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Xu J, Liu M, Liu Q. Outcomes of astigmatic correction with and without two different cyclotorsion compensation methods in small incision lenticule extraction surgery. Photodiagnosis Photodyn Ther 2024; 49:104272. [PMID: 39002831 DOI: 10.1016/j.pdpdt.2024.104272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/30/2024] [Accepted: 07/10/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE To compare the astigmatic correction outcomes of small incision lenticule extraction (SMILE) surgery with or without two different cyclotorsion compensation methods. METHODS This is a prospective randomized clinical trial. Patients with myopic astigmatism that underwent SMILE surgery were randomly divided into static cyclotorsion compensated group (SCC group), slit-lamp group and control group. In the SCC and slit-lamp groups, the intraoperative cyclotorsion was manually compensated with different limbal marking methods. In the control group, the cyclotorsion was not compensated. Visual acuity and manifest refraction were measured preoperatively and postoperatively. Astigmatic outcomes were estimated with vector analysis. RESULTS A total of 94 eyes from 94 patients were analyzed postoperatively at the 3-month follow-up. Their mean preoperative cylinder was -1.56±0.86 D (range: -4.25 to -0.25 D). The mean preoperative spherical equivalent was -5.95±1.72 D (range: -10.50 to -2.75 D). All groups showed favorable results in the correction of myopic astigmatism. No statistically differences were found among three groups in postoperative visual acuity, refractive outcomes or vector parameters. CONCLUSION Cyclotorsion compensation with two different manual limbal marking methods was helpful in aligning the surgical position in SMILE, but it was not as effective as expected for the correction of myopic astigmatism under well controlled surgical positioning.
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Affiliation(s)
- Jiping Xu
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
| | - Manli Liu
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
| | - Quan Liu
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China.
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Li FF, Yang YZ, Bao FJ, Cheng D, Zhu J, Ye YF. Comparison of Astigmatic Correction With and Without Cross-axis Alignment During Small Incision Lenticule Extraction. J Refract Surg 2022; 38:624-631. [DOI: 10.3928/1081597x-20220830-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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3
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Jabbarvand M, Khodaparast M, Moravvej Z, Shahraki K, Ahmadi H, Shahraki K, Jamali A, Narooie-Noori F. Vector analysis of moderate to high myopic astigmatism after small-incision lenticule extraction (SMILE): 12-month follow-up. Eur J Ophthalmol 2022; 32:3312-3320. [PMID: 35175136 DOI: 10.1177/11206721221080821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the refractive outcomes of small-incision lenticule extraction (SMILE) surgery in moderate to high myopic astigmatism. STUDY DESIGN Prospective interventional case series. METHODS This study evaluated 111 eyes of 68 patients treated with femtosecond SMILE surgery for the correction of myopia and astigmatism. Inclusion criteria were myopia of - 0.5 D or more and astigmatism between - 1.0 D and -5.0 D. Refractive and visual measurements were obtained preoperatively, 1 and 12 month(s) postoperatively. Vector analysis was used to study the astigmatic outcomes at 12-month follow-up. Comparison of results in two groups of patients with astigmatism below and over 3.00 D was performed. RESULTS The preoperative mean spherical equivalent was -5.48 ± 2.17 D (range - 1.75 to - 10.00 D) and the mean cylinder was -2.02 ± 1.09 D (range - 1.00 to - 5.00 D). The mean postoperative cylinder value was -0.60 ± 0.52 D at 12-month visit. The 12-month safety and efficacy indices were 0.98 ± 0.07 and 0.97 ± 0.12, respectively. The high astigmatism group showed significantly lower safety and efficacy indices. The postoperative residual astigmatism was 0.5 D or less in 73% of the eyes. Higher amount of residual astigmatism was observed in the high astigmatism group. The angle of error was ± 5 degrees in 49% and ± 15 degrees in 87% of the eyes. CONCLUSION SMILE surgery is effective and safe method for correcting myopic astigmatism. Vector analysis indicated a tendency for the under correction of astigmatism in subjects with high astigmatism.
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Affiliation(s)
- Mahmoud Jabbarvand
- Eye Research Center, 48438Farabi Eye Hospital, Tehran University of Medical Sciences, Iran
| | - Mehdi Khodaparast
- Eye Research Center, 48438Farabi Eye Hospital, Tehran University of Medical Sciences, Iran
| | - Zahra Moravvej
- Eye Research Center, 48438Farabi Eye Hospital, Tehran University of Medical Sciences, Iran.,Eye Research Center, Eye Department, Amiralmomenin Hospital, School of Medicine, 37554Guilan University of Medical Sciences, Rasht, Iran
| | - Kianoush Shahraki
- Eye Research Center, 48438Farabi Eye Hospital, Tehran University of Medical Sciences, Iran
| | - Hanie Ahmadi
- Eye Research Center, 48438Farabi Eye Hospital, Tehran University of Medical Sciences, Iran.,Department of Ophthalmology, 92948Mazandaran University of Medical sciences, Sari, Iran
| | - Kourosh Shahraki
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Jamali
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, 440827Iran University Of medical Sciences, Tehran, Iran
| | - Foroozan Narooie-Noori
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, 440827Iran University Of medical Sciences, Tehran, Iran
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Comparison of astigmatic correction with and without limbal marking during small incision lenticule extraction. J Cataract Refract Surg 2022; 48:924-928. [DOI: 10.1097/j.jcrs.0000000000000889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 01/10/2022] [Indexed: 11/26/2022]
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Nenning M, Hirnschall N, Döller B, Varsits R, Findl O. Evaluation of an intraoperative marking technique using the body axis as a reference. SPEKTRUM DER AUGENHEILKUNDE 2021. [DOI: 10.1007/s00717-021-00498-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sharma A, Batra A. Evaluation of Scheimpflug imaging system as an added tool in improving the accuracy of reference marking (as compared to the slit lamp marking system) for toric intraocular lens implantation. Indian J Ophthalmol 2021; 68:583-586. [PMID: 32174573 PMCID: PMC7210844 DOI: 10.4103/ijo.ijo_1253_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: To assess the role of Scheimpflug imaging in improving the accuracy of reference marking for toric IOL implantation. Methods: In this prospective, randomized, clinical trial all patients with cataract and pre-existing significant regular corneal astigmatism, who required implantation of a toric IOL were included in the study, and patients with any ocular pathology or abnormality were excluded. Patients were divided into two groups: For one group of patients, Group I (GI), reference marking was finalized using slit lamp only, and for the second group, Group II (GII), after slit lamp marking, the reference marks were checked using Goniometer of Scheimpflug imaging. The primary outcome was to determine the axis of toric intraocular lens (IOL) postoperatively (within 1 hour) and compare it with the desired axis of placement. Results: We found a statistically significant difference in the two groups (P < 0.001) suggesting Group II (4 step technique) is better than Group I (3 step technique). Conclusion: Scheimpflug imaging, an extra step preoperatively, is an effective measure to reduce errors in reference marking and thereby improving the refractive outcome of toric intraocular lens.
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Affiliation(s)
- Ajay Sharma
- Amber Eye Care and Micro Surgery Centre, Thane, Maharashtra, India
| | - Akanksha Batra
- Amber Eye Care and Micro Surgery Centre, Thane, Maharashtra, India
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Srujana D, Singh R, Titiyal JS, Sinha R. Assessment of posture-induced cyclotorsion during cataract surgery using the Verion image-guided system. Med J Armed Forces India 2020; 77:293-296. [PMID: 34305282 DOI: 10.1016/j.mjafi.2020.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 08/29/2020] [Indexed: 10/23/2022] Open
Abstract
Background The purpose of this prospective observational study is to analyse posture-induced cyclotorsion in eyes undergoing conventional phacoemulsification with toric intraocular lens (IOL) implantation and femtolaser-assisted cataract surgery (FLACS) using the Verion image-guided system. Methods Cyclotorsion was assessed in patients who underwent conventional phacoemulsification with toric IOL implantation and FLACS between June 2017 and November 2017 with registration of iris architecture, limbal and bulbar conjunctival blood vessels acquired preoperatively using the Verion Reference Unit (the patient in sitting position) and intraoperatively under the microscope using the digital marker of the Verion image-guided system with the patient in supine position. Results Forty-four eyes of 30 patients (21 men and 9 women) were included with the mean age of 56.5 ± 17.1 (range, 19-89; median, 62) years. The mean cyclotorsion induced by change in posture from sitting to supine position was 5.84 ± 3.25° (range, 1-17; median, 5). Overall, clockwise (CW) rotation (59.1%) was noted to be more common than counter clockwise (CCW) rotation (40.9%). Furthermore, CW rotation was more common in men than in women, and CCW rotation was significantly more common in women. Patients who underwent bilateral sequential cataract surgery show similar cyclorotation (CW or CCW) in both eyes more often than mixed rotation (85.7% vs 14.3%). Conclusion Significant cyclotorsion can occur in supine position during cataract surgery. Accurate assessment of the amount and direction of cyclotorsion aids in appropriate alignment of the toric IOL for optimal visual outcomes.
