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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: 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 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.)

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 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 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.)

Purpose: The aim of this study was to determine whether residual spherical and cylindrical errors could be corrected postoperatively in a non-invasive manner using ultraviolet irradiation in patients with axial hyperopia undergoing cataract surgery and implantation of a light-adjustable lens, silicone intraocular lens (LAL) (Calhoun Vision, Pasadena, CA)., Methods: In a prospective, non-randomised clinical trial at Center for Vision Science, Ruhr University Eye Clinic, Bochum, Germany, 15 eyes of 15 patients with axial hyperopia (less than 22.2 mm) were studied. The manifest refraction, uncorrected visual acuity (UCVA), and best spectacle-corrected visual acuity (BSCVA) were determined with a follow-up time of six months to determine the achieved refractive corrections and their stability., Results: The adjustment and lock-in procedures were well tolerated by patients. Preoperative refraction was in mean + 2.56 D as spherical equivalent, postoperative before adjustment + 1.01 D, one month after lock-in procedure + 0.03 D, after 3 months + 0.12 D and after 6 months 0.0 D (± 0.21 D). 6 months after lock-in all patients reached an uncorrected visual acuity of 20/30 or better, 10 of 15 patients reached 20/25 and 1 patient 20/20. The data demonstrate the stability of the achieved refractive change after the adjustment and lock-in procedures., Conclusion: Postoperative refractive errors were successfully corrected with precision and significant improvement in UCVA and without compromising BSCVA using the light adjustable intraocular lens technology. Our data demonstrate the stability of the achieved refractive change after the adjustment and lock-in procedures. The light-adjustable lens is a promising technology with the potential to eliminate postoperative refractive surprises of up to 2 diopters of refractive and cylindrical error following cataract surgery., (© Georg Thieme Verlag KG Stuttgart · New York.)