Distance vision after bilateral implantation of AcrySof toric intraocular lenses:a randomized,controlled,prospective trial

·AIM:To evaluate the distance vision of Chinese patients with cataracts and corneal astigmatism after implantation of bilateral AcrySof toric intraocular lens (IOL) versus bilateral AcrySof spherical IOL.·METHODS:This study randomized 60 patients into equal groups to receive toric IOL or spherical IOL.IOL powers targeting emmetropia were selected for 93% of toric IOL patients and for 90% of spherical IOL patients.Assessments included monocular and binocular distance vision,with and without best correction.Patients also completed surveys about their distance vision.·RESULTS:Preoperatively,the two study groups were similar in age,in distance visual acuity,and in the magnitude of corneal astigmatism.At 6 months postoperative,binocular uncorrected distance vision was 0.06?à0.14 logMAR in the AcrySof toric IOL group,significantly better than the 0.14?à0.11 logMAR in the spherical IOL group (P<0.05).For eyes with emmetropia as a target,the equivalent of 20/20 uncorrected vision was more likely (P<0.001) in the toric IOL group (36% of eyes) than in the spherical IOL group (4% of eyes).No patients in the emmetropia/toric IOL group used distance glasses,as compared to 52% of patients in the emmetropia/spherical IOL group.All patients were satisfied or highly satisfied.Quality of distance vision was rated higher by toric IOL patients than by spherical IOL patients (P<0.05).·CONCLUSION:Bilateral AcrySof toric IOL is superior to bilateral spherical IOL in providing uncorrected distance vision to cataract patients with corneal astigmatism.·

Rotational stability of plate haptic toric intraocular lenses after combined 25-gauge vitrectomy and cataract surgery

AIM:To evaluate the postoperative intraocular lens(IOL)rotational stability and residual refractive astigmatism following combined 25-gauge vitrectomy and cataract surgery with implantation of a plate haptic toric IOL.METHODS:In this retrospective case series,32 eyes of 32 patients underwent a combined 25-gauge vitrectomy and phacoemulsification for vitreoretinal diseases and cataract with regular corneal astigmatism of at least 1 diopter(D).A plate haptic toric IOL(AT Torbi 709M,Carl Zeiss Meditec AG)was implanted in all eyes.The outcome measures were rotational stability and refractive astigmatism up to 6mo postoperatively as well as the best corrected visual acuity(BCVA).RESULTS:Preoperative refractive astigmatism was 2.14±1.17 D,which was significantly reduced to 0.77±0.37 D six to eight weeks postoperatively and remained stable throughout the observation period(0.67±0.44 D at three months and 0.75±0.25 D at six months;for all groups:P<0.0001 compared to baseline).BCVA improved significantly from 0.36±0.33 logMAR preoperatively to 0.10±0.15 logMAR following surgery(P=0.02).Mean IOL axis deviation from the target axis was 3.4°±2.9°after six to eight weeks and significantly decreased over time(2.4°±2.6°six months after surgery;P=0.04).In one patient IOL,re-alignment was performed.CONCLUSION:Corneal astigmatism is significantly reduced following combined 25-gauge vitrectomy and cataract surgery.The plate haptic toric IOL position and axis remain stable during the observation period of six months.

Trifocal toric intraocular lenses in eyes with low amount of corneal astigmatism

AIM:To evaluate the refractive and visual outcomes following cataract surgery and implantation of a trifocal toric intraocular lens(IOL)in eyes with low degrees of corneal astigmatism.METHODS:Twenty-six eyes of 22 patients who underwent implantation a trifocal toric IOL(FineVision PODFT,PhysIOL s.a.,Liege,Belgium)were enrolled.Phacoemulsification with femtosecond laser,capsular tension ring insertion and intraoperative aberrometry were performed in all cases.All IOLs used showed a cylinder power of 1.00 D.Main outcome measures were refractive error and corrected-distance visual acuity(CDVA)and uncorrected-distance visual acuity(UDVA)values.Eyes were evaluated at 4 mo post-surgery.RESULTS:Totally 50%of eyes showed a spherical equivalent(SE)within±0.13 D and all of them within±0.50 D.The mean SE and refractive cylinder were-0.02±0.23 and-0.16±0.22 D,respectively.Vector analysis revealed that 100%of eyes were within±0.50 D for the SE and cylindrical components(J0 and J45).Refractive changes were not correlated with keratometric changes(P>0.05)showing that the reduction in astigmatism comes from the trifocal toric IOL.Of 81%and 96%of eyes showed UDVA and CDVA of 20/20,respectively.The postoperative mean values of monocular distance Snellen decimal UDVA and CDVA were 0.97±0.05 and 0.99±0.02(about 20/20),respectively.CONCLUSION:Our study suggests that the use of this trifocal toric IOL in patients with low amount of astigmatism provides accurate refractive outcomes and enables them to achieve excellent visual acuity.