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Affiliation(s)
- Dubbaka Srujana
- Associate Professor, Dept of Ophthalmology, Armed Forces Medical College, Pune, India
| | - Reena Singh
- Senior Resident, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S Titiyal
- Professor & HOD, Cornea, Lens & Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sinha
- Professor, Cornea, Lens & Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Chun J, Kim SJ. Factors influencing the result of superior oblique weakening procedures in patients with superior oblique overaction in horizontal strabismus. BMC Ophthalmol 2020; 20:420. [PMID: 33081747 PMCID: PMC7576696 DOI: 10.1186/s12886-020-01687-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/08/2020] [Indexed: 11/23/2022] Open
Abstract
Background Few studies have evaluated the surgical outcome of superior oblique weakening procedures in patients with superior oblique overaction associated with exotropia or esotropia. This study aimed to evaluate the outcome of superior oblique muscle weakening and the influencing factors in patients with superior oblique overaction. Methods The medical charts of 37 patients (55 eyes) with superior oblique overaction associated with esotropia or exotropia who were treated with a superior oblique weakening procedure at the Seoul National University Hospital from January 2010 to June 2017 were retrospectively reviewed. Superior oblique overaction was graded using, a 6-point scale ranging from + 0.5 to + 3, and pre- and postoperative grades were recorded for all patients. Results The mean age of the patients was 91.81 ± 59.37 months. Superior oblique muscle suture spacer and superior oblique posterior tenectomy were performed for 17 (23 eyes) and 20 (32 eyes) patients, respectively. Surgical success was achieved in 15 (65.2%) eyes in the suture spacer group and 23 (71.9%) eyes in the posterior tenectomy group. Surgical success was achieved for 69.1% (38/55 eyes) of patients. Dissociated vertical deviation exhibited a significant negative association with the surgical success rate (p < 0.001). Conclusions There was no significant difference in surgical success rate between the superior oblique posterior tenectomy and superior oblique suture spacer groups in superior oblique overaction associated with horizontal strabismus. Associated dissociated vertical deviation can affect the surgical success of the superior oblique weakening procedure.
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Affiliation(s)
- Junwoo Chun
- Department of Ophthalmology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea.
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Mortazavi SAA, Fazel F, Radmanesh P, Peyman A, Pourazizi M. Wavefront-guided photorefractive keratectomy with and without iris registration: comparison of astigmatic correction. Lasers Med Sci 2020; 36:75-81. [PMID: 32297251 DOI: 10.1007/s10103-020-03010-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/25/2020] [Indexed: 11/26/2022]
Abstract
This study aimed to compare the visual outcomes after photorefractive keratectomy (PRK), with and without the iris registration (IR) technology. The retrospective cohort study was performed for wavefront-guided PRK using the Technolas 217z100 excimer laser system in patients with myopic astigmatism (cylinder error - 2 to - 4 diopter [D]). Eyes were divided into IR group (IRPRK) and non-IR group (non-IRPRK). Visual acuity (VA), cylindrical refraction, and the astigmatic vector components using the Alpins method were compared between the two groups preoperatively and 6 months postoperatively. Fifty IRPRK patients (66% female, mean age 30.56 ± 6.31 years) and 50 non-IRPRK (60% female, mean age 29.60 ± 5.63 years) were enrolled. The mean logMAR uncorrected VA improved from 0.89 ± 0.44 to 0.032 ± 0.05 in the IRPRK group (P < 0.001) and from 0.89 ± 0.46 to 0.042 ± 0.06 postoperatively while follow-up in the non-IRPRK group (P < 0.001). No statistically significant differences were observed between the two groups regarding mean uncorrected distance VA (P = 0.4), corrected distance VA (P = 0.5), spherical equivalent (P = 0.16), defocus equivalent (P = 0.18), and absolute cylinder (P = 0.94). More than 90% eyes were within ± 1.00 D of emmetropia in both groups. Moreover, Alpins vector analysis revealed that no significant differences were found in any astigmatic parameters between the two groups (P > 0.05). Wavefront-guided PRK independent of the IR status is effective, safe, and predictable in patients with myopic astigmatism. No statistical significance was observed supporting data for the better outcome of visual acuity and astigmatism correction using IR in comparison with a non-IR system.
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Affiliation(s)
- Seyed Ali-Akbar Mortazavi
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farhad Fazel
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pouria Radmanesh
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Peyman
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Pourazizi
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran.
- Department of Ophthalmology, Feiz Hospital, Modares St, Isfahan, Isfahan, Iran.
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Liu F, Zhang T, Liu Q. One year results of presbyLASIK using hybrid bi-aspheric micro-monovision ablation profile in correction of presbyopia and myopic astigmatism. Int J Ophthalmol 2020; 13:271-277. [PMID: 32090037 DOI: 10.18240/ijo.2020.02.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To analyze one year clinical outcomes and subjective rating of hybrid bi-aspheric multifocal central presbyLASIK with micro-monovision for correction of presbyopia and myopic astigmatism. METHODS Seventy-four eyes of 37 patients consecutively treated with presbyLASIK were assessed. The mean age of the patients was 43.8±3.0y with a mean spherical equivalent refraction of -5.21±1.87 diopters (D) and mean astigmatism of -0.82±0.64 D. Visual acuity, manifest refraction, contrast sensitivity, aberrometry and patients' subjective rating were evaluated pre- and postoperatively. RESULTS At 1y postoperatively (68 eyes of 34 patients), the mean spherical equivalent (SE) refraction in distance eyes was 0.06±0.05 D, whereas the achieved SE in near eyes was -0.83±0.05 D. Ninety-nine percent of eyes were within ±0.50 D of target correction of SE. The binocular mean uncorrected distance visual acuity (UDVA) was 0.00±0.18 logMAR (20/20). Sixty-four percent of patients achieved 0.0 logMAR (20/20) or better of UDVA and 0.1 logRAD or better of UNVA as well. There was a binocularly loss of one line CDVA after surgery for only one patient (3%, 1/34) and no patient lost 2 lines. The changes in binocular contrast sensitivity (CS) in all test conditions were not significant at any frequency after surgery. The changes of entire eye total higher order aberrations (tHOA) and spherical aberrations (SA) significantly higher in near eyes than in distance eyes. The overall satisfaction score for surgery was 93±8. CONCLUSION The hybrid bi-aspheric multifocal central presbyLASIK with micro-monovision appears to be an efficacious option for myopic presbyopes. One year postoperative outcomes in a relatively young presbyopia population indicate improvements in both far and near vision with high satisfaction.
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Affiliation(s)
- Fang Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Ting Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Quan Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
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Posture-related ocular cyclotorsion during cataract surgery with an ocular registration system. Sci Rep 2020; 10:2136. [PMID: 32034232 PMCID: PMC7005750 DOI: 10.1038/s41598-020-59118-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/23/2020] [Indexed: 12/03/2022] Open
Abstract
Ocular cyclotorsion when a patient changes from seated to supine position in cataract surgery and factors predicting the amount of cyclotorsion were investigated using VERION system. Variables analyzed were age, gender, preoperative visual acuity, axial length, laterality of eyes, operative duration, and the direction and degree of cyclotorsion. The mean cyclotorsion of 107 eyes of 93 cataract patients was 0.98 ± 4.85 degrees (median, 1 degree; range, -11 to 12 degrees), and the median absolute value was 4 degrees (mean, 4.05 ± 2.82 degrees; range, 0 to 12 degrees). Cyclotorsion was ≥3 degrees in 68 (63.6%) eyes. Excyclotorsion occurred more frequently than incyclotorsion (50.5% vs. 43.0%). There was no cyclotorsion in seven (6.5%). Multiple regression analysis showed that gender was a significant predictive factor for the absolute value of cyclotorsion (β = 1.06, P = 0.041); however, the other variables had no effect on cyclotorsion. The absolute value of cyclotorsion was significantly larger in female than in male patients [median, 4 degrees and 3 degrees, respectively; mean, 4.66 ± 3.02 degrees and 3.44 ± 2.52 degrees, respectively (P = 0.039)]. In conclusion, cataract patients had significant posture-related ocular cyclotorsion. The amount of cyclotorsion was larger for female than male patients.
