The endocapsular tension ring has helped in the management of patients with moderate loss of zonular support. However, the eye with profound zonular dialysis or weakness may require scleral fixation of the ring for centration and long-term stabilization. We used a new, modified endocapsular tension ring designed to provide scleral support without violating the integrity of the capsular bag in 4 patients. All patients had extreme loss of zonular support preoperatively or a significant risk of progressive zonular weakness. In each case, the new ring provided excellent support and centration of the capsular bag and intraocular lens intraoperatively and postoperatively.

Implantation of prosthetic iris devices improved postoperative outcomes by reducing glare disability and, in selected cases, by correcting aphakia. Although operating on traumatized, congenitally aniridic, or uveitic eyes presents special challenges, implantation of prosthetic iris devices appears to be a safe and effective method for reducing the ubiquitous glare in patients with iris deficiency.

Use of the MCTR resulted in centration of the capsular bag and PC IOL in 90 eyes with congenitally subluxated crystalline lenses. Fixation of a 9-0 polypropylene suture is recommended to decrease the risk for late suture breakage.

Intermediate vision at a mean reading distance of approximately 40 cm was better with the aspheric IOL with a +3.0 D add than with the aspheric IOL with a +4.0 D add, as shown by the near peak in the mean binocular defocus curve; near and distance acuity were similar between the 2 IOLs. Patients reported excellent overall quality of vision, spectacle independence, and satisfaction.

We developed and evaluated a method of visualizing vitreous gel in the anterior segment. In this study, 0.2 mL of injectable triamcinolone (Kenalog) 40 mg/mL was captured in a 5 microm filter and rinsed with 2 mL of balanced salt solution (BSS). It was then resuspended in 5 mL of BSS and recaptured to thoroughly remove the preservative. The Kenalog particles were ultimately resuspended in 2 mL of BSS and injected into the anterior chamber through a 27-gauge cannula. Kenalog particles were trapped on and within the vitreous gel, making it clearly visible. The visualization provided direct observation of vitreous behavior in various experimental settings and assisted surgeons intraoperatively in the identification and removal of vitreous in the anterior segment.

Drs. Solomon and Cionni are consultants to Alcon Research, Ltd., and received compensation for conduct of the study. Dr. Lorente received compensation for clinical work in the study. Mr. Fanney is an employee of Alcon Research, Ltd.

We present a technique that uses intracameral lidocaine to induce pupil dilation without using preoperative mydriatic eyedrops. After 1 or 2 drops of topical lidocaine hydrochloride 1% (Xylocaine-MPF 1%) are applied to the ocular surface, a 1.0 mm side-port incision is created through which Xylocaine-MPF 1% is injected into the anterior chamber. The lidocaine paralyzes the pupil sphincter, and adequate mydriasis occurs within 90 seconds. Epinephrine (0.3 cc of 1:1000) is added to the irrigation fluid comprising balanced salt solution (BSS), and standard phacoemulsification with intraocular lens implantation is performed. Pupil dilation is maintained or increased during the procedure. Postoperatively, the pupil returns more quickly to normal size and reaction. Using lidocaine for mydriasis instead of standard dilating drops eliminates the cardiac risk of topical sympathetic agents, decreases the time patients wait in the holding area before surgery, reduces the risk of superficial punctate keratopathy, and provides faster recovery of normal pupil function.

To evaluate the effectiveness and safety of a trifocal intraocular lens (IOL), the TFNT00 (Alcon, Fort Worth, TX), versus a monofocal IOL, the SN60AT (Alcon).Design: Food and Drug Administrationeapproved, prospective, multicenter, nonrandomized, parallel-group, assessor-masked, confirmatory trial.Participants: Patients enrolled were 22 years of age or older with a diagnosis of bilateral cataract with planned removal by phacoemulsification with a clear corneal incision.Methods: Consented participants selected their preferred IOL, which was implanted sequentially into each eye of patients meeting eligibility criteria.Main Outcome Measures: The coprimary effectiveness outcomes were mean photopic monocular bestcorrected distance visual acuity (BCDVA; 4 m) and distance-corrected near visual acuity (DCNVA; 40 cm) at 6 months after surgery. Secondary effectiveness outcomes included mean monocular distance-corrected intermediate visual acuity (DCIVA; 66 cm) and proportion of participants responding "never" to question 1 of the Intraocular Lens Satisfaction questionnaire (regarding frequency of spectacle use in the past 7 days). Safety outcomes included frequency of "severe" and "most bothersome" visual disturbances.Results: Two hundred forty-three patients underwent cataract surgery with bilateral implantation of the TFNT00 (n ¼ 129) or SN60AT (n ¼ 114) and were followed up for 6 months. Noninferiority of TFNT00 to SN60AT in mean photopic monocular BCDVA (95% upper confidence limit of the difference was <0.1 logarithm of the minimum angle of resolution [logMAR] margin), and superiority in mean photopic monocular DCNVA (difference of 0.42 logMAR; P < 0.001) and DCIVA (difference of 0.26 logMAR; P < 0.001) were demonstrated. The proportion of patients never requiring glasses overall was superior for TFNT00 versus SN60AT (80.5% and 8.2%, respectively). Starbursts, halos, and glare were the most frequently rated severe symptoms with TFNT00; however, less than 5% of patients were very bothered at month 6.Conclusions: The TFNT00 exhibited superior monocular DCNVA and DCIVA to a spherical monofocal IOL, with comparable monocular BCDVA. Binocular visual acuity was 20/25 or better for distance to near (þ0.5 D to e2.5 D), resulting in high levels of spectacle independence. Less than 5% of patients were very bothered by the photic visual disturbances associated with the TFNT00 at 6 months after surgery.