[Multifocal, toric, and aspheric intraocular lenses for glaucoma patients]

[Premium IOL's in glaucoma patients: Guidelines from the French Glaucoma Society (SFG) and the Society of the French Intraocular Lens and Refractive Surgery Association]

Recent advances in surgical techniques and intraocular lens implants have transformed cataract surgery into a true refractive procedure, enabling many patients to forgo optical correction. "Premium" IOL's offer multiple options for correcting refractive errors, including astigmatism, and addressing the effects of presbyopia. While cataract surgery is often beneficial for glaucoma patients, glaucomatous optic neuropathy can impair visual quality and impact the outcomes of premium IOL's, particularly multifocal IOL's. This concise review provides practical recommendations for the use of premium IOL's based on the type, stage and progression profile of glaucoma, supported by current scientific data. Monofocal toric IOL's may be considered to correct astigmatism in glaucoma patients but require careful clinical evaluation. "Monofocal plus" IOL's and certain extended depth of focus (EDOF) IOL's may also be viable options, provided that specific precautions are taken. However, diffractive and refractive multifocal IOL's are not recommended for patients with glaucoma or ocular hypertension with risk factors for development of glaucoma. In conclusion, the indications for premium IOL's in glaucoma patients should include rigorous, individualized selection, along with comprehensive patient counseling.

[First experience of implantation of extended depth of focus intraocular lenses in patients with glaucoma]

PURPOSE

This study evaluates the effectiveness of implantation of extended depth of focus (EDOF) intraocular lenses (IOL) in patients with cataract and glaucoma.

MATERIAL AND METHODS

The study included 13 patients (16 eyes) who underwent implantation of the Lentis Comfort EDOF IOL (Teleon Surgical BV, Netherlands). Standard phacoemulsification cataract surgery with IOL implantation was performed in a planned manner after the hypotensive surgery stage in two eyes; a combined procedure was performed in 14 cases. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), near visual acuity, and intraocular pressure (IOP) measured with a Maklakov tonometer were assessed preoperatively, on the first day, and 3-6 months after surgery. Computer perimetry using the 30-2 program and spatial contrast sensitivity (SCS) assessment were also performed preoperatively and at the same follow-up time points.

RESULTS

On the first day after surgery, UCVA was 0.53±0.65, BCVA was 0.85±0.45. Near UCVA (at 40 cm) was 0.5±0.14 on the first day after surgery and 0.56±0.18 at 3-6 months. According to computer perimetry data, retinal light sensitivity values increased in all patients in the long-term (-3.1±2.9 dB). SCS values increased for objects of all sizes compared to preoperative values.

CONCLUSION

Implantation of EDOF IOL contributes to improved vision without reducing contrast sensitivity and retinal light sensitivity in patients with concomitant cataract and glaucoma.

Consensus on the management of astigmatism in cataract surgery

This project was aimed at achieving consensus on the management of astigmatism during cataract surgery by ophthalmologists from Latin America using modified Delphi technique. Relevant peer-reviewed literature was identified, and 21 clinical research questions associated with the definition, classification, measurement, and treatment of astigmatism during cataract surgery were formulated. Twenty participants were divided into seven groups, and each group was assigned three questions to which they had to respond in written form, after thoroughly reviewing the literature. The assigned questions with corresponding responses by each group were discussed with other participants in round 4 – presentation of findings. The consensus was achieved if approval was obtained from at least 80% of participants. The present paper provides several agreements and recommendations for management of astigmatism during cataract surgery, which could potentially minimize the variability in practice patterns and help ophthalmologists adopt optimal practices for cataract patients with astigmatism and improve patient satisfaction.

[Clinical and functional results of bifocal IOLs implanted during combined cataract and glaucoma surgery]

At present, implantation of multifocal IOLs in patients with primary open-angle glaucoma (POAG) remains questionable.

PURPOSE

To comparatively analyze the clinical and functional effectiveness of bifocal IOLs implanted during combined cataract and glaucoma surgery.

MATERIAL AND METHODS

The prospective study included 41 patients (75 eyes) with presbyopia and POAG who underwent one-stage cataract phacoemulsification with implantation of a multifocal IOL and non-penetrating deep sclerectomy (NPDS) with lens capsule. Group 1 included 24 patients (44 eyes) with implantation of diffractive-refractive IOL. Group 2 consisted of 17 patients (31 eyes) who were implanted aspheric diffractive IOL with asymmetric optics.

RESULTS

Mean IOP in both groups was 18.1±2.9 mmHg, and the difference with the preoperative parameters (26.1±2.8) was statistically significant (p<0.05). On average, the patients received 1.3±0.5 antihypertensive drugs compared to 2.4±0.61 before surgery (0.05<p<0.1). Near uncorrected visual acuity (nUCVA) in group 1 was 0.51±0.12 (p=0.009), in group 2 - 0.53±0.1 (p=0.01). Distant uncorrected visual acuity (dUCVA) was 0.59±0.09 (p=0.043) In group 1, and 0.57±0.04 (p=0.021) in group 2. Near best corrected visual acuity (nBCVA) in group 1 was 0.64±0.07, and 0.64±0.09 in group 2. In all studied groups postoperative nBCVA after 1 year of observation was significantly higher than before the surgery (p=0.006 and p=0.009 respectively).

CONCLUSION

The main study goal (dBCVA=1.0 at 1 year after surgery) was achieved in 31.8% of cases in group 1 and in 29.1% of cases in group 2 (p>0.1). Implantation of multifocal IOLs in combination cataract and glaucoma surgery is a safe and effective surgical intervention for the described group of patients.

Premium IOLs in Glaucoma

Advanced technology or premium intraocular lenses have been developed to meet the patient expectations of perfect distance and near vision without the need for spectacles. Careful patient selection is critical when implanting these implants. This brief review focusses mainly on multifocal and toric IOLs and their application and limitations in patients with glaucoma.

How to cite this article: Ichhpujani P, Bhartiya S, Sharma A. Premium IOLs in Glaucoma. J Current Glau Prac 2013;7(2): 54-57.

[Combined glaucoma cataract surgeries]

The combined cataract-glaucoma surgery is a procedure gaining a higher role in the surgical treatment for patients having both cataract and glaucoma. Both these pathologies are strongly related to the age. A good knowledge of surgical indications and techniques, complications and postoperative follow-up can improve the outcome of this surgery, which is considered to be the best technique in the treatment of combined cataract and glaucoma. The combined glaucoma and cataract surgery enables us to lower the intraocular pressure and gain in visual acuity in one surgery, with the treatment of two distinct disorders. This kind of surgery requires a close follow-up to spot and manage the post-operative complications.