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Introduction: This study evaluated 7-year effectiveness and safety of second-generation trabecular micro-bypass implantation (iStent inject) either in combination with cataract surgery or as a standalone procedure (Combined or Standalone subgroups, respectively) in eyes with open-angle glaucoma., Methods: This prospective, non-randomized, unmasked, longitudinal study included 125 consecutive iStent inject cases of a single surgeon at a large German academic hospital. Patients had considerable preoperative disease burden, with mean intraocular pressure (IOP) of 23.5 mmHg, 84.8% of eyes on ≥ 2 medications, and 38.4% of eyes with prior glaucoma surgery. IOP, medications, adverse events, and secondary surgeries were assessed through 7 years in the Overall cohort and in Combined (n = 81) and Standalone (n = 44) subgroups., Results: Over 7-year follow-up, mean IOP decreased by 36.2-40.0% in Overall eyes, 34.1-38.9% in Combined eyes, and 39.5-43.5% in Standalone eyes (p < 0.001 at all timepoints for all groups). Meanwhile, mean medications decreased by 59.3-71.3% in Overall eyes, 57.9-69.0% in Combined eyes, and 62.1-76.2% in Standalone eyes (p < 0.001 at all timepoints in all groups). At last follow-up (mean 77.4 months; 92.8% of patients with last visit at 6 or 7 years), 83.7% of Overall eyes, 82.3% of Combined eyes, and 86.4% of Standalone eyes had achieved ≥ 20% IOP reduction vs preoperative. At last follow-up vs preoperative, 100% of eyes in all groups had the same or lower IOP and 100% had the same or lower medication regimen. Safety outcomes were favorable, with no filtration surgeries and only 4.84% of eyes experiencing clinically significant visual field loss over 7 years of follow-up., Conclusion: iStent inject implantation with or without phacoemulsification produced significant and durable 7-year reductions in IOP (~ 34-44% reduction) and medications (~ 58-76% reduction) while preventing filtering surgery in this cohort of patients with relatively high preoperative disease burden. Combined and Standalone cases had similarly favorable effectiveness and safety., (© 2024. The Author(s).)

Introduction: This study evaluated the 5-year effectiveness and safety of iStent inject ® trabecular micro-bypass with or without cataract surgery (Combined or Standalone, respectively) in patients with open-angle glaucoma (OAG)., Methods: This prospective longitudinal case series included consecutive iStent inject cases from a single surgeon at a large German academic hospital. Intraocular pressure (IOP), medications, safety, and indicators of disease stability through 5 years were assessed in the Overall cohort and in subgroup analyses stratified by usage (Combined or Standalone)., Results: Preoperative mean IOP in the Overall cohort (n = 125) was 23.5 ± 6.2 mmHg on 2.68 ± 1.02 mean medications, reducing to 14.1 ± 1.8 mmHg on 0.77 ± 0.82 medications at 5 years (40% and 71% reductions, respectively; both p < 0.001). All but 1 eye (> 99%) were on medication(s) preoperatively, but 46% were medication-free at 5 years (p < 0.001). In Combined eyes (n = 81), mean IOP decreased by 39% (22.6 mmHg to 13.8 mmHg, p < 0.001) and medications by 69% (2.52 to 0.78, p < 0.001). In Standalone eyes, mean IOP reduced by 42% (25.3 mmHg to 14.6 mmHg, p < 0.001) and medications by 75% (2.98 to 0.74, p < 0.001). At final follow-up, 83% of eyes had achieved ≥ 20% IOP reduction, and all but 1 eye (> 99%) had the same or lower IOP versus preoperative; all eyes (100%) maintained or reduced their medication burden versus preoperative. Favorable safety included 0 intraoperative complications and 0 filtration surgeries through 5 years. Long-term indicators of disease stability (visual fields, retinal nerve-fiber layer thickness, and cup:disc ratio) were unchanged over the course of 5-year follow-up., Conclusions: iStent inject produced significant and durable 5-year reductions in IOP (nearly 10-mmHg reduction) and medications (nearly 2-medication reduction), with stable disease parameters over time. Combined and Standalone subgroups had similar outcomes., (© 2022. The Author(s).)

Introduction: The aim of our analysis was to compare the effectiveness of the XEN45 gel stent implantation in patients without and with prior glaucoma intervention., Methods: Retrospective analysis including 148 medical records of consecutive glaucoma eyes without prior glaucoma intervention (group A, n = 45) or with prior glaucoma intervention (group B, n = 103). Follow-up data up to 12 months after XEN45 gel implantation were available for all eyes., Results: At 12 months, qualified success (IOP reduction of ≥ 20% and IOP < 18 mmHg without and with medication) was achieved in 76% of eyes in group A and in 72% of eyes in group B; corresponding values for complete success (IOP reduction of ≥ 20% and IOP < 18 mmHg without medication) were 56% and 55%. Mean IOP was significantly reduced by 58% from 36.0 ± 10.7 mmHg preoperatively to 14.2 ± 3.4 mmHg at 12 months in group A (p = 0.000) and by 53% from 31.6 ± 8.9 mmHg to 14.3 ± 4.2 mmHg and in group B (p = 0.000). The mean number of hypotensive medications had significantly decreased from 3.6 ± 0.8 at baseline to 0.3 ± 0.7 medications in group A (p = 0.000) and from 3.0 ± 1.0 to 0.3 ± 0.7 medications in group B (p = 0.000). Needling was required in 29% of eyes in group A and in 35% of group B within 12 months. No statistically significant differences were observed between eyes without and with prior glaucoma intervention., Conclusion: The 1-year results of our retrospective analysis indicate that patients without and with previous glaucoma intervention can benefit from XEN45 gel stent implantation. Both groups achieved significant and similar reductions in IOP and hypotensive medication, with a slight trend towards greater reductions in eyes without prior glaucoma intervention. Further controlled prospective studies with longer follow-ups are required., Funding: Editorial support and article processing charges were funded by Allergan.

