Ab interno gel implant in patients with primary open angle glaucoma and pseudoexfoliation glaucoma

Purpose: To compare efficacy and safety results of an ab interno gel implant in patients with pseudoexfoliation glaucoma (PXG) and primary open angle glaucoma (POAG). Methods: Retrospective analysis of the medical records of 110 consecutive eyes with open angle glaucoma who had received a XEN45 gel implant between March 2014 and June 2015. Intraocular pressure course, number of glaucoma medications, the need for additional intervention (including needling) and complications were evaluated until 12 months postoperatively. Results: Data of 67 eyes with POAG and 43 eyes with PXG were analyzed. At 12 months postoperatively, the mean IOP had significantly decreased by 54.0% from preoperatively 31.85 ± 8.5 mmHg to 13.99 ± 2.6 mmHg in the POAG group, (p = 0.000; Wilcoxon test), and by 55.2% from 31.63 ± 9.0 mmHg to 13.28 ± 3.1 mmHg in the PXG group (p = 0.000; Wilcoxon test). The mean number of anti-glaucoma medications had significantly decreased from 3.25 ± 0.8 at baseline to 0.3 ± 0.7 medications at 12 months postoperatively in POAG eyes (p = 0.000; Wilcoxon test), and from 3.05 ± 1.0 to 0.3 ± 0.6 medications in PXG eyes (p = 0.000; Wilcoxon test). Hypotony (IOP ≤ 6 mmHg) was observed in 2 POAG eyes (3.0%) and in 5 PXG eyes (11.7%) at 1 month but normalized in all eyes at 12 months postoperatively. Severe complications were not observed. No statistically significant differences were found between PXG eyes and POAG eyes. Conclusion: Our data indicate that the XEN45 gel implant provides significant and comparable reduction in IOP and anti-glaucoma medication during the one-year follow-up period in POAG as well as PXG eyes. This suggests that it may be a noteworthy alternative to traditional filtering procedures in patients with POAG and PXG respectively

Simulations of Decentration and Tilt of a Supplementary Sulcus-Fixated Intraocular Lens in a Polypseudophakic Combination Using Ray-Tracing Software

This study aimed to assess image quality after the tilt and decentration of supplementary intraocular lenses (IOLs) in a two-lens configuration. One was designed for sulcus fixation with a nominal power range of 1D–10D and was combined with a capsular fixation 20D IOL. The optical performance of a ray-tracing model was tested under IOL misalignment through the area under the modulation transfer function (MTFa) and wave aberrations. Tilting by 10° resulted in a 4% reduction of the MTFa for a 10D IOL as compared to 9% for the 20D lens. The two models demonstrated good tolerance to a 1 mm decentration; as for the 10D sulcus-fixated lens, the MTFa loss was 2%, and 4% for the capsular fixation lens. Coma and astigmatism increased three- and four-fold, respectively, after a 10° tilt compared to the aberration level induced by the 1 mm decentration. Both analyses showed a trend towards a lower MTF impact and fewer optical errors with decreasing nominal power. In conclusion, when misaligned, low-power sulcus-fixated IOLs might retain their good optical quality. An extreme tilt of 10° has a more detrimental effect on the IOL performance than a 1 mm decentration. The proper alignment of a high-power capsular fixation lens is important in achieving a desirable postoperative outcome

Laboratory analysis and ray visualization of diffractive optics with enhanced intermediate vision

Background!#!To assess the optical behavior of a new diffractive intraocular lens (IOL) and compare its performance to that of an established extended-depth-of-focus (EDOF) IOL.!##!Methods!#!This study assessed the Proming EDOF Multifocal AM2UX [Eyebright Medical Technology (Beijing) Co., Ltd., China] and the AT LARA 829MP [Carl Zeiss Meditec, Germany]. An experimental set-up with 0.01% fluorescein solution and monochromatic light (532 nm) was used to visualize the IOLs' ray propagation. In addition, the optical quality of the IOLs was assessed by measuring the modulation transfer function (MTF) values at 50lp/mm and 3.0 and 4.5 mm apertures on the optical bench OptiSpheric® IOL PRO II [Trioptics GmbH, Germany].!##!Results!#!The ray propagation of the two IOLs showed two distinct foci. Light intensity assessment revealed that both IOLs allocate more energy to primary than secondary focus. At 3.0 mm pupil, the MTF values at 50lp/mm for the primary focus were 0.39 and 0.37, and for the secondary focus, 0.29 and 0.26 for the AT LARA and Proming IOLs, respectively. At 4.5 mm pupil, the single-frequency MTF for the primary focus was 0.51 and 0.24 and for the secondary focus 0.21 and 0.15 for the AT LARA and Proming IOLs, respectively.!##!Conclusions!#!When tested with an aberration-free model cornea under monochromatic conditions, the Proming behaved as a low-add bifocal lens; however, its properties did not differ much from the well-established AT LARA EDOF IOL. The AT LARA outperformed the Proming at low defocus (up to 2D), while the latter demonstrated better image quality in the 2-3D range