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Ozulken K, Ilhan C. Effects of Cyclotorsion Orientation and Magnitude in Eyes with Compound Myopic Astigmatism on the Compensation Capacity of WaveLight EX500 Photorefractive Keratectomy. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:458-466. [PMID: 31612657 PMCID: PMC6791944 DOI: 10.3341/kjo.2019.0042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/01/2019] [Accepted: 08/08/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the clinical effects of different orientation and magnitude of cyclotorsion on the compensation capacity of the WaveLight EX500 photorefractive keratectomy (PRK) platform. Methods This retrospective study comprised 400 eyes of 200 patients who underwent bilateral simultaneous PRK due to compound myopic astigmatism. The subjects were separated according to the orientation of cyclotorsion into incyclotorsion and excyclotorsion groups, and by the magnitude of cyclotorsion into group 1 (0.50 to 2.50 degrees), group 2 (3.00 to 5.00 degrees), group 3 (5.50 to 7.50 degrees), and group 4 (8.00 to 9.50 degrees). Results The mean magnitude of cyclotorsion was 3.50 ± 2.4 degrees (0.50 to 9.50 degrees) in the incyclotorsion group and 3.32 ± 2.3 degrees (0.50 to 9.50 degrees) in the excyclotorsion group (p = 0.617). The postoperative refractive outcomes of the incyclotorsion and excyclotorsion groups were similar (p > 0.05 for all). The postoperative mean cylindrical refractive error was −0.32 ± 0.3 diopters (D, −1.25 to 0.00 D) in group 1, −0.47 ± 0.2 D (−2.00 to 0.00 D) in group 2, −0.62 ± 0.2 D (−1.00 to −0.25 D) in group 3, and −0.91 ± 0.2 D (−1.50 to −0.50 D) in group 4 (p < 0.001). Preoperative cylindrical refractive error was positively correlated with magnitude of cyclotorsion (r = 0.125 and p = 0.013), which was also positively correlated with postoperative cylindrical refractive error (r = 0.600 and p < 0.001). Conclusions Incyclotorsion and excyclotorsion can be equally compensable in the WaveLight EX500 PRK platform for compound myopic astigmatism. A value of ≤2.50 degrees cyclotorsion magnitude was observed to be more compensable than higher degrees of cyclotorsion magnitude. Preoperative high astigmatism was associated with high cyclotorsion magnitude, which was also associated with a high degree of postoperative astigmatism.
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Affiliation(s)
- Kemal Ozulken
- Department of Ophthalmology, TOBB ETU Hospital, Ankara, Turkey
| | - Cagri Ilhan
- Department of Ophthalmology, Hatay State Hospital, Hatay, Turkey.
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Xu J, Liu F, Liu M, Yang X, Weng S, Lin L, Lin H, Xie Y, Liu Q. Effect of Cyclotorsion Compensation With a Novel Technique in Small Incision Lenticule Extraction Surgery for the Correction of Myopic Astigmatism. J Refract Surg 2019; 35:301-308. [DOI: 10.3928/1081597x-20190402-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/04/2019] [Indexed: 11/20/2022]
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Mohammadpour M, Khorrami-Nejad M, Chini-Foroush N. Correlation between iris-registered static and dynamic cyclotorsions with preoperative refractive astigmatism in PRK candidates. J Curr Ophthalmol 2019; 31:36-42. [PMID: 30899844 PMCID: PMC6407146 DOI: 10.1016/j.joco.2018.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 10/04/2018] [Accepted: 10/15/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate static and dynamic cyclotorsions during photorefractive keratotomy (PRK) surgery in refractive surgery candidates and their correlations with preoperative factors. Methods This cross-sectional case series was performed in 138 eyes of 77 patients who underwent PRK surgery by Technolas 217z100. Iris registration was used to evaluate the degree of static and dynamic cyclotorsion. Wavefront measurements were performed in sitting position using Zywave (versions 3.1 and 3.2, Bausch & Lomb) Hartmann Shack aberrometer (Bausch & Lomb), and the cyclotorsion from upright to supine position was measured using iris image comparison. Dynamic cyclotorsions were measured by Advanced Cyclotorsional Eye Tracker (ACE) mounted on Excimer laser machine Technolas 217z100 during surgery. Results The mean absolute static cyclotorsion that was captured in surgery time was 3.37 ± 2.38° (range, 0.00 to 11.30), and the mean absolute dynamic cyclotorsion was 2.54 ± 2.50° (range, 0.00 to 13.60). There was a significant correlation between dynamic cyclotorsions and static cyclotorsions (P < 0.001 and R = 0.704). There was a strong association between preoperative refractive astigmatism and range dynamic cyclotorsion. Total pulses (P = 0.009), ablation depth (P = 0.012), gender (P = 0.008) had significant correlations with cyclotorsional movements. Conclusion The measurements of static and dynamic cyclotorsions are highly recommended for refractive surgery candidates with significant preoperative refractive astigmatism.
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Affiliation(s)
- Mehrdad Mohammadpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author.
| | - Masoud Khorrami-Nejad
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Noushin Chini-Foroush
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Jun I, Kang DSY, Reinstein DZ, Arba-Mosquera S, Archer TJ, Seo KY, Kim TI. Clinical Outcomes of SMILE With a Triple Centration Technique and Corneal Wavefront-Guided Transepithelial PRK in High Astigmatism. J Refract Surg 2018. [PMID: 29522224 DOI: 10.3928/1081597x-20180104-03] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To comparatively investigate the clinical outcomes, vector parameters, and corneal aberrations of small incision lenticule extraction (SMILE) with a triple centration technique and corneal wavefront-guided transepithelial photorefractive keratectomy (PRK) for the correction of high astigmatism. METHODS This retrospective, comparative case series study included 89 eyes (89 patients) that received treatment for myopia with high astigmatism (≥ 2.50 diopters) using SMILE with a triple centration technique (SMILE group; 45 eyes) and corneal wavefront-guided transepithelial PRK (transepithelial PRK group; 44 eyes). Visual acuity measurement, manifest refraction, slit-lamp examination, autokeratometry, corneal topography, and evaluation of corneal wavefront aberration were performed preoperatively and at 1, 3, and 6 months after surgery. The safety, efficacy, vector parameters, and corneal aberrations at 6 months after surgery were compared between the two groups. RESULTS At 6 months after surgery, the transepithelial PRK and SMILE groups exhibited comparable mean uncorrected distance visual acuities (-0.06 ± 0.07 and -0.05 ± 0.07 logMAR, respectively), safety, efficacy, and predictability of refractive and visual outcomes. There was a slight but statistically significant difference in the correction index between the transepithelial PRK and SMILE groups (0.96 ± 0.11 and 0.91 ± 0.10, respectively). Whereas the transepithelial PRK group exhibited increased corneal spherical aberration and significantly reduced corneal coma and trefoil, no changes in aberrometric values were noted in the SMILE group. CONCLUSIONS Both SMILE with a triple centration technique and corneal wavefront-guided transepithelial PRK are effective and provide predictable outcomes for the correction of high myopic astigmatism, although slight undercorrection was observed in the SMILE group. The triple centration technique was helpful in astigmatism correction by SMILE. [J Refract Surg. 2018;34(3):156-163.].
