Pavel Stodulka

Purpose: To compare safety and efficacy of ophthalmic viscosurgical devices (OVDs) – OphteisBio 3.0 (Rayner) and Healon Endocoat (J&J Vision) in phacoemulsification cataract removal surgery. Materials and Methods: In this prospective subject/evaluator-masked post-market randomized study patients undergoing phacoemulsification were assigned to receive one of two hyaluronate-based OVDs – OphteisBio 3.0 and Healon Endocoat. The outcomes were the rate of intraocular pressure (IOP) spikes ≥ 30 mmHg at the 7-day postoperative visit, endothelial cell density changes, the surgeon acceptance rate, IOP change from baseline, rates of inflammation and rates of serious and/or device-related adverse events. Results: The study included 293 eyes – 146 in the Ophteis group and 147 in the Healon group. No IOP spikes were noted at the 7-day postoperative visit with mean IOP of 14.5 mmHg for Ophteis group and 14.3 mmHg for the Healon group. The mean endothelial cell density loss after the surgery was 9.8% in the Ophteis group and 10.2% in the Healon group with no statistically significant difference between the two OVD groups (p = 0.6292). At the 7-day visit, anterior chamber flare was absent in 98% and 99% of eyes in the Ophteis and Healon group, respectively. 82% of eyes had no anterior chamber cells at 7-day visit in both groups. No adverse events were recorded during surgery and at 7-day follow up. No clinically relevant differences were found between the two OVDs. Conclusion: Ophteis 3.0 and Healon Endocoat have comparable results following phacoemulsification surgery.

Introduction: This case reports the first clinical use, to the authors' knowledge, of femtosecond laser–created refractive index shaping (RIS) to create multifocality in a previously implanted monofocal intraocular lens (IOL), offering noninvasive enhancement for pseudophakic patients dissatisfied with near and intermediate vision. Patient and Clinical Findings: A 71-year-old woman underwent routine bilateral cataract surgery with 1-piece hydrophobic acrylic IOLs (21.5 diopters). Postoperatively, uncorrected distance vision was excellent (0.00 logMAR), but near and intermediate vision was limited (uncorrected near visual acuity [UNVA] 0.54, uncorrected intermediate visual acuity 0.64 logMAR). Diagnosis, Intervention, and Outcomes: The patient received bilateral RIS using the Perfect Lens femtosecond laser, creating a multifocal profile within the IOL. 1 week postprocedure, UNVA improved to 0.02 logMAR and remained stable through 3 months. Intermediate acuity improved to 0.48 logMAR, while distance vision remained excellent (corrected distance visual acuity ≤−0.18 logMAR). No adverse effects were observed. Conclusions: RIS safely and effectively enhances visual range in pseudophakic patients by modifying implanted IOL optics without additional surgery.

Purpose To demonstrate the surgical technique of the implantation of the trifocal IOL with the 7-mm large optic. Methods The retrospective case series study included 94 eyes of 59 patients who underwent the routine laser-assisted cataract surgery through 5.0 mm capsulotomy and were implanted with Triva-aXAY IOL (HumanOptics Holding AG, Erlangen, Germany) using the 3L implantation method. The 3L method consisted of three consecutive steps before and during the IOL implantation. The 3L implantation videos were analysed to determine the surgery course. The visual acuity and dysphotopsia occurrence were assessed at 6 months postoperatively. Results The mean monocular CDVA, DCIVA and DCNVA were 0.0 ± 0.04 logMAR, 0.11 ± 0.12 logMAR and 0.07 ± 0.09 logMAR. Regarding dysphotopsia, 36% of patients reported no dysphotopsia at all. ‘No or mild’ halo, glare and starburst were reported in 79%, 64% and 64% of patients, respectively. The median time of IOL implantation (IQR) was 47.5 s (39; 68 s). Conclusions The innovative 3L implantation technique enables the surgeons to implant the IOL with the large optic or bulky platform easily, safely and without additional manipulation. Video abstract in Supplement online material.

