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A new forceps-needle to facilitate intrascleral haptic fixation surgery is described. In an initial series of 10 cases, the forceps-needle was used to grasp and externalize the haptic of a 3-piece intraocular lens (IOL) for transscleral fixation. The site of perforation was marked at 180 degrees 2.0 mm away from the limbus. Then, the IOL with polypropylene haptics was folded and implanted partially into the anterior chamber. A transconjunctival, scleral tunnel of about 2.0 mm length parallel to the limbus was prepared with the forceps-needle on 1 side, with the second hand holding the leading haptic through a side-port incision. The end of the first haptic was grasped and externalized after which the end of the haptic was flanged. Subsequently, a second scleral tunnel was prepared with the forceps-needle, and the second haptic was externalized and flanged. All procedures could be performed without any intraoperative complication., (Copyright © 2020 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: To assess capsular bag and sulcus intraocular lens (IOL) centration in eyes that had implantation of a sulcus-fixated supplementary IOL anterior to a preexisting capsular bag IOL., Setting: Academic Teaching Hospital of St. John, Vienna, Austria., Design: Retrospective case series., Methods: A sulcus-fixated supplementary IOL (Sulcoflex) was implanted anterior to a preexisting capsular bag IOL. The geometric center of preexisting capsular bag IOLs and newly implanted sulcus-fixated IOLs was evaluated at least 12 months postoperatively and in relation to the geometric center of the pupil and limbus., Results: The study comprised 48 eyes of 43 patients with a mean follow-up of 25 months (range 12 to 84 months). The mean decentration of the capsular bag-fixated IOL was 0.29 mm ± 0.02 (SEM) when compared with the limbus and 0.29 ± 0.03 mm when compared with the dilated pupil. The mean decentration of the sulcus-fixated IOL was 0.23 ± 0.02 mm in relation to the limbus and 0.22 ± 0.02 mm when in relation to the dilated pupil. Sulcus-fixated supplementary IOLs showed significantly better centration than bag-fixated IOLs when compared with the limbus and with the pupil (both P = .03, paired t test)., Conclusions: Implantation of a sulcus-fixated supplementary IOL resulted in good centration of capsular bag-fixated IOLs and ciliary sulcus-fixated IOLs. However, ciliary sulcus-fixated IOLs achieved significantly better centration., (Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate and compare the 5-year postoperative anterior (ACO) and posterior capsule opacification (PCO), the occurrence of glistenings, and the level of anterior capsule retraction after implantation of 2 designs of 1-piece hydrophobic acrylic IOLs., Setting: Hospital St. John, Vienna, Austria., Design: Randomized controlled prospective case series., Methods: Patients had an Acrysof SA60AT IOL (Group A) implanted in 1 eye and a Tecnis ZCB00 IOL (Group B) implanted in the fellow eye. At 1, 3, and 5 years, the PCO level was evaluated with the Evaluation of Posterior Capsule Opacification software. The level of ACO and capsule retraction was graded subjectively. Glistenings were scored as present or not present., Results: Fifty eyes of 25 patients were evaluated after 5 years. No significant differences in PCO scores were found between the 2 groups at all follow-up visits (1 year: 0.06 ± 0.12 [SD] versus 0.07 ± 0.13, P = .35; 3 years: 0.23 ± 0.36 versus 0.22 ± 0.32, P = .66; 5 years: 0.36 ± 0.41 versus 0.36 ± 0.54, P = .98). A significant increase in PCO score was found between 3 and 5 years (P < .01). Anterior capsule opacification was present in Group A and Group B in 18.0% and 2.7% of eyes (P = .03), in 92.0% and 24.0% of eyes, and in 100% and 52% of eyes (P < .01) at 1, 3, and 5 years, respectively. Glistenings (5 years 100%) were observed in Group A., Conclusion: Both IOLs had a comparable PCO rate 5 years after surgery, although more ACO and retraction as well as glistenings were observed in Group A., (Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare the 3-year postoperative anterior (ACO) and posterior (PCO) capsule opacification and the level of anterior capsule retraction after implantation of 2 single-piece hydrophobic acrylic intraocular lens (IOL) models., Setting: Hospital of St. John of God, Vienna, Austria., Design: Comparative randomized controlled double-blind clinical trial., Methods: Eyes with bilateral cataract were evaluated. Each patient had an Acrysof SA60AT (interrupted