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Ning R, Xu H, Li Z, Yu J, Xu S, Lei CS, Wang Y, Savini G, Schiano-Lomoriello D, Zhou X, Huang J. Agreement between a new fully automatic ocular biometer based on optical low-coherence reflectometry and an optical biometer based on Scheimpflug imaging combined with partial coherence interferometry. BMC Ophthalmol 2024; 24:455. [PMID: 39420260 PMCID: PMC11484231 DOI: 10.1186/s12886-024-03716-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 10/07/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND To analyze the difference and agreement between measurements obtained by a new fully automatic optical biometer, the SW-9000 μm Plus, based on optical low-coherence reflectometry (OLCR) and a commonly used optical biometer (Pentacam AXL) based on Scheimpflug imaging with partial coherence interferometry (PCI). METHODS The central corneal thickness (CCT), anterior chamber depth (ACD, from epithelium to anterior lens surface), lens thickness (LT), mean keratometry (Km), corneal astigmatism, corneal diameter (CD), pupil diameter (PD), and axial length (AL) of 74 eyes (from 74 healthy subjects) were measured using the SW-9000 μm Plus and the Pentacam AXL to determine the agreement. Double angle plots were used for astigmatism vector analysis. Bland-Altman and 95% limits of agreement (LoA) were calculated. RESULTS Statistically significant differences were detected for all parameters but J0 vector. The Bland-Altman analysis of AL, CCT, ACD, Km, CD, J0 and J45 indicated a high level of agreement between the two devices. Among AL, CCT, ACD, Km, J0, J45, CD, and PD, the 95% LoA ranged from -0.07 to 0.05 mm, -9.67 to 7.34 mm, -0.11 to 0.04 mm, -0.25 to 0.50 D, -0.22 to 0.20 D, -0.15 to 0.20 D, -0.23 to 0.35 mm and 1.55 to 3.77 mm, respectively. CONCLUSIONS The measurements of AL, CCT, ACD, Km, corneal astigmatism, and CD showed a narrow LoA and may be used interchangeably in healthy subjects between the new OLCR optical biometer and the Scheimpflug/PCI biometer; however, a poor agreement was noted for PD values.
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Affiliation(s)
- Rui Ning
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, NHC Key laboratory of Myopia and Related Eye Diseases; Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Huilin Xu
- Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zheng Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, NHC Key laboratory of Myopia and Related Eye Diseases; Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jinjin Yu
- Ningbo No.2 Hospital, Ningbo, Zhejiang, China
| | - Shuoyu Xu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, NHC Key laboratory of Myopia and Related Eye Diseases; Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Chak Seng Lei
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, NHC Key laboratory of Myopia and Related Eye Diseases; Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yiran Wang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, NHC Key laboratory of Myopia and Related Eye Diseases; Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | | | | | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, NHC Key laboratory of Myopia and Related Eye Diseases; Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
| | - Jinhai Huang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, NHC Key laboratory of Myopia and Related Eye Diseases; Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
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Sun Y, Yuan W, Jiang Y, Zhao Z. Incidence and mechanism of conjunctival chemosis during phacoemulsification. BMC Ophthalmol 2024; 24:447. [PMID: 39394580 PMCID: PMC11470692 DOI: 10.1186/s12886-024-03670-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 09/03/2024] [Indexed: 10/13/2024] Open
Abstract
BACKGROUND This study aims to determine the incidence of conjunctival chemosis during phacoemulsification and to explore the possible mechanism and treatments. METHODS Patients with or without chemosis during phacoemulsification by the same operator within two years were included. The initial site of chemosis, the chemosis originated time, and the degree of chemosis at the end of the surgery were recorded. The differences in phacoemulsification energy/time and irrigation volume were compared between two groups. Meanwhile, the distance between the clear corneal incision (CCI) and the end of the Bowman's layer, surgically induced astigmatism (SIA), intraocular pressure and central corneal thickness were also compared between the two groups. RESULTS The incidence of intraoperative chemosis was 9.17% (66/720). The distance between CCI and the end of the Bowman's layer in the chemosis group was significantly longer than that in the non-chemosis group postoperatively (P < 0.0001). The initial sites of chemosis were located on both sides of the external opening of the CCI. The average time from the phacoemulsification probe introducing into the anterior chamber to the originating of chemosis was 30.23 ± 49.23s. CONCLUSION Intraoperative chemosis is related to the distance from CCI to the end of Bowmen's layer. The residual conjunctiva around the incision wraps the phacoemulsification probe sleeve to form a passage, the leakage fluid enters the subconjunctiva through this passage, forming chemosis. Conjunctival incision on both sides of CCI can effectively prevent the development of chemosis.
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Affiliation(s)
- Yang Sun
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenyi Yuan
- Department of nursing, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Yongxiang Jiang
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China.
| | - Zhennan Zhao
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China.
