Background The TetraFlex accommodating intraocular lens （IOL） was designed to supply the patients both satisfied far and near vision after cataract surgery.So we need to evaluate the safety, distance and near visual...Background The TetraFlex accommodating intraocular lens （IOL） was designed to supply the patients both satisfied far and near vision after cataract surgery.So we need to evaluate the safety, distance and near visual acuity, subjective accommodation and IOL mobility with the TetraFlex accommodating IOL implantation.Methods Fifty eyes of 42 study-eligible cataract patients, who gave informed consent at a single eye clinic in China over a 10-month period, underwent phacoemulsification with TetraFlex IOL implantation.At three months postoperation,uncorrected visual acuities （UCVA）, best corrected visual acuities （BCVA）, distance-corrected near visual acuities （DCNVA）, subjective accommodation using the defocus method, and pilocarpine-induced IOL mobility were measured.Results No postoperative complications were noted in the study.Three months postoperation UCVA and BCVA were 20/40 or bettter in 82% （41/50） and 92% （46/50） of eyes, respectively; 66% （33/50） of the eyes had DCNVA of Jager （J） 4or better at 3 months.In addition, the mean subjective accommodation was （0.94±0.61） diopters （D） （range from 0.50 to 1.50 D） and pilocarpine-induced IOL mobility was （337±124） μm （range from 121 to 501 μm） with the TetraFlex.High relationship （r2=0.901, P 〈0.01） was found between these two measurements.Conclusion Implantation of the TetraFlex is safe and leads to excellent uncorrected distance vision and good uncorrected near vision.展开更多
Presbyopia still remains the last frontier of refractive surgery.Its surgical management is under constant evolution due to the limitations that exist today with respect to its management,which is probably in relation...Presbyopia still remains the last frontier of refractive surgery.Its surgical management is under constant evolution due to the limitations that exist today with respect to its management,which is probably in relation with the multifactorial basis in which presbyopia is clinically developed in the human.Until currently,virtually all surgical techniques that have been proposed for its correction are based on the induction of pseudoaccommodation in the presbyopic eye,including multifocality.However,the real restoration of accommodation is more complex,and it has been tried by the use of different,so called,“accommodative”pseudophakic intraocular lenses(AIOL).Overall,the reported results with these lenses by independent authors have been modest in relation with the restoration of the accommodative power of the eye and these modest benefits are usually lost with time due to the long term changes in the capsular bag.This fact made these lenses to be almost abandoned in the last few years,but there are currently other AIOL models being used with innovative mechanisms of action and different anatomical support outside the capsular bag that offer encouraging preliminary results that could bring a new potential of application to these types of lenses.In this article,we will update the modern refractive surgeon about the fundamentals and provide updated information about the outcomes of AIOLs by reviewing the concept of accommodation,the different attempts that have been accomplished in the past,their demonstrated published results in human clinical trials,and the future alternatives that may arrive in the near future.展开更多
Background:To study and compare the clinical optical image quality following implantation with different premium IOLs by analysing the point spread function(PSF)Strehl ratio using a pyramidal wavefront sensor(PWS)-bas...Background:To study and compare the clinical optical image quality following implantation with different premium IOLs by analysing the point spread function(PSF)Strehl ratio using a pyramidal wavefront sensor(PWS)-based aberrometer.Methods:This study included 194 eyes implanted with:(a)19 AcrySof SA60AT(control group);(b)19 Miniwell;(c)24 LENTIS Mplus LS-313 MF30;(d)33 LENTIS Mplus LS-313 MF15;(e)17 AkkoLens Lumina;(f)31 AT LISA Tri 839MP;(g)20 Precizon Presbyopic;(h)20 AcrySof IQ PanOptix;(i)11 Tecnis Eyhance.Main outcome measures were PSF Strehl ratio,PSF Strehl ratio excluding second-order aberrations(PSFw2),total root mean square(RMS),low-order aberration(LOA)and high-order aberration(HOA)RMS measured by PWS aberrometer.Results:AT LISA Tri had the highest PSFw2 Strehl ratio at both 3.0-and 4.0-mm pupil size(0.52±0.14 and 0.31±0.10;P<0.05),followed by SA60AT(0.41±0.11 and 0.28±0.07)and PanOptix(0.4±0.07 and 0.26±0.04).AT LISA Tri was found to provide a significantly better retinal image quality than PanOptix at both 3.0 mm(P<0.0001)and 4.0 mm(P=0.004).Mplus MF15 was found to be significantly better than Mplus MF30 at both 3.0 mm(P<0.0001)and 4.0 mm(P=0.002).Total RMS,LOA RMS,HOA RMS,PSF Strehl ratio and PSFw2 varied significantly between the studied groups(P<0.001).Conclusions:Far distance clinical image quality parameters measured by PWS aberrometer differed significantly according to the technology of the implanted lens.AT LISA Tri,SA60AT and PanOptix showed the highest values of far distance retinal image quality,while the lowest PSFw2 Strehl ratios were displayed by Miniwell,Mplus MF30 and Precizon Presbyopic.展开更多
