Visual outcomes of laser vision correction in eyes with preoperative amblyopia

Visual Acuity Improvement in Low, Moderate and High Myopia After Posterior-Chamber Phakic Implantable Collamer Lens Surgery in a Large Patient Cohort

Purpose

To compare best-corrected visual acuity (BCVA) before and after implantable collamer lens (ICL) surgery in patients with low, moderate and high myopia.

Methods

A single-centre, prospective, registry-based study involving patients with myopia who received ICLs between October 2018 and August 2020. The study population was divided into three groups of subjects with low (from 0 to -6 D), moderate (-6 to -10 D) and high myopia (more than -10 D). We analysed uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), spherical equivalent (SE), differences between BCVA pre- and 1-month postoperative, and line gain in BCVA 1 month after surgery.

Results

A total of 770 eyes belonging to 473 patients were surgically intervened during the study period, of which 692 eyes completed 1 month of postoperative follow-up and were included in the study population. At 1-month follow-up, 478 eyes (69%) achieved a BCVA of 20/20, 599 (87%) obtained 20/25 or better, and 663 (96%) had a BCVA of 20/40 or better. We identified a significant improvement in BCVA (baseline 0.15±0.2 logMAR vs follow-up 0.07±0.2 logMAR, p<0.0001) and a significant reduction in SE (baseline -9.23±4.1 D, vs follow-up -0.21±0.8 D, p<0.0001), with a significant relationship between preoperative SE and line gain (r = -0.46, p<0.0001). We identified a significantly higher line gain among eyes with higher degrees of myopia (low myopia 0.22±0.69 lines compared to moderate myopia 0.56±1.1 lines and high myopia 1.51±1.9 lines, p<0.0001). Notably, 99.6% of eyes with a high grade of myopia achieved improvement to a low degree (less than -6 D) at follow-up. The safety and efficacy indexes were 0.083±0.1 and -0.001±0.1, respectively.

Conclusion

In this large patient cohort, ICL surgery was related to a significant line gain in BCVA, particularly among eyes with higher degrees of myopia.

Refractive outcomes of implantable collamer lens implantation in 1212 eyes with suboptimal corrected distance vision acuity

Purpose: To analyze the factors related to corrected distance vision acuity (CDVA) after implantable collamer lens (ICL) implantation in patients with preoperative suboptimal CDVA.Methods: This retrospective study included patients with suboptimal preoperative CDVA (CDVA ≤20/25) who underwent ICL implantation (V4 or V4c). Preoperative and postoperative clinical evaluations included CDVA, uncorrected distance visual acuity (UDVA), and refraction.Results: A total of 1,212 eyes from 731 patients were identified. CDVA increased in 90.8% of the eyes after surgery. Among them, 57.5% of the eyes (697 eyes) gained more than one line. The preoperative LogMAR CDVA was 0.32 ± 0.23, which significantly improved to 0.13 ± 0.17 postoperatively (p < 0.001). There was no significant difference between ICL V4c and ICL V4 in the LogMAR UDVA, sphere, cylinder, SE, LogMAR CDVA, efficacy index, and safety index after surgery (p > 0.05). For eyes with full correction, the postoperative LogMAR CDVA =0.575 * preoperative LogMAR CDVA -0.061 (p < 0.001, R² = 0.53). For eyes with partial correction, the postoperative LogMAR CDVA =0.536 * preoperative LogMAR CDVA - 0.007 * SE - 0.196 (P < 0.001, R² = 0.55).Conclusion: ICL implantation can improve CDVA in eyes with suboptimal CDVA. This study provides the postoperative outcomes of eyes with different preoperative CDVA, which makes it convenient for surgeons to communicate with such patients before surgery.

Refractive Lens Exchange Surgery in Early-Onset High Myopia Patients With Partial Cataract

Purpose

By reporting clinical characteristics and retinal image quality before and after refractive lens replacement surgery in early-onset high myopia (eoHM) patients presenting with partial cataract, we emphasized the need for an objective way to grade the severity of partial cataracts.

Methods

This retrospective, consecutive case series included six Chinese patients (nine eyes). Analysis of previous medical records, visual acuity, optometry, retinal image quality, and axial length (AXL) before surgery and after surgery was performed.

Results

Five females and one male (nine eyes) with a mean (± SD) age of 11.6 ± 7.9 years (range: 4–25 years) were included in this study. The preoperative spherical power ranged from −7.5 to −42 D. The mean follow-up time was 36 months (range: 24–48 months). Phacoemulsification was followed by in-the-bag implantation of intraocular lens. For patients who were under 6 years old, posterior capsulotomy + anterior vitrectomy were performed simultaneously. All surgeries were uneventful and no postoperative complications occurred during the entire follow-up period. All patients’ uncorrected visual acuity improved by ≥2 lines postoperatively(Snellen acuity). LogMAR best-corrected visual acuity was improved at 24-month (P = 0.042) and endpoint (P = 0.046) follow-ups. Modulation transfer function cutoff frequency (MTF_cutoff) and objective scatter index (OSI) was significantly improved at 12-month (P = 0.025, P = 0.038), 24-month (P = 0.005, P = 0.007) and endpoint (P = 0.005, P = 0.008) follow-ups. Postoperative AXL remained stable during 2–4 year follow-ups (P > 0.05).