Repeatability of in-vitro optical quality measurements of intraocular lenses with a deflectometry technique effect of the toricity

AIM： To evaluate the repeatability of an optical device for measuring the Zernike coefficients of toric intraocular lenses（IOLs） and assess whether its toricity has any impact in its repeatability. METHODS： An experienced technician used the NIMO TR1504 to measure the Zernike coefficients 30 times for an aperture of 4.50 mm for all lenses included. The IOLs included were divided into two group： toric and nontoric ones. The cylindrical powers of the toric lenses included in the present study were 1.00, 1.50, 2.25, 3.00 and 3.75 D. Finally, the repeatability of the NIMO TR1504 was described in terms of within subject standard deviation（Sw） and repeatability limit. RESULTS： The Sw was smaller than 0.011 μm for both lens groups and all Zernike coefficients, and the difference between both groups was smaller than 0.004 μm for all Zernike coefficients. Regarding the repeatability limit, this value was smaller than 0.025 μm for the toric lens group, and smaller than 0.031 μm for the non-toric lens one for all Zernike coefficients. Furthermore, the maximum difference between both lens groups was 0.010 μm. CONCLUSION： The repeatability of the NIMO TR1504 to measure the optical quality is high and independent of the lens toricity. These results reflect that this system is robust and could be used to measure the in-vitro optical quality of either toric or non-toric IOLs.

Sutured scleral fixation of existing subluxated/dislocated acrylic one-piece intraocular lenses

AIM:To evaluate the visual and refractive outcomes in cases after sutured scleral fixation of existing subluxated or dislocated acrylic one-piece intraocular lenses(IOLs).METHODS:This study retrospectively enrolled a consecutive series of patients who underwent a surgery of sutured existing subluxated or dislocated IOLs from October 2018 to June 2020.All patients underwent comprehensive preoperative and postoperative ophthalmologic examination,and data were collected including age,sex,surgical indications,best-corrected visual acuity,refractive error,intraocular pressure.Presence of intraoperative and postoperative surgical complications was documented.RESULTS:A total of 20 consecutive cases were enrolled for analysis with mean final follow-up period 9.8±5.3mo.Visual acuity improved from a mean of 0.35(0.46±0.32 logMAR)preoperatively to 0.61(0.21±0.18 logMAR)at the 3-month follow-up(P=0.002).The mean amount of preoperative keratometric astigmatism and total postoperative refractive astigmatism was-1.24±0.80 diopters(D)and-1.42±0.97 D,respectively.There was no statistically significant difference between preoperative and postoperative astigmatism(P=0.156).The mean IOL-induced astigmatism was-0.23±0.53 D.The mean spherical equivalent at the 3-month follow-up was-0.1±0.94 D.No major complications were noted during the follow-up period.CONCLUSION:Surgical techniques using sutured scleral fixation of existing subluxated or dislocated acrylic one-piece IOLs result in favorable visual and refractive outcomes without major complications.

