Eyeworld

EW INTERNATIONAL 152 April 2016 those without. Longer axial length and longer follow-up period were found in eyes with PCO than those without." While triple surgery was found effective, most especially in terms of BCVA improvement, the investiga- tors emphasized that caution should be observed related to risk factors of complications. "AC [anterior chamber] P-IOL implantation and corneal decom- pensation should be observed closely in eyes with progressive ECD loss presenting with thin CCT, pupil ovalization, corneal edema or corneal inflammation prior to triplex surgery. This is especially the case for eyes with other related ocular or systemic abnormalities when the triplex surgery or simple explantation of AC P-IOL should be performed early. Attention should be paid [to] eyes with long axial length for PCO," Dr. Luo concluded. Furthermore, indications for corneal transplantation such as keratoconus and larger graft size, according to Javadi and colleagues, have been identified as factors that influence visual outcomes after the triple procedure when keratoplasty is involved. EW References 1. Girard P, et al. A triple procedure: phacoemulsification, intraocular lens implantation, and scleral buckling surgery. Retina. 1997;17:502–6. 2. Javadi MA, et al. Simultaneous penetrating keratoplasty and cataract surgery. J Ophthal- mic Vis Res. 2013;8:39–46. 3. Shimmura S, et al. Corneal opacity and cataract: triple procedure versus secondary approach. Cornea. 2003;22:234–238. Editors' note: Drs. Luo and Sheppard have no financial interests related to their comments. Contact information Luo: yeeluo116@sina.com Sheppard: docshep@hotmail.com But unlike standard triple sur- gery involving penetrating kerato- plasty, with refractive visual results called into question, this procedure led to more severe complications in some cases. Among 1,251 eyes of 696 pa- tients that received a phakic IOL in a retrospective review, 17 that received anterior chamber IOLs and 5 that received posterior chamber IOLs developed cataract and underwent "triplex" surgery. Primary outcomes measured included best corrected visual acuity (BCVA), endothelial cell density (ECD), complications and their risks. The mean follow-up time after this type of triple surgery was 42+12 months, and the mean logMAR BCVA did significantly improve after the triple surgery (P=0.023). Intraoperatively, mild anterior chamber hemorrhage occurred in 1 eye, while 1 eye developed acute endophthalmitis 5 days postoper- atively and underwent pars plana vitrectomy, according to the inves- tigators. Also, the investigators report- ed a mean percentage of 26.4% in endothelial cell density loss over the mean period of 6.6+1.2 years after phakic IOL implantation and 4.1% over 6 months after triple surgery, becoming stable thereafter. They noted, however, that 5 eyes (31.3%) with severe endothelial cell loss preoperatively developed corneal decompensation at a mean time of 9.4+2.6 months after the triple surgery. "Two eyes underwent penetrat- ing keratoplasty and 3 eyes under- went endothelial keratoplasty," said Yi Luo, MD, Department of Oph- thalmology, Eye and ENT Hospital of Fudan University, Shanghai, China. "Six eyes (27.3%) developed posterior capsule opacification (PCO). A thinner central corneal thickness (CCT), higher incidence of pupil ovalization and the presence of corneal edema preoperatively were observed in eyes with corneal decompensation compared with *Average refraction time for patients without medical conditions FEATURES & BENEFITS Subjective and/or Objective More Control in Subjective Refraction Helping Medical Patients Maximizing Patient's Visual Acuity 5X More Accurate - Refinement Steps Subjective Refraction Time Per Eye * Subjective Nighttime Refraction Delegation/Learning Subjective Refraction Becoming a Proficient Refractionist Operator Skill Requirements PSF Based Technology Randomized Snellen & Douchrome One Touch Comparison Multiple Rxs Footprint or Exam Lane Size Mobile Wavefront Autorefraction Other Advanced Features PERFECTUS™ Both in One 4 Jackson Cross Cylinders Easier and Less Stressful To 20/12+ 0.05D 1 Minute or Less Yes 4 Hours 2 Weeks Little Experience Yes Yes Yes 1.2 Feet x 1.5 Feet Yes Yes Direct View of Cataract Formation PatientActive™ Fixation High Repeatability in WF Small Pupil Size Normal to 1.5 MM PHOROPTER™ Subjective Only 1 Jackson Cross Cylinder NOT APPLiCABLE 20/20 0.25D 2 - 3 Minutes NOT APPLiCABLE Optometry Schooling 6 Months - Years Advanced NOT APPLiCABLE NOT APPLiCABLE NOT APPLiCABLE 10 - 20 Feet NOT APPLiCABLE NOT APPLiCABLE NOT APPLiCABLE NOT APPLiCABLE NOT APPLiCABLE NOT APPLiCABLE Visit us at ASCRS 2016 in booth 1223 Contact Vmax Vision for more information or a demonstration of Perfectus. 1 www.vmaxvision.com 888.413.7038 info@vmaxvision.com 2 Is the phoropter really your ultimate refraction tool? COMPARE THEN DECIDE WHICH IS BETTER ? Pros continued from page 151

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