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• W2106671625 abstract "We were very interested to learn of the difficulties Dr. Bhavsar and colleagues reported in performing membrane dissection surgery on two patients with thin epiretinal membranes without any edges. They reported difficulty in fine focusing on the surface of the retina and suggest that this was due to the surgeon “viewing images that are as much as 3.5 diopters (D) disparate in focus between the two eyes” because of the multifocal design of the ARRAY intraocular lens. We did not note problems in focusing on the retina in our rabbit study.1Lim J.I. Kuppermann B.D. Gwon A. Gruber L. Vitreoretinal surgery through multifocal intraocular lenses compared with monofocal intraocular lenses in fluid-filled and air-filled rabbit eyes.Ophthalmology. 2000; 107: 1083-1088Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar On the contrary, we were surprised at how little we needed to adjust the fine focus as we moved toward the periphery of the retina when looking through the ARRAY intraocular lens (IOL). A change in focus suggests to us a change in the optical path. This could occur if, during the pars plana vitrectomy, manipulation of the surgical instruments through the sclerotomy sites caused the IOL to move anteriorly or tilt. The effect also occurs in pseudophakes with monofocal implants. However, the planned compromise of image quality in simultaneous vision multifocal IOL designs theoretically makes them more sensitive to IOL centration. This might not be as much of a problem in the rabbit, because the rabbit corneal diameter (14–15 mm) is larger than the human corneal diameter (11–12 mm) and thus the IOL is further from the sclerotomy sites and instruments. The ARRAY IOL consists of five concentric zones alternating between the power for distance and a power for near (3.5 D accommodation). In general, the entrance pupil of the stereomicroscope is similar in size to the patient’s natural pupil. Light from both the distance and near power zones contributes simultaneously to the stereomicroscope’s image. Thus, it is very unlikely that one of the stereo view paths is 3.5 D stronger compared with the other. Overall, the image contrast will be reduced. However, in theory, the optical design maintains the high spatial frequencies required for the fine detail in retinal procedures. Our rabbit study was designed to test this hypothesis. We agree with the authors that the rabbit model may not exactly reproduce surgical maneuvers in the human eye. However, careful attention to the effect of the surgical maneuvers on IOL position may decrease any difficulties involved in maintaining fine focus." @default.
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• W2106671625 date "2001-09-01" @default.
• W2106671625 modified "2023-09-28" @default.
• W2106671625 title "Vitrectomy and membrane dissection surger: Author reply" @default.
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• W2106671625 doi "https://doi.org/10.1016/s0161-6420(01)00681-9" @default.
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