In The Journal Of Cataract & Refractive Surgery June 2009

Posterior vitreous detachment after cataract surgery
Alireza Mirshahi, M.D., F.E.B.O., Fabian Hoehn, M.D., F.E.B.O., Katrin Lorenz, M.D., Lars-Olof Hattenbach, M.D.

In this prospective study, investigators set out to determine how patients undergoing uneventful phacoemulsification with implantation of a posterior chamber intraocular lens, fared in terms of posterior vitreous detachment. Of the 188 eyes included here just 58 had not preoperatively undergone a posterior vitreous detachment. Postoperatively, at one week 12 eyes had developed a posterior vitreous detachment, at one month this had occurred in an additional 18 eyes and in one year in 4 more eyes. Investigators determined that no other factors measured preoperatively such as refraction age or axial length had any predictive value here. They concluded that in cases where the hyloid face was still attached to the retinal surface preoperatively that there was a high prevalence of posterior vitreous detachment after modern cataract surgery.

Dissatisfaction with Multifocal IOL
Maria A. Woodward, M.D., J. Bradley Randleman, M.D., R. Doyle Stulting, M.D., Ph.D.

This retrospective review focused on patient dissatisfaction with multifocal IOL outcomes. Investigators here analyzed just what was at the root of these outcomes and how patients ultimately did when the issues were addressed. After multifocal lens implantation, unwanted visual symptoms were reported in 43 eyes—65% of these eyes were implanted with an AcrySof ReStor IOL (Alcon, Fort Worth, Texas) and 35% with a ReZoom IOL (Abbott Medical Optics, Santa Ana, Calif.). Also blurred vision was an issue in 41 eyes. In 29% of cases this was caused by ametropia, in 15% by dry eye, in 54% this resulted from posterior capsule opacification (PCO) and in 2% of cases was unexplained. Photopic phenomenon was an issue in 18 eyes. In 12% of cases this was related to decentration, in 6% to a retained lens fragment, in 66% to PCO, in 2% to dry eye syndrome, and in 11% of cases was unexplained. In 16 of cases patients reported both blurred vision and photopic phenomenon—this was attributed to PCO. In 81% of cases conservative treatment was all that was needed to remedy the situation. Investigators found that 12% did not respond to any treatment combination, and ultimately 7% required a lens exchange. Investigators concluded that with appropriate treatment blurred vision and photopic phenomena could effectively be managed. However, IOL exchange is needed in a few cases. Investigators urge practitioners to delay use of ND YAG capsultomy until they can determine if the multifocal lens will remain in place.

Patient satisfaction after pseudophakic monovision
Yaron M. Finkelman, M.D., Jonathon Q. Ng, M.B.B.S., Ph.D., Graham D. Barrett, F.R.A.C.S., F.R.A.C.O.

Investigators here considered how satisfied patients were with modified pseudophakic monovision. In this prospective study, patients who were emmetropic after having cataract surgery performed in their first eye were offered moderate monovision with lens implantation in the second eye. For this eye a refraction of –1 D to –1.5 D was targeting. Following implantation of the second lens 96% of patients attained at least 20/30 uncorrected distance acuity with 92% also attaining J4 or better near acuity. In 25% of cases patients were completely independent of spectacles. One patient, however, remained totally dependant on glasses. The majority of patients were satisfied with the procedure, with no one requesting a lens exchange or additional refractive correction. Investigators concluded that good visual function with high patient satisfaction could be attained using pseudophakic monovision with modest targets.