Conclusion

Refractive lens replacement surgery is safe and effective for improving functional vision in eoHM patients presenting with partial cataract. Retinal image quality could provide a useful and objective way to facilitate partial cataract severity evaluation and surgery decision making.

Laser keratomileusis in treatment of anisometropic amblyopia in adults

PURPOSE

To compare and evaluate improvement in corrected distant visual acuity (CDVA) between myopia and hyperopia after laser in situ keratomileusis (LASIK) in adult patients with anisometropic amblyopia.

MATERIALS AND METHODS

This prospective clinical study included 103 amblyopic eyes (103 patients), which underwent LASIK correction of refractive error from January 2013 to January 2018. Uncorrected distance visual acuity (UDVA), CDVA, spherical equivalent (SE), postoperative astigmatism, and intraocular pressure were evaluated at time points of 1, 6, and 12 months.

RESULTS

Patients were divided into two groups according to refractive error. Group 1: Forty-six patients with myopia and Group 2: Fifty-seven patients with hyperopia. Mean CDVA (logarithm of the minimum angle of resolution [logMAR]) preoperatively was 0.23 ± 0.16 in Group 1 and 0.40 ± 0.19 in Group 2. Postoperative CDVA (logMAR) was 0.17 ± 0.13 in Group 1 and 0.32 ± 0.17 in Group 2. There was statistically significant increase in UDVA (P < 0.0001) postoperatively and no change during the follow-up period of 12 months in both groups. Group 1 showed more expectable results, 95% of variability SE achieved was dependent on SE intended (R² = 0.95), while in Group 2, the percentage was slightly lower of expected 87% (R² = 0.87). There was statistical significance in respect of CDVA change postoperatively and preoperatively in both groups. Correlation factors are low, in Group 1 r = -0.53 and in Group 2 r = -0.39.

CONCLUSION

LASIK can improve CDVA in a considerable portion of amblyopic eyes, both myopic and hyperopic. Eyes with better initial CDVA and those with myopia were associated with greater improvement in postoperative CDVA.

Three-Month Outcomes of Laser Vision Correction for Myopia and Hyperopia in Adults With Amblyopia

PURPOSE

To evaluate the visual outcomes of laser vision correction in adults with myopic and hyperopic amblyopia.

METHODS

The medical records of patients diagnosed as having amblyopia who underwent laser refractive surgery between February 2013 and October 2017 were retrospectively reviewed. Eyes with amblyopia were analyzed, and the nonamblyopic fellow eyes of the patients who underwent laser vision correction were used as controls. The uncorrected distance visual acuity (UDVA), subjective manifest refraction, and corrected distance visual acuity (CDVA) were analyzed at the 3-month postoperative time point.

RESULTS

This study included 323 eyes of 164 patients. All patients underwent laser in situ keratomileusis (90.1%, 291 eyes) or photorefractive keratectomy (9.9%, 32 eyes). Three months postoperatively, the manifest spherical equivalent was -0.07 ± 0.55 diopters (D) (range: -1.75 to +1.30 D) and -0.10 ± 0.54 D (range: -2.13 to +1.30 D) in the amblyopia group and fellow eye group, respectively. The percentage of eyes achieving UDVA of 20/20 or better was 16.9% (15 eyes) in the amblyopia group and 61.9% (52 eyes) in the fellow eye group. The percentage of eyes that gained two or more lines of CDVA was 27.9% (24 eyes) in the amblyopia group and 6.2% (5 eyes) in the fellow eye group (P < .01). In the amblyopia group, there was no statistically significant difference in the mean manifest spherical equivalent between the myopic eyes and hyper-opic eyes at any follow-up visit (P = .87, 1 month postoperatively; P = .68, 3 months postoperatively).

CONCLUSIONS

Laser vision correction was found to be effective and safe in adult patients with amblyopia. [J Refract Surg. 2020;36(8):511-519.].

Visual outcomes after refractive laser corneal surgery and phakic IOL in amblyopic eyes

PURPOSE

To evaluate the outcomes of laser corneal surgery and phakic IOL surgery in adult amblyopic eyes.

METHODS

Retrospective assessment was done in 688 amblyopic eyes 640 patients who underwent LASIK or phakic IOLs. Ophthalmological evaluation included measurement of uncorrected (UDVA) and corrected (CDVA) distance visual acuities. Analysis of modulation transfer function (MTF) was also done post-operatively as a measure of contrast sensitivity. Patients completed follow-up examinations at 1 day, 3 day, 3 months and 12 months after surgery.

RESULTS

The mean patient age was 24.30 ± 3.04 years with 59% females. The CDVA of amblyopic eyes improved significantly from the mean preoperative level of 0.48 ± 0.18 to 0.59 ± 0.18 at 12 months. There was improvement in the contrast sensitivity at all spatial frequencies. Refractive errors were corrected in both LASIK and phakic IOL group, but there was no clinically significant difference in visual outcomes between each group.

CONCLUSION

Laser vision correction and phakic IOL surgery for amblyopic eyes are promising alternative methods for improving visual outcomes in adult refractive amblyopia patients who have failed with conventional approaches.