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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] [MESH Headings] [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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Sandhu U, Osborn AR, Dang DH, Murphy DA, Langenbucher A, Wendelstein JA, Riaz KM. Refractive Astigmatism Outcomes of Femtosecond Laser-Assisted Arcuate Keratotomies Combined with Femtosecond Laser-Assisted Cataract Surgery: Two-Year Results. Curr Eye Res 2024; 49:961-971. [PMID: 38780904 DOI: 10.1080/02713683.2024.2353268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/30/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To evaluate the effectiveness and stability of refractive astigmatism reduction after penetrating femtosecond laser-assisted arcuate keratotomy performed at the time of femtosecond laser-assisted cataract surgery. METHODS Non-randomized retrospective data analysis of all patients that underwent femtosecond laser-assisted cataract surgery with femtosecond laser-assisted arcuate keratotomy over a 4-year period with a non-toric monofocal intraocular lens (2017-2021) at a tertiary care academic center. Postoperative visual acuity, manifest refraction, and predicted residual refractive error were also recorded at 1 month, 3-6 months, 12-18 months, and 2 years postoperatively. Preoperative keratometric astigmatism was compared to postoperative refractive astigmatism using vector calculations and the ASCRS double-angle plot tool. RESULTS This study comprised 266 eyes (179 patients) that met inclusion criteria. The mean preoperative keratometric astigmatism magnitude was 0.99 ± 0.53 D. At 1 month, 3-6 months, 12-18 months, and 2 years postoperatively, the mean refractive cylinder was 0.49 ± 0.45 D, 0.49 ± 0.45 D, 0.55 ± 0.54 D, and 0.52 ± 0.46 D, respectively. Horizontal against-the-rule astigmatism showed a higher tendency toward undercorrection than vertical with-the-rule astigmatism, which had a slightly higher tendency toward overcorrection. With-the-rule astigmatism had smaller difference vectors between target-induced astigmatism and surgically induced astigmatism. CONCLUSIONS Femtosecond laser-assisted arcuate keratotomy performed at the time of femtosecond laser-assisted cataract surgery was an effective option for correcting low-to-moderate corneal astigmatism for up to 2 years.
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Affiliation(s)
- Umar Sandhu
- College of Medicine, University of Oklahoma, Oklahoma City, OK, USA
- Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
| | - Andrew R Osborn
- Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
- Missouri Eye Institute, Springfield, MO, USA
| | - Deanna H Dang
- Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
| | - David A Murphy
- Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
| | - Achim Langenbucher
- Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany
| | - Jascha A Wendelstein
- Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany
- Department for Ophthalmology and Optometry, Kepler University Hospital, Linz, Austria
- Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zurich, Switzerland
| | - Kamran M Riaz
- Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
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Akbas YB, Yildiz BK, Sucu ME, Agca A, Tunc U, Yildirim Y. Three-year outcomes of a novel toric intraocular lens implantation for moderate-high myopic astigmatism in phakic eyes. BMC Ophthalmol 2024; 24:362. [PMID: 39174922 PMCID: PMC11340137 DOI: 10.1186/s12886-024-03633-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/13/2024] [Indexed: 08/24/2024] Open
Abstract
PURPOSE To investigate the three-year visual, refractive outcomes and adverse events of the Eyecryl toric phakic IOL (pIOL) for moderate-to-high myopic astigmatism. METHODS This retrospective study included eligible patients who underwent refractive surgery in one or both eyes with Eyecryl toric pIOL for myopic astigmatism. The efficacy, safety, predictability, rotational stability, vector analysis, and adverse events were evaluated in patients with spherical refraction from - 4.50 to -17.00 diopters (D) and cylindrical refraction from - 0.75 to -5.50 D. RESULTS Fifty-two eyes of 28 patients were included in the study. The mean efficacy and safety index were 1.12 ± 0.35 and 1.38 ± 0.42, respectively. The mean manifest refraction spherical equivalent was - 10.06 ± 2.69 D and - 0.64 ± 0.61 D preoperatively and postoperatively at 36 months, respectively. The mean manifest astigmatism was - 2.06 ± 1.16 D and - 0.44 ± 0.48 D preoperatively and 36 months postoperative, respectively. During the final examination, 70% of the eyes showed an increase in CDVA of one or more lines compared to their preoperative state. There was a cumulative endothelial cell loss of 3.1% at 36 months postoperatively. One eye developed visually significant anterior subcapsular opacity, whereas another eye experienced pIOL opacification. CONCLUSION The Eyecryl toric pIOL demonstrated satisfactory visual acuity and refractive outcomes, as assessed by efficacy, safety and stability over a three-year period.
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Affiliation(s)
- Yusuf Berk Akbas
- University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Olimpiyat Bulvari Yolu, Basaksehir, Istanbul, 34480, Turkey.