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Zhao F, Li L, Zhou W, Shi D, Fan Y, Ma L. Correlative factors' analysis of postural-related ocular cyclotorsion with image-guided system. Jpn J Ophthalmol 2017; 62:237-242. [PMID: 29134322 DOI: 10.1007/s10384-017-0544-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 10/08/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore the correlation between ocular cyclotorsion induced by sitting and supine positions as well as other selected factors, validated by an image-guided system. STUDY DESIGN A cross-sectional study conducted in 73 inpatients (85 eyes) who received intraocular operations in China Medical University. METHODS The ocular cyclotorsion degree was recorded using an image-guided system (Verion Reference Unit, Alcon) by comparing images captured in sitting position, as well as pre- and post-different anesthesia methods in the supine position. Possible correlative factors including age, gender, eye axial length, best corrected visual acuity (BCVA), astigmatism degree, astigmatism axis, anesthesia, and comparison in laterality of eyes on ocular cyclotorsion were analyzed. RESULTS The total cyclotorsion rate was 88.24% and the cyclotorsion degree ranged from - 14.0° to + 12.0° with an average of 4.6° ± 3.4°. Excyclotorsion was predominant OD whereas incyclotorsion was predominant OS (p < 0.05). The effect of eye axial length, BCVA, astigmatism degree, astigmatism axis, anesthesia method, age and gender on cyclotorsion orientation was not statistically significant, neither did these factors show any significant differences in the ocular cyclotorsion degree (p > 0.05). Pre- and post-anesthesia, and different anesthetic methods, did not show any significant influence on the ocular cyclotorsion degree (p > 0.05). CONCLUSIONS Cyclotorsion orientation seems to be correlated only with eye laterality. None of the other investigated factors, including age, gender, eye axial length, BCVA, astigmatism degree, astigmatism axis and anesthesia seems to affect cyclotorsion orientation or degree.
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Affiliation(s)
- Fangkun Zhao
- Department of Ophthalmology, the Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, China
- The Key Lens Research Laboratory of Liaoning Province, Shenyang, China
| | - Ling Li
- Department of Ophthalmology, the Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, China
- The Key Lens Research Laboratory of Liaoning Province, Shenyang, China
- Beijing AIER-Intech Eye Hospital, Beijing, China
| | - Wenkai Zhou
- Department of Ophthalmology, the Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, China
- The Key Lens Research Laboratory of Liaoning Province, Shenyang, China
| | - Dong Shi
- Department of Ophthalmology, the Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, China
- The Key Lens Research Laboratory of Liaoning Province, Shenyang, China
| | - Yu Fan
- Department of Ophthalmology, the Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, China
- The Key Lens Research Laboratory of Liaoning Province, Shenyang, China
| | - Liwei Ma
- Department of Ophthalmology, the Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, China.
- The Key Lens Research Laboratory of Liaoning Province, Shenyang, China.
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Effect of iris registration on outcomes of FEMTOLASIK for myopia and myopic astigmatism. Int Ophthalmol 2017; 38:2077-2087. [PMID: 28875250 DOI: 10.1007/s10792-017-0703-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the visual and refractive outcomes after FEMTOLASIK with and without iris registration. METHODS In this randomized, prospective, comparative, contralateral eye study, 118 eyes of 59 patients with myopia and myopic astigmatism underwent LASIK using the Femto LDV femtosecond laser (160 µm) and the MEL80 with or without iris registration. For each patient, iris registration FEMTOLASIK was performed on one eye and non-iris registration FEMTOLASIK was performed on the other eye, assigned at random. Patients were evaluated before and 12 months. Uncorrected visual acuity, best-corrected visual acuity, manifest refraction, contrast sensitivity, and higher-order aberrations (HOAs) were evaluated. RESULTS At 12 months, the mean UDVA was 0.002 ± 0.07 logMAR (20/19) in iris registration eyes and 0.00 ± 0.06 logMAR (20/24) in non-iris registration eyes (P = 0.9). 61% of iris registration eyes and 71.2% of non-iris registration eyes achieved a UDVA of 20/20 or better (P = 0.31); 98.3% of eyes with the iris registration FEMTOLASIK and 94.9% with the non-iris registration FEMTOLASIK were within ±0.50 D from emmetropia (P = 0.71). No statistically significant difference was found in postoperative contrast sensitivity between groups at 3, 6, 12, or 18 cycles/degree (P > 0.05). There was significant increase in total HOA root mean square in two groups. The mean error magnitude of surgically induced astigmatism 12 months postoperatively was -0.33 in iris registration eyes and -0.24 in the non-iris registration eyes (P = 0.36). CONCLUSIONS FEMTOLASIK with and without iris registration provides similar results in myopic and myopic astigmatism patients.
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Kaya A, Keçeli AS, Can AB, Çakmak HB. Cyclotorsion measurement using scleral blood vessels. Comput Biol Med 2017; 87:152-161. [PMID: 28595130 DOI: 10.1016/j.compbiomed.2017.05.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/29/2017] [Accepted: 05/29/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Measurements of the cyclotorsional movement of the eye are crucial in refractive surgery procedures. The planned surgery pattern may vary substantially during an operation because of the position and eye movements of the patient. Since these factors affect the outcome of an operation, eye registration methods are applied in order to compensate for errors. While the majority of applications are based on features of the iris, we propose a registration method which uses scleral blood vessels. Unlike previous offline techniques, the proposed method is applicable during surgery. METHODS The sensitivity of the proposed registration method is tested on an artificial benchmark dataset involving five eye models and 46,305 instances of eye images. The cyclotorsion angles of the dataset vary between -10° and +10° at 1° intervals. Repeated measurements and ANOVA and Cochran's Q tests are applied in order to determine the significance of the proposed method. Additionally, a pilot study is carried out using data obtained from a commercially available device. The real data are validated using manual marking by an expert. RESULTS AND CONCLUSIONS The results confirm that the proposed method produces a smaller error rate (mean = 0.44 ± 0.41) compared to the existing method in [1] (mean = 0.64 ± 0.58). A further conclusion is that feature extraction algorithms affect the results of the proposed method. The SIFT (mean = 0.74 ± 0.78), SURF64 (mean = 0.56 ± 0.46), SURF128 (mean = 0.57 ± 0.48) and ASIFT (mean = 0.29 ± 0.25) feature extraction algorithms were examined; the ASIFT method was the most successful of these algorithms. Scleral blood vessels are observed to be useful as a feature extraction region due to their textural properties.
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Affiliation(s)
- Aydın Kaya
- Hacettepe University, Faculty of Engineering, Department of Computer Engineering, 06800, Ankara, Turkey.
| | - Ali Seydi Keçeli
- Hacettepe University, Faculty of Engineering, Department of Computer Engineering, 06800, Ankara, Turkey.
| | - Ahmet Burak Can
- Hacettepe University, Faculty of Engineering, Department of Computer Engineering, 06800, Ankara, Turkey.
| | - Hasan Basri Çakmak
- Hitit University, Faculty of Medicine, Department of Ophthalmology, 19030, Çorum, Turkey.
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Lee JJ, Kim MK, Wee WR. Effect of Iris registration on visual outcome in wavefront-guided LASEK for myopic astigmatism. Int Ophthalmol 2017; 38:513-525. [PMID: 28285388 DOI: 10.1007/s10792-017-0486-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 03/04/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to investigate the effect of iris registration (IR) on visual outcomes in wavefront-guided LASEK for myopic astigmatism. METHODS The retrospective chart review was performed for wavefront-guided LASEK using VISX Star S4 in patients with myopic astigmatism (cylinder ≥ 1.00 diopter[D]). Eyes were divided into IR group (LASEK with IR at the time of surgery) and Non-IR group (LASEK without IR system + failed-IR engagement during LASEK). Visual acuity (VA), astigmatism, higher-order aberration (HOA), and contrast sensitivity were assessed preoperatively and 3 months postoperatively. The IR and Non-IR groups were subcategorized depending on the spherical equivalent (lower myopia ≤-5.00 D vs. higher myopia >-5.00 D) for the comparison of HOA changes. RESULTS Postoperative uncorrected VAs showed no differences between IR (n = 30) and Non-IR (n = 46). In astigmatic vector analyses, no differences were noted in the mean magnitude of error and the mean angle of error between two groups. There were no differences in postoperative total HOA, spherical aberration (SA), coma, and trefoil between the groups, either. The total HOA and SA increased in both groups, while coma increased only in Non-IR. In higher myopia, ΔRMS of coma was smaller in IR. Preoperative and postoperative total HOA were linearly correlated in Non-IR, but not for IR. Contrast sensitivity of 12 cycles per degree improved in both groups. CONCLUSION IR had similar outcomes to conventional trackers in wavefront-guided LASEK, with less tendency of inducing coma, especially in higher myopia.
