obtained for a monofocal IOL based on the same platform. Methods Prospective, experimental, laboratory study comparing the surface profile of the DFT015 (AcrySof IQ Vivity; Alcon Laboratories, Inc.), a new-generation presbyopia-correcting IOL, with the profile of the SN60WF (AcrySof IQ; Alcon Laboratories, Inc.), an aspheric monofocal IOL based on the same platform. Raw profiles were obtained using contact profilometry. The best-fit form was then subtracted from each raw profile to highlight potential differences. Results No significant differences were appreciated in raw profiles. On the contrary, after form removal, the new extended range-of-vision IOL showed a peculiar profile characterized by the presence of two altitudinal symmetrical changes in the order of 1 µm, localized in the central portion of the optic. Conclusions The new-generation extended range-of-vision IOL evaluated showed a smooth change of its surface compared to the same platform monofocal IOL. The altitudinal changes blended in the central design of the new presbyopia-correcting IOL, although micrometric, might play a crucial role in creating a continuous focal range while minimizing visual disturbances.

Long-Term Clinically Significant Posterior Capsular Opacification Development Pattern in Eyes Implanted with an Aspheric Monofocal Intraocular Lens with a Square Optic Edge

Purpose. To analyse the posterior capsular opacification (PCO) development pattern in the long term in eyes implanted with a monofocal intraocular lens (IOL) with a square edge all around the optic. Methods. Longitudinal retrospective study is data analyzed from a total of 7059 eyes from 4764 patients (mean age: 75.8 years) undergoing cataract surgery with implantation of an aspheric monofocal IOL (Bi-Flex HL 677AB/677P, Medicontur, Budapest, Hungary). These data were retrospectively collected using the electronic medical record of the hospitals involved. Nd : YAG capsulotomy rates were calculated per year during a follow-up of more than 10 years. The Kaplan–Meier analysis was used to establish the transparent capsule survival rate. Results. The Nd : YAG capsulotomy rate increased from 1.1% at 1 year postoperatively to 17.2% at 5 years after surgery. No significant differences were found between eyes with and without capsulotomy in terms of age p = 0.202 , gender p = 0.061 , type of anaesthesia used p = 0.128 , and presence of conditions such as hard cataract p = 0.111 or pseudoexfoliation p = 0.137 . IOL power was significantly lower in those eyes of patients requiring Nd : YAG capsulotomy during the follow-up p < 0.001 . Significantly more eyes implanted with the preloaded model of the IOL required capsulotomy p < 0.001 . Mean survival time and rate were 9.38 years and 85.9%, respectively. Conclusions. Most eyes undergoing cataract with implantation of the Bi-Flex IOL do not develop a clinically significant PCO requiring Nd : YAG capsulotomy in the long term. IOL material and design may be the main factors accounting for this finding.

Comparison of Visual Outcomes and Patient Satisfaction Following Cataract Surgery with Two Monofocal Intraocular Lenses: Clareon® vs AcrySof® IQ Monofocal

Aim: This study aimed to compare the performance of two monofocal Intraocular Lenses (IOL) platforms. Background: The Clareon® Intraocular Lens (IOL) is a relatively new monofocal lens platform designed to improve postoperative results compared to other monofocal platforms. Objective: This study aimed to assess and compare the visual and refractive outcomes, and incidence of YAG capsulotomy of the Clareon® IOL and a standard non-preloaded AcrySof® monofocal IOL following contralateral implantation in patients undergoing cataract surgery. Methods: A total of 20 patients (40 eyes; 12 female, average age 72.8±6.4 years) who had undergone contralateral implantation of an AcrySof® IQ monofocal lens (SN60WF or SN6AT; Alcon; Texas, USA) and a Clareon®monofocal lens (CNAOT0; Alcon; Texas, USA) were selected. Uncorrected Distance Visual Acuity (UDVA), Contrast Sensitivity (CS), kinetic perimetry, and refraction were measured 1 month following the second surgery and subjective vision was measured 6 months following the second surgery using a quality-of-life questionnaire. Results: There was no difference in postoperative UDVA (P=0.94), CS (P>0.05), or refraction (P=0.64) between eyes that received the Clareon® and AcrySof® IQ lenses. Clareon® eyes had a higher incidence of glare/haloes and positive dysphotopsia while AcrySof® IQ eyes had a higher incidence of negative dysphotopsia. Patient satisfaction was similar between the groups (P=0.86), although 25% of patients reported more clarity in the eye that received the Clareon® lens. The incidence of posterior capsular opacification was low for both groups. Conclusion: Clareon® and AcrySof® IQ lenses perform similarly, providing good refractive, visual, and subjective outcomes. Clareon® is available as a preloaded lens option and may reduce PCO and the need for Nd: YAG capsulotomy.

Combining primary and sulcus piggyback IOLs for the correction of a spherical-cylindrical defect in an eye with abnormal cornea

Introduction: Piggyback IntraOcular Lenses (IOLs), or supplementary secondary implant lenses, have been developed to provide a sufficient dioptric power in eyes with high refractive defects, which are not fully correctable after cataract surgery with single IOL in the range of powers available. These lenses can also be used for the correction of refractive errors that occurred for a wrong choice of the IOL power after cataract surgery. Case description: We report the case of a complete refractive success obtained in a patient with an abnormal cornea, with a central stable ectasia, with thinning, high myopic astigmatism and cataract, obtained with the implant of a primary posterior chamber IOL at the time of cataract surgery and a subsequent implant of a secondary piggyback, sulcus-based customized toric IOL (Camellens FIL 622-2 Toric Monofocal IOL, Soleko, Rome, Italy). Conclusions: This brief report demonstrates the utility of combining primary and piggyback IOLs implant for the correction of a complex spherical-cylindrical refractive defect in a case of abnormal cornea and cataract.

Clinical outcomes of the piggyback secondary implantation of a novel multifocal lens in the ciliary sulcus: A case series

Purpose: Evaluate the clinical outcomes of the secondary piggyback add-on IOL implantation in the ciliary sulcus for pseudophakic patients previously implanted with a monofocal IOL, who pursue a spectacle-free option after IOL surgery. Methods: A prospective case series including seven pseudophakic patients who underwent an in-the-bag monofocal IOL implantation. All eyes underwent a piggyback IOL implantation of the new sulcus designed A4 AddOn IOL in the ciliary sulcus as a secondary procedure for pseudophakic patients pursuing a spectacle-free option for near and intermediate distance after IOL surgery. Results: Seven eyes from six patients were included in this study, from which 4 (71.43%) were female, with a mean age of 58.33 ± 3.5 years (range 54–63; 95% CI 54.66, 62.01). The postoperative spherical equivalent at the 3-month visit was −0.10 m ± 0.82. Also, the UDVA was 0.11 ± 0.08 logMAR, the UIVA 0.01 ± 0.03, and the UNVA 0.01 ± 0.03 3 months after their surgical procedure. Conclusions: The A4 AddOn multifocal IOL’s secondary piggyback implant is an efficient alternative for monofocal pseudophakic patients seeking presbyopia solutions. This sulcus-designed IOL provides an optimal visual outcome for near and distance vision.