| | - Burcin Kepez Yildiz
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | | | - Alper Agca
- Dunya Goz Hospital, Atakoy, Istanbul, Turkey
| | - Ugur Tunc
- Johns Hopkins University, The Wilmer Eye Institute, Maryland, USA
| | - Yusuf Yildirim
- University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Olimpiyat Bulvari Yolu, Basaksehir, Istanbul, 34480, Turkey
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Dai Z, Liu Z, Zhang Y, Yuan Y, Liu Y, Wang Y, Yu S, Chen Y. Topography-guided photorefractive keratectomy combined with accelerated corneal collagen cross-linking versus cross-linking alone for progressive keratoconus: a long-term prospective cohort study. Front Med (Lausanne) 2024; 11:1420264. [PMID: 39188874 PMCID: PMC11345261 DOI: 10.3389/fmed.2024.1420264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/02/2024] [Indexed: 08/28/2024] Open
Abstract
Purpose To comprehensively compare the long-term outcome of the combined topography guided photorefractive keratectomy (TG-PRK) with accelerated corneal cross-linking (ACXL) and ACXL alone in eyes with progressive keratoconus. The analysis focused on the changes in the detailed corneal aberrometric values. Methods This single-center, prospective cohort study included 28 patients (30 eyes) of the TG-PRK plus ACXL group and 14 patients (15 eyes) of the ACXL alone group. The mean duration of the follow-up was 44 ± 10.18 months (ranged from 31 to 65 months). The preoperative data and the postoperative measurement data at the last follow-up visit, including demographic data, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, corneal topography, pachymetry, aberrometry and densitometry were analyzed. Results The CDVA significantly improved in the TG-PRK plus ACXL group at the last follow-up visit (p = 0.006), while no significant improvement was found in the ACXL alone group (p = 0.432). The maximal keratometry of the anterior corneal surface (Kmax) of both groups significantly decreased at the last follow-up visit (p < 0.05). Compared with the ACXL alone group, the Kmax of the TG-PRK plus ACXL group showed a greater decline (p = 0.008). The total corneal aberrations, the corneal lower-order aberrations (LOAs), the corneal higher order aberrations (HOAs), the vertical coma and the spherical aberration (SA) at the 4.0 mm and 6.0 mm zone of the TG-PRK plus ACXL group significantly decreased at the last follow-up visit (all p < 0.05). The declines of the total corneal aberrations, the corneal LOAs, the corneal HOAs and the vertical coma at the 4.0 mm and 6.0 mm zone of the TG-PRK plus ACXL group were significantly higher than those in the ACXL alone group (p < 0.001). Conclusion Compared with ACXL alone, combined TG-PRK with ACXL procedure had a significantly higher reduction in the corneal HOAs and better CDVA, while providing a similar long-term stability and safety. For progressive keratoconus patients with adequate corneal thickness, the combined procedure might be a recommended treatment option.
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Affiliation(s)
- Zhihao Dai
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
- Peking University Institute of Laser Medicine, Beijing, China
| | - Ziyuan Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
- Peking University Institute of Laser Medicine, Beijing, China
| | - Yu Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
- Peking University Institute of Laser Medicine, Beijing, China
| | - Yufei Yuan
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
- Peking University Institute of Laser Medicine, Beijing, China
| | - Yan Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
- Peking University Institute of Laser Medicine, Beijing, China
| | - Yuexin Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
- Peking University Institute of Laser Medicine, Beijing, China
| | - Shuo Yu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
- Peking University Institute of Laser Medicine, Beijing, China
| | - Yueguo Chen
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
- Peking University Institute of Laser Medicine, Beijing, China
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Cohen KL, Patel NK. Using Total Corneal Astigmatism With Femtosecond Laser Cataract Surgery and Arcuate Keratotomy(ies) to Treat Low Amounts of Astigmatism. Cornea 2024; 43:999-1007. [PMID: 38289747 DOI: 10.1097/ico.0000000000003482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/17/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE The aim of this study was to evaluate outcomes using total corneal astigmatism (TCA) to calculate arcuate keratotomy(ies) (AK) parameters performed with femtosecond laser-assisted cataract surgery to reduce low corneal astigmatism. METHODS Patients who had femtosecond laser-assisted cataract surgery and AK with 0.50 diopter (D) to 1.30 D of TCA were included. Exclusion criteria were intraoperative complications, preexisting corneal surgery, and comorbidities that might adversely affect outcomes. Corneal tomography (Galilei G4, Zeimer Ophthalmic Systems AG) was performed preoperatively and 1 month postoperatively. TCA was input into the Donnenfeld limbal relaxing incisions nomogram to calculate the AK parameters. Preoperative and postoperative tomographic and subjective refractive measurements were compared. The Alpins method for vector analysis evaluated results. RESULTS Eighty-two eyes of 82 patients were included. Mean preoperative TCA was significantly reduced from 0.80 ± 0.19 D to 0.51 D ± 0.26 D ( P < 0.001). Preoperative posterior corneal astigmatism, -0.28 ± 0.13 D, was unchanged, postoperative posterior corneal astigmatism, -0.28 ± 0.14 D ( P = 0.653). Target-induced astigmatism arithmetic mean (0.82 ± 0.21 D) was greater than that of the surgically induced astigmatism (0.70 ± 0.40 D), resulting in an arithmetic mean difference vector of 0.51 ± 0.27 D with a summated mean at 0.16 D at 20 degrees. The correction index was 0.87, indicating undercorrection. Angle of error arithmetic mean, -1.27 ± 23.27 degrees, indicated good alignment. CONCLUSIONS Inputting TCA for calculation of femtosecond laser AK parameters can reduce low amounts of preoperative corneal astigmatism, thereby improving uncorrected vision.
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Affiliation(s)
- Kenneth L Cohen
- School of Medicine, Department of Ophthalmology and the Kittner Eye Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Kim S, Na S, Choi S, Choi SH. Comparison of Outcomes after Wavefront-optimized and Topography-guided Transepithelial Photorefractive Keratectomy. KOREAN JOURNAL OF OPHTHALMOLOGY 2024; 38:275-283. [PMID: 38897594 PMCID: PMC11321827 DOI: 10.3341/kjo.2024.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/09/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
PURPOSE To evaluate the outcomes of wavefront-optimized (WFO) and topography-guided (TG) transepithelial photorefractive keratectomy (transPRK) in the treatment of myopia and myopic astigmatism. METHODS Patients who underwent transPRK using the WaveLight EX500 excimer laser for the correction of myopia and myopic astigmatism between January 2022 and March 2023 were divided into groups of WFO transPRK (77 eyes of 36 patients) or TG transPRK (63 eyes of 31 patients) in this retrospective, observational cohort study. The preoperative and postoperative 3-month refractive and visual outcomes of the two groups were analyzed. RESULTS In both groups, the uncorrected distance visual acuity was 0.0 logarithm of the minimum angle of resolution or better in 95% of eyes 3 months postoperatively, and the mean manifest refraction spherical equivalent was within ±1.0 diopter in 90% of eyes. No significant differences were observed between the groups in terms of the uncorrected distance visual acuity or astigmatism. A significant induction of higher order aberrations (HOAs) was observed in both groups. However, the induction of total corneal HOAs (p = 0.014) and spherical aberrations (p < 0.001) was significantly lower in the TG group than that in the WFO group. CONCLUSIONS WFO and TG transPRK effectively improved the visual and refractive outcomes; however, the induction of total corneal HOAs and spherical aberration was lesser following the TG ablation.
