Purpose: To analyze the target induced astigmatism (TIA), surgically induced astigmatism (SIA), difference vector (DV), and correction index (CI) in the correction of astigmatism with phakic lenses, and its influence on visual acuity, and to analyze the safety and efficacy indexes of the correction of high and low power astigmatism with toric phakic lenses. Design: Retrospective comparative study. Methods: The medical records of patients that were operated on at the research center during the period were analyzed. Results were divided into Low Astigmatism Group – LAG (33 eyes) and High Astigmatism Group – HAG (93 eyes) according to the implanted toric ICL lens power. Preoperative refraction and resultant postoperative refraction were analyzed by vector analysis. Visual acuity pre and postop, with and without optical correction, were compared. Results: A total of 126 eyes were studied. The average preop refraction was −5.02 D sphere with −2.61 D cylinder. The average ICL lens power implanted was −8.31 D sphere +2.77 D cylinder. Refractive remaining was −0.01 ± 0.11 D sphere −0.15 ± 0.28 D cylinder. The arithmetic average angle of error in the astigmatism correction was 1.08°. The resultant cylinder was −0.03 ± 0.12 D and −0.19 ± 0.30 D in the low and high astigmatism groups, respectively, with a mean UDVA −0.01 ± 0.10 and 0.01 ± 0.16 and CDVA −0.03 ± 0.08 and −0.01 ± 0.17 for each group. The safety and efficacy indexes for the low astigmatism group were 1.09 ± 0.16 and 1.05 ± 0.17, respectively, with 1.11 ± 0.17 and 1.06 ± 0.16 for the high astigmatism group. Conclusions: The correction of astigmatism by the implantation of toric phakic lenses of the posterior chamber is safe and effective, independently of the amount of cylinder corrected.

Purpose: To report our first clinical and patient-reported outcomes in the early postoperative period with a new model of trifocal diffractive intraocular lens (IOL). Methods: Pilot prospective analysis of the results of 26 eyes of 13 patients (age, 44–79 years) undergoing cataract surgery with implantation of the trifocal diffractive IOL Liberty 677MY (Medicontur Medical Engineering Ltd., Zsámbék, Hungary). The following clinical outcomes were evaluated during the first postoperative month: measurement of distance, intermediate and near visual acuity, binocular defocus curve, and level of spectacle independence, patient satisfaction, perception of photic phenomena, and difficulty in performing several vision-related daily tasks by means of a questionnaire. Results: Mean binocular LogMAR uncorrected distance, intermediate and near visual acuities were −0.03 ± 0.13, 0.21 ± 0.16, and 0.16 ± 0.09, respectively. Furthermore, 100.0%, 84.6% and 92.3% of patients achieved a binocular corrected distance, distance-corrected intermediate and distance-corrected near visual acuity of 20/32 or better, respectively. In the defocus curve, visual acuities were better than 0.2 logMAR for defocus levels between +1.00 and −3.00 D. Spectacle independence was referred by all patients, with any of them reporting dissatisfaction with the outcome of the surgery. The postoperative vision did not lead to difficulties in the daily life in 92.3% of patients. Bothersome halos, glare or starbursts were only reported by only 7.7% of patients. Conclusions: The trifocal IOL evaluated provides a successful visual rehabilitation with minimal photic phenomena associated, leading to high levels of spectacle independence and patient satisfaction.

Purpose: To evaluate the clinical outcomes of the Visian implantable collamer lens (ICL) in eyes with ≥17 years of follow-up. Setting: Single-center. Design: Retrospective observational study. Methods: 70 eyes from 38 patients who underwent surgery between 2002 and 2006 with V4 ICL implantation were analyzed. Preintervention data included corrected distance visual acuity (CDVA), refraction, and intraocular pressure (IOP). At the 19-year mark, CDVA, refraction, IOP, endothelial count, and vault were measured using Tomey Casia 2 anterior pole tomography, along with recording long-term events. Results: The operated patients had a spherical correction between −4 diopters (D) and −21 D and a cylinder up to 7.5 D. The mean CDVA (decimal) at the 17-year check-up was 0.89 ± 0.18, with a spherical equivalent of −1.05 ± 1.36 D. IOP has remained stable because mean measurements before surgery and currently were 15.16 ± 2.54 mm Hg and 16.19 ± 3.29 mm Hg, respectively. The endothelial cell count showed values of 2191 ± 386 cells/mm², with a maximum of 2804 cells and a minimum of 1125 cells. Finally, the vault obtained was 348.53 ± 234.58 mm. Over the years, 2 eyes developed angle-closure glaucoma and 9 eyes were operated on for the development of anterior subcapsular cataracts. Conclusions: Visian ICL implantation demonstrated long-term visual and refractive stability, indicating it as a low-risk procedure. The ICL V4 model yielded satisfactory results for myopia and astigmatism correction after 17 years.