Automatic Quantitative Assessment of Lens Opacities Using Two Anterior Segment Imaging Techniques: Correlation with Functional and Surgical Metrics

The purpose of this study is to quantitatively assess lens opacity, using a swept-source optical coherence tomography (SS-OCT) device for anterior segment assessment, and establish the correlation with Scheimpflug imaging, corrected distance visual acuity (CDVA) and cumulative dissipated energy (CDE). This prospective cross-sectional single-center study enrolled 51 patients (51 eyes) with crystalline lens opacity. Patients with previous ocular surgery, pathologies or general disorders affecting vision were excluded. Eyes were scanned with an SS-OCT device, and lens densitometry was automatically analyzed using a custom MATLAB script which examined lens density, nuclear density and linear density. The same analyses were performed on Scheimpflug images. Preoperative CDVA and CDE during phacoemulsification were recorded. Spearman’s (ρ) and Pearson’s (r) correlation coefficients were assessed according to data normality. Statistically significant correlations were established between SS-OCT and Scheimpflug imaging using lens analysis (ρ = 0.47, p < 0.001), nuclear analysis (ρ = 0.73, p < 0.001) and linear analysis (r = 0.44, p < 0.001). A significant correlation with CDE was found with all the SS-OCT methods (r = 0.57, p < 0.001). Only the nuclear analysis of the SS-OCT scans (Tb = −0.33, p < 0.01) and Pentacam Nucleus Staging (Tb = −0.26, p < 0.05) showed a statistically significant correlation with CDVA. Good inter-device agreement in lens densitometry was found. However, SS-OCT yielded improved lens imaging compared with the Scheimpflug device and a higher correlation with clinical parameters. Thus, high-resolution SS-OCT has the potential to become a preferable option for automatic cataract grading and preoperative planning

Bilateral trifocal IOL implantation in a pediatric case of cataract following steroid-therapy for acute lymphoblastic leukemia

Purpose: To present the case of a 9-year-old child with bilateral posterior subcapsular cataract developed through steroid treatment for acute lymphoblastic leukemia. Cataract surgery with trifocal intraocular lens implantation was performed in both eyes. Observations: Uncorrected distance visual acuity increased from +0.3 and + 0.4 logMAR preoperatively to 0.00 and + 0.04 logMAR after surgery. Binocular uncorrected values for intermediate and near visual acuity were −0.04 logMAR and 0.02 logMAR after surgery, respectively. The patient did not report side effects like halos or glare and was able to participate in his daily activities (school and sports) without spectacles. Conclusions and Importance: This report represents the first description of a bilateral implantation of trifocal intraocular lenses in a pediatric cataract case with restoration of visual function in far, intermediate and near distance. Trifocal intraocular lenses to compensate for the loss of accommodation can be an option in selected cases of children with cataract. Keywords: Pediatric cataract surgery, Trifocal IOL, Leukemia, Steroid-induced catarac

Ray propagation imaging and optical quality evaluation of different intraocular lens models.

PURPOSE:Ray propagation visualization and optical performance analysis of four different intraocular lenses (IOLs). METHODS:In this laboratory study, four IOLs with different optical designs were assessed: a monofocal AcrySof IQ SN60WF [Alcon], a diffractive-refractive bifocal AcrySof IQ Restor SN6AD1 [Alcon], a diffractive trifocal AcrySof IQ PanOptix TFNT00 [Alcon], and a diffractive extended-depth-of-focus (EDOF) Symfony ZXR00 [Johnson&Johnson]. An experimental set-up with a water bath containing 0.01% fluorescein solution and monochromatic green laser light (532 nm) was used to visualize the propagation of light rays. Also, the optical performance of the IOLs was evaluated by measuring the modulation transfer function (MTF) values at a pupil sizes of 3.0 and 4.5 mm on the optical bench OptiSpheric® IOL PRO II (Trioptics GmbH, Germany). RESULTS:Both the diffractive-refractive bifocal IOL and the EDOF IOL showed two defined foci for distance and near vision. In the diffractive trifocal IOL, three distinct foci for distance, intermediate, and near vision could be visualized. CONCLUSIONS:The ray propagation visualization technique allows a qualitative assessment and comparison of light energy distribution between different IOL models. The measured Through-Focus Response (TFR) quantitatively confirmed the evaluated ray propagation behavior

Correction: Ray propagation imaging and optical quality evaluation of different intraocular lens models.