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Affiliation(s)
- SooJin Kim
- Department of Ophthalmology, Veterans Health Service Medical Center, Seoul,
Korea
| | | | - Sangkyung Choi
- Department of Ophthalmology, Veterans Health Service Medical Center, Seoul,
Korea
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Badri Y, Levron A, Agard E, Remignon CH, Chudzinski R, Billant J, Bouvarel H, Leroux P, Fenniri I, Pradat P, Dot C. Assessment of the refractive outcomes of patients with regular corneal astigmatism implanted with high-power toric intraocular lenses. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06586-8. [PMID: 39060795 DOI: 10.1007/s00417-024-06586-8] [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: 02/14/2024] [Revised: 05/29/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND To describe the refractive outcomes of eyes with high regular corneal astigmatism undergoing age-related cataract surgery. METHODS Astigmatic patients who underwent cataract surgery with implantation of high-power XY1AT HOYA® toric lenses (IOLs) (≥ T5) between March 2020 and June 2022 were included. Patients were divided into 2 groups based on the type of Total Corneal Astigmatism (TCA) used for the toric IOL calculation: group 1 = TCATK- 700 (TCA measured by the Iol Master 700®) and group 2 = TCAAK- 700 (TCA estimated from the anterior keratometry of the Iol Master 700® and using the Abulafia-Koch regression). The best-uncorrected (UDVA) and corrected (CDVA) distance visual acuity, subjective spherical equivalent (SSEq) and subjective residual cylinder (SRC) were assessed at 1 month. The predictability (centroid [CEPA] and mean absolute error in predicted astigmatism [MAEPA]) of the 2 TCA assessment methods was analyzed. RESULTS 96 eyes of 74 patients were included. In the whole cohort, the UDVA was 0.14 ± 0.19 logMAR, the CDVA was 0.04 ± 0.07 logMAR. Postoperative SSEq was - 0.24 ± 0.53D. Postoperative SRC was - 0.48 ± 0.56D. The UDVA, SSEq and SRC did not significantly differ between groups. The MAEPA was significantly better with TCAAK-700 compared to TCATK-700: 0.58 ± 0.52D versus 0.65 ± 0.55D (p = 0.01). No significant difference was observed for the CEPA (p(x) = 0.09, p(y) = 0.19). CONCLUSIONS XY1AT HOYA® toric IOLs are a very good alternative even in case of high toricity. Residual astigmatism predictability is high, it would be better with TCAAK- 700. This data should be confirmed with a larger sample of patients.
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Affiliation(s)
- Yannis Badri
- Department of Ophthalmology, Edouard Herriot University Hospital, 69003, Lyon, France.
| | | | - Emilie Agard
- Ophtalmology Department, HIA Desgenettes, Lyon, France
| | | | - Roman Chudzinski
- Department of Ophthalmology, Edouard Herriot University Hospital, 69003, Lyon, France
| | | | - Hugo Bouvarel
- Department of Ophthalmology, Edouard Herriot University Hospital, 69003, Lyon, France
| | - Pierre Leroux
- Department of Ophthalmology, Edouard Herriot University Hospital, 69003, Lyon, France
| | - Ines Fenniri
- Department of Ophthalmology, Edouard Herriot University Hospital, 69003, Lyon, France
| | - Pierre Pradat
- Department of Ophthalmology, Edouard Herriot University Hospital, 69003, Lyon, France
| | - Corinne Dot
- Department of Ophthalmology, Edouard Herriot University Hospital, 69003, Lyon, France
- Ophtalmology Department, HIA Desgenettes, Lyon, France
- French Military Health Service Academy, Val de Grâce, Paris, France
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Ding X, Zhang F, Li S. Modified femtosecond laser-assisted arcuate keratotomy for managing low corneal astigmatism using trifocal intraocular lens implantation in Chinese cataract patients. Lasers Med Sci 2024; 39:178. [PMID: 38990392 DOI: 10.1007/s10103-024-04131-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 07/02/2024] [Indexed: 07/12/2024]
Abstract
To evaluate the visual outcome and astigmatic correction following trifocal intraocular lens (IOL) implantation using the modified femtosecond laser-assisted arcuate keratotomy (FSAK) in Chinese cataract patients with low astigmatism. This retrospective study included consecutive cataract patients with regular corneal astigmatism ranging from 0.75 to 1.5 D who underwent FSAK combined with the trifocal IOL implantation between November 2020 and September 2022. Monocular uncorrected distance visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity, and refractive data were collected at the 3-month follow-up. The pre- and post-operative high-order aberrations (HOAs) were recorded. The variation in astigmatism was analyzed using Alpins vector analysis. A total of 27 eyes from 23 patients were analyzed. The monocular uncorrected distance visual acuity (UDVA) (5 m) at the 3-month follow-up was 0.04 ± 0.09 logarithm of the minimum angle of resolution (logMAR), which was significantly improved compared with the preoperative value of 0.95 ± 0.51 logMAR (P <.001). The corneal astigmatism was significantly reduced from 1.24 ± 0.42 D to 0.49 ± 0.34 D (P <.001). The target-induced astigmatism (TIA) was 1.25 ± 0.43 D, the surgically induced astigmatism (SIA) was 1.16 ± 0.52 D, and the difference vector (DV) was 0.5 ± 0.34 D. The magnitude of error (ME) (difference between SIA and TIA) was -0.1 ± 0.41 D, and the correction index (CI) (ratio of SIA to TIA) was 0.93 ± 0.36. The angle of error was 3.92° ± 16.90°. Total HOA was reduced from 0.89 ± 1.11 to 0.41 ± 0.55 (P = 0.184), and the corneal HOA was lowered from 0.17 ± 0.18 to 0.10 ± 0.10 (P = 0.129). Implantation of trifocal IOL following the modified FSAK in Chinese cataract patients exhibited excellent visual efficacy and effectively reduced corneal astigmatism.