Introduction: To evaluate long-term outcomes following stand-alone implantation of two second-generation trabecular micro-bypass stents (iStent inject ® , Glaukos Corp., San Clemente, CA, USA) in eyes with predominantly primary open-angle glaucoma (POAG) and considerable preoperative disease burden., Methods: Eyes with POAG, pseudoexfoliative glaucoma (PXG), appositional narrow-angle glaucoma (NAG, with open-angle configuration in the area of implantation), or secondary glaucoma were included in this prospective, non-randomized, consecutive case series. All eyes underwent ab interno iStent inject implantation as a sole procedure. Assessments through 36 months included IOP, medications, corrected distance visual acuity (CDVA), secondary glaucoma surgeries, and complications and adverse events., Results: Two iStent inject stents were implanted in 44 consecutive eyes (POAG = 38, PXG = 4, appositional NAG = 1, secondary neovascular glaucoma = 1) of 31 patients, and 33 eyes had 36-month follow-up data. Preoperative mean IOP was 25.3 ± 6.0 mmHg on a mean of 2.98 ± 0.88 medications, with 75% of eyes on 3-5 medications, no eyes medication-free, and 50% of eyes with history of prior glaucoma surgery. At 36 months postoperatively, mean IOP reduced by 42% to 14.6 ± 2.0 mmHg (p < 0.0001) and 87.9% of eyes achieved an IOP reduction of ≥ 20% versus preoperatively. In addition, 97% of eyes reached IOP ≤ 18 mmHg (vs. 9.1% preoperatively; p < 0.0001) and 70.0% of eyes reached IOP ≤ 15 mmHg (vs. 2.3% preoperatively; p < 0.0001). Mean medication burden decreased by 82% to 0.55 ± 0.79 (p < 0.0001), and 61% of eyes became medication-free. All eyes maintained or decreased their 36-month medication burden versus preoperatively. Safety was favorable, including minimal adverse events and stable CDVA through 36 months postoperatively., Conclusion: This real-world cohort of glaucomatous eyes with substantial preoperative disease burden experienced significant, sustained, safe IOP and medication reductions through 36 months following stand-alone iStent inject implantation., Funding: Article processing charges and writing assistance were provided by Glaukos Corp. (San Clemente, CA, USA).

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.

Introduction: The aim of this study was to assess 36-month outcomes after cataract surgery and implantation of two second-generation trabecular micro-bypass stents (iStent inject, Glaukos Corporation, San Clemente, CA, USA) into eyes with predominantly primary open-angle glaucoma (POAG) or pseudoexfoliative glaucoma (PEX)., Methods: This prospective, non-randomized, consecutive cohort study included eyes with POAG (n = 60), PEX (n = 15), appositional narrow-angle (n = 4), pigmentary (n = 1), or neovascular (secondary) (n = 1) glaucoma and cataract requiring surgery. All eyes (n = 81) underwent ab interno iStent inject implantation following cataract surgery. Effectiveness endpoints through 36 months included intraocular pressure (IOP), number of medications, and proportion of eyes with ≥ 20% IOP reduction, IOP ≤ 18 mmHg, and IOP ≤ 15 mmHg. Safety measures included corrected distance visual acuity (CDVA), adverse events, and secondary surgeries. Outcomes were evaluated for the overall cohort, and for the POAG and PEX subgroups., Results: Preoperatively, 32.1% of eyes had undergone prior glaucoma surgery, 56% were on 3-4 medications, and 1 eye (1%) was medication-free. At 36 months postoperatively, mean IOP reduced by 37% (14.3 ± 1.7 mmHg versus 22.6 ± 6.2 mmHg preoperatively), and mean medication burden decreased by 68% (0.8 ± 0.9 versus 2.5 ± 1.1 medications preoperatively). IOP reduced by ≥ 20% in 78% of eyes; 100% of eyes reached IOP ≤ 18 mmHg and 71% reached ≤ 15 mmHg. Medication burden reduced considerably: 22 eyes (54%) were medication-free compared to 1 eye (1%) preoperatively; 1 eye (2%) required ≥ 3 medications compared to 45 eyes (56%) preoperatively; and 92.7% of eyes required reduced medications postoperatively. From 3 through 36 months, mean IOP remained ≤ 15.0 mmHg, and mean number of medications remained ≤ 0.9. Outcomes in the POAG and PEX subgroups included 33% and 32% lower IOP, and 68% and 64% fewer medications, respectively. iStent inject showed a favorable safety profile, including no intraoperative complications, minimal adverse events, and a stable CDVA., Conclusion: This real-world cohort of eyes with various types of glaucoma and considerable disease burden exhibited durable and safe IOP and medication reductions through 36 months following iStent inject implantation with cataract surgery. Outcomes were similarly beneficial in eyes with POAG and PEX., Funding: Article processing charges were funded by Glaukos Corporation (San Clemente, CA, USA).