Changes in visual performance after implantation of different intraocular lenses

AIM:To evaluate the trending visual performance of different intraocular lenses(IOLs)over time after implantation.METHODS:Ninety-one patients received cataract surgery with implantations of monofocal(Mon)IOLs,segmental refractive(SegRef)IOLs,diffractive(Dif)IOLs,and extendeddepth-of-focus(EDoF)IOLs were included.The aberrations and optical quality collected with iTrace and OQAS within postoperative 6mo were followed and compared.RESULTS:Most of the visual parameters improved over the postoperative 6mo.The postoperative visual acuity(POVA)of the Mon IOL,SegRef IOL,and EDoF IOL groups achieved relative stability in earlier states compared with the Dif IOL group.Nevertheless,the overall visual performance of the 3 IOLs continued to upturn in small extents within the postoperative 6mo.The optical quality initially improved in the EDoF IOL group,then in the Mon IOL,SegRef IOL,and Dif IOL groups.POVA and objective visual performance of the Mon IOL and EDoF IOL groups,as well as POVA and visual quality of the Dif IOL group,improved in the postoperative 1mo and stabilized.Within the postoperative 6mo,gradual improvements were observed in the visual acuity and objective visual performance of the SegRef IOL group,as well as in the postoperative optical quality of the Dif IOL group.CONCLUSION:The visual performance is different among eyes implanted with different IOLs.The findings of the current study provide a potential reference for ophthalmologists to choose suitable IOLs for cataract patients in a personalized solution.

Effectivity and safety of trifocal intraocular lenses and capsular tension rings implantation for cataract patients with axial high myopia

●AIM:To assess effectivity and safety of trifocal intraocular lenses(IOLs)and capsular tension rings in treating cataract patients with axial high myopia.●METHODS:A prospective nonrandomized controlled clinical trial was conducted.Totally 98 eyes(74 patients)who underwent femtosecond laser-assisted cataract surgery(FLACS)with trifocal IOLs were enrolled in the study and followed up for 2y after surgery:46 eyes(33 patients)with capsular tension ring implantation in the long axial lengths(AL)group(26<AL<29 mm)and 52 eyes(41 patients)in the normal AL group(22<AL<24.5 mm).Postoperative outcomes about effectivity and safety,including the subjective and objective visual quality,and postoperative complications were assessed.●RESULTS:Uncorrected distance visual acuity at 5 m and uncorrected intermediate visual acuity at 60 and 80 cm in the long AL group were significantly worse than those in the normal AL group at 3mo postoperatively(P<0.05).The differences in reading speed,spectacle independence and potential visual complaints between the two groups were not statistically significant(P>0.05).The dysfunctional lens index and total modulation transfer function(MTF)average height were similar between the two groups.The postoperative internal coma aberrations in the axial high myopia eyes were significantly higher than that in the normal AL group(P<0.05).The total satisfaction score in the long AL group(91.32±2.76)was slightly higher than that in the normal AL group(90.36±3.47),but there was no difference(P=0.136).A statistically negative correlation was found between corrected distance visual acuity(CDVA)and dysfunctional lens index(r=-0.382,P=0.009),and between CDVA and the total MTF average height(r=-0.374,P=0.01).But there was no significant correlation between CDVA and total satisfaction score(r=0.059,P=0.696).Postoperative complications mainly presented as posterior capsular opacity(PCO),retinal detachment and cystoid macular edema.There was no difference in the incidence of fundus disease(6.5%vs 3.8%,P=0.663)or PCO(17.4%vs 7.7%,P=0.217)between the two groups at two years.●CONCLUSION:The utilization of trifocal IOL and capsular tension ring implantation is beneficial for cataract patients with axial high myopia undergoing FLACS.This approach not only ensures excellent subjective feelings and objective visual quality,but also does not increase the incidence of postoperative complications.

Considerations in the management of single-piece intraocular lenses outside the capsular bag

AIM: To investigate the outcomes of off label singlepiece acrylic intraocular lenses(SPA-IOL) ciliary sulcus placement compared to three-piece IOL(3P-IOL). METHODS: The charts of eight consecutive eyes of patients who received sulcus-placed SPA-IOLs between 2006 and 2009 were reviewed. None of the patients underwent IOL exchange. Charts of six age-matched patients who received sulcus placed 3P-IOLs were reviewed as a control group. RESULTS: Mean follow up was 16 mo for SPA-IOL and 23 mo for 3P-IOL. Five of 8 patients in the SPA-IOL group required chronic use of IOP lowering medications at final follow up. Of these, one patient needed glaucoma implant surgery for uncontrolled IOP. One patient in the 3P-IOL group used chronic aqueous suppression pre- and postoperatively. Four of eight eyes with SPAIOL were treated with chronic topical steroids and or non-steroidal anti-inflammatory drugs for cystoid macu-la edema, chronic uveitis, pigment dispersion syndrome or a combination of the above, compared to none in the control group. Mean best-corrected visual acuity was 20/35 in the SPA-IOL group and 20/47 in the 3PIOL group.CONCLUSION: Sulcus placed SPA-IOLs are associated with increased ocular morbidity. In select cases good visual acuity may be achieved. Due to postoperative rotation of sulcus placed toric SPA-IOLs stable astigmatism correction cannot be achieved. Alternative intraocular lenses should be considered when in-the-bag placement of SPA-IOL is not possible.