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Affiliation(s)
- Xue Ding
- Beijing Aier-Intech Eye Hospital, Beijing, 100021, China
| | - Fan Zhang
- Aier Academy of Ophthalmology, Central South University, Changsha, 410004, China
| | - Shaowei Li
- Beijing Aier-Intech Eye Hospital, Beijing, 100021, China.
- Aier Academy of Ophthalmology, Central South University, Changsha, 410004, China.
- Institute of Corneatology in Aier Eye Hospital, Beijing, 100021, China.
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Camellin U, Franchina F, Latino G, Ninotta I, Palino P, Meduri A, Aragona P. Comparison between IOL MASTER 500 and MYAH with vector analysis in low and mild anterior corneal astigmatism. Eur J Ophthalmol 2024; 34:1046-1052. [PMID: 37919941 DOI: 10.1177/11206721231210895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
PURPOSE Evaluate the agreement between IOL Master 500 (Carl Zeiss Meditec AG, Germany) and MYAH (Topcon EU, Visia Imaging, Japan) in measuring axial length, keratometry, and anterior corneal astigmatism. SETTING Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Ophthalmology Clinic, University of Messina, Messina, Italy. METHODS In this prospective study, 40 eyes (right eye 25, left eye 15) of 40 patients were included. Axial length (AL), keratometry (K1, K2), and anterior corneal astigmatism (ACA) were measured. AL, mean K (Kavg) and magnitude of ACA were compared using Bland - Altman plot analysis, parametric and nonparametric statistical analysis. The difference vector and angle of error of the ACA measured by the two devices were evaluated by vector analysis using polar diagrams. RESULTS Mean and standard deviation with IOL Master and with MYAH device was for AL 24.25 ± 1.22 mm and 24.25 ± 1.22 mm (p = .99), for Kavg 42.75 ± 1.53 D and 42.85 ± 1.52 D (p = .78), for Magnitude of ACA 1.00 ± 0.58 D and 0.89 ± 0.56 D (p = .38) respectively. High correlations were found for AL (R² = 0.999), Kavg (R² = 0.996), and ACA Magnitude (R² = 0.889). Bland-Altman analysis of the two devices found high agreement and absence of proportional bias (MYAH-IOL MASTER) were found between the two assessments for AL (bias = -0.0005 mm, p = .93), Kavg (bias = 0.0955 D, p = .76) and ACA (bias = 0.11 D, p = .41). Limit of agreement (upper/lower LoA, 95%CI) were respectively +0.057/-0.058 mm for AL, + 0.29/-0.09 D for Kavg and +0.49/-0.27 D for ACA. No statistical difference was found between the x-component and y-component of the ACA vector (p > .01), the difference vector (IOL MASTER-MYAH) was +0.14 D axis 159 with an absolute mean angle of error of 7.2 ± 7.5 degree. CONCLUSIONS The instruments appear to be interchangeable for measurements of AL, keratometry, and magnitude of ACA with high agreement between the two devices. Also, in the presence of low astigmatism, the two instruments give the same results in terms of ACA.