This study focuses on the analysis of the rotational stability after implantation of a biconvex aspheric toric monofocal intraocular lens (IOL) with a double C-loop haptic-design in eyes with normal versus high axial lengths. This was a prospective comparative study including 150 eyes with corneal astigmatism (≥0.75D) implanted with the biconvex aspheric monofocal PODEYE toric IOL and assessed up to 1 year after surgery. From these 150 eyes, 81 and 69 eyes belonged to normal (≤23.9mm) and high (≥24mm) axial lengths, respectively. About 4–6 and 11–13 months postoperatively, refraction and rotational stability of the PODEYE toric IOL were evaluated to find possible differences among both groups. At the last postoperative-visit, 74.07% of eyes were within ±0.50D and 95.06% of eyes were within ±1.00D of the target-refraction for the normal group and 92.75% and 100% for the high axial length group, respectively. For the normal group, 77.78% and 96.30% of eyes had a postoperative refractive cylinder of ≤0.50D and ≤1.00D, respectively; and for the high axial length group these percentages were 84.05% and 100%, respectively. About 81.84% of eyes in the normal and 94.20% of eyes in the high axial length group were <5 degrees of the intended axis. The mean IOL rotation was 2.93 ± 2.48 degrees in the normal axial length group, and 2.17 ± 1.73 degrees in the high axial length group. Based on the mixed ANOVA results, there is no evidence of a significant difference in IOL rotation over time, nor is there evidence that axial length plays a statistically significant role in rotational stability between 4–6 and 11–13 months postsurgery. Both groups exhibited similar and stable rotation outcomes. Our results reveal that the biconvex aspheric monofocal PODEYE toric IOL with double C-loop haptic-design shows excellent rotational stability without significant differences between eyes with normal and high axial lengths.

As an addition to the original publication

Purpose: This study aimed to evaluate one-year clinical outcomes in cataract patients with pre-existing corneal astigmatism implanted with a biconvex aspheric toric monofocal intraocular lens (IOL) with a double C-loop haptic-design. Methods: One hundred and eighteen patients (236 eyes) with corneal astigmatism (≥ 0.75D) were implanted bilaterally with the PODEYE toric IOL and assessed up to 1-year after surgery. Postoperative evaluation included monocular and binocular uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), under both photopic and mesopic lighting conditions, refraction, photopic and mesopic contrast sensitivity (with and without glare), and rotational stability. Results: At the last postoperative visit, 74.6% and 95.8% of eyes were within ± 0.50D and ± 1.00D of the target refraction, respectively. About 78.0% and 97.5% of eyes showed a postoperative refractive cylinder of ≤ 0.50D and ≤ 1.00D, respectively. The mean manifest spherical equivalent value was 0.16± 0.40D, and the mean refractive cylinder value was − 0.42± 0.33D. 97.5% and 100% of patients had a binocular UDVA and CDVA of ≥ 20/32, respectively. The mean binocular UDVA and CDVA were 0.01± 0.09 and − 0.03± 0.07 logMAR, respectively. Under mesopic conditions, 79.5% and 89.8% of patients showed a binocular UDVA and CDVA of ≥ 20/32, respectively. The mean binocular UDVA and CDVA were 0.15± 0.11 and 0.10± 0.10 logMAR, respectively. Binocular contrast sensitivity function both under photopic and mesopic conditions was good. The mean absolute IOL rotation was 2.52± 2.59 degrees with 98.56% of eyes having a rotation of less than 10 degrees. Conclusion: Bilateral implantation of an aspheric toric monofocal IOL with a double C-loop haptic design in cataract patients with corneal astigmatism provides good visual and refractive outcomes up to 1-year post-surgery.

Purpose: To show the visual and refractive outcomes in cataract patients with corneal astigmatism when bilaterally implanted with a biconvex aspheric toric monofocal intraocular lens (IOL) with a double C-loop haptic-design. Methods: Forty-seven cataract patients (94 eyes) with corneal astigmatism (≥ 0.75D) were implanted with the monofocal PODEYE toric IOL and assessed for 4– 6 months post-surgery. Measurements included monocular and binocular uncorrected-distance visual acuity (UDVA) and corrected-distance visual acuity (CDVA), under both photopic and mesopic lighting conditions. Refraction, photopic and mesopic contrast sensitivity (with and without glare), and rotational stability were also recorded at the last postoperative visit. Results: At 4– 6 months, 78.2% and 98.9% of eyes were within ± 0.50D and ± 1.00D of the target refraction, respectively. The mean spherical equivalent and refractive cylinder values were 0.09± 0.35D and − 0.36± 0.35D, respectively. 76.5% and 98.8% of eyes presented a postoperative refractive cylinder of ≤ 0.50D and ≤ 1.00D, respectively. 91.5% and 100% of patients had a binocular UDVA and CDVA of ≥ 20/25, respectively. The mean binocular UDVA and CDVA were 0.02± 0.08 and − 0.02± 0.07 logMAR, respectively. Under mesopic conditions, 78.7% and 83.0% of patients presented a binocular UDVA and CDVA ≥ 20/32, respectively. The mean binocular UDVA and CDVA were 0.15± 0.11 and 0.12± 0.11 logMAR, respectively. The patients showed good contrast sensitivity under photopic and mesopic conditions. The mean absolute IOL rotation was 1.22± 2.21 degrees with 97.87% of eyes having a rotation of < 10 degrees. Conclusion: This study shows good visual and refractive outcomes for the PODEYE toric IOL when implanted bilaterally in cataract patients with corneal astigmatism.