Purpose: To evaluate postoperative interventions, visual outcomes, and number of postoperative office visits after standalone ab interno gelatin microstent implantation with mitomycin C (MMC) vs. trabeculectomy with MMC., Design: International, multicenter, retrospective cohort study., Participants: A total of 354 eyes of 293 patients, including 185 microstent eyes and 169 trabeculectomy eyes., Methods: Consecutive eyes with uncontrolled glaucoma underwent microstent or trabeculectomy surgery from January 1, 2011, through July 31, 2015, at 4 academic ophthalmology centers: Toronto, Canada; Frankfurt, Germany; Salzburg, Austria; and Leuven, Belgium., Main Outcome Measures: Assessed outcomes included (1) in-clinic interventions, (2) transconjunctival needle revision (TCNR), (3) postoperative visits at 1 and 3 months, (4) >2 lines vision loss at last follow-up, (5) complete visual recovery, and (6) >0.5 or >1 diopter (D) of surgically induced astigmatism., Results: Ninety-five (51.4%) of the microstent eyes and 105 (62.1%) of the trabeculectomy eyes underwent an intervention by last follow-up (log-rank P = 0.0004). The most common intervention was TCNR, followed by laser suture lysis. Seventy-eight (42.2%) microstent eyes and 55 (32.5%) trabeculectomy eyes received TCNR (adjusted hazard ratio [HR], 1.73 [95% confidence interval (CI), 1.10-2.71]): 128 total TCNRs in the microstent group and 95 in the trabeculectomy group. Predictors for TCNR included prior laser peripheral iridotomy and diabetes. Microstent eyes had on average 1.00 (standard deviation 2.32) fewer visits compared with trabeculectomy eyes in the first month (P < 0.001), adjusted for baseline characteristics. The percentage of eyes that had lost >2 lines of vision at last follow-up or reoperation was 12.4% (95% CI, 8.0%-18.7%) and was 21.9% (95% CI, 15.3%-30.1%) adjusted (P = 0.0383). A higher proportion of microstent eyes regained their baseline preoperative visual acuity compared with trabeculectomy eyes (log-rank P = 0.0250; adjusted HR, 1.46 [95% CI, 1.10-2.00]). Altogether, 25.3% (95% CI, 15.3%-38.9%) of microstent eyes and 40.7% (95% CI, 27.7%-55.3%) of trabeculectomy eyes had > 0.5 D surgically induced astigmatism on an adjusted basis; 8.0% (95% CI, 3.2%-18.6%) vs. 17.3% (95% CI, 8.9%-9.8%) had >1 D., Conclusions: Microstent eyes had more TCNRs (though fewer in-clinic interventions), fewer postoperative visits, and less vision loss, and experienced less surgically induced astigmatism, than trabeculectomy eyes. Overall, the postoperative course was less intensive for the microstent, except for more TCNRs., (Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine the visual outcomes of the EyeMax Mono intraocular lens (IOL) technology (London Eye Hospital Pharma, London, UK), which is a foldable and injectable hydrophobic acrylic IOL implanted as an add-on solution in pseudophakic eyes with age-related macular degeneration, in a pilot study., Design: A prospective, interventional case series., Participants: A total of 22 pseudophakic eyes (11 patients) with bilateral severe or intermediate dry age-related macular degeneration (AMD) (13 eyes) or stable wet AMD or disciform scarring (9 eyes) meeting the criteria for sulcal IOL implantation., Methods: Both eyes of participating subjects underwent small-incision ciliary sulcal implantation of a hyperaspheric, soft hydrophobic acrylic intraocular lens designed to improve the quality of the retinal image in all areas of the macula ≤10° from fixation and to generate a moderate hypermetropic correction for magnification., Main Outcome Measures: The primary outcome was safety as determined by intra- and postoperative complications, raised intraocular pressure requiring medical or surgical intervention, postoperative diplopia, reduction in visual field, and loss of ≥2 lines of visual acuity. Secondary outcomes were improvements in subjective and objective visual acuity (logarithm of the minimum angle of resolution)., Results: No intraoperative complication occurred. Elevated intraocular pressure values were measured directly after the operative procedure in 2 eyes (25 mmHg and 27 mmHg) and at the 1-week postoperative visit in 1 eye (22 mmHg) but not later. The mean postoperative spherical equivalent of refraction changed to +2.5 diopters, and all eyes had gained ≥2 lines of visual improvement (corrected distance visual acuity) by 6 months after surgery. Corrected near visual acuity as well as corrected distance visual acuity improved over time, suggesting a neuroadaptive component to improved visual function with the device. Devices were implanted bilaterally in all patients, and there were no reported symptoms of dysphotopsia or diplopia., Conclusions: Safety concerns were not identified in the short-term or medium term. These results indicate the potential of the EyeMax Mono IOL to improve near and distance visual acuity in pseudophakic eyes with intermediate to severe AMD., (Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine safety and visual outcomes in eyes with age-related macular degeneration (AMD) implanted with a novel intraocular lens (IOL) that delivers an optimized retinal image to all macular areas within 10 degrees of retinal eccentricity., Methods: This was a consecutive case series of 244 eyes with dry/stable wet AMD and logMAR visual acuity ≥0.3 implanted with iolAMD Eyemax mono TM (London Eye Hospital Pharma), a single-piece, injectable, hydrophobic acrylic IOL sited in the capsular bag. Primary outcome was safety. Secondary outcomes were changes in corrected distance visual acuity (CDVA) and corrected near visual acuity (CNVA) (logMAR)., Results: Mean age at surgery was 80 years. Mean duration of follow-up was 3 months (range 1-16 months). No eyes had worsening of CDVA. Frequency of perioperative complications was equivalent to standard IOL implantation. Postoperative refractive outcomes were within ±1 D of the target refraction in 88% of cases. Mean preoperative CDVA improved from 1.06 to 0.71 postoperatively (mean of differences -0.35; 95% confidence interval [CI] -0.3886 to -0.3223; p<0.0001), equating to an approximate Early Treatment Diabetic Retinopathy Study gain of 18 letters. Mean preoperative CNVA (N-point; logMAR conversion) improved from 1.36 to 0.88 postoperatively (mean of differences -0.48; 95% CI -0.53 to -0.44; p<0.0001)., Conclusions: This novel IOL appears safe in the short to medium term. Improvements in postoperative CDVA and CNVA exceed those observed with standard implants.

Purpose: The purpose of this study is to evaluate IOP lowering effects and complication management of an ab interno gel implant for the treatment of patients refractory to antiglaucoma medication or glaucoma surgery., Methods: Retrospective analysis of the medical records of 242 consecutive eyes of 146 patients with uncontrolled intraocular pressure (IOP) despite maximum tolerated medical therapy or prior surgical intervention that underwent XEN45 implantation (as sole procedure or in combination with cataract surgery) between March 2014 and June 2015. Data included IOP, number of glaucoma medications, the need for additional surgery, needling, and complications., Results: During the study period, mean IOP had decreased by 54.1% from 32.19 (±9.1) mm Hg to 14.24 (±4.0) mm Hg (P=0.00; Wilcoxon test). The number of antiglaucoma medications had decreased from a mean of 3.13±1.0 to 0.3±0.7 (P=0.00; Wilcoxon test). Needling was required between week 1 and months 3 in 27.7% of all eyes to enhance the outflow. Hypotony (IOP<6 mm Hg) was observed in 9 eyes (4.0%) at 1 month but normalized in all eyes at 12 months postoperatively. Two eyes experienced hypotony requiring the refill of the anterior chamber., Conclusions: Our data indicate that the XEN45 gel implant has a favorable safety profile and is an effective treatment option for controlling IOP in glaucoma patients with unregulated IOP despite IOP lowering medical therapy or prior surgical intervention. It offers an effective approach, both as sole procedure and in combination with cataract surgery.

