PurposeThe purpose of this study was to compare the visual outcomes and subjective visual quality between bilateral implantation of a diffractive trifocal intraocular lens, Alcon Acrysof IQ® PanOptix® TNFT00 (group A), and blended implantation of an extended depth of focus lens, J&J Tecnis Symfony® ZXR00 with a diffractive bifocal intraocular lens, J&J Vision Tecnis® ZMB00 (group B).MethodsThis prospective, nonrandomized, consecutive, comparative study included the assessment of 40 eyes in 20 patients implanted with multifocal intraocular lens. Exclusion criteria were existence of any corneal, retina, or optic nerve disease, previous eye surgery, illiteracy, previous refractive surgery, high axial myopia, expected postoperative corneal astigmatism of >1.00 cylindrical diopter (D), and intraoperative or postoperative complications. Binocular visual acuity was tested in all cases. Ophthalmological evaluation included the measurement of uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), and uncorrected intermediate visual acuity (UIVA), with the analysis of contrast sensitivity (CS), and visual defocus curve.ResultsPostoperative UDVA was 0.01 and −0.096 logMAR (p<0.01) in groups A and B, respectively; postoperative CDVA was −0.07 and −0.16 logMAR (p<0.01) in groups A and B, respectively; UIVA was 0.14 and 0.20 logMAR (p<0.01) in groups A and B, respectively; UNVA was −0.03 and 0.11 logMAR (p<0.01) in groups A and B, respectively. Under photopic conditions group B had better CS at low frequencies with and without glare.ConclusionBoth groups promoted good quality of vision for long, intermediate, and short distances. Group B exhibited a better performance for very short distances and for intermediate and long distances ≥−1.50 D of vergence. Group A exhibited a better performance for UIVA at 60 cm and for UNVA at 40 cm.

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PURPOSE:To compare the intraoperative safety of two techniques of capsulorhexis for intumescent white cataracts: traditional one-stage continuous curvilinear capsulorhexis and two-stage continuous curvilinear capsulorhexis.METHODS:This prospective comparative randomized study included two groups: the 1-CCC group (11 patients) received traditional one-stage continuous curvilinear capsulorhexis with 5–6 mm diameter, and the 2-CCC (13 patients) group received a deliberately small continuous curvilinear capsulorhexis that was secondarily enlarged, or a two-stage continuous curvilinear capsulorhexis. Patients were stratified according to cataract subset, which was characterized echographically. Six patients were considered as type 1, fifteen as type 2 and three as type 3. Type 1 included intumescent white cataracts with cortex liquefaction and extensive internal acoustic reflections, type 2 included white cataracts with voluminous nuclei, a small amount of whitish solid cortex, and minimal internal acoustic reflections, and type 3 included white cataracts with fibrous anterior capsules and few internal echo spikes.RESULTS:With the one-stage technique, 46.15% of patients had leakage of the liquefied cortex; in addition, the surgeon perceived high intracapsular pressure in 61.53% of cases. Anterior capsule tears occurred in 23.07% of cases, discontinuity of capsulorhexis in 30.79% of cases and no posterior capsular rupture occurred. With the two-stage technique, leakage of the liquefied cortex occurred in 45.45% of cases; additionally, the surgeon perceived high intracapsular pressure in 36.36% of cases. No anterior capsule tears, discontinuity of capsulorhexis or posterior capsular rupture occurred. Considering each cataract subset, there was a higher incidence of leakage for type 2 as compared to types 1 and 3.CONCLUSIONS:Two-stage continuous curvilinear capsulorhexis helps prevent unexpected radial tears of the initial capsulotomy from high intracapsular pressure, sudden radialization of the CCC and other intraoperative complications due to high intracapsular pressure, thus providing a safe cataract surgery in cases of white cataracts. These findings were supported by ultrasonography.

Purpose To compare the anti-inflammatory efficacy of ketorolac of tromethamine 0.4% and nepafenac 0.1% eye drops for prophylaxis of cystoid macular oedema (CME) after small-incision cataract extraction.