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Affiliation(s)
- Umberto Camellin
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Ophthalmology Clinic, University of Messina, Messina, Italy
| | - Francesco Franchina
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Ophthalmology Clinic, University of Messina, Messina, Italy
| | - Gianluigi Latino
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Ophthalmology Clinic, University of Messina, Messina, Italy
| | - Ivan Ninotta
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Ophthalmology Clinic, University of Messina, Messina, Italy
| | - Paola Palino
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Ophthalmology Clinic, University of Messina, Messina, Italy
| | - Alessandro Meduri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Ophthalmology Clinic, University of Messina, Messina, Italy
| | - Pasquale Aragona
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Ophthalmology Clinic, University of Messina, Messina, Italy
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Ganesh S, Brar S, Bose S, Shah ML. Feasibility study of treatment of mixed astigmatism with small-incision lenticule extraction (SMILE) by using research software. Indian J Ophthalmol 2024; 72:1056-1063. [PMID: 38905464 PMCID: PMC11329817 DOI: 10.4103/ijo.ijo_1273_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/08/2023] [Accepted: 02/01/2024] [Indexed: 06/23/2024] Open
Abstract
PURPOSE To report the preliminary experience and initial clinical results following SMILE for the treatment of mixed astigmatism. METHODS Thirteen eyes of nine patients with a mean age of 27 ± 4.36 years were included in the series. In 8/13 eyes, myopic SMILE license and in 4/13 eyes, hyperopic SMILE license (available as part of an open/research software) was used for the treatment. The mean follow-up was 9.5 ± 8.7 (0.5-24) months, and the median follow-up was 6 months. SETTING Nethradhama Superspeciality Eye Hospital, Bangalore, India. DESIGN Exploratory study. RESULTS The mean preoperative sphere, cylinder, and spherical equivalent (SE) were 1.44 ± 1.63, -2.70 ± 2.30, and -0.24 ± 1.14 D, which changed to -0.03 ± 0.30, -0.28 ± 0.48, and -0.18 ± 0.49 D, respectively, 6 months postoperatively. Furthermore, 85% (11/13) eyes were within ± 0.50 D, 92% (12/13) eyes were within ± 1.00 D, while all eyes were within ± 1.50 D of SE correction. All eyes were within ± 1.00 D of cylinder correction. In addition, 92% (12/13) eyes had UDVA better than 20/32, with 54% (7/13) eyes having UDVA 20/20 or better. Safety and efficacy indices were 1.08 and 0.92, respectively. No eyes lost more than 1 line of CDVA. The mean corneal higher order aberrations (HOA) increased from 0.111 ± 0.048 to 0.209 ± 0.056 (P < 0.001). The mean objective scatter index (OSI) did not show a significant change (pre = 0.71 ± 0.69, 6 months = 0.89 ± 0.20; P = 0.35). CONCLUSION Early experience showed that SMILE was feasible for the management of eyes with mixed astigmatism, without any intraoperative complications, unique to the procedure.
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Affiliation(s)
- Sri Ganesh
- Phaco and Refractive Services, Nethradhama Super Specialty Eye Hospital, Bengaluru, Karnataka, India
| | - Sheetal Brar
- Phaco and Refractive Services, Nethradhama Super Specialty Eye Hospital, Bengaluru, Karnataka, India
| | - Shilpi Bose
- Phaco and Refractive Services, Nethradhama Super Specialty Eye Hospital, Bengaluru, Karnataka, India
| | - Mamta Lakhana Shah
- Phaco and Refractive Services, Nethradhama Super Specialty Eye Hospital, Bengaluru, Karnataka, India
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13
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Qin X, Yao P, Wu X, Wu Y, Hong Y, Chen Z, Yuan Y. Visual and refractive outcomes of opposite clear corneal incision combined with rotationally asymmetric multifocal intraocular lens implantation. Front Med (Lausanne) 2024; 11:1389186. [PMID: 39005649 PMCID: PMC11239574 DOI: 10.3389/fmed.2024.1389186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/14/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To evaluate the visual and refractive outcomes of astigmatic cataract patients following opposite clear corneal incision (OCCI) combined with rotationally asymmetric multifocal intraocular lens (IOL) implantation. Setting Department of Ophthalmology, Zhongshan Hospital (Xiamen), Fudan University, People's Republic of China. Design Retrospective cohort study. Methods This study comprised 58 cataract eyes of 54 patients with corneal astigmatism who underwent phacoemulsification and rotationally asymmetric multifocal IOL implantation which received either OCCI (OCCI group) or a single clear corneal incision (SCCI group). The follow-up period was 3 months after surgery. Distance, intermediate and near visual acuity, refractive outcomes, and corneal anterior keratometry were compared between the two groups. Vector analysis was used to evaluate astigmatism correction. Results Three months after surgery, the distance, intermediate and near visual acuity, and sphere remained comparable between the two groups, but a significant difference was detected in residual astigmatism and anterior corneal keratometric astigmatism. In the OCCI group, the residual astigmatism and keratometric astigmatism were -0.60 ± 0.29 D and 0.59 ± 0.28 D, respectively, which were lower than those in SCCI groups (-1.18 ± 0.47 D and 1.15 ± 0.45 D, both p < 0.05). In vector analysis, the difference vector (DV), angle of error (AoE), absolute AoE, index of success (IoS) and correction index (CI) were statistically significantly different between the two groups (p < 0.05). Conclusion OCCI combined with rotationally asymmetric multifocal intraocular lens implantation showed predictable and desirable efficacy in treating cataract patients with astigmatism.