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Affiliation(s)
- Jong Joo Lee
- Department of Ophthalmology, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Won Ryang Wee
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
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Piao J, Li YJ, Whang WJ, Choi M, Kang MJ, Lee JH, Yoon G, Joo CK. Comparative evaluation of visual outcomes and corneal asphericity after laser-assisted in situ keratomileusis with the six-dimension Amaris excimer laser system. PLoS One 2017; 12:e0171851. [PMID: 28187180 PMCID: PMC5302827 DOI: 10.1371/journal.pone.0171851] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/26/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose To compare the visual and refractive outcomes after laser-assisted in situ keratomileusis (LASIK) surgery for correction of myopia or myopic astigmatism using a six-dimensional Amaris excimer laser. Methods In this retrospective cohort study, we enrolled 47 eyes of 28 patients (age: 19–36 years) with myopia or myopic astigmatism. We used the Custom Ablation Manager protocol and performed ablations with the SCHWIND AMARIS system. LASIK flaps were cut with an iFS Advanced Femtosecond Laser. Mean static (SCC) and dynamic cyclotorsion (DCC) were evaluated. Visual and refractive outcomes were evaluated during 6 months’ follow-up. Corneal asphericity (Q-value) was analyzed at 4 months postoperatively. Results The spherical equivalent (SE) reduction was statistically significant reduce 1 day after refractive surgery (P < 0.001), with no additional significant changes during follow-up (P = 0.854). SCC registration rates were 81% in the Aberration-Free mode (AF) and 90% in the Corneal Wavefront mode (CW). SCC measurements were within ± 5 degrees in 57% (AF) and 68% (CW) of eyes. Mean DCC was within ± 1 degree in 96% (AF) or 95% (CW) of cases. At 6 months, the uncorrected distance visual acuity was 20/25 or better in all eyes. At last follow-up, both steep and flat keratometry values had significantly flattened in both groups (P < 0.001). Corneal asphericity also increased significantly during the postoperative period for an 8-mm corneal diameter (P < 0.001). Conclusions LASIK for myopia or myopic compound astigmatism correction using the six-dimensional AMARIS 750S excimer laser is safe, effective, and predictable. Postoperative corneal asphericity can be analyzed by linear regression to predict the changes in postoperative corneal asphericity with this approach.
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Affiliation(s)
- JunJie Piao
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ying-Jun Li
- Department of Ophthalmology, Affiliated Hospital, Yanbian University Medical College, Jilin, China
| | - Woong-Joo Whang
- Department of Ophthalmology, Catholic Institute for Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mihyun Choi
- Department of Ophthalmology, Catholic Institute for Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Ji Kang
- Department of Ophthalmology, Catholic Institute for Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jee Hye Lee
- Department of Ophthalmology, Catholic Institute for Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Geunyoung Yoon
- Flaum Eye Institute, Center for Visual Science, The Institute of Optics, University of Rochester, Rochester, New York, United States of America
| | - Choun-Ki Joo
- Department of Ophthalmology, Catholic Institute for Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail:
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Sasse AC, Shajari M, Kohnen T. Influence of blurred vision, accommodation, and target laser settings on eye movements during LASIK. J Cataract Refract Surg 2016; 42:1424-1430. [PMID: 27839596 DOI: 10.1016/j.jcrs.2016.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 07/19/2016] [Accepted: 07/22/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To analyze the influence of blurred vision, accommodation, and target laser settings on eye movements during laser in situ keratomileusis (LASIK). SETTING Department of Ophthalmology, Goethe University, Frankfurt, Germany. DESIGN Prospective randomized study. METHODS Participants had simulated LASIK treatment. They were instructed to focus on the fixation light; the treatment laser was blocked, and all other settings were applied according to standard LASIK treatments. To simulate blurred vision a 0.0 diopter (D) soft contact lens received a 5.0 D myopia laser treatment and was then applied to the participant's eye. To diminish accommodation, a second lens that had a refraction of the patient's spherical equivalent, plus 3.0 D to compensate for accommodation, was used. There were 4 treatment modalities as follows: (1) blurred lens with target laser on, (2) blurred lens with target laser turned off, (3) +3.0 D lens with target laser on, and (4) +3.0 D lens with target laser turned off. Lateral and torsional eye movements were recorded. Fourier analysis was used to obtain temporal power spectra from dynamic eye movements. The Fn criterion was set as the frequency below which n% of eye movements in the cohort occurred (n = 95%, 80%, and 50%). RESULTS The study comprised 11 eyes of 11 participants. There was 1 significant difference between the eye movements based on measurement modalities. In 1 variable in the y-axis, there was movement that showed a significant difference in the F80 criterion. CONCLUSION Surgical circumstances such as blurred vision, accommodation, and target light had little influence on eye movements during LASIK. FINANCIAL DISCLOSURE Proprietary or commercial disclosures are listed after the references.
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Affiliation(s)
- Anna Christina Sasse
- From the Department of Ophthalmology, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - Mehdi Shajari
- From the Department of Ophthalmology, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - Thomas Kohnen
- From the Department of Ophthalmology, Goethe-University Frankfurt am Main, Frankfurt, Germany.
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Qi H, Jiang JJ, Jiang YM, Wang LQ, Huang YF. Kappa angles in different positions in patients with myopia during LASIK. Int J Ophthalmol 2016; 9:585-9. [PMID: 27162734 DOI: 10.18240/ijo.2016.04.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 07/10/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the difference in kappa angle between sitting and supine positions during laser-assisted in situ keratomileusis (LASIK). METHODS A retrospective study was performed on 395 eyes from 215 patients with myopia that received LASIK. Low, moderate, and high myopia groups were assigned according to diopters. The horizontal and vertical components of kappa angle in sitting position were measured before the operation, and in supine position during the operation. The data from the two positions were compared and the relationship between kappa angle and diopters were analyzed. RESULTS Two hundred and twenty-three eyes (56.5%) in sitting position and 343 eyes (86.8%) in supine position had positive kappa angles. There were no significant differences in horizontal and vertical components of kappa angle in the sitting position or horizontal components of kappa angle in the supine position between the three groups (P>0.05). A significant difference in the vertical components of kappa angle in the supine position was seen in the three groups (P<0.01). Differences in both horizontal and vertical components of kappa angles were significant between the sitting and supine positions. Positive correlations in both horizontal and vertical components of kappa angles (P<0.05) were found and vertical components of kappa angle in sitting and supine positions were negatively correlated with the degree of myopia (sitting position: r=-0.109; supine position: r=-0.172; P<0.05). CONCLUSION There is a correlation in horizontal and vertical components of kappa angle in sitting and supine positions. Positive correlations in both horizontal and vertical components of kappa angle in sitting and supine positions till the end of the results. This result still needs further observation. Clinicians should take into account different postures when excimer laser surgery needs to be performed.
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Affiliation(s)
- Hui Qi
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing 100853, China; Department of Ophthalmology, Bethune International Peace Hospital of PLA, Shijiazhuang 50082, Hebei Province, China
| | - Jing-Jing Jiang
- Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Yan-Ming Jiang
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing 100853, China
| | - Li-Qiang Wang
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing 100853, China
| | - Yi-Fei Huang
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing 100853, China
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Comparison of Moderate- to High-Astigmatism Corrections Using WaveFront–Guided Laser In Situ Keratomileusis and Small-Incision Lenticule Extraction. Cornea 2016; 35:523-30. [DOI: 10.1097/ico.0000000000000782] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Via R, Fassi A, Fattori G, Fontana G, Pella A, Tagaste B, Riboldi M, Ciocca M, Orecchia R, Baroni G. Optical eye tracking system for real-time noninvasive tumor localization in external beam radiotherapy. Med Phys 2016; 42:2194-202. [PMID: 25979013 DOI: 10.1118/1.4915921] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE External beam radiotherapy currently represents an important therapeutic strategy for the treatment of intraocular tumors. Accurate target localization and efficient compensation of involuntary eye movements are crucial to avoid deviations in dose distribution with respect to the treatment plan. This paper describes an eye tracking system (ETS) based on noninvasive infrared video imaging. The system was designed for capturing the tridimensional (3D) ocular motion and provides an on-line estimation of intraocular lesions position based on a priori knowledge coming from volumetric imaging. METHODS Eye tracking is performed by localizing cornea and pupil centers on stereo images captured by two calibrated video cameras, exploiting eye reflections produced by infrared illumination. Additionally, torsional eye movements are detected by template matching in the iris region of eye images. This information allows estimating the 3D position and orientation of the eye by means of an eye local reference system. By combining ETS measurements with volumetric imaging for treatment planning [computed tomography (CT) and magnetic resonance (MR)], one is able to map the position of the lesion to be treated in local eye coordinates, thus enabling real-time tumor referencing during treatment setup and irradiation. Experimental tests on an eye phantom and seven healthy subjects were performed to assess ETS tracking accuracy. RESULTS Measurements on phantom showed an overall median accuracy within 0.16 mm and 0.40° for translations and rotations, respectively. Torsional movements were affected by 0.28° median uncertainty. On healthy subjects, the gaze direction error ranged between 0.19° and 0.82° at a median working distance of 29 cm. The median processing time of the eye tracking algorithm was 18.60 ms, thus allowing eye monitoring up to 50 Hz. CONCLUSIONS A noninvasive ETS prototype was designed to perform real-time target localization and eye movement monitoring during ocular radiotherapy treatments. The device aims at improving state-of-the-art invasive procedures based on surgical implantation of radiopaque clips and repeated acquisition of X-ray images, with expected positive effects on treatment quality and patient outcome.