PURPOSE: To compare the accuracy of Optiwave Refractive Analysis (ORA) intraoperative aberrometry (Alcon Laboratories, Inc., Fort Worth, TX) with preoperative biometry in predicting residual refractive error after cataract surgery in eyes that underwent radial keratotomy. METHODS: This was a prospective consecutive case series of patients with cataract and prior radial keratotomy. Each patient underwent a preoperative intraocular lens (IOL) power calculation using partial coherence interferometry (IOLMaster version 5; Carl Zeiss Meditec, Jena, Germany). For each eye, the Barrett True-K formula was used to select an IOL targeting emmetropia. Residual refractive error was predicted preoperatively using the SRK/T, Hoffer Q, Haigis, and Holladay formulas 1 and 2, and the ORA intraoperatively. Between 8 and 12 weeks after cataract extraction with IOL implantation, the postoperative refraction was compared with the preoperative and intraoperative predictions. RESULTS: The study comprised 52 eyes of 34 patients. The median absolute errors associated with each method were as follows: Barrett True-K formula (0.34), ORA aberrometer (0.53), and SRK/T (0.54), Hoffer Q (0.51), Haigis (0.54), SRK/T (0.57), and Holladay formulas 1 and 2 (0.44) ( P = .08). The proportion of patients within ±0.50 diopters of the predicted error was 63.5%, 48.1%, 44.2%, 48.1%, 53.8%, 36.5%, and 57.7%, respectively ( P = .03). No statistically significant difference was observed in the number of eyes with hyperopic outcomes ( P = .68). CONCLUSIONS: In eyes with prior radial keratotomy surgery, the ORA aberrometer performance was similar to the Barrett True-K formula and all of the other established formulas, with no significant difference between median absolute error and mean absolute error. The Barrett True-K formula produced significantly more eyes within ±0.50 diopters than the SRK/T, Hoffer Q, and Holladay 1 formulas. [ J Refract Surg. 2019;35(10):656–661.]

PurposeTo compare visual outcomes and performance between bilateral implantation of a diffractive trifocal intraocular lens (IOL) Acrysof®PanOptix® TFNT00 and blended implantation of two different near add power bifocal IOLs: Acrysof® Restor® SV25T0 in dominant eye and Acrysof® Restor® SN6AD1 in the nondominant eye.MethodsThis prospective, nonrandomized, consecutive and comparative study assessed 20 patients (40 eyes) who had bilateral cataract surgery performed using the IOLs described. Patients were divided into groups, bilateral trifocal implant and blended implant. Evaluation included measurement of binocular uncorrected and corrected distance visual acuity at 4 m (UDVA, CDVA) and uncorrected intermediate (60 cm) and near (at 40 cm) visual acuity; contrast sensitivity (CS) and visual defocus curve.ResultsPostoperative CDVA comparison showed no statistical significance between groups. UDVA was significantly better in the trifocal groups. Under photopic conditions, the trifocal group had better CS in higher frequencies with and without glare. The binocular defocus curve demonstrated a trifocal behavior in both groups, with the bilateral trifocal group exhibiting better performance for intermediate vision.ConclusionBoth lens combinations were able to provide good near, intermediate and distance vision, with the trifocal group showing significantly better performance at intermediate distances and better CS under photopic conditions.

Nota Editorial: Depois de concluída a análise do artigo sob sigilo editorial e com a anuência dos Drs. Paulo Gilberto Jorge Fasdel e Breno Barth sobre a divulgação de seus nomes como revisores, agradecemos suas participações neste processo. Objetivos:Comparar o desempenho visual e a análise de frente de onda entre as lentes intra-oculares (LIOs) multifocal difrativa Tecnis ® ZM900 asférica e AcrySof ® ReSTOR ® esférica SN60D3. Métodos: Trata-se de estudo prospectivo comparativo que incluiu 78 olhos de 39 pacientes. A avaliação oftalmológica contou com medida da acuidade visual para longe, intermediária e curta distância, sem correção e com a melhor correção óptica, teste de sensibilidade ao contraste e análise de frente de onda por meio do aberrômetro OPD-Scan. Resultados: Acuidade visual para longe e para perto sem correção óptica e análise de aberrometria foram estatisticamente semelhantes em relação a ambas as LIOs; já a visão intermediária e a sensibilidade ao contraste em condições fotópicas revelaram diferença estatisticamente significante entre as duas lentes a favor da Tecnis ZM900. Conclusão: Ambas as lentes intra-oculares promoveram excelente visão para longe e para perto em situações de alto contraste. A LIO Tecnis multifocal necessita de menos luminosidade para visão em situações de alto contraste, apresenta menos aberrações ópticas e melhor visão intermediária que a LIO ReSTOR. RESUMO INTRODUÇÃOUm dos principais desafios da moderna cirurgia de catarata é a recuperação da capacidade visual para perto. Muitas formas de abordagem com o objetivo de correção da presbiopia foram tentadas, como monovisão e miopização contralateral (1)(2) . As lentes intra-oculares (LIOs) multifocais tentam compensar a eventual perda de estereopsia e visão binocular que limitavam as estratégias usadas com as LIOs monofocais. Apesar de se mostrarem efetivas na visão de perto e de longe, uma limitação destas lentes, sejam refrativas ou difrativas, é a dispersão de energia, que leva à formação de halos e "glare" e à redução da sensibilidade ao contraste (1)(2)(3)(4)(5)(6)(7) . As modificações no cristalino que ocorrem com o passar do tempo levam à diminuição da sensibilidade ao contraste (8) . A qualidade da visão é ainda mais prejudicada quando se desenvolve catarata. Ao se submeterem à facectomia, os pacientes têm expectativas de melhora da sua visão, com conseqüente

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