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Purpose: To analyze ocular wavefront error and corneal asphericity (Q) in patients treated with aspheric profile photorefractive keratectomy (PRK) compared with patients having conventional PRK to correct myopia and myopic astigmatism and to evaluate the effect of postoperative corneal shape on visual performance. Setting: Eye Clinic, University G. d''Annunzio, Chieti-Pescara, Italy. Methods: Fifty eyes were treated with aspheric profile PRK using the MEL 80 flying-spot excimer laser, and 24 eyes were treated with standard PRK using the MEL 70 flying-spot excimer laser. Results: Postoperative wavefront error increased in both groups. Six months after surgery, there was a smaller increase in root mean square (RMS) of total higher-order aberrations and spherical aberration (59% and 106%, respectively) in the aspheric profile PRK group than in the conventional PRK group (94% and 136%, respectively) (P<.01).The aspheric profile PRK group showed more prolate corneal asphericities (mean Q of 0.15 ± 0.26) than the conventional group (mean Q of 0.45 ± 0.26) (P<.001), with increasing oblateness for higher attempted corrections. A higher percentage of patients with better low-contrast uncorrected visual acuity and best corrected visual acuity was observed in the aspheric PRK group than in the conventional PRK group (P<.05). Conclusions: Aspheric profile and conventional PRK were safe and efficient for the correction of myopia and myopic astigmatism. Moreover, aspheric profile PRK induced a smaller increment of total wavefront error, was related to a smaller increase in spherical aberration, and better maintained the physiology of the corneal surface than conventional treatment. [Copyright &y& Elsevier]

A 34-year-old woman had posterior chamber phakic intraocular lens (PCP IOL) implantation to correct high myopia in both eyes. Five years postoperatively, the patient presented with a decrease in visual acuity from central anterior subcapsular cataract formation in both eyes and IOL dislocation in the left eye. In vivo confocal microscopy of the cornea showed markedly decreased endothelial cell density in both eyes and the presence of bright endothelial microdeposits possibly related to pigmentary dispersion. Gonioscopy showed angle pigmentary deposits with no intraocular pressure increase. The patient was successfully treated by removing the PCP IOLs and performing phacoemulsification with in-the-bag IOL implantation in both eyes. This led to a recovery of visual acuity. This case report presents the rare occurrence and surgical management of cataract formation, IOL dislocation, and severe endothelial cell loss as a late complication of PCP IOL implantation. [Copyright &y& Elsevier]

: PurposeTo compare the near functional capacities of patients with an accommodating intraocular lens (IOL) with those of patients with a conventional monofocal IOL.: SettingDepartment of Ophthalmology, University of Chieti, Chieti, Italy.: MethodsThis prospective double-blind case-control study comprised 42 eyes that had phacoemulsification and implantation of 1 of 2 types of IOLs: HumanOptics accommodating 1CU® (study group) and Eurocrystal IFP 3G 6.00 (control group). The main outcome measures were subjective refraction, uncorrected distance acuity, best corrected distance acuity, distance corrected near acuity at 40 cm, best corrected near acuity at 40 cm, and subjective amplitude of accommodation. Patients were examined 7, 30, 90, and 180 days after surgery.: ResultsPostoperatively, both groups had excellent uncorrected distance acuity, best corrected distance acuity, and best corrected near acuity. In the study group, the mean distance corrected near acuity (Jaeger) was 5.43 ± 0.98 (SD) (range 4 to 7) at 7 days, 2.33 ± 0.48 (range 2 to 3) at 1 and 3 months, and 3.66 ± 2.12 (range 2 to 7) at 6 months. In the control group, the mean distance corrected near acuity was 7.43 ± 0.50 (range 7 to 8) during the entire follow-up. The differences between the groups was statistically significant (P<.001). The mean amplitude of accommodation was 0.00 diopter (D) in the control group and 1.14 ± 0.44 D (range 0.75 to 2.00 D) in the study group at 7 days, 2.36 ± 0.28 D (range 2.00 to 2.75 D) at 30 and 90 days, and 1.90 ± 0.77 D (range 0.75 to 2.75 D) at 6 months.: ConclusionsThe 1CU accommodating IOL provided better useful spectacle-free near visual acuity than the conventional monofocal IOL. However, the accommodating mechanism can play a role in capsule fibrosis. [Copyright &y& Elsevier]

