Eyeworld

EW CATARACT 31 September 2014 The majority of patients reported satisfaction and improvements in quality of life. Complications included postop IOP increase (19 eyes), anterior capsule rupture due to toric IOL rotatio n (1 eye), and Sulcofl ex explantation (4 eyes). Conclusion: Implantation of the multifocal Sulcofl ex IOL improves near and distance visual acuity in cataract patients. Patients with retinal abnormalities were able to tolerate the multifocal IOL. The secondary IOL implantation is reversible and safe. Dr. Malyugin: This is a very interesting and appealing concept of bi-pseudopha- kia. The surgeon was using a combination of 2 lenses, one of which, a regular monofocal, was implanted into the capsular bag, while the other one, a multifocal, was placed in the ciliary sulcus. The second lens (Sulcofl ex, Rayner, East Sussex, U.K.) has a special design with the poste- rior surface that is concave and does not touch the anterior surface of the fi rst lens optic, thus eliminating the risk of interlenticular opacifi cation, which was not an infrequent fi nding in piggyback IOL cases with both im- plants positioned in the capsular bag. The appealing idea of easily handling unsatisfi ed multifocal lens patients is in the reversibility of the procedure; second lens explantation is relatively easy. Managing irregular corneal astigmatism and pseudophakic presbyopia with novel small aperture intraocular implant Claudio C. Trindade, MD Purpose: The purpose of this paper is to present the initial results of a novel small aperture intraocular implant. It acts as an intraocular pinhole, improving vision in cases of irregular corneal astigmatism and extending depth of focus of normal pseudophakic eyes. Methods: For this pilot study we en- rolled 3 pseudophakic patients with poor vision caused by irregular cor- neal astigmatism secondary to pre- vious corneal surgeries (RK and PK) and 3 other patients complaining of poor near vision after cataract sur- gery. A small aperture device, made of black acrylic, was implanted in the ciliary sulcus of these patients. The implant material is transpar- ent to infrared light, which allows fundus imaging after implantation. Uncorrected and best corrected dis- tance, intermediate and near visual acuity, contrast sensitivity and visual fi eld examination were assessed 1 week and 1 month postoperatively. Patient satisfaction was evaluated with a subjective questionnaire. Results: Ciliary sulcus implantation of this novel device was uneventful, with signifi cant improvement of visual function. There were no signs of complications, with high patient satisfaction in all cases. Conclusion: This novel intraocu- lar implant signifi cantly improved vision of patients with irregular cor- neal astigmatism. Also, it was able to extend depth of focus of monofocal pseudophakic eyes, thus improving uncorrected intermediate and near visual acuity without any signifi cant compromise in optical quality. Dr. Malyugin: The work by Dr. Trindade from Brazil is truly fasci- nating. We know that small aperture intracorneal inlays are helpful in restoring near vision in phakic patients by extending the depth of focus. The authors used a similar concept and tint- ed the periphery of the intraocular lens (manufactured by Morcher, Stuttgart, Germany) leaving the central portion of the optic (1.5 mm) clear. Not very sur- prisingly, after surgery patients achieved signifi cant improvement in uncorrected far, intermediate, and near vision. Also the lenses proved to be effective in eyes having high corneal astigmatism after penetrating keratoplasty. Interestingly, the black-colored peripheral part of the implant optic was 100% transparent for the infrared light. Thus the examin- er was able to observe the eye structures located behind the IOL and even per- form retinal optical coherence tomogra- phy (demonstrated by the presenter with the OCT made by Heidelberg Engineering, Heidelberg, Germany). EW Editors' note: Dr. Malyugin has no fi nancial interests related to his comments. Contact information Malyugin: boris.malyugin@gmail.com Best in international cataract View Dr. Malyugin's presentation at Clinical.EWrePlay.org.

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