PURPOSE: To compare the quality of vision with aspheric and spherical intraocular lenses (IOLs) in pseudophakic patients. METHODS: This prospective, comparative, randomized study included 250 eyes of 125 patients with bilateral cataracts. Patients were randomly assigned to receive either IOLs with a spherical biconvex optic (Acrysof SN60AT [Alcon] or Sensar AR40e [Advanced Medical Optics, AMO]) or IOLs with an aspheric optic (Acrysof IQ SN60WF [Alcon], Tecnis Z9000 [AMO], or Sofport L161AO [Bausch & Lomb]). Ophthalmologic examination including best spectacle-corrected visual acuity, pupil size, ocular dominance investigation, contrast sensitivity under mesopic and photopic conditions, and wavefront analysis was performed 2 months postoperatively. RESULTS: Aspheric IOLs showed better contrast sensitivity compared to spherical IOLs at spatial frequencies of 6, 12, and 18 cycles per degree (cpd) under photopic conditions and at all spatial frequencies under mesopic conditions. There was no significant difference among the three aspheric IOLs at all spatial frequencies under either photopic or mesopic conditions. Mean total spherical aberration was statistically lower in dominant eyes with aspheric IOLs (0.05±0.06, 0.11±0.1, and 0.19±0.08 µm for the Tecnis Z9000, Acrysof IQ SN60WF, and Sofport L161AO, respectively) compared with eyes with spherical IOLs (0.62±0.24 and 0.46±0.19 µm for the Acrysof SN60AT and Sensar AR40e, respectively) for a 5- mm pupil diameter. CONCLUSIONS: The aspheric IOLs had less wavefront aberrations and performed better under both photopic and mesopic contrast sensitivity compared to the spherical IOLs. These findings confirm it is possible to improve the optical performance of IOLs by modifying the surfaces. [J Refract Surg. 2007;23:639-648.]

Pseudoexfoliation (PEX) syndrome is a common ocular disease that also affects the cornea. A case of clinical PEX syndrome, studied by in vivo corneal confocal microscopy is reported. The morphological analysis of the confocal images demonstrated hyper-reflective deposits and several dendritic cells in the basal epithelial layer. A fibrillar subepithelial structure was also found. The endothelial layer showed cell anomalies (polymegathism and pleomorphism) and hyper-reflective small endothelial deposits. Confocal microscopy is an in vivo imaging method that may provide new information on corneal alterations in PEX, and detect early corneal features.

ABSTRACT.Purpose: To compare differences in subjective glare and spherical aberration between five foldable intraocular lenses (IOLs) made of different materials and to different designs. Methods: This prospective study comprised 175 cataract patients who underwent phacoemulsification and were randomized to receive one of five types of foldable IOL (AcrySof 1 MA30BA, Alcon; Sensar 1 AR40, AMO; AcrySof 1 SA30AL, Alcon; Sensar 1 AR40e, AMO, and Tecnis 1 Z9000, Pharmacia & Upjohn). All patients received a questionnaire investigating the incidence of subjective photic phenomena. Two months postoperatively, we collected data regarding subjective glare and evaluated pupil size, visual acuity and wavefront aberration of the cornea and eye. Results: With regard to difficulty in performing ordinary activities under different light conditions and light and dark adaptation, the difference between the groups was not significant (p > 0.05, chi-squared test). With respect to difficulty in driving at night, the MA30BA group had a significant higher incidence of photic phenomena than the SA30AL, AR40e and Z9000 groups (p < 0.05, chisquared test). Wavefront measurements revealed a significant difference between the Z9000, AR40e and SA30AL groups, which showed the lowest values, and the MA30BA group, which showed the highest value (p < 0.05, ANOVA with Tamhane posthoc test). Conclusions: New generation IOLs such as the Pharmacia Z9000, AMO AR40e and AcrySof 1 SA30AL have a lower incidence of glare and spherical aberrations; however, their impact on future IOL design should be conditioned by further data, especially regarding posterior capsule opacification.

Initial results indicate that the single-piece AcrySof SA30AL IOL has good biocompatibility, haptic flexibility and resistance, and stability in the capsular bag. The incidence of PCO in 1 eye could have been the result of several factors and requires further evaluation. An area of future study is the wide haptic of the lens, which may create a path for cells to proliferate as they travel from the equatorial capsule.

Combined phacoemulsification, posterior chamber IOL implantation, and trabeculectomy was safe and effective in patients with coexisting glaucoma and cataract.