Purpose: To compare the efficacy, safety, and risk factors for failure of standalone ab interno gelatin microstent implantation with mitomycin C (MMC) versus trabeculectomy with MMC., Design: International, multicenter, retrospective interventional cohort study., Participants: Three hundred fifty-four eyes of 293 patients (185 microstent and 169 trabeculectomy) with no prior incisional surgery., Methods: Consecutive eyes with uncontrolled glaucoma underwent microstent or trabeculectomy surgery from January 1, 2011 through July 31, 2015 at 4 academic ophthalmology centers: Toronto, Canada; Frankfurt, Germany; Salzburg, Austria; and Leuven, Belgium., Main Outcome Measures: Primary outcome measure was hazard ratio (HR) of failure, with failure defined as 2 consecutive intraocular pressure (IOP) readings of <6 mmHg with vision loss or >17 mmHg without glaucoma medications (complete success) at least 1 month after surgery despite in-clinic interventions (including needling). Secondary outcome measures included IOP thresholds of 6 to 14 mmHg and 6 to 21 mmHg and same thresholds allowing for medications (qualified success), interventions, complications, and reoperations., Results: Baseline characteristics were similar, except more men (56% vs. 43%), younger patients (average, by 3 years), better preoperative visual acuity (22% vs. 32% with 0.4 logarithm of the minimum angle of resolution vision or worse), and more trabeculoplasty (52% vs. 30%) among microstent eyes. The adjusted HR of failure of the microstent relative to trabeculectomy was 1.2 (95% confidence interval [CI], 0.7-2.0) for complete success and 1.3 (95% CI, 0.6-2.8) for qualified success, and similar for other outcomes. Time to 25% failure was 11.2 months (95% CI, 6.9-16.1 months) and 10.6 months (95% CI, 6.8-16.2 months) for complete success and 30.3 months (95% CI, 19.0-∞ months) and 33.3 months (95% CI, 25.7-46.2 months) for qualified success. Overall, white ethnicity was associated with decreased risk of failure (adjusted HR, 0.49; 95% CI, 0.25-0.96), and diabetes was associated with increased risk of failure (adjusted HR, 4.21; 95% CI, 2.10-8.45). There were 117 and 165 distinct interventions: 43% and 31% underwent needling, respectively, and 50% of trabeculectomy eyes underwent laser suture lysis. There were 22 and 30 distinct complications, although most were transient. Ten percent and 5% underwent reoperation (P = 0.11)., Conclusions: There was no detectable difference in risk of failure and safety profiles between standalone ab interno microstent with MMC and trabeculectomy with MMC., (Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare histological analyses of capsulotomies from different laser systems with regard to tissue alteration, laser spot formation, and energy settings., Methods: Four femtosecond laser platforms approved for cataract surgery were evaluated: LenSx (Alcon Laboratories, Inc., Fort Worth, TX), Catalys (Abbott Medical Optics, Santa Ana, CA), Victus (Tecnolas/Bausch & Lomb, Munich, Germany), and LensAR (Topcon, Gamagori, Japan). Ten human anterior lens capsulotomy disks from each laser system were analyzed: five by means of light microscopy and five by transmission electron microscopy (TEM). TEM was used especially to examine the cellular and stromal changes at the cutting edges. The cellular demarcation line was measured at 15 points along the rim and statistically compared with the findings from all laser platforms. Three capsules of each laser platform were prepared for TEM to evaluate the cellular and tissue edges of the laser cuttings., Results: All capsulotomies revealed a circular demarcation zone of different sizes along the cutting edges. Light microscopy showed a radial tissue damage of 36.0 ± 12.3 μm after Victus laser capsulotomy, 8.9 ± 2.9 μm after Catalys laser capsulotomy, 25.2 ± 5.6 μm after LensAR laser capsulotomy, and 39.8 ± 5.1 μm after LenSx laser capsulotomy. Differences between the damaged tissue zones correlated with the laser systems and their energy settings., Conclusions: The use of less energy and larger spot separation led to smaller collateral damaged tissue areas along the cutting edges. The aberrant laser spots along the cutting edge may result in weakening of the remaining tissue, thereby enhancing the risk for capsular ruptures during surgery. [J Refract Surg. 2017;33(10):670-675.]., (Copyright 2017, SLACK Incorporated.)

Purpose: To detect changes in retinal perfusion and macular thickness using fluorescein angiography and spectral-domain optical coherence tomography (OCT) before and after implantation of a Calhoun light-adjustable intraocular lens (Calhoun Vision, Pasadena, CA) and application of profiled doses of ultraviolet light for postoperative refractive adjustments., Methods: This prospective trial of non-consecutive cases comprised 125 eyes of 125 patients who had cataract surgery and light-adjustable intraocular lens implantation. OCT examinations were performed preoperatively and postoperatively before first adjustment (10 to 14 days postoperatively) and 1 week (20 to 25 days postoperatively), 1 month (6 weeks postoperatively), 3 months (4 months postoperatively), and 12 months (13 months postoperatively) after lock-in. A control group of 104 eyes was evaluated for comparison., Results: One hundred twenty-two eyes at 12 months postoperatively were included and analyzed. Despite a general increase in macular thickness measurements overall during the first postoperative weeks, no changes to the integrity of inner segment/outer segment junction, outer nuclear layer, external limiting membrane, or retinal pigment endothelium were detected. The neuroretina returned to baseline by 3 months after surgery and there was no significant difference between preoperative and postoperative measurements after 3-month thickness values., Conclusions: Ultraviolet light exposure for light-adjustable IOL adjustments did not influence the incidence of postoperative macular edema and did not induce any changes in the macular layers., (Copyright 2016, SLACK Incorporated.)

Purpose: To compare visual recovery and refractive changes between femtosecond laser-assisted cataract surgery and standard cataract surgery., Setting: Center for Vision Science, Ruhr University Eye Clinic, Bochum, Germany., Design: Prospective randomized intraindividual cohort study., Methods: Eyes were treated with femtosecond laser-assisted cataract surgery or conventional phacoemulsification using pulsed ultrasound energy. Both groups had intraocular lens (IOL) implantation. The manifest refraction, corrected distance visual acuity, and anterior chamber depth were determined preoperatively and 2 hours, 3 to 4 days, 1 week, and 1, 2, 3, and 6 months postoperatively to determine the achieved deviation from target refraction, IOL position, and refractive stability., Results: One hundred eyes of 100 patients were treated with femtosecond laser-assisted cataract surgery; the fellow 100 eyes had conventional phacoemulsification. Six months postoperatively, 196 eyes were included and analyzed. At 6 months, 90 eyes (92%) in the femtosecond laser-assisted group and 70 eyes (71%) in the conventional group were within ±0.50 D of the target refractive outcome and 98 eyes (100%) in both groups were within ±1.00 D. The mean refractive spherical equivalent showed no significant change between 1 week and 1 month in the femtosecond laser-assisted group and between 1, 2, 3, and 6 months postoperatively in both groups., Conclusion: Femtosecond laser-assisted cataract surgery yielded faster visual recovery, less deviation from the target refraction, and earlier stabilization of refraction., Financial Disclosure: Dr. Dick is a member of the medical advisory board of Abbott Medical Optics, Inc. No other author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2015. Published by Elsevier Inc.)