Comparison of trifocal toric and bifocal toric intraocular lens implantation in patients with cataract and high corneal astigmatism

AIM:To investigate and compare the quality of life,satisfaction,contrast sensitivity,glare,depth perception,and intraocular lens(IOL)rotation in patients who underwent trifocal toric and bifocal toric IOLs.METHODS:A total of 80 eyes of 40 patients were included in this prospective study.Twenty patients in each group were implanted with trifocal toric and bifocal toric IOL,respectively.Preoperative and postoperative 6-month measurements were recorded for both patient groups.Comprehensive anterior and posterior segment examinations,distance-intermediate-near visual acuity values and the visual function scale questionnaire results were evaluated at these examinations.Patient satisfaction,contrast sensitivity,glare,intermediate-near and distance stereopsis and IOL rotation were also evaluated.RESULTS:No significant difference was found between the groups in terms of distance and near visual acuities(P=0.269,P=0.451).Intermediate visual acuity was significantly increased in the trifocal toric group(P<0.001).The visual function scale results were increased after surgery in both groups(P=0.001 and P<0.001),with no difference determined between them(P=0.158 and P=0.691).The number of patients wearing glasses was low in both groups and there was no significant difference between the groups(P>0.05).The overall satisfaction in the trifocal toric group was significantly higher than in the bifocal toric group(P=0.03).The highest sensitivity was observed at 6 cpd spatial frequency in all patients under photopic conditions(1.80±0.24 logU,1.74±0.20 logU).Distance-intermediate-near binocular depth perception results in both groups were higher in the trifocal toric group(P=0.02,0.048,0.003,respectively).Although there was no significant difference for 3 meters stereopsis,the trifocal toric group had higher depth perception(P=0.577).Mean rotation was 5.76°±3.93°in the trifocal toric group and 12°±7.1°in the bifocal toric group.CONCLUSION:Better results in the middle distance are obtained in the trifocal toric group and less IOL rotation due to digital system-coordinated surgery.Moreover,the overall satisfaction in the trifocal toric group is significantly higher than in the bifocal toric group.

Biocompatibility of light responsive materials prepared for accommodative intraocular lenses manufacturing

AIM:To investigate the biocompatibility and bacterial adhesion properties of light responsive materials(LRM)and analyze the feasibility and biosafety of employing LRM in the preparation of accommodative intraocular lenses(AIOLs).METHODS:Employing fundamental experimental research techniques,LRM with human lens epithelial cells(hLECs)and human retinal pigment epithelium cells(ARPE-19 cells)were co-cultured.Commercially available intraocular lenses(IOLs)were used as controls to perform cell counting kit-8(CCK-8),cell staining under varying light intensities,cell adhesion and bacterial adhesion experiments.RESULTS:LRM exhibited a stronger inhibitory effect on the proliferation of ARPE19 cells than commercially available IOLs when co-cultured with the undiluted extract for 96h(P<0.05).Under other culturing conditions,the effects on the proliferation of hLECs and ARPE-19 cells were not significantly different between the two materials.Under the influence of light irradiation at intensities of 200 and 300 mW/cm^(2),LRM demonstrated a markedly higher inhibitory effect on the survival of hLECs compared to commercially available IOLs(P<0.0001).They also showed a stronger suppressive effect on the survival rate of ARPE-19 cells,with significant differences observed at 200 mW/cm^(2)(P<0.001)and extremely significant differences at 300 mW/cm^(2)(P<0.0001).Additionally,compared to commercially available IOLs,LRM had a higher number of cells adhering to their surface(P<0.05),as well as a significantly greater number of adherent bacterium(P<0.0001).CONCLUSION:LRM,characterized by their excellent non-contact tunable deformability and low cytotoxicity to ocular tissues,show considerable potential for use in the fabrication of AIOLs.These materials demonstrate strong cell adhesion;however,during photothermal conversion processes involving shape deformation under various light intensities,the resultant temperature rise may harm surrounding cells.These factors suggest that while the material plays a positive role in reducing the incidence of posterior capsule opacification(PCO),it also poses potential risks for retinal damage.Additionally,the strong bacterial adhesion of these materials indicates an increased risk of endophthalmitis.