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Affiliation(s)
- Xiaoyu Qin
- Department of Ophthalmology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Pengxiang Yao
- Department of Ophthalmology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Xinyuan Wu
- Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yang Wu
- Department of Ophthalmology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Yufang Hong
- Department of Ophthalmology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Zhenzong Chen
- Department of Ophthalmology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Yuanzhi Yuan
- Department of Ophthalmology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
- Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai, China
- The Centre for Evidence-based Medicine, Fudan University, Shanghai, China
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Zhou J, Li S, He G, Wang W. Predicting the impact of femtosecond-assisted arcuate keratotomy combined with tri-planar clear corneal incisions on astigmatism in implantable collamer lens surgery: one-year follow-up. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06547-1. [PMID: 38896281 DOI: 10.1007/s00417-024-06547-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 05/30/2024] [Accepted: 06/07/2024] [Indexed: 06/21/2024] Open
Abstract
PURPOSE To investigate the factors associated with and impact on the femtosecond-assisted (FS-assisted) limbal relaxing incision (LRI) combined with the steep-meridian tri-planar clear corneal incision (TCCI) to reduce astigmatism in patients undergoing Implantable Collamer Lens (ICL) surgery. METHODS Retrospective case series. The study reviewed patients with ICL surgery combined with FS-assisted LRIs paired with steep-meridian TCCIs. Correlation analysis examined the relationship between independent variables, including preoperative characteristics (intraocular pressure, corneal thickness, axial length, et al.), TCCI, and LRI surgical parameters. The predictors of surgically induced astigmatism (SIA) were determined using individual-level analysis and accounting for inter-eye correlation with the generalized estimating equation (GEE). RESULTS The study enrolled 69 patients, with 114 eyes (55 right and 59 left). The mean spherical equivalent (SEQ) was - 10.29 ± 2.99D and - 9.99 ± 2.72D for the right and left eye, respectively, while the mean preoperative corneal astigmatism was - 1.54 ± 0.47D and - 1.54 ± 0.46D for the right and left eyes, respectively. After 12 months of follow-up, univariate analysis revealed significant correlations between SIA and intraocular pressure (IOP), astigmatism type, TCCI position (degree), peripheral corneal thickness (PCT), LRI arc incision diameter, post depth (%), and angle, respectively (P = 0.046, 0.016, 0.039, 0.040, 0.009, 0.000, 0.000). Multivariate analysis using GEE demonstrated that axial length (AL), astigmatism type, LRI arc diameter, and angle were independent predictors of SIA (P = 0.000, 0.005, 0.029, 0.000). CONCLUSIONS The type of astigmatism and axial length were independent factors that affected SIA when modifying the LRI arc diameter and angle through FS-assisted steep-meridian TCCI paired with LRI in ICL surgery.
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Affiliation(s)
- Jihong Zhou
- Beijing Aier Intech Eye Hospital, Panjiayuan Plaza, #12 Panjiayuan Nanli, Chaoyang District, Beijing, China.
- Beijing Ophthalmology and Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
- Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dongjiaomin Xiang, Dongcheng District, Beijing, 100730, China.
| | - Shaowei Li
- Beijing Aier Intech Eye Hospital, Panjiayuan Plaza, #12 Panjiayuan Nanli, Chaoyang District, Beijing, China
| | - Guoli He
- Beijing Aier Intech Eye Hospital, Panjiayuan Plaza, #12 Panjiayuan Nanli, Chaoyang District, Beijing, China
| | - Wenjuan Wang
- Beijing Aier Intech Eye Hospital, Panjiayuan Plaza, #12 Panjiayuan Nanli, Chaoyang District, Beijing, China
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15
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Na KS, An D, Kim HS, Kim EC. Relation between change of effective lens position and toric IOL rotation after toric IOL implantation. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00154-6. [PMID: 38889881 DOI: 10.1016/j.jcjo.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/16/2024] [Accepted: 05/12/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE To evaluate the relationship between change of effective lens position (ELP) and toric intraocular lens (IOL) rotation in patients with increasing postoperative refractive astigmatism after successful toric IOL implantation. METHODS The subjects include 61 people (61 eyes) with increasing residual astigmatism >0.5 D 3 months after successful toric IOL implantation. Clinical measurements included preoperative, 1-week, and 1-, 2-, and 3-month postoperative visual acuity; refraction; keratometer; anterior and posterior corneal astigmatism; ELP by Scheimpflug camera imaging; and IOL axis by slit-lamp biomicroscopic photograph with pupil dilation. RESULTS Residual astigmatism in postoperative month 3 (0.81 ± 0.50 D) is higher than that at postoperative week 1 (0.41 ± 0.38 D; p < 0.05). ELP decreased by 264.44 ± 163.25 μm, and the IOL rotated by 2.91 ± 1.44 degrees from week 1 to month 3 (p < 0.05). The ELP change had a positive correlation with IOL rotation (R2 = 0.383; p = 0.006), and the postoperative refractive astigmatic change had a positive correlation with ELP change (R2 = 0.272; p = 0.027) and IOL rotation (R2 = 0.272; p = 0.0001) from week 1 to month 3. CONCLUSION ELP change can influence toric IOL rotation and increase residual astigmatism after toric IOL implantation.
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Affiliation(s)
- Kyung-Sun Na
- Department of Ophthalmology and Visual Science, Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Dohyeon An
- Department of Ophthalmology and Visual Science, Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Hyun Seung Kim
- Department of Ophthalmology and Visual Science, Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Eun Chul Kim
- Department of Ophthalmology and Visual Science, Catholic University of Korea College of Medicine, Seoul, South Korea.
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16
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Yoo TK, Kim D, Kim JS, Kim HS, Ryu IH, Lee IS, Kim JK, Na KH. Comparison of early visual outcomes after SMILE using VISUMAX 800 and VISUMAX 500 for myopia: a retrospective matched case-control study. Sci Rep 2024; 14:11989. [PMID: 38796537 PMCID: PMC11127987 DOI: 10.1038/s41598-024-62354-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/16/2024] [Indexed: 05/28/2024] Open
Abstract
VISUMAX 800 was introduced to improve the patient experience and clinical outcomes of small incision lenticule extraction (SMILE). This was a retrospective, matched, and case-control study (1:2) controlled for preoperative central corneal thickness and refractive error that compared early refractive and visual outcomes after SMILE using VISUMAX 800 and VISUMAX 500 to treat myopia. We included 50 eyes that underwent the VISUMAX 800 SMILE and 100 eyes that underwent the VISUMAX 500 SMILE. SMILE using VISUMAX 800 was performed using the CentraLign aid for vertex centration. Cyclotorsion was controlled by an OcuLign assistant in the VISUMAX 800 group after corneal marking. Corneal higher-order aberrations (HOAs) were evaluated using a Pentacam 1 month after surgery. No differences were observed in the pre- and post-operative refractive and visual outcomes at 1 day, 1 month, and 6 months after surgery. VISUMAX 800 induced less total HOAs than VISUMAX 500 (P = 0.036). No statistically significant differences were observed in the amounts of induced spherical aberrations or vertical and horizontal comas. No differences were observed in the 1 month and 6 months refractive and visual outcomes between two SMILE procedures, except for VISUMAX 800, which resulted in lower postoperative total HOAs than VISUMAX 500.
