Eyeworld

36 | EYEWORLD | MAY 2019 R EFRACTIVE the dominant eye, vs. the same IOL bilaterally implanted in the control group. The manifest refraction in the nondominant inlay implant- ed eye was –0.39 ± 0.66 D. With 12 weeks of follow-up, investigators found a statistically significant increase in uncorrected intermediate vision in the inlay cohort vs. the control and a two-line enhancement in near vision, although the latter did not reach statistical significance. This improvement in unaided near and interme- diate vision was confirmed by a flatter defocus curve in the inlay group, with no statistically significant decrease in binocular contrast sensi- tivity or visual field testing. 4 Drs. Ang and Remo have had similar experience in adding the KAMRA inlay to the nondominant eye of four patients with another monofocal IOL, the Crystalens (Baus- ch + Lomb), which is labeled as having the equivalent of about 1 D of accommodation. The mean preoperative refraction was +0.125 sphere and –0.50 cylinder. The mean uncorrect- ed distance visual acuity was 20/25 (logMAR 0.1), uncorrected intermediate visual acuity was 20/24 (logMAR 0.1), and near visual acuity was J3 for two patients and J8 and J10 for the other two. The KAMRA was implanted in eyes with prior Crystalens IOL implants under a deep lamellar flap. The mean corneal thickness was 552 µm prior to lamellar flap creation. The mean corneal flap thickness created was 208 µm. At the 1-year follow-up, all patients noted improvement of uncorrected intermediate and near vision, with minimal impact on distance acuity (Tables 1 and 2). There was a modest reduction in monocular but not binocular con- trast sensitivity. Results were stable at 4 years of follow-up, and there were no photic complaints. In addition to their use in patients with monofocal IOLs, Dr. Fox and colleagues continued from page 35 References 1. Vukich JA, et al. Evaluation of the small-aperture intracorneal inlay: Three-year results from the cohort of the U.S. Food and Drug Administration clinical trial. J Cataract Refract Surg. 2018;44:541–556. 2. Dick HB, et al. Prospective multicenter trial of a small-aper- ture intraocular lens in cataract surgery. J Cataract Refract Surg. 2017;43:956–968. 3. Linn SH, et al. Stereoacuity after small aperture corneal inlay implantation. Clin Ophthalmol. 2017;11:233 –235. 4. Elling M, et al. Implantation of a corneal inlay in pseudophakic eyes: A prospective comparative clinical trial. J Refract Surg. 2018;34:746–750. 5. Tan TE, Mehta JS. Cataract surgery following KAMRA pres- byopic implant. Clin Ophthalmol. 2013;7:1899–903. 6. Moshirfar M, et al. Cataract surgery in patients with a previous history of KAMRA inlay implantation: A case series. Oph- thalmol Ther. 2017;6:207–213 Financial interests Pepose: AcuFocus, Bausch + Lomb Ang: AcuFocus, Bausch + Lomb Remo: None A B C D UCDVA 20/20 (0) 20/40 (0.3) 20/20 (0) 20/20 (0) UCIVA 20/16 (–0.1) 20/20 (0) 20/16 (–0.1) 20/20 (0) UCNVA J2 (0.10) J1+ (–0.10) J1+ (–0.10) J1+ (–0.10) BCDVA 20/20 (0) 20/20 (0) 20/20 (0) 20/20 (0) BCIVA 20/16 (–0.10) 20/20 (0) 20/25 (0.1) 20/20 (0) DVNVA J2 (0.1) J3 (0.18) J3 (0.18) J1+ (0.18) BCNVA J1+ (–0.1) J1+ (–0.10) J1+ (–0.10) J1+ (–0.10) Table 1. 1 year postoperative visual acuity (Snellen/logMAR) Table 2. 1 year postoperative manifest refraction (D) A B C D Sphere 0 –1.00 –1.00 0 Cylinder 0 –0.75 –0.25 –0.50 Sph. Equiv. 0 –1.375 –1.125 –0.25 Adds 1.00 1.00 1.00 0

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