optic edge) IOL implanted in 1 eye (Group A) and a Tecnis ZCB00 (continuous optic edge) IOL implanted in the fellow eye (Group B). One and 3 years postoperatively, PCO was evaluated using Evaluation of Posterior Capsule Opacification software and the ACO level and capsule-retraction level were evaluated and graded subjectively., Results: The study evaluated 100 eyes of 50 patients ranging from 61 to 80 years. Postoperatively, there were no statistically significant differences in PCO between Group A and Group B at 1 year (0.06 ± 0.12 [SD] and 0.07 ± 0.13, respectively; P = 4.35) or 3 years (0.23 ± 0.36 and 0.22 ± 0.32, respectively; P = .66). In Group A and Group B, ACO was present in 18.0% of eyes and 2.7% of eyes, respectively, at 1 year (P = .03) and in 92.0% and 24.0%, respectively, at 3 years (P < .01). Capsule phimosis (18.0% at 1 year; 30.0% at 3 years) and glistenings (66.0% at 1 year; 86.0% at 3 years) were observed in Group A only., Conclusion: Both IOLs had similarly low PCO rates 3 years postoperatively, although more ACO and capsule retraction were observed in eyes with the interrupted optic edge IOL., (Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate and compare the 1-year postoperative levels of posterior capsule opacification (PCO) as well as the level of anterior capsule retraction and opacification (ACO) after implantation of two single-piece hydrophobic acrylic intraocular lens (IOL) models., Methods: Randomised, controlled, prospective and double-blind study including 148 eyes of 74 patients (age range, 61-80 years) with bilateral senile cataract. Each patient underwent surgery with implantation of an AcrySof SA60AT (Group A) in one eye and Tecnis ZCB00 (Group B) in the fellow eye by the same experienced surgeon. Lens allocation to the first or second operated eye followed a randomisation process. At 12 months postoperatively, the PCO level was evaluated with the Evaluation of Posterior Capsule Opacification software, whereas the level of ACO and capsule retraction was evaluated and graded subjectively., Results: All surgeries were uneventful. The mean PCO scores were 0.10 ± 0.17 and 0.21 ± 0.89 in Groups A and B, respectively, with no statistically significant differences between the groups (p=0.47). No significant correlation was found between the PCO scores in Groups A and B (r=0.16, p=0.17). Regarding ACO, it was present in 15 eyes (20.3%) and two eyes (2.7%) in Groups A and B, respectively (p=0.37). Capsular phimosis (13 eyes, 17.6%) was only observed in Group A., Conclusions: Both IOLs had a similar low rate of PCO 1 year after surgery. However, there seems to be a difference in the anterior capsule behaviour between both IOL models.

Purpose: To evaluate the long-term uveal and capsular biocompatibility of 5 intraocular lenses (IOLs) in eyes with uveitic cataract., Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria., Design: Comparative case series., Methods: Patients with uveitis of various origin were consecutively recruited for cataract surgery (1998-2006) and received 1 of 3 hydrophilic acrylic IOLs (Hydroview, AcrySof MA60BM, or Injectacryl F3000), a silicone IOL (CeeOn 911), or a hydrophilic acrylic IOL with heparin surface modification (BioVue(3)). A 7-year follow-up was performed in the Hydroview, AcrySof, and CeeOn groups. Visual acuity, anterior chamber flare measurements, specular microscopy, biomicroscopy, and fundoscopy were performed postoperatively at 6 months and 1, 2, and 3 years., Results: The study enrolled 136 eyes of 115 patients. There were no significant differences in anterior chamber flare results between the 5 groups. The Hydroview group had the highest grade and the CeeOn IOL and AcrySof groups had the lowest grade of posterior capsule opacification. The BioVue(3) and Injectacryl IOLs had good uveal biocompatibility. Patients in all groups had better visual acuity postoperatively., Conclusions: Overall, patients with uveitis benefited from cataract surgery. The long-term results indicate that all sharp-edged hydrophilic and hydrophobic IOLs performed well in eyes with uveitis. Higher uveal biocompatibility was achieved with the modern hydrophilic acrylic IOLs than with the hydrophobic acrylic IOL. Modern hydrophilic acrylic IOLs seem to be a good option in these cases., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the efficacy and safety of implanting a secondary intraocular lens (IOL) in the ciliary sulcus to correct pseudophakic ametropia., Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria., Methods: This prospective nonrandomized