Purpose: To evaluate intraoperative complications during capsulorhexis and phacoemulsification in intumescent white cataracts using 2 ophthalmic viscosurgical device (OVD) techniques., Setting: Ruhr University Eye Clinic, Bochum, Germany., Design: Case series., Methods: Patients with eyes with intumescent white cataract were recruited and placed in 2 groups. After capsule staining using trypan blue, a central indentation of the anterior lens capsule was created in the eyes in Group 1 using a medium-viscosity OVD (Healon 1.0%) and in the eyes in Group 2 using both medium-viscosity (1.0%) and high-viscosity (2.3%) OVDs. Then a continuous curvilinear capsulorhexis (CCC) was performed. The outcomes measured were the horizontal and vertical diameters of the CCC, the deviation from the target diameter, and intraoperative complications., Results: In Group 1 (21 eyes), deviation from the target CCC diameter occurred in 12 eyes (10 oversized, 2 undersized), and in Group 2 (20 eyes) deviation occurred in 6 eyes (4 oversized, 2 undersized). In Group 1, capsule tears appeared in 2 eyes and in 1 eye, the procedure had to be converted to extracapsular cataract extraction with anterior vitrectomy. In Group 2, there were no capsule tears., Conclusion: Using 2 different OVDs and placing the high-viscosity OVD centrally led to safe indentation of the anterior lens capsule and reduced the risk for CCC enlargement and capsule tear during surgery., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the safety and efficacy of the iol-AMD technology (London Eye Hospital Pharma, London, UK), which includes two injectable, hydrophobic acrylic intraocular lenses (IOLs) in a pilot study of patients diagnosed as having cataract and dry age-related macular degeneration., Methods: The cataract surgery and IOL implantation were performed after a preoperative evaluation using the iolAMD simulator in eyes with bilateral intermediate dry age-related macular degeneration. Outcomes were intraoperative and postoperative complications, subjective and objective visual acuity improvement, visual field changes, and postoperative diplopia., Results: Three eyes of 2 patients were evaluated. The surgeries were uneventful. All eyes gained monocular reading vision at the 1-week postoperative visit. One patient with monocular implantation recognized diplopia for distance vision. Preoperative corrected distance visual acuity ranged from 20/800 to 20/125 and corrected near visual acuity was 20/800 or less. Two months after surgery, corrected distance and near visual acuities increased to levels between 20/40 and 20/25 (uncorrected distance visual acuity was 20/60 to 20/32; uncorrected near visual acuity was 20/200 to 20/25)., Conclusions: These early results showed that the iolAMD simulator is a promising technology improving near and distance visual acuity in eyes with intermediate dry macular degeneration. The prismatic IOL effect did not lead to diplopia when implanted bilaterally. The surgery was safely performed., (Copyright 2015, SLACK Incorporated.)

Purpose: To evaluate the ease of anterior cortex removal and hydrodissection of the lens in femtosecond laser-assisted cataract surgery compared with standard phacoemulsification., Methods: In the femtosecond laser-assisted cataract surgery group (400 eyes), a femtosecond laser was used for capsulotomy and followed by lens fragmentation. In the standard group, the capsulorhexis was performed manually. In both groups, a normal hydrodissection was set, the nucleus was aspirated with or without ultrasound phacoemulsification energy, and residual cortex removal and posterior capsule polishing were performed using bimanual irrigation/aspiration. The primary end point was the time (in seconds) required for the removal of the cortex from instrument insertion in the eye until aspiration tip removal. Secondary end points were the effective phacoemulsification time, quality of the anterior capsule, and anterior or posterior capsule ruptures., Results: Cortex removal time measured 30 ± 13 seconds (range: 10 to 76 seconds) for the standard group and 27 ± 10 seconds (range: 9 to 72 seconds) for the femtosecond laser-assisted cataract surgery group (P < .005). After laser-assisted capsulotomy, one capsule was still adherent following removal by forceps. No anterior or posterior capsular tears were observed in either group., Conclusions: In femtosecond laser-assisted cataract surgery, the biaxial cortex removal time was comparable with the time in standard phacoemulsification.

Purpose: To compare femtosecond laser-assisted cataract surgery with standard phacoemulsification concerning the incidence of postoperative clinical or subclinical macular edema and the correlation between macular thickness and postoperative intraocular inflammation values., Methods: One hundred four eyes of 104 patients were treated by laser-assisted cataract surgery and the fellow 104 eyes underwent phacoemulsification using pulsed ultrasound energy and intraocular lens implantation in this prospective randomized study. Laser flare photometry was measured preoperatively and at 2 hours, 3 to 4 days, 1 month, 3 months, and 6 months postoperatively. Retinal thickness was measured by spectral-domain optical coherence tomography., Results: Two hundred two eyes (97%) were included and analyzed at 6 months postoperatively. The mean center thickness in the laser group was 210 ± 24 μm at 4 days postoperatively, 214 ± 22 μm at 1 month postoperatively, 219 ± 20 μm at 3 months postoperatively, and 215 ± 22 μm at 6 months postoperatively. The mean center thickness in the standard group was 211 ± 32 μm at 4 days postoperatively, 210 ± 34 μm at 1 month postoperatively, 217 ± 29 μm at 3 months postoperatively, and 209 ± 30 μm at 6 months postoperatively. Laser flare photometry showed higher levels in the standard group at the first postoperative visit 2 hours after surgery compared with the laser group., Conclusions: Femtosecond laser-assisted cataract surgery did not obviously influence the incidence of postoperative macular edema., (Copyright 2014, SLACK Incorporated.)

Purpose: To examine the dynamics of capsular bag changes over 3 months of healing after standard cataract surgery and laser-assisted cataract surgery., Methods: One hundred six eyes of 53 patients with visually significant cataracts were treated with laser-assisted cataract surgery in one eye and standard phacoemulsification in the other. A capsular measuring ring was implanted in both eyes and effective phacoemulsification time was recorded. Capsular bag diameter was measured at six time points within 3 months of follow-up. Intraindividual capsular bag shrinkage was calculated., Results: The laser group required less ultrasound energy to remove the softened nucleus than the standard group (effective phacoemulsification time: 0.03 vs 1.25 sec; P < .005). The laser group had statistically significantly less capsular bag shrinkage than the standard group at all time points from 1 to 3 months (P < .001)., Conclusions: Lens position changes within 3 months postoperatively may be lessened with laser-assisted cataract surgery in comparison to standard phacoemulsification due the decreased capsular bag shrinkage during this period. A tendency toward earlier stabilization of the capsular bag diameter with laser-assisted cataract surgery provides potential for more predictable effective lens position and intraocular lens power calculations., (Copyright 2014, SLACK Incorporated.)

