JCRS highlights – selected by Thomas Kohnen, European Editor, JCRS

Thomas Kohnen

Posted: Wednesday, December 4, 2019

Upright phaco surgery
A new slit-lamp-based technique allows phacoemulsification surgery to be performed on patients who until now had been refused for cataract surgery. The new technique enabled surgeons to perform phacoemulsification on four eyes of two patients, who were sitting in a strictly upright position, by using a slit lamp rather than an operating microscope. The surgeon sits on the other side of the slit lamp, facing the patient, and operates via a temporal corneal incision. Both patients achieved a corrected distance visual acuity of 20/20 in both eyes. This approach could prove useful in patients unable to lie flat, including those with orthopnea, spinal deformity or Ménière’s disease.

M Muraine et al., “Face-to-face phacoemulsification using a slit lamp in patients who are unable to lie flat”, Volume 45, #11, 1535-38.


Long-term ICL results
Phakic IOL implantation offers a treatment option for high myopia that preserves accommodation and spares the cornea. The implantable collamer lens (ICL, STAAR Surgical) is a posterior chamber pIOL that first appeared in 1993. The V4 model of the ICL was introduced in 1998 to address some issues encountered with the original version. Little is known about the long-term visual outcomes and anatomic effects of the V4 ICL. A new retrospective study of 110 eyes of 60 patients showed that the lens provided long-term stability and good refractive outcomes at the 10-year mark. Mean spherical equivalent was -0.65 ± 1.09D 10 years postoperatively. The mean vault height was 562.4 ± 175.9μm six months postoperatively, decreasing to 352.9 ± 171.8μm at 10 years. Lens opacities developed in 21 eyes (12.1%) during the 10-year follow-up. The mean vault in the lens opacity group was significantly lower than in the clear lens group after four years. No patient who had ICL implantation when they were 30 years or younger developed lens opacity or required phacoemulsification. The study found no significant decrease in endothelial cell density or increase in intraocular pressure over time.

JH Choi et al., “Ten-year clinical outcomes after implantation of a posterior chamber phakic intraocular lens for myopia”, Volume 45, #11, 1555-61.

Comparing defocus curves
Researchers evaluated the defocus curves of four presbyopia-correcting IOLs in a prospective clinical study. The four IOLs provided equally good corrected distance visual acuity (VA). The EDOF IOL yielded slightly better distance-corrected intermediate VA, but provided worse distance-corrected near VA than the other IOLs. That finding was clinically relevant, and a lower percentage of patients in the EDOF group achieved spectacle independence. Only the panfocal IOL gave better distance corrected intermediate VA at 50cm.

M Böhm et al., “Defocus curves of 4 presbyopia-correcting IOL designs: Diffractive panfocal, diffractive trifocal, segmental refractive, and extended-depth-of-focus”, Volume 45, #11, 1625-36.

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