[This corrects the article DOI: 10.1371/journal.pone.0228342.]

Aesthetics of iris reconstruction with a custom-made artificial iris prosthesis.

Patients with large iris defects not only suffer from functional disadvantages but also from aesthetic limitations. The aim of this study was to evaluate the aesthetic outcome of iris reconstruction using an artificial iris (AI). In this study, 82 eyes of 79 consecutive patients with mostly traumatic partial or total aniridia that underwent iris reconstruction surgery using a custom-made silicone AI (HumanOptics, Erlangen, Germany). Pre- and postoperative photographs of 66 patients were analysed subjectively and objectively. Subjective evaluation was based questionnaires. Objective evaluation included measurement of pupil centration and iris colour analysis. Averaged hues from iris areas were transferred to numerical values using the LAB-colour-system. Single parameters and overall difference value (ΔE) were compared between AI and remaining iris (RI), as well as AI and fellow eye iris (FI). Patients, eye doctors and laymen rated the overall aesthetic outcome with 8.9 ±1.4, 7.7 ±1.1 and 7.3 ±1.1 out of 10 points, respectively. Mean AI decentration was 0.35 ±0.24 mm. Better pupil centration correlated with a higher overall score for aesthetic outcome (p<0.05). The AI was on average 4.65 ±10 points brighter than RI and FI. Aniridia treatment using a custom-made artificial iris prosthesis offers a good aesthetic outcome. Pupil centration was a key factor that correlated with the amount of aesthetic satisfaction. The AI was on average slightly brighter than the RI and FI

Development and Verification of an Adjustment Factor for Determining the Axial Length Using Optical Biometry in Silicone Oil-Filled Eyes

The aim of this prospective clinical study was to establish and verify an adaptation for axial length (AL) measurement in silicone oil (SO)-filled pseudophakic eyes with a Scheimpflug and partial coherence interferometry (PCI)-based biometer. The AL was measured with a Pentacam AXL (OCULUS Optikger&auml;te GmbH, Wetzler, Germany) and IOLMaster 700 (Carl Zeiss Meditec, Jena, Germany). The coefficients of variation (CoV) and the mean systematic difference (95% confidence interval (CI)) between the devices were calculated. After implementing a setting for measuring AL in tamponaded eyes with a Pentacam based on data of 29 eyes, another 12 eyes were examined for verification. The mean AL obtained with the Pentacam was 25.53 &plusmn; 1.94 mm (range: 21.70 to 30.76 mm), and with IOLMaster, 24.73 &plusmn; 1.97 mm (ranged 20.84 to 29.92 mm), resulting in a mean offset of 0.80 &plusmn; 0.08 mm (95% CI: 0.77, 0.83 mm), p &lt; 0.001. The AL values of both devices showed a strong linear correlation (r = 0.999). Verification data confirmed good agreement, with a statistically and clinically non-significant mean difference of 0.02 &plusmn; 0.04 (95% CI: &minus;0.01, 0.05) mm, p = 0.134. We implemented a specific adaptation for obtaining reliable AL values in SO-filled eyes with the Pentacam AXL

Visualization of Forward Light Scatter in Opacified Intraocular Lenses and Straylight Assessment

Background: Qualitative visualization of forward light scatter and quantitative straylight measurement of intraocular lenses (IOLs). Methods: We analyzed two calcified IOL-explants, the Euromaxx ALI313Y (Argonoptics GmbH) and the LS-312 MF30 (Oculentis BV), one IOL with artificially induced glistenings (PC-60AD, Hoya), and one control (CT Asphina 409MP, Carl Zeiss Meditec AG) free of any opacification. Analysis included light microscopy, qualitative light scatter visualization using ray propagation imaging technique, and quantitative straylight measurement using C-Quant (Oculus). Results: More light scattering effect—visible as increased light intensity outside the IOL’s main focus—was evident in all opacified IOLs than the control. The highest straylight levels were observed in the Euromaxx (289.71 deg2/sr), which showed extensive granular deposits throughout its optic, followed by the MF30 (78.58 deg2/sr), which only showed opacification in its center. The glistenings-IOL demonstrated numerous microvacuoles within the optic and had straylight levels of 22.6 deg2/sr, while the control showed the lowest straylight levels (1.7 deg2/sr). Conclusions: Ray propagation imaging technique allowed qualitative assessment of off-axis veils of light that result from increased forward light scattering. Straylight was increased in all opacified lenses compared to the clear control lens. The IOL opacifications are significant sources of glare