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 le...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 inc展开更多
AIM:To report the clinical characteristics and diagnostic procedures used in patients with spasm of the near reflex(SNR),in order to present common investigation strategies and diagnostic pitfalls.METHODS:Retrospectiv...AIM:To report the clinical characteristics and diagnostic procedures used in patients with spasm of the near reflex(SNR),in order to present common investigation strategies and diagnostic pitfalls.METHODS:Retrospective case series of twenty-two patients,mainly children,with SNR or accommodation spasm(AS).AS was diagnosed on the basis of blurred vision and a difference of>2 dioptres between manifest and cycloplegic retinoscopy.If esotropia and miosis were present,the patients were diagnosed with SNR.All patients underwent visual acuity testing,orthoptic evaluation,assessment of refraction before and after cycloplegia,and dilated fundoscopy.Additional diagnostic investigations,such as neuroimaging,lumbar puncture(LP),electrophysiology and blood tests,were also recorded.Screen use among children was assessed in hours per day.RESULTS:There were 19 female and 3 male patients(age range 7-33 y,median=10 y).Seventeen patients had AS and 5 patients had SNR,with episodic blurry vision and headaches being the most common symptoms.Brain neuroimaging was performed in six patients(27%),although only one had a history of brain trauma.Two of those patients underwent visual evoked potentials and three also underwent LP and received intravenous steroid therapy.The majority of patients(90%)reported prolonged daily screen time(>2 h/d),and in 55%of cases there were concurrent social problems or psychological triggers.Treatment consisted of careful explanation of the condition,atropine1%eye drops and full cycloplegic correction by means of bifocal glasses.CONCLUSION:The diagnosis of SNR and AS may be challenging,because symptoms are usually intermittent and nonspecific,and a large number of patients are often subjected to redundant and potentially time-consuming examinations and treatment,that may exaggerate the underlying psychological disorder.Hence,detailed clinical testing and assessment of psychosocial profile is necessary,in order to avoid unnecessary investigations.Neuroimaging should be performed only in selected cases.Finally展开更多
文摘Background The TetraFlex accommodating intraocular lens （IOL） was designed to supply the patients both satisfied far and near vision after cataract surgery.So we need to evaluate the safety, distance and near visual acuity, subjective accommodation and IOL mobility with the TetraFlex accommodating IOL implantation.Methods Fifty eyes of 42 study-eligible cataract patients, who gave informed consent at a single eye clinic in China over a 10-month period, underwent phacoemulsification with TetraFlex IOL implantation.At three months postoperation,uncorrected visual acuities （UCVA）, best corrected visual acuities （BCVA）, distance-corrected near visual acuities （DCNVA）, subjective accommodation using the defocus method, and pilocarpine-induced IOL mobility were measured.Results No postoperative complications were noted in the study.Three months postoperation UCVA and BCVA were 20/40 or bettter in 82% （41/50） and 92% （46/50） of eyes, respectively; 66% （33/50） of the eyes had DCNVA of Jager （J） 4or better at 3 months.In addition, the mean subjective accommodation was （0.94±0.61） diopters （D） （range from 0.50 to 1.50 D） and pilocarpine-induced IOL mobility was （337±124） μm （range from 121 to 501 μm） with the TetraFlex.High relationship （r2=0.901, P 〈0.01） was found between these two measurements.Conclusion Implantation of the TetraFlex is safe and leads to excellent uncorrected distance vision and good uncorrected near vision.
基金the funding of the framework of the Red Temática de Investigación Cooperativa en Salud(RETICS),reference number RD12/0034/0007financed by the Instituto Carlos III–General Subdirection of Networks and Cooperative Investigation Centers(R&D&I National Plan 2008–2011)the European Regional Development Fund(Fondo europeo de desarrollo regional FEDER).
