Bilateral implantation of AcrySof IQ ReSTOR +3.0 multifocal intraocular lenses (Alcon) produced statistically significant and clinically relevant postoperative improvements in uncorrected near, uncorrected intermediate and uncorrected distance visual acuity, suggests a study from the University of Minnesota. To assess changes in patient-reported outcomes, satisfaction, vision quality and visual acuity after bilateral implantations of multifocal IOLs with a 3-D add, researchers conducted a six-month, randomized multicenter clinical trial evaluating 147 cataract patients. Cataract patients received bilateral implantation of the AcrySof IQ ReSTOR +3.0 IOL (model SN6AD1). Patient-reported outcomes were collected using the Cataract TyPE questionnaire. Clinical outcomes included UNVA, UIVA and UDVA.

Results showed significant postoperative improvements in patient-reported uncorrected functional vision, satisfaction with uncorrected vision and social activities. From preoperatively to six months postoperatively, the mean UDVA improved from 0.45 logMAR (approximate Snellen, 20/56) to 0.04 logMAR (20/22 Snellen); the mean UIVA from 0.56 logMAR (20/73) to 0.17 logMAR (20/30); and the mean UNVA from 0.62 logMAR (20/83) to 0.10 logMAR (20/25). All improvements were clinically and statistically significant (p<0.0001). There was also a statistically significant improvement in patient satisfaction with uncorrected vision (p<0.0001). Clinically and statistically significant reductions occurred in trouble with vision (daytime and nighttime), trouble with glare, limitations with UDVA, limitations with UNVA, and limitations in social activities (p<0.0001).

J Cataract Refract Surg 2010;36:1887-96
Lane SS, Javitt JC, Nethery DA, Waycaster C.

Dual-Optic IOL Demonstrates Improved Reading Stability Two Years Postop

The Synchrony dual-optic accommodating intraocular lens (Abbott Medical Optics) provided stable or improved reading ability over a two-year period in a Colombian study. To evaluate reading ability in patients who had cataract surgery with binocular implantation of a dual-optic accommodating IOL, a group at the Department of Ophthalmology, Cataract and Refractive Surgery, Salucoop EPS-ServiOftalmos in Bogota conducted a prospective case series to assess reading ability one to two years after bilateral implantation of the Synchrony using standardized reading charts based on MNRead charts. Testing was performed with distance correction and without near addition (40 cm). Patients read aloud sentences with a print size ranging from 1.0 to 0.0 logMAR. Responses were audio taped and analyzed offline to obtain reading speed (words per minute), reading acuity (logMAR) and critical print size (logMAR).

Mixed-model analysis of variance with time (one and two years) and print size (1.0 to 0.0 logMAR; 11 levels) as factors showed statistically significantly better reading speed at two years, with significant differences at print sizes from 0.3 to 0.1 logMAR (p<0.01). Mean reading acuity (0.07 logMAR versus 0.15 logMAR) (p<0.01, paired t test) and critical print size (0.28 logMAR versus 0.48 logMAR) were also statistically significantly better at two years than at one year (both p<0.01, paired t test). There was no significant difference in reading speed at 0.4 logMAR (newspaper print or 20/50 Snellen equivalent) between one year (180.5 wpm) and two years (184.2 wpm) (p=0.90, paired t test).

J Cataract Refract Surg 2010;36:1880-6
Bohórquez V, Alarcon R

Prophylactic Antibiotics May Complicate   Dacryocystorhinostomy

A new study questions the routine usage of prophylactic antibiotics prior to external dacryocystorhinostomy. The authors reviewed cases of 697 patients (536 women) diagnosed with distal nasolacrimal duct obstruction who were operated on by the same surgeon. Lacrimal sacs were cultured, and data were collected regarding clinical signs and symptoms, and use of intraoperative antibiotics. Also, the postoperative period was analyzed with regard to the presence of complications.

