To evaluate the long-term safety and efficacy of posterior chamber collagen copolymer phakic intraocular lens (pIOL) implantation to correct myopia. Fernández-Vega Ophthalmological Institute, Oviedo, Spain. Cohort study. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, pIOL vault, endothelial cell loss, and adverse events were evaluated for 5 years after implantation of the Visian Implantable Collamer Lens pIOL for moderate to high myopia. The mean spherical equivalent (188 eyes) decreased from -11.17 diopters (D) ± 3.40 (SD) preoperatively to -0.88 ± 0.72 D 5 years postoperatively. The mean change in refraction from 1 month to 5 years was -0.65 ± 0.65 D. The mean UDVA and CDVA (Snellen decimal) were 0.69 ± 0.26 and 0.83 ± 0.15, respectively. The mean safety and efficacy indices were 1.27 ± 0.33 and 0.89 ± 0.35, respectively. No eye lost more than 2 lines of visual acuity; 70% achieved 0.80 or better CDVA. Three eyes (1.6%) developed late anterior subcapsular cataract that was clinically significant in 1 case, leading to pIOL removal and phacoemulsification. Of the 3 eyes (1.6%) with a mild transient increase in intraocular pressure (up to 27 mm Hg), none required a second surgical procedure or prolonged topical medication. The total endothelial cell loss (considered cumulatively at consecutive intervals through 5 years) was 7.7%. There was a tendency toward decreased pIOL vault decrease over time. No vision-threatening complications occurred. Implantation of the collagen copolymer pIOL for moderate to high myopia was safe and effective and provided long-term predictable, stable refractive results.

To evaluate distance, intermediate, and near visual performance in patients who had multifocal apodized diffractive intraocular lens (IOL) implantation. Fernández-Vega Ophthalmological Institute, Oviedo, Spain. The best corrected distance visual acuity, best distance-corrected near visual acuity, intermediate visual acuity, distance contrast sensitivity under photopic and mesopic conditions, and patient satisfaction were measured in 325 patients and 335 patients who had bilateral implantation of the model SA60D3 IOL (AcrySof ReSTOR, Alcon) and model SN60D3 IOL (AcrySof Natural ReSTOR), respectively. At the 6-month postoperative visit, binocular best corrected distance acuity with the ReSTOR IOL and the Natural ReSTOR IOL was 0.034 logMAR+/-0.004 (SD) and 0.019+/-0.020 logMAR, respectively (approximately 20/20). Binocular best distance-corrected near acuity was 0.011+/-0.012 logMAR and 0.035+/-0.013 logMAR, respectively (approximately 20/20). Intermediate visual acuity with both IOL models worsened significantly as a function of the distance of the test (P<.01). Photopic contrast sensitivity was within the standard normal range with both IOLs. Under mesopic conditions, contrast sensitivity with both IOLs was comparable to that with monofocal IOLs and lower, particularly at higher spatial frequencies, than under photopic conditions. No statistically significant differences in visual acuity or photopic and mesopic contrast sensitivity were found between the 2 IOL models (P>.1). A patient satisfaction questionnaire showed that both IOLs performed well and were comparable in satisfaction regarding distance, intermediate, and near activities under different lighting conditions. The AcrySof ReSTOR IOL and AcrySof Natural ReSTOR IOL provided good visual performance at distance and near under photopic and mesopic conditions. Intermediate vision with both models was reduced compared with distance and near vision.

To compare visual acuity at different distances after bilateral implantation of 1 of 4 multifocal intraocular lenses (IOLs). Fernández-Vega Ophthalmological Institute, Oviedo, Spain. This study evaluated consecutive patients who had bilateral implantation of a spherical multifocal IOL with a +4.00 diopter (D) addition (add) (AcrySof ReSTOR SN60D3) or an aspheric multifocal IOL with a +4.00 D add (AcrySof ReSTOR SN6AD3), +3.75 D add (Acri.LISA 366D), or +3.00 D add (AcrySof ReSTOR SN6AD1). Six months postoperatively, binocular measurement of corrected distance visual acuity (CDVA) at 4 m, corrected near visual acuity (CNVA) at 40 cm, and corrected intermediate visual acuity (CIVA) at 50, 60, 70, and 80 cm were performed; the defocus curve was also measured. Each IOL model was implanted in 20 eyes (10 patients). All IOL models resulted in good distance vision, with no statistically significant differences between models. Patients with the +3.00 aspheric IOL had statistically better binocular CIVA at 50, 60, and 70 cm (P<.0001) and binocular CNVA at 40 cm (P = 3 x 10(-3)) than patients with the other IOL models. Patients with bilateral multifocal aspheric IOLs with a lower add had better intermediate and distance near visual acuity than patients with bilateral multifocal spherical IOLs or bilateral aspheric IOLs with a higher add.