Objective: This study aimed to evaluate the initial clinical outcomes of and patient satisfaction with the newly introduced extended monofocal Evolux™ intraocular lens following cataract surgery. Methods: A retrospective study was conducted, involving 18 patients (36 eyes) who received Evolux™ lenses bilaterally. The inclusion criteria comprised individuals over 40 years old with no active eye diseases, excluding cataracts, and no postoperative complications. Various parameters were evaluated, including distance, intermediate, and near visual acuity; refraction; defocus curves; dependency on spectacles; and patient satisfaction. Patient satisfaction and visual quality of life were measured using the Catquest-9SF and QOV questionnaires. Results: The average age of the patients was 72.7 years, with the majority being women (77.8%). The results demonstrated excellent postoperative visual acuity at different distances. The mean logMAR values for uncorrected visual acuity were −0.04 for distance vision, 0.15 for intermediate vision, and 0.35 for near vision. The defocus curve indicated good tolerance, with visual acuity exceeding 20/20 in significant defocus ranges. Most patients expressed high satisfaction with their vision without spectacles, particularly for distance and intermediate vision. The need for spectacles for near vision was notably reduced. Furthermore, there was a low incidence of photic phenomena like halos and glare, contributing to the overall high patient satisfaction. Conclusions: Evolux™ lenses were found to be an effective choice for cataract surgery, providing excellent visual acuity at various distances and high patient satisfaction.

The main objective was to evaluate distance, intermediate, and near vision in patients who have undergone cataract extraction with bilateral implantation of a new trifocal diffractive intraocular lens (IOL), along with patient-reported outcomes (PRO). A total of 50 eyes from 25 patients after Asqelio^TM Trifocal IOL (AST Products, Inc., Billerica MA, USA) implantation were assessed in this study. At 3 months after surgery, the photopic visual acuity (VA) at distance, intermediate, and near distances was measured. Binocular photopic defocus curves were also obtained. Three questionnaires to assess patients’ visual satisfaction and spectacle dependence, among other items, were completed: the Catquest-9SF, the patient-reported spectacle independence questionnaire (PRSIQ), and the patient-reported visual symptoms questionnaire (PRVSQ). The average spherical equivalent was 0.21 ± 0.37 D at 3 months post-operation, and the average absolute tolerance to defocus was 3.64 ± 0.70 D. The mean binocular uncorrected VAs for distance, intermediate, and near vision were −0.02 ± 0.09, 0.06 ± 0.08, and 0.11 ± 0.07 logMAR, respectively. The best-corrected VA was better than 0.1 logMAR for the whole range from distance to near. PROs revealed spectacle independence and general satisfaction with vision, and the incidence of photic phenomena were low. This study shows that the new bi-aspheric diffractive trifocal IOL provides a good visual performance at different distances under photopic conditions, accompanied by patient satisfaction and spectacle independence.

Purpose: To compare 2 techniques to correct low astigmatism during implantable collamer lens (ICL) surgery: astigmatic opposite clear corneal incisions (OCCIs) and toric ICL (T-ICL). Setting: Arruzafa Ophthalmological Hospital, Cordoba, Spain. Design: Randomized prospective comparative study. Methods: The study comprised 152 myopic eyes undergoing ICL surgery. Patients were separated into 2 groups: Group 1 (57 patients; 76 eyes) received a spherical ICL with OCCIs and Group 2 (53 patients; 76 eyes) received a T-ICL. The inclusion criteria were refractive astigmatism up to 1.50 diopters (D), regular corneal astigmatism up to 2.00 D (Sim K, Pentacam), and agreement between the refractive and topographic corneal cylinders (discrepancies less than 30 degrees axis or 0.50 D). The outcomes were evaluated after a 1-month follow-up. Results: The T-ICL group achieved a mean postoperative spherical equivalent refraction and refractive astigmatism of −0.04 ± 0.17 D and −0.03 ± 0.12 D, respectively, vs −0.14 ± 0.33 D and −0.20 ± 0.36 D, in the OCCI group (P < .001). Postoperative refractive astigmatism of less than 0.25 D was achieved in 94.74% of cases in the T-ICL group vs 73.68% in the OCCI group. Undercorrection of corneal astigmatism occurred in the OCCI group with a surgically induced astigmatism of 0.48 ± 0.24 D and correction index = 0.46. Conclusions: Both the T-ICL and OCCI techniques provided excellent results in terms of safety and efficacy. T-ICL surgery was shown to be more predictable and accurate for correcting low astigmatism with a lower postoperative spherical equivalent and less residual astigmatism compared to incisional management.