here are currently numerous different multifocal intraocular lens (IOL) models available in the market. Some are bifocal or trifocal, whereas recent ones claim to generate a so-called extended depth of focus (EDOF), which describes the ability of the lens to provide a continuous range of vision across multiple distances. Typically, multifocal lenses are implanted bilaterally. Alternatively, surgeons can "mix-and-match," a technique that describes an asymmetrical implantation of two different IOL models as an attempt to reinforce their advantages and thereby improve the visual outcomes. 1,2 Numerous studies have reported visual results after mixing and matching different multifocal IOLs. 3-7 In this study, we present the clinical outcomes after asymmetrical implantation of an EDOF IOL and a segmental-refractive bifocal lens.

Purpose We present the case of a 49-year old female who underwent bilateral exchange of a supplementary trifocal sulcus-fixated intraocular lens (IOL) to correct a residual refractive error. Six months beforehand, she had been treated for hyperopia, astigmatism and presbyopia with a duet procedure to create reversible trifocality. Observations Refractive lens exchange with combined implantation of a monofocal toric IOL into the capsular bag and a trifocal supplementary IOL into the ciliary sulcus (duet procedure) had been performed in both eyes. Decreased uncorrected distance visual acuity due to the refractive outcome of −0.75 diopter sphere (DS)/-0.25 diopter cylinder (DC)x10° for the right eye and −1.0DS for the left eye as well as the perception of photic phenomena were inacceptable for the patient. In the second operations, we exchanged the supplementary IOLs to correct the residual refractive error and achieve the target refraction of emmetropia. UDVA increased from 0.50 logMAR in both eyes prior to the IOL exchange to −0.22 logMAR in the right eye and −0.20 logMAR in the left eye. Binocular uncorrected near and intermediate visual acuity were −0.10 logMAR and 0.00 logMAR respectively after exchanging the sulcus-fixated supplementary IOLs, allowing for complete spectacle independence. Conclusions This case demonstrates one of the most important benefits of the duet procedure: the possibility, if necessary, to easily remove or exchange the supplementary IOL from the ciliary sulcus. The duet procedure offers a safe treatment option in the event of postoperative complications like residual refractive error or intolerance to a multifocal optic.

This paper explored epidemiology and evaluation of posterior segment involvement as prognostic factors for functional outcome of patients with open globe injuries. A retrospective analysis of 151 patients with open globe injuries was conducted. Pre- and postoperative-corrected distance visual acuity (CDVA), epidemiologic data, classification of the injuries including the ocular trauma score (OTS), performed surgeries, intraocular pressure (IOP) and correlation analyses between OTS and postoperative CDVA were obtained. A total of 147 eyes were included in the study. Mean age was 42.9 ± 22.2 years, 78.2% were male, and 36.7% of injuries occurred in the workplace. Thirty-eight patients (25.9%) had intraocular foreign bodies. Concerning injury location, 51.7% of the injuries were located in zone I (cornea, corneoscleral limbus), 15.0% in zone II (up to 5 mm posterior the sclerocorneal limbus) and 32.0% in zone III (posterior of zone 2). Affected structures were eyelids (17.7%), cornea (74.8%), iris (63.9%), lens (56.5%), sclera (48.3%), retina (47.6%) and optic nerve (19.7%). Mean preoperative CDVA was 1.304 ± 0.794 logMAR and 1.289 ± 0.729 logMAR postoperatively (p = 0.780). Patients with posterior segment involvement had significantly worse postoperative CDVA than patients without (1.523 ± 0.654 logMAR vs. 0.944 ± 0.708 logMAR, p < 0.01). Predictive factors for good visual outcome of open globe injuries are good initial CDVA and ocular trauma affecting only zone I and II.

Purpose: Patients who have suffered an ocular trauma may present with varying degrees of injury to the anterior segment. In this retrospective interventional case series, we report the outcome of seven patients who underwent complete anterior segment reconstruction in a single surgery. Methods: All patients with posttraumatic corneal decompensation or scar, aphakia, and iris defect underwent human donor corneal graft transplantation and implantation of an intraocular lens combined with a flexible silicone iris prosthesis. Postoperative examinations included assessment of best corrected distance visual acuity, objective refraction, and intraocular pressure. Sensitivity to glare and subjective discontent with the eye’s appearance was rated on a scale from 1 to 10, with 1 standing for low and 10 for high severity. Results: Mean best corrected distance visual acuity (BCDVA) was 1.51 ± 0.26 logMAR preoperatively and 1.29 ± 0.36 logMAR postoperatively. Mean IOP was 15.71 ± 8.94 mmHg pre-surgery and 13.57 ± 6.52 mmHg post-surgery. The mean sensitivity to glare was reduced from 7.17 ± 2.91 to 3.80 ± 3.43 and subjective cosmetic disfigurement was reduced from 5.33 ± 3.35 to 1.80 ± 1.60. Conclusions: A single surgery technique for entire anterior segment reconstruction in trauma patients can effectively reduce glare and patient discontent with the eye’s appearance.

PURPOSE: To assess enlargement of the clear corneal incision site and functional outcome in patients with cataract, following the use of two preloaded intraocular lens (IOL) injectors. METHODS: In this prospective, randomized, intraindividual comparative clinical study, 58 paired-eyes were randomly assigned for implantation with two preloaded injectors: AutonoMe with a Clareon IOL (Alcon Laboratories, Inc) and iSert with a Vivinex IOL (Hoya). The size of the corneal incision, 2 mm for the iSert and 2.2 mm for the AutonoMe, was measured before and after phacoemulsification and after IOL implantation. Patients were examined 3 months after surgery to assess keratometry, subjective refraction, and visual acuity. RESULTS: The incision enlargement was 0.20 ± 0.10 mm for the AutonoMe and 0.29 ± 0.10 mm for the iSert, with a statistically significant difference ( P < .05). The final wound size after IOL implantation was 2.41 mm for the AutonoMe and 2.35 mm for the iSert. The mean absolute surgically induced astigmatism (SIA) was 0.50 ± 0.25 diopters (D) in the iSert eyes and 0.45 ± 0.20 D in the AutonoMe eyes ( P > .05). The 3-month postoperative uncorrected and corrected distance visual acuity (UDVA and CDVA) were similar in both groups, with a UDVA of 0.10 and 0.12 logMAR and CDVA of −0.04 and −0.03 logMAR, respectively for the AutonoMe and iSert. CONCLUSIONS: The iSert injector caused more enlargement of the corneal wound during IOL implantation compared to the AutonoMe. Despite the initially different incision sizes, the final incision size and functional outcomes were similar in both groups. [ J Refract Surg . 2021;37(5):331–336.]