The mean age at surgery was 67 ±13.3 years. Prior to surgery, 19.5, 18.5, 11 and 17.8 percent of patients showed recurrent conjunctivitis, mucocele, mucopyocele and episodes of acute dacryocystitis, respectively. Seventy-three patients did not receive prophylactic treatment during surgery. A total of 8.3 percent of lacrimal sacs were culture positive, the most commonly isolated organism being Staphylococcus aureus. The use of antibiotics during surgery was not associated with a lower rate of postoperative complications. A statistically significant association was found between some clinical pictures, such as mucocele, mucopyocele and dacryocystitis, and a higher rate of positive cultures. Though providing evidence to indicate their use for patients who have had prior episodes of mucocele, mucopyocele or acute dacryocystitis, these results question the generalized use of prophylactic antibiotics for external dacryocystorhinostomy.

Ophthal Plast Reconstr Surg 2010;26:467-72
Pinar-Sueiro S, Fernández-Hermida RV, Gibelalde A, Martínez-Indart L.

SuperCresent Proves Its Worth in Glaucoma Surgery
The SuperCrescent knife, a 100-µm diamond blade forged with a pentium-faceted, trapezoidal design and a square front surface area, has shown success in trabeculectomy and non-penetrating glaucoma surgery due to the better control it gives during dissection. The authors of this study used the blade for more than 700 consecutive procedures, the majority of which were non-penetrating deep sclerectomies performed under topical anesthesia. During this procedure, the SuperCresent was used to create a deep scleral flap for unroofing Schlemm’s canal. With deep scleral dissection just above the choroid, new planes can be created within a range of 50 µm. The leading square front edge protected against loss of dissecting plane or perforation, allowing Schlemm’s canal to be unroofed with the same blade. The added advantage of using a knife in lieu of Vannas scissors is that it helps to prevent a deep flap removal situation, which could potentially lead to a residual lip of tissue that would encroach on the trabeculo-Descemet window.

During trabeculectomy, the Super-Cresent reduced the need for counter traction and significantly less eye movement, resulting in a more controlled surgery. The blade was used to establish a one-half to three-quarters thickness scleral flap over a smooth bed and an anterior dissection deep into the clear cornea. With a dissection plane established, the blade allowed the authors to tunnel forward with minimum resistance. The blade proved particularly advantageous in eyes with previous surgery and limbal scarring, allowing a clean plane to be created through compromised tissue. The diamond blade also proved efficacious in soft eyes where dissection may be more difficult with straight blades.

J Glaucoma 2010;19:501-3
Ahmed II, Hasanee K, Belovay GW.

Femto and Microkeratome Yield Similar Post-LASIK Effects
Subbasal nerve density and corneal sensitivity did not differ between femtosecond laser and mechanical microkeratome methods of flap creation during LASIK in a randomized study. Twenty-one patients received myopic LASIK with the flap created by a femtosecond laser in one eye and by a mechanical microkeratome in the fellow eye. Eyes were examined before and at one, three, six, 12 and 36 months after LASIK. Central subbasal nerve density was measured by using confocal microscopy. Corneal mechanical sensitivity was measured by using a gas esthesiometer and was expressed as the ratio of mechanical threshold in eyes that received LASIK to mechanical threshold in concurrent control eyes.

Mean nerve density was decreased at one month (femto, 974 [2,453] µm/mm2; microkeratome, 1,308 [2,881] µm/mm2) compared with the preoperative examination (femto, 10,883 [5,083] µm/mm2, p<0.001; microkeratome, 12,464 [6,683] µm/mm2, p<0.001) and remained decreased through 12 months (p<0.001). Mechanical threshold ratios did not differ from those at the preoperative examination through 36 months for either LASIK treatment; but when all LASIK eyes were combined, the mechanical threshold ratio was transiently higher (decreased sensitivity) at one month (1.29 [0.85]) compared with the preoperative examination (0.89 [0.73], p=0.05). The planar configuration of the femtosecond laser flaps is not associated with faster reinnervation compared with the microkeratome flaps. Prolonged decrease in subbasal nerve density after LASIK is not accompanied by a prolonged decrease in corneal sensitivity.

Arch Ophthalmol 2010;128:1413-9
Patel SV, McLaren JW, Kittleson KM, Bourne WM.