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Affiliation(s)
- Riccardo Via
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy
| | - Aurora Fassi
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy
| | - Giovanni Fattori
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy
| | - Giulia Fontana
- CNAO Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy
| | - Andrea Pella
- CNAO Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy
| | - Barbara Tagaste
- CNAO Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy
| | - Marco Riboldi
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy and CNAO Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy
| | - Mario Ciocca
- CNAO Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy
| | - Roberto Orecchia
- CNAO Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy and European Institute of Oncology, Milano 20141, Italy
| | - Guido Baroni
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy and CNAO Centro Nazionale di Adroterapia Oncologica, Pavia 27100, Italy
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Shajari M, Bühren J, Kohnen T. Dynamic torsional misalignment of eyes during laser in-situ keratomileusis. Graefes Arch Clin Exp Ophthalmol 2016; 254:911-6. [PMID: 26968722 DOI: 10.1007/s00417-016-3309-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/16/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To determine the amount and characteristics of dynamic torsional misalignment of eyes during excimer ablation in laser in-situ keratomileusis (LASIK). METHODS Retrospective trial for evaluation of dynamic intraoperative torsional misalignment of 179 eyes that underwent LASIK for correction of myopia and/or astigmatism. Patients were treated with the Keracor 217z excimer laser implementing 25 Hz dynamic eye tracker ACE 100 (both Technolas Perfect Vision, Munich, Germany). From dynamic torsional misalignments, temporal power spectra were obtained by Fourier analysis up to a frequency of 12.5 Hz and an amplitude of ±15° from initial torsional status (limited by the tracking system). The f90, f95, and f99 criteria were defined as the frequency below which 90 %, 95 %, and 99 % of misalignments occur. A Wilcoxon rank sum test was performed to detect differences of f90, f95, and f99 in groups' gender, age, and eye (if both eyes underwent surgery at same day). Multiple regression analysis (MRA) was performed to evaluate possible preoperative predictors of f90, f95, and f99. RESULTS Fourier analysis showed a dominance of high-frequency, low-power dynamic torsional misalignment. Mean f95 threshold of rotational movements was 4.89±2.12 Hz (median 4.54, ranging from 0.44 to 9.23 Hz). Wilcoxon rank sum test showed no differences in f90, f95, and f99 between groups' gender, age, and eye. MRA revealed age, gender, and optical zone as preoperative predictors on intraoperative f90, f95, and f99. CONCLUSIONS Dynamic intraoperative torsional misalignments of eyes undergoing LASIK are dominated by low-frequency (slow), high-power (large) movements, with 95 % being slower than 4.89Hz regarding the spectrum analyzed (0-12.5Hz, ±15°). Movements can be predicted preoperatively by eye treated, patients' gender, and age in pre-LASIK diagnostics.
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Affiliation(s)
- Mehdi Shajari
- Department of Ophthalmology, Goethe University, Frankfurt Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Jens Bühren
- Department of Ophthalmology, Goethe University, Frankfurt Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Thomas Kohnen
- Department of Ophthalmology, Goethe University, Frankfurt Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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Theodoulidou S, Asproudis I, Kalogeropoulos C, Athanasiadis A, Aspiotis M. The role of sideport incision in astigmatism change after cataract surgery. Clin Ophthalmol 2015; 9:1421-8. [PMID: 26346741 PMCID: PMC4531009 DOI: 10.2147/opth.s86213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To study the changes in corneal astigmatism after cataract surgery when the sideport incision is performed at a predetermined location away from the tunnel incision. SETTING General Hospital of Piraeus "Tzaneio", Attiki, Greece. MATERIALS AND METHODS A total of 333 eyes with corneal astigmatism ≤1.5 diopters (D) underwent cataract surgery. A three-step superotemporal clear corneal incision for the right eye and a superonasal clear corneal incision for the left eye (3.0 mm) was made, while the sideport incision was located at <90°, 90°-110°, and >110°. Keratometric data were measured with corneal topography EyeSys Vista 2000 pre- and postoperatively at the 1st and 6th month. Surgically induced astigmatism was calculated by vector analysis. We noted all cases in which a change >0.5 D in corneal astigmatic power occurred, as well as a change >20° in axis torque, despite axis direction. RESULTS After multiple logistic regression analysis was conducted, cases with >110° distance between the tunnel and sideport incision had 2.22 times (P=0.021) greater likelihood for having changed >0.5 D in astigmatic power at the 1st month and 3.45 times (P=0.031) at the 6th month postoperatively, as compared with cases with a 90°-110° distance between the tunnel and sideport incision. As for the change in the astigmatic axis, cases with <90° distance had a 4.18 times greater likelihood for having a change >20° (P<0.001) (preoperative to 1st month) as compared with cases having 90°-110° of distance. CONCLUSION For surgeons that operate only from the superior position, we propose that in order to produce an incision that is as "astigmatically neutral" as possible, they should perform the sideport incision at a 90°-110° distance.
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Affiliation(s)
- Sofia Theodoulidou
- Department of Ophthalmology, Medical School, University of Ioannina, Ioannina, Greece
| | - Ioannis Asproudis
- Department of Ophthalmology, Medical School, University of Ioannina, Ioannina, Greece
| | | | | | - Miltiadis Aspiotis
- Department of Ophthalmology, Medical School, University of Ioannina, Ioannina, Greece
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Mosquera SA, Verma S. Effects of torsional movements in refractive procedures. J Cataract Refract Surg 2015; 41:1752-66. [DOI: 10.1016/j.jcrs.2015.07.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 01/13/2015] [Accepted: 01/14/2015] [Indexed: 11/26/2022]
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Woo YJ, Lee H, Kim HS, Kim EK, Seo KY, Kim TI. Comparison of 3 marking techniques in preoperative assessment of toric intraocular lenses using a wavefront aberrometer. J Cataract Refract Surg 2015; 41:1232-40. [PMID: 26092366 DOI: 10.1016/j.jcrs.2014.09.045] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/11/2014] [Accepted: 09/19/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the accuracy of 3 corneal horizontal meridian marking techniques using the iTrace Surgical Workstation in preoperative assessment for toric intraocular lens (IOL) implantation. SETTING Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea. DESIGN Prospective comparative observational study. METHODS Patients were allocated into 3 groups. Three techniques-marking with a nonpendular marker with a surgeon's direct visualization, slitlamp-assisted marking with a pendulum-attached marker, and slitlamp-assisted marking with a horizontal slit beam-were used to perform the horizontal meridian marking. The marks were immediately documented and aligned with the Zaldivar toric caliper transparent topographic map. Using a horizontal reference meridian determined by the toric caliper, the accuracy of corneal horizontal marking techniques was quantitatively evaluated by determining the rotational deviation and vertical misalignment. RESULTS For rotational deviation, the pendular marking showed the fewest errors to the horizontal reference meridian (mean error -0.66 degrees; mean absolute error [MAE] 3.77 degrees). There was a significant difference between the pendular marking and the surgeon's direct visual marking. For the MAE, the pendular marking showed less deviation than the surgeon's direct visual marking and the horizontal slit-beam marking. With vertical misalignment, there was no significant difference between the 3 different corneal horizontal meridian marking techniques. CONCLUSION The slitlamp-assisted technique with the pendulum-attached marker was more precise than marking with a nonpendular marker with a surgeon's direct visualization and marking with a horizontal slit beam in preoperative assessment for toric IOLs. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Young Jae Woo
- From the Institute of Vision Research (Y.J. Woo, H. Lee, H.S. Kim, E.K. Kim, K.Y. Seo, T-i. Kim), Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Department of Ophthalmology (H. Lee), International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, and the Severance Biomedical Science Institute and Brain Korea 21 Project for Medical Science (E.K. Kim), Yonsei University College of Medicine, Seoul, South Korea
| | - Hun Lee
- From the Institute of Vision Research (Y.J. Woo, H. Lee, H.S. Kim, E.K. Kim, K.Y. Seo, T-i. Kim), Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Department of Ophthalmology (H. Lee), International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, and the Severance Biomedical Science Institute and Brain Korea 21 Project for Medical Science (E.K. Kim), Yonsei University College of Medicine, Seoul, South Korea
| | - Hong Seok Kim
- From the Institute of Vision Research (Y.J. Woo, H. Lee, H.S. Kim, E.K. Kim, K.Y. Seo, T-i. Kim), Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Department of Ophthalmology (H. Lee), International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, and the Severance Biomedical Science Institute and Brain Korea 21 Project for Medical Science (E.K. Kim), Yonsei University College of Medicine, Seoul, South Korea
| | - Eung Kweon Kim
- From the Institute of Vision Research (Y.J. Woo, H. Lee, H.S. Kim, E.K. Kim, K.Y. Seo, T-i. Kim), Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Department of Ophthalmology (H. Lee), International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, and the Severance Biomedical Science Institute and Brain Korea 21 Project for Medical Science (E.K. Kim), Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoung Yul Seo
- From the Institute of Vision Research (Y.J. Woo, H. Lee, H.S. Kim, E.K. Kim, K.Y. Seo, T-i. Kim), Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Department of Ophthalmology (H. Lee), International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, and the Severance Biomedical Science Institute and Brain Korea 21 Project for Medical Science (E.K. Kim), Yonsei University College of Medicine, Seoul, South Korea
| | - Tae-im Kim
- From the Institute of Vision Research (Y.J. Woo, H. Lee, H.S. Kim, E.K. Kim, K.Y. Seo, T-i. Kim), Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Department of Ophthalmology (H. Lee), International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, and the Severance Biomedical Science Institute and Brain Korea 21 Project for Medical Science (E.K. Kim), Yonsei University College of Medicine, Seoul, South Korea.