study included patients who had implantation of a secondary IOL (Sulcoflex 653L) to correct residual refractive error after phacoemulsification with IOL implantation in the capsular bag. After implantation of the secondary IOL in the ciliary sulcus, visual and refractive outcomes were evaluated. Inflammation was measured with a laser flare-cell meter. The position and rotation of the IOLs were documented at all control visits, and Scheimpflug images were taken. Postoperative follow-up was at 1 week and 1, 6, 12, and 17 months., Results: Twelve eyes of 10 patients were evaluated. The mean spherical equivalent decreased from -1.25 diopters (D) +/- 0.25 (SD) (range -2.00 to +4.00 D) preoperatively to -0.25 +/- 0.40 D (range -0.50 to +0.25 D) postoperatively. Uncorrected distance visual acuity improved in all cases. There were no significant intraoperative or postoperative complications., Conclusions: Sulcus implantation of the secondary IOL to correct pseudophakic refractive error was safe and predictable. The IOL was well tolerated in all eyes., Financial Disclosure: Neither author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes., (Copyright 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the uveal and capsular biocompatibility of 3 types of sharp-edged foldable intraocular lenses (IOLs) in eyes with pseudoexfoliation syndrome (PEX)., Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria., Methods: Eighty-five eyes with PEX had implantation of 1 of the following sharp-edged 3-piece IOLs: hydrophilic acrylic (Injectacryl F3000, OphthalMed), hydrophobic acrylic (AcrySof MA60MB, Alcon), or silicone (CeeOn 911, AMO). Postoperative evaluation (flare, cellular reaction, and capsular reaction) was performed at 1, 3, and 7 days as well as 1, 3, 6, and 12 to 18 months., Results: One year after surgery, flare was comparable between the IOLs. In terms of uveal biocompatibility, whereas the Injectacryl had the highest deposition of debris on the IOL surface (P = .04), the CeeOn 911 had significantly more small round cells in the first 6 months (P<.03). The AcrySof had the highest number of foreign-body giant cells (P = .01). In terms of capsular biocompatibility, lens epithelial cell outgrowth was highest in the AcrySof group (P<.02). Anterior capsule opacification was comparable between the 3 groups. Posterior capsule opacification was mild in all groups but was significantly greater in the Injectacryl group (P<.05). There were no cases of clinically significant IOL decentration or capsule contraction., Conclusions: In general, inflammatory cells accumulated more easily on hydrophobic IOLs than on hydrophilic IOLs; the AcrySof IOL had the highest prevalence of foreign-body giant cells. All 3 IOLs had good biocompatibility, although the AcrySof group had increased inflammatory signs.

Purpose: To compare the surgical trauma after microincision phacoemulsification and small-incision coaxial phacoemulsification after implantation of conventional, foldable, hydrophobic acrylic intraocular lenses (IOLs)., Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria., Methods: A prospective investigator-masked case series comprised patients with bilateral cataract who had cataract surgery on the same day. Thirty-three patients (66 eyes) were randomized. Microincision cataract surgery (MICS) was performed through 2, 1.4 mm clear corneal incisions (CCIs) using bimanual sleeveless phacoemulsification (cool phaco) in 1 eye. Small-incision cataract surgery (SICS) was performed on the other eye through a 3.2 mm CCI. In all cases, an AcrySof SA60AT IOL was inserted, in the MICS group after the CCI was enlarged. Laser flare photometry, specular microscopy, corneal endothelial cell density, and pachymetry were evaluated preoperatively and postoperatively. Intraindividual comparison and statistical analyses were performed., Results: There were no relevant clinical differences or perioperative complications in either group. There were no statistically significant differences between preoperative and postoperative anterior chamber flare or endothelial cell loss. On the first postoperative day, the MICS group had statistically significantly increased corneal swelling (P = .008). Postoperatively, the mean endothelial cell density loss was higher in the MICS group (6.2%) than in the SICS group (3.10%); however, the difference between groups was not significant (P = .08), Conclusions: Microincision cataract surgery was a safe and reproducible technique. The postoperative results in the MICS group were comparable to those in the SICS group.