Purpose: To evaluate the feasibility and safety of femtosecond laser-assisted capsulotomy in eyes with intumescent white cataract., Setting: Ruhr University Eye Clinic, Bochum, Germany., Design: Prospective clinical trial., Methods: After femtosecond laser-assisted capsulotomy (Catalys Precision system), phacoemulsification was performed using pulsed ultrasound energy and the effective phacoemulsification time was evaluated. The lenticular capsule disk was stained intraoperatively with trypan blue and pulled out using a microsurgical forceps for further analysis of form and shape., Results: Twenty-five eyes were included in this trial. Automatic optical coherence tomography detection of the anterior capsule was performed successfully in all eyes. Radial anterior tears occurred in 2 eyes, an adherent tongue-like capsule adhesion in 9 eyes, and an incomplete capsulotomy button in 3 eyes. In all cases, the intraocular lens was centered and the implantation was uneventful. The mean deviation from the target diameter of the extracted capsule disks was 60 μm ± 44 (SD)., Conclusion: The use of the femtosecond laser-assisted system for capsulotomy in surgery for intumescent white cataract appears to be safe and technically feasible., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

We present a 39-year-old patient with a penetrating injury of the cornea and anterior lens capsule containing an intralenticular foreign body. One week after the accident, the patient consulted our emergency unit. Clinical examination showed no Seidel II phenomenon. A femtosecond laser-assisted capsulotomy was performed followed by lens removal and intraocular lens implantation. The capsulotomy diameter was increased to 6.7 mm to include the foreign-body area and the break in the anterior capsule. The procedure was uneventful, and the capsule leaf, including the foreign body, was extracted safely., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the efficacy of different treatment modalities in eyes with small pupils before femtosecond laser-assisted cataract surgery., Setting: Ruhr University Eye Clinic, Bochum, Germany., Design: Prospective clinical trial., Methods: Eyes with an intraoperative pupil size smaller than 5.5 mm received sequential treatments to achieve a pupil larger than 5.5 mm in 3 steps: (1) intracameral administration of epinephrine solution, (2) additional viscomydriasis, and (3) implantation of a Malyugin ring pupil expander. When a step enlarged the pupil to at least 5.5 mm, femtosecond laser-assisted cataract surgery with an anterior capsulotomy diameter of at least 4.5 mm and 350 μm nuclear fragmentation grids, ultrasound phacoemulsification, and intraocular lens implantation were performed. Main outcome measures were achieved preoperative pupil size in each sequential treatment group and analysis of intraoperative complications., Results: Of 850 eyes scheduled for cataract surgery, 40 received sequential treatments. To achieve a pupil larger than 5.5 mm, epinephrine was sufficient in 7% of the eyes; additional viscomydriasis was necessary in 25%, and the pupil expander was implanted in 68%. The most frequent comorbidities were pseudoexfoliation of the lens capsule (30.0%) and intraoperative floppy-iris syndrome (12.5%). Tongue-like lesions of the capsulotomies were detected in 5 eyes., Conclusions: The 3-step treatment allowed the surgeon to increase the efficiency and safety of femtosecond-assisted cataract surgery in eyes with a small preoperative pupil, providing good safety margins at the pupil boundary for the capsulotomy and the softened nuclear volume., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To quantify changes in endothelial cell counts and corneal thickness measurements in patients having standard phacoemulsification compared with femtosecond laser-assisted cataract removal., Setting: Ruhr University Eye Clinic, Bochum, Germany., Design: Prospective randomized intraindividual cohort study., Methods: One eye of each patient had standard phacoemulsification (control group) and the other eye had femtosecond laser-assisted phacoemulsification (study group), both with intraocular lens implantation. Pulsed ultrasound energy was used for phacoemulsification. Noncontact endothelial cell microscopy and corneal pachymetry were performed preoperatively and 1 day, 3 to 4 days, 7 to 10 days, 50 to 60 days, and 90 to 100 days postoperatively., Results: The mean endothelial cell loss was 7.9% ± 7.8% (SD) 1 week postoperatively and 8.1% ± 8.1% 3 months postoperatively in the study group and 12.1% ± 7.3% and 13.7% ± 8.4%, respectively, in the control group. The mean relative change in corneal thickness from the preoperative values was -0.0% ± 1.9% at 1 day, 2.8% ± 1.8% at 1 week, and 3.3% ± 1.7% at 3 months in the study group and -0.9% ± 2.3%, 2.4% ± 1.5%, and 3.2% ± 1.4%, respectively, in the control group., Conclusion: The femtosecond laser did not add to the endothelial damage caused by cataract surgery and might be beneficial in eyes with low preoperative endothelial cell values (eg, cornea guttata cases)., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate intraocular pressure (IOP) during femtosecond laser-assisted cataract surgery using a fluid-filled interface., Setting: Ruhr University Eye Clinic, Bochum, Germany., Design: Prospective clinical trial., Methods: The absolute IOP was measured with a modified Schiotz tonometer before and after laser-assisted cataract surgery with and without a fluid-filled interface (Liquid Optics interface, Catalys Precision Laser System)., Results: The study evaluated 100 eyes. Tonometry and laser cataract surgery were completed successfully in all eyes. The mean preoperative IOP was 15.6 mm Hg ± 2.5 (SD). Upon application of the suction ring and vacuum, the mean IOP rose to 25.9 ± 5.0 mm Hg and remained nearly constant after the laser procedure (27.6 ± 5.5 mm Hg). After removal of the suction ring, the mean IOP was 19.1 ± 4.4 mm Hg. The IOP 1 hour after surgery was not significantly higher than the preoperative values., Conclusions: The results indicate a minor increase in IOP using the fluid-filled interface. This is in strong contrast to substantially higher values reported in the literature with flat and curved applanating contact interfaces., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare the effect of femtosecond laser-assisted cataract surgery on effective phacoemulsification time (EPT) with standard cataract surgery., Methods: This prospective clinical trial evaluated the feasibility of using a femtosecond laser system (Catalys Precision Laser System, OptiMedica) to perform capsulotomy and lens fragmentation in the treatment of patients with senile cataract. Patients were evaluated preoperatively with the Lens Opacities Classification System III (LOCS III). Fifty-two patients underwent standard cataract surgery and 57 patients underwent femtosecond laser-assisted cataract surgery in December 2011. Both groups underwent phacoemulsification using pulsed ultrasound energy and EPT was evaluated., Results: Preoperative LOCS III grades were 3.4±0.9 in the femtosecond laser-assisted cataract surgery group and 3.1±0.9 in the standard group. In the femtosecond laser-assisted cataract surgery group, mean laser treatment time was 54.9 seconds and EPT was 0.16±0.21 seconds compared to 4.07±3.14 seconds in the standard group., Conclusions: The use of the femtosecond laser-assisted system in cataract surgery led to a lower EPT compared to the standard procedure., (Copyright 2012, SLACK Incorporated.)