Purpose: To evaluate the formation of glistenings in foldable intraocular lenses (IOLs) of various materials after cataract surgery.Setting: University Eye Clinic of Trieste, Trieste, Italy.Methods: In this prospective study, 273 patients were randomized to have implantation of 1 of 7 types of foldable IOLs in the capsular bag after phacoemulsification. The IOLs were the CeeOn® Edge 911A (Pharmacia & Upjohn Co.), ACR6D® (Corneal), AcrySof® (Alcon), SI-40NB (AMO), Hydroview® H60M (Storz), Sensar® (AMO), and Stabibag® (Ioltech). The presence of glistenings in the IOL optic was assessed by slitlamp evaluation 7, 30, 90, 180, 360, and 720 days after surgery. The glistenings were graded at each control.Results: Glistenings were observed in all IOL groups. The percentage of patients with glistenings ranged from 40.0% to 67.5%, with the percentage increasing up to 90 days after surgery and then becoming stable in most groups. The AcrySof group had a continuous increase over time. The mean grade of glistenings increased up to 180 days after surgery and then became stable in most groups. The AcrySof and 911A groups had a continuous increase over time.Conclusions: Glistening formation was observed in 7 different foldable IOLs. The AcrySof group had a higher percentage and a greater density of glistenings. [Copyright &y& Elsevier]

Purpose: To assess the biocompatibility of 3 hydrophilic acrylic intraocular lenses (IOLs) by evaluating the postoperative cell reaction on the IOL surface, anterior capsule opacification (ACO) rate, and presence of membrane growth over the anterior IOL surface.Setting: University Eye Clinic of Trieste, Trieste, Italy.Methods: In this prospective study, 73 patients were randomized to receive 1 of 3 types of hydrogel IOLs after phacoemulsification: Storz Hydroview H60M, Corneal ACR6D, or Ioltech Stabibag. To analyze and photograph the anterior IOL surface, slitlamp biomicroscopy and specular microscopy were performed 7, 30, 90, and 180 days after surgery. Small, epithelioid, and giant inflammatory cell reaction was evaluated. In addition, ACO and membrane growth on the anterior IOL surface were assessed.Results: Low inflammatory cell adhesion was observed on the anterior surface of all 3 IOLs. The Stabibag group had a significantly higher grade of small inflammatory cell reaction 7 and 30 days after surgery. A significantly higher rate of ACO was observed in the ACR6D group. The Hydroview and ACR6D groups had a significantly higher percentage of membrane growth from the capsulorhexis edge onto the anterior IOL surface than the Stabibag group.Conclusions: Clinically, the 3 hydrophilic IOLs behaved in a different manner, showing the different forms of biocompatibility. Results indicate that a different chemical composition determines correspondingly different protein absorption on IOL surfaces. This might result in a different adhesion pattern and spreading of lens epithelial and inflammatory cells. [Copyright &y& Elsevier]

A 78-year-old cataract patient with horizontal jerk nystagmus had phacoemulsification and intraocular lens (IOL) implantation in the capsular bag with continuous curvilinear capsulorhexis. One week postoperatively, the posterior capsule ballooned posteriorly, the anterior capsule opening was sealed to the IOL optic, and a transparent liquefied substance accumulated between the lens optic and the posterior capsule. The best corrected visual acuity was 0.6 with a myopic shift compared with the refraction after the first day. A neodymium:YAG laser posterior capsulotomy was performed, and the capsular block syndrome (CBS) resolved. The results confirm the experimental model proposed by Zacharias suggesting that saccadic eye movements contribute to CBS under certain anatomic conditions. [Copyright &y& Elsevier]