Multifocal and extended depth of focus intraocular lenses

Advances in intraocular lens(IOL)design have rendered cataract surgery a refractive procedure.Newer IOL types include bifocal,trifocal and extended depth of focus(EDOF)IOLs.Their basic difference nestles in the number of focal points that each lens provides,which in turn leads to different visual outcomes.Familiarity of surgeons with the various characteristics of each lens is of utmost importance for accurate IOL selection to match each patient’s needs.In this review,we aim to compare the clinical outcomes after implantation of multifocal and EDOF IOLs in terms of distance,intermediate and near vision,contrast sensitivity,and reading performance.Finally,we discuss the defocus curve and the optical and photic phenomena associated with each type of IOL.

Optical quality of toric intraocular lens implantation in cataract surgery

AIM: To analyze the optical quality after implantation of toric intraocular lens with optical quality analysis system.METHODS: Fifty-two eyes of forty-four patients with regular corneal astigmatism of at least 1.00 D underwent implantation of Acry Sof toric intraocular lens, including T3 group 19 eyes, T4 group 18 eyes, T5 group 10 eyes,T6 group 5 eyes. Main outcomes evaluated at 3mo of follow-up, included uncorrected distance visual acuity(UDVA), corrected distance visual acuity(CDVA), residual refractive cylinder and intraocular lens(IOL) axis rotation.Objective optical quality were measured using optical quality analysis system(OQAS Ⅱ, Visiometrics, Spain),included the cutoff frequency of modulation transfer function(MTFcutoff), objective scattering index(OSI),Strehl ratio, optical quality analysis system value(OV)100%, OV 20% and OV 9% [the optical quality analysis system(OQAS) values at contrasts of 100%, 20%, and 9%].RESULTS: At 3mo postoperative, the mean UDVA and CDVA was 0.18 ±0.11 and 0.07 ±0.08 log MAR; the mean residual refractive cylinder was 0.50 ±0.29 D; the mean toric IOL axis rotation was 3.62 ±1.76 degrees, the mean MTFcutoff, OSI, Strehl ratio, OV 100%, OV 20% and OV9% were 22.862 ±5.584, 1.80 ±0.84, 0.155 ±0.038, 0.76 ±0.18,0.77±0.19 and 0.78±0.21. The values of UDVA, CDVA, IOL axis rotation, MTFcutoff, OSI, Strehl ratio, OV100%,OV20% and OV9% depending on the power of the cylinder of the implantation were not significantly different(P 】0.05), except the residual refractive cylinder(P 【0.05).CONCLUSION: The optical quality analysis system was useful for characterizing the optical quality of Acry Sof toric IOL implantation. Implantation of an Acry Sof toric IOL is an effective and safe method to correct corneal astigmatism during cataract surgery.

Visual performance after implantation of two types of phakic foldable intraocular lenses for correction of high myopia

AIM: To compare Visian lens(model V4 c) and Artiflex lens regarding quality(contrast sensitivity) and quantity(efficacy, predictability, safety and stability) of vision in correcting high myopia with recording and analysis of complications. METHODS: The comparative prospective study included 39 eyes of 23 patients with high myopia, 19 eyes had Visian lens implantation(model V4 c) and 20 eyes had Artiflex lens implantation. The inclusion criteria were high myopia(higher than 6.0 D) and stable refraction(<0.5 D change over one year). Outcomes included assessment of safety and efficacy indices, predictability, stability, contrast sensitivity and analysis of complications at postoperative 1 d, 1 wk and 1, 3, 6 and 12 mo. Selection of the type of phakic intraocular lens for patients was based on surgeons' preferences, which was no specific selection criteria. RESULTS: After 12 mo of follow up, difference in uncorrected and corrected distant visual acuity(CDVA) between both groups was statistically insignificant(UDVA for VisianV4 c and Artiflex lens were 0.33±0.2 logMAR and 0.37±0.2 logMAR respectively, P=0.59, CDVA for VisianV4 c and Artiflex lens were 0.155±0.1 logMAR and 0.147± 0.1 logMAR respectively, P=0.87). The efficacy index was 1.25 for VisianV4 c lens and 0.8 for Artiflex lens, 78.9% of eyes were within one diopter spherical equivalent in Visian V4 c lens group compared to 70% in the Artiflex lens group. No eye lost lines of CVDA proving a good safety index for both lenses(safety index was 1.67 for VisianV4 c lens and 1.34 for Artiflex lens). Difference in contrast sensitivity between both groups was statistically insignificant(P=0.15, 0.88, 0.27, 0.32 and 0.82 at five spatial frequencies). CONCLUSION: Both Visian ICL V4 c and Artiflex lensesare safe and effective with stable and predictable refraction and they have comparable contrast sensitivity outcomes with no vision threatening complications.