Purpose: To compare the effect of different fragmentation softening grids in femtosecond laser-assisted cataract surgery on effective phacoemulsification time (EPT)., Setting: Ruhr University Eye Clinic, Bochum, Germany., Design: Prospective randomized clinical trial., Methods: The study evaluated the feasibility of using a femtosecond laser (Catalys Precision Laser System) to perform capsulotomy and lens fragmentation in the treatment of patients with senile cataract. Patients were evaluated preoperatively with the Lens Opacities Classification System III (LOCS III). Patients had laser refractive cataract surgery with 350 μm fragmentation grids or with 500 μm fragmentation grids. Both groups had phacoemulsification using pulsed ultrasound energy, and the EPT was evaluated., Results: Eighty patients were treated with 350 μm fragmentation grids and 80 patients with 500 μm fragmentation grids. The mean preoperative LOCS III grade was 3.7 ± 0.8 (SD) in the 350 μm group and 3.5 ± 0.8 in the 500 μm group. The mean laser treatment time was 66.4 ± 14.4 seconds in the 350 μm group and 52.8 ± 11.9 seconds in the 500 μm grid group and the mean EPT, 0.03 ± 0.05 seconds and 0.21 ± 0.26 seconds, respectively., Conclusion: The use of the femtosecond laser-assisted system in cataract surgery with 350 μm grid softening led to a statistically significant lower EPT than the 500 μm grid., Financial Disclosure: Dr. Dick is a member of the medical advisory board of Optimedica Corp. No other author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate potential differences in the quality of vision after implantation of a blue light-filtering intraocular lens (IOL) and an ultraviolet (UV) light-filtering IOL., Setting: Department of Ophthalmology, Ruhr-University, Bochum, Germany., Design: Prospective randomized cohort study., Methods: Patients with age-related cataract had bilateral standardized small-incision Kelman phacoemulsification-based cataract surgery with implantation of a blue light-filtering IOL (Oculaid PC 440Y Orange Series) in 1 eye and a UV light-filtering IOL (Oculaid PC 430 Elite Series) in the other eye. Outcome measures included scotopic and photopic corrected distance visual acuity (CDVA) and photopic uncorrected distance visual acuity (UDVA), color discrimination, and contrast sensitivity with and without glare. A questionnaire was used to assess patient satisfaction. Postoperative follow-up visits were scheduled at 1, 3, and 6 months., Results: Twenty-two patients (44 eyes) completed the study. There were no statistically significant differences in UDVA, CDVA, or contrast sensitivity with or without glare between the 2 IOL groups. Color discrimination was significantly decreased in eyes with blue light-filtering IOLs compared with UV light-filtering IOLs, except along the red-green axis (P=.118). No subjective differences in color or light perception were found., Conclusions: Both IOL types provided similar postoperative visual function except color perception, which was slightly better in eyes with a clear IOL. Although differences were not clinically significant, information about potential disturbances in color vision might be provided before implanting an orange blue light-filtering IOL., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2012. Published by Elsevier Inc.)