文摘Presbyopia still remains the last frontier of refractive surgery.Its surgical management is under constant evolution due to the limitations that exist today with respect to its management,which is probably in relation with the multifactorial basis in which presbyopia is clinically developed in the human.Until currently,virtually all surgical techniques that have been proposed for its correction are based on the induction of pseudoaccommodation in the presbyopic eye,including multifocality.However,the real restoration of accommodation is more complex,and it has been tried by the use of different,so called,“accommodative”pseudophakic intraocular lenses(AIOL).Overall,the reported results with these lenses by independent authors have been modest in relation with the restoration of the accommodative power of the eye and these modest benefits are usually lost with time due to the long term changes in the capsular bag.This fact made these lenses to be almost abandoned in the last few years,but there are currently other AIOL models being used with innovative mechanisms of action and different anatomical support outside the capsular bag that offer encouraging preliminary results that could bring a new potential of application to these types of lenses.In this article,we will update the modern refractive surgeon about the fundamentals and provide updated information about the outcomes of AIOLs by reviewing the concept of accommodation,the different attempts that have been accomplished in the past,their demonstrated published results in human clinical trials,and the future alternatives that may arrive in the near future.
基金financed in part by the Network for Cooperative Research in Health“OFTARED”—Reference:RD16/0008/0012Funded by Instituto de Salud Carlos IIIco-funded by European Regional Development Fund(ERDF),Project"A way to make Europe".
文摘Background:To study and compare the clinical optical image quality following implantation with different premium IOLs by analysing the point spread function(PSF)Strehl ratio using a pyramidal wavefront sensor(PWS)-based aberrometer.Methods:This study included 194 eyes implanted with:(a)19 AcrySof SA60AT(control group);(b)19 Miniwell;(c)24 LENTIS Mplus LS-313 MF30;(d)33 LENTIS Mplus LS-313 MF15;(e)17 AkkoLens Lumina;(f)31 AT LISA Tri 839MP;(g)20 Precizon Presbyopic;(h)20 AcrySof IQ PanOptix;(i)11 Tecnis Eyhance.Main outcome measures were PSF Strehl ratio,PSF Strehl ratio excluding second-order aberrations(PSFw2),total root mean square(RMS),low-order aberration(LOA)and high-order aberration(HOA)RMS measured by PWS aberrometer.Results:AT LISA Tri had the highest PSFw2 Strehl ratio at both 3.0-and 4.0-mm pupil size(0.52±0.14 and 0.31±0.10;P<0.05),followed by SA60AT(0.41±0.11 and 0.28±0.07)and PanOptix(0.4±0.07 and 0.26±0.04).AT LISA Tri was found to provide a significantly better retinal image quality than PanOptix at both 3.0 mm(P<0.0001)and 4.0 mm(P=0.004).Mplus MF15 was found to be significantly better than Mplus MF30 at both 3.0 mm(P<0.0001)and 4.0 mm(P=0.002).Total RMS,LOA RMS,HOA RMS,PSF Strehl ratio and PSFw2 varied significantly between the studied groups(P<0.001).Conclusions:Far distance clinical image quality parameters measured by PWS aberrometer differed significantly according to the technology of the implanted lens.AT LISA Tri,SA60AT and PanOptix showed the highest values of far distance retinal image quality,while the lowest PSFw2 Strehl ratios were displayed by Miniwell,Mplus MF30 and Precizon Presbyopic.
基金Supported by the National Natural Science Foundation of China(No.52073181,No.52273134).
文摘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 inc
文摘AIM:To report the clinical characteristics and diagnostic procedures used in patients with spasm of the near reflex(SNR),in order to present common investigation strategies and diagnostic pitfalls.METHODS:Retrospective case series of twenty-two patients,mainly children,with SNR or accommodation spasm(AS).AS was diagnosed on the basis of blurred vision and a difference of>2 dioptres between manifest and cycloplegic retinoscopy.If esotropia and miosis were present,the patients were diagnosed with SNR.All patients underwent visual acuity testing,orthoptic evaluation,assessment of refraction before and after cycloplegia,and dilated fundoscopy.Additional diagnostic investigations,such as neuroimaging,lumbar puncture(LP),electrophysiology and blood tests,were also recorded.Screen use among children was assessed in hours per day.RESULTS:There were 19 female and 3 male patients(age range 7-33 y,median=10 y).Seventeen patients had AS and 5 patients had SNR,with episodic blurry vision and headaches being the most common symptoms.Brain neuroimaging was performed in six patients(27%),although only one had a history of brain trauma.Two of those patients underwent visual evoked potentials and three also underwent LP and received intravenous steroid therapy.The majority of patients(90%)reported prolonged daily screen time(>2 h/d),and in 55%of cases there were concurrent social problems or psychological triggers.Treatment consisted of careful explanation of the condition,atropine1%eye drops and full cycloplegic correction by means of bifocal glasses.CONCLUSION:The diagnosis of SNR and AS may be challenging,because symptoms are usually intermittent and nonspecific,and a large number of patients are often subjected to redundant and potentially time-consuming examinations and treatment,that may exaggerate the underlying psychological disorder.Hence,detailed clinical testing and assessment of psychosocial profile is necessary,in order to avoid unnecessary investigations.Neuroimaging should be performed only in selected cases.Finally