Higher order aberration comparison between two aspherical intraocular lenses: MC6125AS and Akreos advanced optics

AIM: To compare higher order aberrations in two aspherical intraocular lenses(IOLs): Akreos advanced optics(AO) and Dr. Schmidt Microcrystalline 6125 aspheric anterior surface(MC6125AS) with each other. METHODS: Forty eyes of 39 patients underwent phacoemulsification and Akreos AO and MC6125 AS were implanted in their eyes in a random manner. Three months post-operatively, higher order aberrations including spherical aberration, coma aberration, and total aberrations were measured and compared.RESULTS: The total aberration was 0.24±0.17 in eyes with Dr. Schmidt and 0.20 ±0.01 in eyes with Akreos AO(P =0.361). The mean of coma aberration was 0.17 ±0.21 and 0.09 ±0.86 in Dr. Schmidt and Akreos lenses,respectively(P =0.825). Total spherical aberration was almost the same in both groups(mean: 0.05, P =0.933).Best corrected visual acuity in Akreos AO(0.10±0.68) and Dr. Schmidt(0.09±0.67) did not differ significantly(P =0.700). CONCLUSION: There is no statistically significant difference in the higher order aberrations between these two aspherical lenses.

Effects of posterior corneal astigmatism on the accuracy of AcrySof toric intraocular lens astigmatism correction

AIM：To evaluate the effects of posterior corneal surface measurements on the accuracy of total estimated corneal astigmatism.METHODS：Fifty-seven patients with toric intraocular lens（IOL） implantation and posterior corneal astigmatism exceeding 0.5 diopter were enrolled in this retrospective study.The keratometric astigmatism（KA） and total corneal astigmatism（TA） were measured using a Pentacam rotating Scheimpflug camera to assess the outcomes of AcrySof IOL implantation.Toric lOLs were evaluated in 26 eyes using KA measurements and in 31 eyes using TA measurements.Preoperative corneal astigmatism and postoperative refractive astigmatism were recorded for statistical analysis.The cylindrical power of toric lOLs was estimated in all eyes.RESULTS：In all cases,the difference of toric IOL astigmatism magnitude between KA and TA measurements for the estimation of preoperative corneal astigmatism was statistically significant.Of a total of 57 cases,the 50.88%decreased from Tn to Tn-1 and 10.53%decreased from Tn to Tn-2.In all cases,5.26%increased from Tn to Tn＋1.The mean postoperative astigmatism within the TA group was significantly lower than that in the KA group.CONCLUSION：The accuracy of total corneal astigmatism calculations and the efficacy of toric IOL correction can be enhanced by measuring both the anterior and posterior corneal surfaces using a Pentacam rotating Scheimpflug camera.

Study on the surface properties of surface modified silicone intraocular lenses

AIM: To prepare a new-type soft intraocular lens (IOL) that silicone intraocular lenses (IOLs) were modified by surface modification technique to assess IOLs biocompatibility. METHODS: With the technique of ion beam combined with low temperature and low pressure plasma, the surface characteristics of the IOLs including physical and optical properties were determined by the instruments of IOLs resolution, UV/VIS scanning spectrophotometer, contact angle measurement system, electron spectroscopy for chemical analysis (ESCA) and scanning electron microscope (SEM). RESULTS: The color of titanium (Ti) modified IOLs was light yellow and that of titanium nitride (TiN) modified IOLs was light brown. The absorptive degree of ultraviolet rays and the hydrophilicity of the surfaces of modified IOLs were increased, and appeared suitable chemical compositions. The resolution of unmodified and modified IOLs reached normal standard. The surfaces of unmodified and Ti-modified IOLs appeared uniform. The surfaces of TIN-modified IOLs presented fine porcelain structure. CONCLUSION: The optical properties of all IOLs and the surface morphology of the modified IOLs were not affected by modification processes. The surface properties of the modified IOLs were improved.