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Ali MA, Kobashi H, Kamiya K, Igarashi A, Miyake T, Elewa MEM, Komatsu M, Shimizu K. Comparison of astigmatic correction after femtosecond lenticule extraction and wavefront-guided LASIK for myopic astigmatism. J Refract Surg 2014; 30:806-11. [PMID: 25437478 DOI: 10.3928/1081597x-20141113-03] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 09/15/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare postoperative astigmatic correction between femtosecond lenticule extraction (FLEx) and wavefront-guided LASIK in eyes with myopic astigmatism. METHODS Fifty-eight eyes of 41 patients undergoing FLEx and 49 eyes of 29 patients undergoing wavefront-guided LASIK to correct myopic astigmatism were examined. Visual acuity, cylindrical refraction, predictability of the astigmatic correction, and astigmatic vector components were compared between groups 6 months after surgery. RESULTS There was no statistically significant difference in manifest cylindrical refraction (P = .08) or percentage of eyes within ± 0.50 diopter (D) of its refraction (P = .11) between the surgical procedures. The index of success in FLEx was statistically significantly better than that of wavefront-guided LASIK (P = .02), although there was no significant difference between the groups in other indices (eg, surgically induced astigmatism, target-induced astigmatism, astigmatic correction index, angle of error, difference vector, and flattening index). Subgroup analysis showed that FLEx had a better index of success (P = .02) and difference vector (P = .04) than wavefront-guided LASIK in the low cylinder subgroup; the angle of error in FLEx was significantly smaller than that of wavefront-guided LASIK in the moderate cylinder subgroup (P = .03). CONCLUSIONS Both FLEx and wavefront-guided LASIK worked well for the correction of myopic astigmatism by the 6-month follow-up visit. Although FLEx had a better index of success than wavefront-guided LASIK when using vector analysis, it appears equivalent to wavefront-guided LASIK in terms of visual acuity and the correction of astigmatism.
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Abdelghany AA, Alio JL. Surgical options for correction of refractive error following cataract surgery. EYE AND VISION 2014; 1:2. [PMID: 26605349 PMCID: PMC4604120 DOI: 10.1186/s40662-014-0002-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/13/2014] [Indexed: 11/10/2022]
Abstract
Refractive errors are frequently found following cataract surgery and refractive lens exchange. Accurate biometric analysis, selection and calculation of the adequate intraocular lens (IOL) and modern techniques for cataract surgery all contribute to achieving the goal of cataract surgery as a refractive procedure with no refractive error. However, in spite of all these advances, residual refractive error still occasionally occurs after cataract surgery and laser in situ keratomileusis (LASIK) can be considered the most accurate method for its correction. Lens-based procedures, such as IOL exchange or piggyback lens implantation are also possible alternatives especially in cases with extreme ametropia, corneal abnormalities, or in situations where excimer laser is unavailable. In our review, we have found that piggyback IOL is safer and more accurate than IOL exchange. Our aim is to provide a review of the recent literature regarding target refraction and residual refractive error in cataract surgery.
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Affiliation(s)
- Ahmed A Abdelghany
- Clinical research fellow in Vissum Corporación Alicante, Universidad Miguel Hernández, Alicante, Spain ; Minia University, Minia, Egypt
| | - Jorge L Alio
- Vissum Corporación, Alicante, Spain ; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain ; Avda de Denia s/n, Edificio Vissum, Alicante, 03016 Spain
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Miyake T, Kamiya K, Amano R, Iida Y, Tsunehiro S, Shimizu K. Long-term clinical outcomes of toric intraocular lens implantation in cataract cases with preexisting astigmatism. J Cataract Refract Surg 2014; 40:1654-60. [PMID: 25149554 DOI: 10.1016/j.jcrs.2014.01.044] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 01/28/2014] [Accepted: 01/29/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the long-term clinical outcomes and rotational stability of toric intraocular lenses (IOLs) to correct preexisting astigmatism in cataract patients. SETTING Kitasato University Hospital, Kanagawa, Japan. DESIGN Prospective observational study. METHODS Phacoemulsification with implantation of a toric IOL (Acrysof IQ toric SN6AT) was performed in cataract patients with corneal astigmatism. The postoperative follow-up was up to 2 years. RESULTS This study enrolled 378 eyes of 302 patients with a mean age of 63.4 years ± 16.9 (SD). The corrected distance visual acuity 3 months postoperatively was 20/25 or better in 94.7% of eyes. The mean refractive cylinder was -1.92 ± 1.45 diopters (D) preoperatively, -0.59 ± 0.62 D 3 months postoperatively (322 eyes), and -0.67 ± 0.90 D at 2 years (73 eyes). There were statistically significant differences between the preoperative and 3-month postoperative measurements (P<.001, Wilcoxon signed-rank test). The mean IOL misalignment was 4.1 ± 3.0 degrees 2 years postoperatively. The mean IOL rotation was 4.5 ± 4.9 degrees within 1 day postoperatively. The rotation was more than 20 degrees in 6 eyes, all of which had an axial length (AL) of more than 25.0 mm. All rotations occurred within 10 days postoperatively. CONCLUSIONS Toric IOLs were effective in reducing preexisting corneal astigmatism and had overall good rotational stability. A large degree of IOL rotation might occur in eyes with a relatively long AL, especially during the early postoperative period. The 6 rotated IOLs were implanted to correct with-the-rule astigmatism. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Toshiyuki Miyake
- From the Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan.
| | - Kazutaka Kamiya
- From the Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
| | - Rie Amano
- From the Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
| | - Yoshihiko Iida
- From the Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
| | - Shuntaro Tsunehiro
- From the Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
| | - Kimiya Shimizu
- From the Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
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Prickett AL, Bui K, Hallak J, Bakhtiyari P, de la Cruz J, Azar DT, Chamon W. Cyclotorsional and non-cyclotorsional components of eye rotation observed from sitting to supine position. Br J Ophthalmol 2014; 99:49-53. [DOI: 10.1136/bjophthalmol-2014-304975] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
PURPOSE To assess the horizontal meridian misalignment of limbal marking under a slit lamp microscope by means of anterior segmental image assessment. METHODS A consecutive series of the 32 eyes of 16 subjects (7 males and 9 females) aged 29 ± 6 years (range, 23-44 years), who had refractive errors but were otherwise healthy, were used in this study. With each subject seated at the slit lamp and a coaxial slit turned to the horizontal meridian, we aligned the subject's head vertically and placed two reference marks aligned with the 3- and 9-o'clock positions on the limbal conjunctiva, using a marker pen or a toric marker. We quantitatively evaluated the accuracy of axis aliment by determining deviation from the horizontal reference line using a corneal topographer with an anterior segment image. RESULTS The amount of the axis misalignment was 3.4° ± 2.2° (range, 0°-8°) when the marker pen was used, and 6.9° ± 5.0° (range, 0-24°) when the toric marker was used. Location identification using the toric marker showed a significantly larger deviation in axis alignment than that using the marker pen (Wilcoxon sign rank test, p < 0.001). CONCLUSIONS Horizontal limbal marking using a slit lamp microscope showed the axis misalignment by an average of 3.4° to 6.9°. These alignment errors led to a reduction of the effectiveness of astigmatism correction by an average of 10% to 20%, which was not necessarily negligible when we aim to correct astigmatism completely, if possible. For successful astigmatic surgical procedures, increased accuracy of preoperative limbal marking by decreased misalignment of the astigmatism axis is essential.