To determine whether pupil size is correlated with visual acuity and contrast sensitivity at all distances in eyes with an apodized diffractive intraocular lens (IOL). Private Clinic, Oviedo, Spain. Six months after surgery, the best corrected distance visual acuity, best distance-corrected near visual acuity, intermediate visual acuity, and distance contrast sensitivity under photopic (85 cd/m2) and mesopic (5 cd/m2) conditions were measured in 670 eyes of 335 consecutive patients who had implantation of the AcrySof ReSTOR Natural IOL (SN60D3, Alcon). Pupil diameters in distance vision were measured using a pupillometer. The logMAR best corrected distance acuity was significantly better with larger pupils (r = 0.297; P = 1.36 x 10(-8)), whereas logMAR best distance-corrected near acuity was significantly worse with larger pupils (r = 0.276, P = 1.02 x 10(-7)). For all pupil diameters, intermediate visual acuity worsened significantly as the distance of the test increased (P<.01). Statistically significant differences in photopic and mesopic contrast sensitivity at all spatial frequencies were found between the small-pupil and large-pupil groups (P<.01). Distance photopic contrast sensitivity and mesopic contrast sensitivity were better in patients with large pupils than in patients with small pupils. A larger pupil was correlated significantly with better distance visual acuity and with worse near visual acuity. For all pupil diameters, intermediate visual acuity worsened significantly as the distance of the test increased. Distance contrast sensitivity was better with larger pupils at all spatial frequencies in bright-light and dim-light conditions.

PURPOSE: To assess the long-term correction of moderate to high myopia using a posterior chamber phakic intraocular lens with a central port design. METHODS: Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, intraocular pressure (IOP), endothelial cell density (ECD), vault, and adverse events over a 5-year period were evaluated retrospectively. RESULTS: A total of 147 eyes (83 patients) were evaluated. Mean postoperative UDVA and CDVA were 0.05 ± 0.11 and 0.02 ± 0.08 logMAR at 1 year and 0.13 ± 0.18 and 0.02 ± 0.09 logMAR at 5 years, respectively. More than 95% of eyes achieved CDVA of 20/25 or better at both follow-up periods. CDVA was unchanged or improved from one to three or more lines in all eyes. Preoperatively, mean spherical equivalent (SE) was −9.20 ± 3.02 diopters (D). At 1 year, the mean SE was −0.17 ± 0.26 D, with 91.53% of eyes within ±0.50 D and 100% of eyes within ±1.00 D of the target. At 5 years, the mean SE was −0.44 ± 0.47 D, with 67.4% of eyes within ±0.50 D and 90.1% of eyes within ±1.00 D of the target. Mean IOP was 12.74 ± 1.65 and 13.0 ± 2.03 mm Hg, at 1 and 5 years, respectively. No significant rise in IOP (> 20 mm Hg) occurred during the follow-up period. Mean ECD was 2,696 ± 358 and 2,645 ± 359 cells/mm ² at 1 and 5 years, respectively, representing a non-significant loss of 0.43% from preoperative values ( P = .304). Mean vault changed significantly from 398 ± 187 µm at 1 year to 340 ± 163 µm at 5 years ( P < .001). No intraoperative or postoperative complications or adverse events occurred during the follow-up period. CONCLUSIONS: The good long-term outcomes found in this study support the use of this lens with a central port design for the correction of moderate to high myopia. [ J Refract Surg . 2019;35(3):169–176.]