Purpose: To determine quantitative changes in endothelial cell loss and corneal thickness in patients having cataract surgery and implantation of a light-adjustable intraocular lens (IOL) to correct residual postoperative refractive errors by application of a spatially profiled near-ultraviolet (UV) light., Setting: Ruhr University Eye Clinic, Bochum, Germany., Design: Cohort study., Methods: The light-adjustable IOLs were implanted after phacoemulsification cataract surgery and treated with spatial-intensity-profiled UV light at 365 nm to induce a targeted refractive change. Once the desired correction was achieved, the light-adjustable IOL was treated again to lock-in the lens power. Noncontact computer-assisted endothelial cell microscopy and corneal pachymetry were performed before surgery; after surgery before adjustment; before lock-in; and 1, 3, 6, and 12 months after final lock-in., Results: One hundred twenty-two eyes were evaluated 12 months after lock-in. The mean cumulative UV light dose at the cornea was 61.47 J/cm(2) ± 2.37 (SD). The mean endothelial cell loss was 6.91% ± 3.66% 2 weeks after surgery before adjustment and 6.57% ± 3.81% 12 months after lock-in. The mean relative change in corneal thickness from preoperatively was 6.18% ± 3.97% 2 weeks postoperatively and -0.64% ± 1.88% 12 months after lock-in., Conclusions: Endothelial cell loss and corneal thickness change 12 months after lock-in agreed well with those reported in the literature after phacoemulsification with IOL implantation. The UV light exposure for adjustment and lock-in procedures did not add to the endothelial damage caused by the cataract surgery., (Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine the accuracy of intraocular lens (IOL) power calculations and to suggest adjusted constants for implantation of ultraviolet light-adjustable IOLs., Setting: Center for Vision Science, Ruhr University Eye Clinic, Bochum, Germany., Design: Cohort study., Methods: Eyes with a visually significant cataract that had phacoemulsification with implantation of a light-adjustable IOL were evaluated. IOLMaster measurements were performed before phacoemulsification and IOL implantation and 4 weeks after surgery before the first adjustment of the IOL. The difference in the expected refraction and estimation error was studied., Results: The study evaluated 125 eyes. Using the surgical constants provided by the manufacturer of the light-adjustable IOL, the SRK/T formula gave a more hyperopic refraction than the Hoffer Q and Holladay 1 formulas. The mean error of prediction was 0.93 diopter (D) ± 0.69 (SD), 0.91 ± 0.63 D, and 0.86 ± 0.65 D, respectively. The corresponding mean absolute error of prediction was 0.98 ± 0.61 D, 0.93 ± 0.61 D, and 0.90 ± 0.59 D, respectively. With optimized constants for the formulas, the mean error of prediction was 0.00 ± 0.63 D for Hoffer Q, 0.00 ± 0.64 D for Holladay 1, and 0.00 ± 0.66 D for SRK/T., Conclusion: The expected refraction after phacoemulsification and implantation of a light-adjustable IOL toward the hyperopic side of the desired refraction could be considered when using the optimized constants for all formulas., (Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine the effectiveness of a light-adjustable intraocular lens (LAL) that can be adjusted postoperatively using ultraviolet (UV) irradiation., Design: A prospective, nonrandomized clinical trial was conducted at Center for Vision Science, Ruhr University Eye Clinic, in Bochum, Germany., Participants: We included 122 eyes of 91 patients with significant cataract., Methods: All patients had a visually significant cataract and were willing to volunteer for the trial. Participants underwent small-incision phacoemulsification followed by implantation of a LAL and were treated with a spatially profiled UV light delivered by a digital light delivery device to induce a targeted spherical and cylindrical refractive change postoperatively. Once the desired correction was achieved, the LAL was treated again to lock in the lens power. Distance visual acuity and manifest refraction was determined with follow-up time to determine the achieved refractive corrections and their stability., Main Outcome Measures: We measured uncorrected visual acuity and best corrected visual acuity achieved versus targeted refractive outcome and refractive stability with a follow-up time of 18 months., Results: Residual postoperative refractive errors of 0.96 ± 0.85 diopters (D) in sphere and -0.98 ± 0.50 D in cylinder were corrected and stable over a follow-up time of 18 months. Final refraction achieved was 0.03 ± 0.17 D in spherical equivalent refraction., Conclusions: Residual spherocylindrical errors up to 2.25 D in sphere and -2.75D in cylinder were successfully corrected with precision. The LAL technology has the potential individually to correct postoperative refractive errors precisely. The achieved refractive corrections are stable for up to 18 months., Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article., (Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine whether residual spherical and cylindrical errors could be corrected postoperatively using spatially profiled UV light irradiation in patients with axial hyperopia undergoing cataract surgery and implantation of a light adjustable, silicone intraocular lens (LAL)., Design: We conducted a prospective, nonrandomized clinical trial. The LALs were implanted in eyes with axial lengths <22.20 mm and were treated with a spatial intensity profile delivered by a digital light delivery device to induce a targeted spherical and cylindrical refractive change postoperatively. Once the desired correction was achieved, the LAL was treated again to lock-in the lens power., Participants: We studied 15 eyes of 15 patients with axial hyperopia., Methods: The manifest refraction, uncorrected visual acuity (UCVA), and best spectacle-corrected visual acuity (BCVA) were determined with follow-up time of 12 months to determine the achieved refractive corrections and their stability., Main Outcome Measures: We measured UCVA, BCVA, achieved versus targeted refractive outcome, and refractive stability with a follow-up time of 12 months., Results: Of 15 eyes, 14 (93%) achieved ± 0.5 diopters (D), and 10 (67%) were within ± 0.25 D of the targeted refractive adjustment up to 12 months postoperative follow-up. Only 1 treated eye showed a change of 0.38 D in manifest spherical equivalent refraction, the remaining 14 eyes showed <0.25 D change between 1 month post lock-in, and at the 3-, 6-, and 12-month postoperative visits., Conclusions: The light-adjustable lens is a promising technology with the potential to reduce the rate of postoperative refractive surprises up to 2 D of spherical and cylindrical errors after cataract surgery. Postoperative refractive errors were successfully corrected with precision and significant improvement in UCVA and without compromising BCVA using the light-adjustable intraocular lens technology. The data demonstrate the stability of the achieved refractive change after the adjustment and lock-in procedures., (Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine the efficacy of light-adjustable intraocular lenses (IOL) in correcting residual spherical and cylindrical errors in patients with axial myopia., Setting: Center for Vision Science, Ruhr University Eye Clinic, Bochum, Germany., Design: Prospective cohort study., Methods: Light-adjustable IOLs were implanted in eyes with axial myopia and treated with spatial irradiance profiles delivered by a digital light-delivery device to induce a target spherical and/or spherocylindrical refractive change. Once the desired correction was achieved, the power of the IOL was locked in (ie, photo locking). The manifest refraction, uncorrected distance visual acuity (UDVA), and corrected distance visual acuity (CDVA) were determined 1, 6, and 12 months after lock-in to determine the achieved refractive corrections and their stability., Results: Twelve months postoperatively, 20 (96%) of the 21 eyes studied were within ± 0.50 diopter (D) of the intended refractive outcome and 17 (81%) were within ± 0.25 D. One eye had a 0.325 D change in mean refractive spherical equivalent (MRSE). The change in MRSE in the other 20 eyes was less than 0.250 D between 1 month after lock-in and the 3-, 6-, and 12-month postoperative visits., Conclusions: The light-adjustable IOL reduced postoperative spherical and cylindrical errors of up to 2.00 D. Postoperative refractive errors were successfully corrected, and there was a significant improvement in UDVA with concomitant maintenance of CDVA. The achieved refractive change was stable after the adjustment and lock-in procedures., (Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the effectiveness of a silicone intraocular lens (IOL) that can be adjusted following implantation using ultraviolet (UV) irradiation., Methods: Prospective clinical trial of 40 patients (40 eyes) with visually significant cataract. Participants underwent small-incision phacoemulsification followed by implantation of a light-adjustable, silicone IOL (Light Adjustable Lens [LAL], Calhoun Vision). All patients were required to wear UV-protective eyewear at all times, until final lock-in. Pre- and postoperative clinical parameters included distance visual acuity and manifest refraction., Results: At average 2 weeks postoperative (range: 10 to 21 days), patients were seen and refracted to determine type and magnitude of refractive error needing correction. All patients required an initial adjustment of the LAL, whereas 28 required a second UV treatment and none required a third adjustment. At 4 months postoperative, mean refraction was 0.04±0.37 diopters (D) (range: -0.88 to 0.50 D), mean sphere was 0.24±0.40 D (range: -0.50 to 0.75 D), and mean cylinder was 0.41±0.25 D (range: 1.00 to 0.0 D). Eighty-one percent of eyes gained 2 or more lines of corrected distance visual acuity., Conclusions: The adjustment and lock-in procedures were well tolerated by patients. The Calhoun Vision LAL is a promising technology with the potential to eliminate postoperative refractive surprises of up to 2.00 D of refractive and cylindrical error following implantation., (Copyright 2010, SLACK Incorporated.)