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The effect of head tilt on keratometric measurement using the IOLMaster. Eye (Lond) 2013; 27:1411-7. [PMID: 24051411 DOI: 10.1038/eye.2013.209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 08/19/2013] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To investigate the effect of head tilt on keratometric measurement using the IOLMaster. METHODS Twenty-seven right eyes of 27 volunteers were examined using a manual keratometer (MK), automated keratometer (AK), and an IOLMaster. MK and AK measurements were performed in the upright head position, whereas IOLMaster measurements were performed in five different head positions (upright, 5° or 15° clockwise head tilt, and 5° or 15° counter-clockwise head tilt). The repeatability of IOLMaster was compared with MK and AK. The keratometric measurements (mean keratometric power, magnitude of astigmatism, and steep meridian) in different head positions were compared. RESULTS The IOLMaster showed good repeatability of keratometric measurement comparable to MK or AK. 15° and 5° clockwise head tilt resulted in 12.09 ± 9.51 (mean ± SD) (P<0.001 vs upright) and 5.51 ± 5.97 (mean ± SD) degrees (P<0.001) of clockwise rotation of steep meridian, respectively. 15° and 5° counter-clockwise head tilt resulted in 12.49 ± 7.07 (mean ± SD) (P<0.001) and 6.08 ± 5.09 (mean ± SD) degrees (P<0.001) of counter-clockwise rotation of steep meridian, respectively. CONCLUSIONS The patient's head tilt (5° or 15°, clockwise or counter-clockwise) significantly changed the steep meridian of astigmatism measured using IOLMaster and the steep meridian generally shifted to the direction of head tilt. The importance of maintaining the upright head posture during IOLMaster measurement is demonstrated.
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Liu YL, Yeh PT, Huang JY, Wang IJ, Chen WL, Hu FR, Hou YC. Pupil centroid shift and cyclotorsion in bilateral wavefront-guided laser refractive surgery and the correlation between both eyes. J Formos Med Assoc 2013; 112:64-71. [DOI: 10.1016/j.jfma.2012.02.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Revised: 02/26/2012] [Accepted: 02/29/2012] [Indexed: 11/28/2022] Open
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Narváez J, Brucks M, Zimmerman G, Bekendam P, Bacon G, Schmid K. Intraoperative Cyclorotation and Pupil Centroid Shift During LASIK and PRK. J Refract Surg 2012; 28:353-7. [DOI: 10.3928/1081597x-20120124-03] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 11/11/2011] [Indexed: 11/20/2022]
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Three-month clinical outcomes with static and dynamic cyclotorsion correction using the SCHWIND AMARIS. Cornea 2011; 30:951-7. [PMID: 21694596 DOI: 10.1097/ico.0b013e318207eac2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate intraoperative static and dynamic cyclotorsions and postoperative outcomes on astigmatism and high-order aberration in astigmatic or aberrated eyes that underwent laser in situ keratomileusis treatments with advanced cyclotorsion control using the SCHWIND AMARIS. METHODS Fifty eyes (30 for aberration neutral and 20 for corneal wavefront) were treated. Treatments were planned with Custom Ablation Manager and ablations were performed using the SCHWIND AMARIS. Laser in situ keratomileusis flaps were cut with an LDV femtosecond laser. Cyclotorsional movements were evaluated for static cyclotorsion component (SCC) for mean and repeatability, and for dynamic cyclotorsion component (DCC) for mean and amplitude. Clinical outcomes were evaluated for predictability, refractive outcome, safety, and wavefront aberration. RESULTS Registration rates were 90% for SCC and 98% for DCC. SCC was within ± 5 degrees in 64% of cases. Repeatability of SCC was ± 1 degree in 88% of cases. Mean DCC was within ± 1 degree in 98% of cases, partly compensating for SCC. DCC amplitude was within ± 2 degrees in 84% of cases. At 3-month follow-up, 88% of eyes were within ± 0.50 diopter (D) of astigmatism. Mean defocus was -0.06 ± 0.24 D and astigmatism was 0.27 ± 0.20 D. Best spectacle-corrected visual acuity improved in 42% of eyes versus 2% losing 1 line. In corneal wavefront-customized treatments, coma, trefoil, spherical aberration, and root mean square high-order magnitudes at 6-mm analysis diameter were reduced by -0.04, -0.13, -0.04, and -0.10 μm, respectively. CONCLUSIONS Laser in situ keratomileusis with advanced cyclotorsion compensation using the SCHWIND AMARIS is safe and predictable and yields superior visual outcomes. Refractions and high-order aberrations were reduced to subclinical values without applying additional nomograms, showing the excellent performance of the system.
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Arba Mosquera S, Arbelaez MC. Use of a Six-dimensional Eye-tracker in Corneal Laser Refractive Surgery With the SCHWIND AMARIS TotalTech Laser. J Refract Surg 2011; 27:582-90. [DOI: 10.3928/1081597x-20110120-02] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 01/07/2011] [Indexed: 11/20/2022]
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Prakash G, Agarwal A, Kumar DA, Jacob S, Agarwal A. Comparison of laser in situ keratomileusis for myopic astigmatism without iris registration, with iris registration, and with iris registration–assisted dynamic rotational eye tracking. J Cataract Refract Surg 2011; 37:574-81. [DOI: 10.1016/j.jcrs.2010.11.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 10/06/2010] [Accepted: 10/11/2010] [Indexed: 11/25/2022]
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Lihua F, Xingdao H, Fengying C. Theoretical analysis of wavefront aberration from treatment decentration with oblique incidence after conventional laser refractive surgery. OPTICS EXPRESS 2010; 18:22418-22431. [PMID: 20941142 DOI: 10.1364/oe.18.022418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Analysis of induced wavefront aberration after refractive surgery is important in the design of vision correction and the development of visual correction technology. Based on a mathematical model of the anterior corneal surface, the influence of treatment decentration on induced wavefront aberrations was studied by considering oblique incidence. The results revealed that significant coma was induced from the treatment translation, and it was nearly proportional to the translation or corrected refraction of vision correction. The induced aberrations from the lateral translation correlated with the angle formed by the position vector and the astigmatism axis of myopia astigmatism correction. The induced spherical aberration did not relate to a lateral translation of the center of the pupil, but was determined only by the corrected refraction. Additionally, no significant higher-order aberrations were induced from eye cyclotorsion for pure myopia or myopia astigmatism correction. Oblique incidence played an important role in the impact of treatment decentration on the induced aberrations in refractive surgery. The induced coma without considering the oblique incidence was obviously larger than that with it. In order to achieve the best postoperative visual performance, the effect of oblique incidence in refractive surgery should be taken into account, and treatment decentration should be minimized by all means, particularly for high myopia.
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Affiliation(s)
- Fang Lihua
- 1Key Laboratory of Nondestructive Test Ministry of Education, Nanchang Hangkong University, Nanchang 330063, China
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Carey PJ, Leccisotti A, McGilligan VE, Goodall EA, Moore TC. Assessment of toric intraocular lens alignment by a refractive power/corneal analyzer system and slitlamp observation. J Cataract Refract Surg 2010; 36:222-9. [DOI: 10.1016/j.jcrs.2009.08.033] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2009] [Revised: 08/16/2009] [Accepted: 08/19/2009] [Indexed: 10/19/2022]
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Laser in situ keratomileusis for residual refractive errors after apodized diffractive multifocal intraocular lens implantation. J Cataract Refract Surg 2009; 35:1063-71. [DOI: 10.1016/j.jcrs.2009.01.028] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 01/24/2009] [Accepted: 01/29/2009] [Indexed: 11/19/2022]
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