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PURPOSE: To evaluate the clinical results and safety obtained with a new type of multifocal intraocular lens (IOL) using a trifocal design to achieve pseudoaccommodation. METHODS: A pilot observational study of patients with a trifocal IOL (FineVision; PhysIOL, Liege, Belgium) implanted by 1 of 12 surgeons between March and December 2010. Visual outcomes that were assessed postoperatively included uncorrected and corrected distance, intermediate, and near visual acuity. RESULTS: One hundred ninety-eight eyes of 99 patients were analyzed. Patients were observed for an average of 6.44 ± 4.67 months (range: 0.2 to 17 months). Preoperative corrected distance visual acuity was 0.22 ± 0.26 logMAR. At the final follow-up visit, corrected distance visual acuity was 0.01 ± 0.10 logMAR, uncorrected distance visual acuity was 0.01 ± 0.06 logMAR, uncorrected intermediate visual acuity was 0.08 ± 0.10 logMAR, and mean uncorrected near visual acuity was 0.00 ± 0.04 logMAR. Postoperative binocular uncorrected distance visual acuity was 0.01 ± 0.07 logMAR, uncorrected intermediate visual acuity was 0.06 ± 0.08 logMAR, and uncorrected near visual acuity was −0.03 ± 0.04 logMAR. Postopeative mean residual sphere was 0.21 ± 0.48 diopters (D), with a residual cylinder of −0.24 ± 0.31 D. Postoperative spherical equivalent was 0.11 ± 0.36 D. CONCLUSIONS: The results demonstrated that the trifocal FineVision IOL is able to restore near, intermediate, and distance visual function. [[ J Refract Surg . 2014;30(11):762–768.]

Rationale Nd:YAG (neodymium:yttrium-aluminum-garnet) capsulotomy ( Nd:YAG-caps ) is the gold standard for the treatment of PCO (Posterior Capsule Opacification). There is a lack of real-world data about Nd:YAG-caps use. Purpose This study’s objectives were to estimate Nd:YAG-caps incidence in France, to describe the patient characteristics, and to analyze the time between surgeries and capsulotomies. Setting: The study was based on data extracted from the EGB database, a 1/97th sample representative of the French population. Design: observational, retrospective, cohort study using national claims data. Methods French adult patients who underwent Nd:YAG-caps between 2014 and 2017 were selected. Main outcomes were the number of patients and procedures performed and the risk factors associated with early Nd:YAG-caps . Results: During the study period, Nd:YAG-caps were performed in 8,425 patients accounting for 10,774 procedures. The extrapolation to the French population led to estimate that 253.10 3 patients had Nd:YAG-caps , representing 312.10 3 procedures in 2017. The mean age at Nd:YAG-caps was 75.1 (± 10.2) years. About 36% of patients presented at least one ocular comorbidity. Nd:YAG-caps was performed within 2 years after surgery in 33.0% of patients and within one year in 9.8% of patients. Patients with Nd:YAG-caps within the first year (OR CI95 0.721 [0.673–0.772]) or in the first two years (OR CI95 0.721 [0.673–0.772]) were younger than patients with later Nd:YAG-caps and had a more frequent history of treated ocular diseases (OR 1.516 and 1.178, respectively). Conclusions This study brought new real-world and large-scale data regarding Nd:YAG-caps use and gave an updated insight into the patients’ characteristics.

ObjectiveWe assessed whether the immediate pressure adjustments provided by a phacoemulsification handpiece with a built-in pressure sensor (Active Sentry, AS) could decrease the amount of energy delivered in the eye during cataract surgery.Methods and analysisThe Study of Active Sentry in Cataract Surgery was a multicentre prospective clinical trial. The Centurion system (Alcon Labs) was used and we compared phacoemulsifications performed with the AS handpiece with procedures using a sensor placed in the phacoemulsifier (non-AS). The primary outcome measure was the cumulative dissipated energy (CDE) used during the procedures. The secondary outcome measures were the total, longitudinal and torsional ultrasound (US) times, the duration of the surgery and the amount of fluid used during the surgeries.ResultsThe study analysed 1432 (800 AS and 632 non-AS) procedures. The mean patient age was 72.4±10.0 years. The median CDE was respectively 6.3 (IQR 3.5–9.9) and 6.7 (IQR 4.5–11.5) with and without AS (p=0.0001). The median US time was, respectively, 48.0 s (IQR 34.0–68.0) and 55.0 s (IQR 38.0–80.0) with and without AS (p<0.0001). Torsional and longitudinal US times were reduced with AS. The median duration of the procedure was, respectively, 9.0 min (IQR 7.0–12.0) and 10.0 min (IQR 7.0–13.0) (p=0.0002) with and without AS. The median balanced salt solution volume used was 52.0 cm3 (IQR 41.0–72.0) and 57.0 cm3 (IQR 42.0–81.0) with and without AS (p=0.0018).ConclusionThe phacoemulsifications performed with a pressure sensor built in the handpiece delivered less energy in the eye and were shorter.Trial registration numberNCT04732351.

The purpose of this study was to record the visual outcomes of patients treated by six surgeons after implantation of a trifocal lens. The setting for this study comprised six ophthalmology units and eye clinics in Belgium and France, with a coordinating center in France, and data management and statistical analysis in France and Belgium. Ninety-four eyes from 47 patients were implanted with a trifocal FineVision(®) intraocular lens by six surgeons. Monocular and binocular, uncorrected and best distance-corrected, and photopic and mesopic visual acuity was measured, as well as the defocus curve between +4 D and -4 D with best distance correction. Near and far monocular visual acuities were similar to the data published after bifocal intraocular lens implantation. Intermediate vision was improved, and was demonstrated by scores of near visual acuity as well as far visual acuity with defocus -1.5 D-add lens. Far vision is maintained in mesopic conditions. The trifocal intraocular lens provides good far, intermediate, and near visual acuity.

The objective of this study was to compare systemic exposure to tropicamide/phenylephrine following intracameral or topical administration before cataract surgery. Mydriatics exposure was calculated in patients randomized to intracameral fixed combination of mydriatics and anesthetic ([ICMA]: tropicamide 0.02%, phenylephrine 0.31%, and lidocaine 1%, N=271) or mydriatic eye drops ([EDs]: tropicamide 0.5% and phenylephrine 10%, N=283). Additional doses were permitted if required. Mydriatic plasma levels were determined by mass spectrometric HPLC in 15 patients per group before and after administration. Most ICMA patients (73.6%) received a single dose (200 µL) representing an exposure to tropicamide of 0.04 mg and phenylephrine of 0.62 mg. None of these patients received additional mydriatics. In the control group (three administrations), the exposure was 0.45 (11.3-fold higher than ICMA) and 10.2 (16.5-fold higher) mg. When additional ED was used in this group (9.2% of patients), it was 37.5-fold higher for tropicamide (10 drops, 1.5 mg) and 54.8-fold higher for phenylephrine (10 drops, 34 mg) than the recommended ICMA dose. Tropicamide plasma levels were not detectable at any time point in ICMA patients while it was detectable in all ED patients at 12 and 30 minutes. Phenylephrine was detectable in 14.3% of ICMA patients compared to all ED patients at least at one time point. More ED patients experienced a meaningful increase in blood pressure and/or heart rate (11.2% vs 6.0% of ICMA patients; =0.03). Systemic exposure to tropicamide/phenylephrine was lower and cardiovascular (CV) effects were less frequent with ICMA. This could be of particular significance in patients at CV risk.