Refractive lens exchange in modern practice: when and when not to do it?

Cataract surgery due to advances in small incision surgery evolved from a procedure concerned with the primary focus on the safe removal of cataractous lens to a procedure focused on the best possible postoperative refractive result.As the outcomes of cataract surgery became better,the use of lens surgery as a refractive modality in patients without cataracts has increased in interest and in popularity.Removal of the crystalline lens for refractive purposes or refractive lens exchange(RLE)presents several advantages over corneal refractive surgery.Patients with high degrees of myopia,hyperopia and astigmatism are still not good candidates for laser surgery.Moreover,presbyopia can currently only be corrected with monovision or reading spectacles.RLE supplemented with multifocal or accommodating intraocular lenses(IOLs)in combination with corneal astigmatic procedures might address all refractive errors including presbyopia,and eliminate the future need for cataract surgery.

Effect of femtosecond laser-assisted lens surgery on the optic nerve head and the macula

AIM: To evaluate the effect of femtosecond laser-assisted lens surgery(FLALS;cataract surgery or refractive lens exchange) on the structure of the optic nerve head and the macula.METHODS: This prospective longitudinal study included healthy eyes undergoing FLALS. Eyes with glaucoma or any other ocular disease that could alter optical coherence tomography results were excluded. Retinal nerve fiber layer(RNFL), Bruch’s membrane opening-minimum rim width(BMO-MRW) and macular thickness(MT) were measured preoperatively, 1 and 6 mo after surgery using spectral-domain optical coherence tomography(SD-OCT). Changes between preoperative and postoperative values were evaluated.RESULTS: A total of 87 eyes of 46 patients were included in this study. Preoperative RNFL, BMO-MRW and MT in microns(μm) were 100.77±10.39, 330.31±49.99 and 276.30±33.39, respectively. Postoperative RNFL, BMO-MRW and MT were 104.74±11.55, 348.32±54.05 and 279.83±22.65 1 mo after surgery and 102.93±11.17, 343.11±53.4 and 278.90±22.19 6 mo after surgery, respectively;which equals an increase of 3.93%, 5.45% and 1.27%,respectively, 1 mo after surgery, and 2.14%, 3.87% and 0.94% 6 mo after surgery. The differences between the preoperative and the postoperative RNFL and BMO-MRW values were statistically significant(P<0.001). Regarding MT values, there were not statistically significant differences(P=0.26).CONCLUSION: Our study suggests that FLALS does not have a negative impact on the structural status of the optic nerve head in healthy eyes, assessed by SD-OCT. There is a slight increase in the values of RNFL, BMO-MRW and MT 1 mo and 6 mo after surgery.

Visual and refractive outcomes following implantation of a new trifocal intraocular lens

Background:Independence from all optical aids,and freedom from unwanted symptoms,following cataract and lens surgery remains the ultimate goal of both patient and surgeon.The development of trifocal IOL technology provides an ever-increasing range of options.The purpose of our study is to understand the predictability,safety and efficacy of a new trifocal intraocular lens(IOL)following cataract or refractive lens exchange(RLE)surgery.Methods:This was a retrospective consecutive case series of patients undergoing cataract extraction or RLE followed by implantation of the Alcon IQ Panoptix IOL.Pre and postoperative refractive and visual parameters were recorded and evaluated.As the cohort followed a normal distribution,standard parametric tests were used.Paired t-test was used to compare the difference between target and postoperative refractive errors.The incidence of intraoperative and postoperative complications was also reported.Results:The IOL was implanted in 66 eyes of 33 patients.Mean postoperative spherical equivalent(SE)refraction was-0.08±0.25 dioptres(D).This was not significantly different from the target refraction(p=0.841).Sixty-five percent of patients were within±0.25 D of the target SE refraction with 100%within±0.50 D of intended correction.Mean postoperative uncorrected distance visual acuity(UDVA)was 0.01±0.10 LogMAR.All patients achieved an unaided distance acuity of 20/40 or better postoperatively.Binocularly,100%saw 0.20 LogMAR or better at near without correction and 88.9%achieved this level for uncorrected intermediate visual acuity.No intraoperative complications were noted.Five patients complained of moderate haloes in the early postoperative period.Conclusion:The AcrySof IQ Panoptix IOL provides functional uncorrected visual acuity at distance,intermediate and near positions.Our results remain equivalent with existing trifocal IOL outcomes and provide surgeons with a further IOL alternative for the patient motivated to obtain true spectacle independence.Surgeons should consider individual reading and working requirements when counselling patients preoperatively to optimise postoperative patient satisfaction.