Visual function and higher order aberration after implantation of aspheric and spherical multifocal intraocular lenses:a meta-analysis

AIMTo assess the visual outcomes of aspheric multifocal intraocular lenses (IOLs) compared with spherical multifocal IOL after cataract surgery.

F-heparin modified intraocular lenses in Rhesus monkeys

AIMIn order to improve the biocompatibility of intraocular lenses (IOL), the polymethylmethacrylate (PMMA) IOL was modified with F-heparin.

Comparison of two different methods of preoperative marking for toric intraocular lens implantation： bubble marker versus pendulum marker

AIM： To compare the accuracy of two different methods of preoperative marking for toric intraocular lens（IOL） implantation, bubble marker versus pendulum marker, as a means of establishing the reference point for the final alignment of the toric IOL to achieve an outcome as close as possible to emmetropia.·METHODS： Toric IOLs were implanted in 180 eyes of110 patients. One group（55 patients） had preoperative marking of both eyes done with bubble marker（ASICO AE-2791TBL） and the other group（55 patients） with pendulum marker（Rumex 誖 3-193）. Reference marks were placed at 3-, 6-, and 9-o＇clock positions on the limbus. Slit-lamp photographs were analyzed using Adobe Photoshop（version 7.0）. Amount of alignment error（in degrees） induced in each group was measured.· RESULTS： Mean absolute rotation error in the preoperative marking in the horizontal axis was 2.42±1.71 in the bubble marker group and 2.83 ±2.31 in the pendulum marker group（P =0.501）. Sixty percent of the pendulum group and 70% of the bubble group had rotation error ≤3（P =0.589）, and 90% eyes of the pendulum group and 96.7% of the bubble group had rotation error ≤5（P =0.612）.·CONCLUSION： Both preoperative marking techniques result in approximately 3 of alignment error. Both marking techniques are simple, predictable, reproducible and easy to perform.

Combination of Toric and multifocal intraocular lens implantation in bilateral cataract patients with unilateral astigmatism

AIM： To assess the binocular visual function in bilateral cataract patients with unilateral astigmatism after combined implantations of Toric with multifocal intraocular lens （IOL）, and to compare with that of Toric and monofocal IOL implantation.METHODS： All the 30 patients with unilateral astigmatism suffered bilateral cataract were randomly divided into two groups： Toric plus multifocal IOL group and Toric plus monofocal IOL group. Uncorrected and corrected visual acuity at distance （5.0 m）, intermediate distance （0.6 m）, and near （0.33 m）, contrast sensitivity, and stereopsis were assessed 6mo after surgery. Patients were also surveyed for visual disturbances and spectacle dependence.RESULTS： Binocular uncorrected visual acuity （LogMAR） of Toric/multifocal IOL eyes at distance, intermediate, near were 0.05±0.05, 0.24±0.10, and 0.14±0.06 respectively. The values of Toric plus monofocal IOL eyes were 0.06±0.07, 0.26±0.08, and 0.37±0.10 respectively. These values did not indicate significant differences between two groups with exception of near visual acuity. In the photopic condition （with or without glare）, the contrast sensitivity of multifocal IOL eyes was significant lower than the monofocal IOL eyes in 18 cpd. In the mesopic condition, the contrast sensitivity of multifocal group was significant lower than monofocal group in 12 cpd, and in mesopic glare condition, this significant difference was found both in 6 cpd and 12 cpd. The stereopsis of Toric/multifocal IOL eyes decreased slightly （100±80 seconds of arc, t=2.222, P=0.136）. Mean near vision for patient satisfaction was statistically significantly higher in Toric/multifocal IOL group patients versus than that in Toric/monofocal IOL group （80% vs 25.5%, P=0.000）. Visual disturbance was not noticed in either group.CONCLUSION： Although the combination of Toric and multifocal IOL implantation results in compromising stereoacuity, it can still provide patients with high levels of spectacle freedom and good overall binocular visual acuity.