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Affiliation(s)
- Tae Keun Yoo
- Department of Ophthalmology, Hangil Eye Hospital, 35 Bupyeong-daero, Bupyeong-gu, Incheon, 21388, South Korea.
- Department of Refractive Surgery, B&VIIT Eye Center, Seoul, South Korea.
| | - Dongyoung Kim
- Research and Development Department, VISUWORKS, Seoul, South Korea
| | - Jung Soo Kim
- Research and Development Department, VISUWORKS, Seoul, South Korea
| | - Hee Sun Kim
- Department of Refractive Surgery, B&VIIT Eye Center, Seoul, South Korea
| | - Ik Hee Ryu
- Department of Refractive Surgery, B&VIIT Eye Center, Seoul, South Korea
- Research and Development Department, VISUWORKS, Seoul, South Korea
| | - In Sik Lee
- Department of Refractive Surgery, B&VIIT Eye Center, Seoul, South Korea
| | - Jin Kuk Kim
- Department of Refractive Surgery, B&VIIT Eye Center, Seoul, South Korea
| | - Kun-Hoo Na
- Department of Refractive Surgery, B&VIIT Eye Center, Seoul, South Korea
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Zhang J, Shao J, Cao X, Zhang Y, Zheng L. Fitting-Shape-based Strategy for Topography-guided LASIK: A Prospective Study. J Refract Surg 2024; 40:e336-e343. [PMID: 38717081 DOI: 10.3928/1081597x-20240415-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2024]
Abstract
PURPOSE To assess and compare the visual acuity and refractive outcomes of topography-guided laser in situ keratomileusis (LASIK) based on the fitting-shape-based refractive compensated and Phorcides software strategies. METHODS Consecutive patients who underwent topography-guided LASIK were included in this study. Through double-masked simple randomization, patients were assigned to the Zhang & Zheng Auto-compensate Refraction (ZZ AR) group (the fitting-shape-based refractive compensated strategy using the ZZ AR calculator was used) or the Phorcides group (the topography analysis algorithm in Phorcides software [Phorcides LLC] was used). Only one eye per patient with binocular correction was randomly enrolled. The preoperative and postoperative visual acuities and refraction were analyzed at the 6-month follow-up visit. RESULTS The ZZ AR and Phorcides groups comprised 156 and 147 eyes, respectively. At the 6-month postoperative follow-up visit, the median (range) absolute residual cylindrical refraction was 0.35 (1.01) and 0.47 (1.63) diopters (D) for the ZZ AR and Phorcides groups, respectively (P < .001). The percentages of patients with residual cylindrical power within 0.25 D were 29.49% and 13.61% for the ZZ AR and Phorcides groups, respectively (P = .001). Based on the percentages of patients with residual cylindrical powers within 0.50 and 1.00 D, the ZZ AR group showed better outcomes (P = .02 and .01). The percentage of patients with visual acuity better than 20/16 was significantly higher for the ZZ AR group than for the Phorcides group (P = .03). CONCLUSIONS The fitting-shape-based refractive compensated strategy for topography-guided LASIK procedures can better optimize the visual acuity and astigmatic refraction than the Phorcides software strategy. [J Refract Surg. 2024;40(5):e336-e343.].
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18
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Icoz M, Yildirim B, Gurturk Icoz SG. Comparison of different methods of correcting astigmatism in cataract surgery. Clin Exp Optom 2024; 107:409-414. [PMID: 37699788 DOI: 10.1080/08164622.2023.2239816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 09/14/2023] Open
Abstract
CLINICAL RELEVANCE Astigmatism causes a decrement in visual acuity, and deterioration in visual quality. BACKGROUND The aim of this study is to compare clear corneal incision (CCI) in the steepest meridian, opposed clear corneal incision (OCCI) and toric intraocular lens implantation methods for the correction of astigmatism in cataract surgery. METHODS Total of 93 preoperative patients with the rule corneal astigmatism (between 1.00-3.00 D)underwent uncomplicated cataract surgery are retrospectively included in this study. Whole patients are divided into three groups of equal number of patients of 31 by considering the astigmatism correcting methods that are as follows. Group 1 consists of patients underwent CCI on the steepest meridian, group 2 consists of the patients underwent paired OCCI, and group 3 consists of those with toric intraocular lens implantation. The preoperative and postoperative 3rd month uncorrected distance visual acuity, refraction and, keratometry values, and surgically induced astigmatism values calculated by Alpins method are recorded. RESULTS The age, preoperative and postoperative 3rd month spherical, spherical equivalent refraction and keratometry values of the groups are similar (p > 0.05). The preoperative uncorrected distance visual acuity values are similar in whole groups, postoperative uncorrected distance visual acuity values are the highest in group 1, and lowest in group 3 (p = 0.85, p = 0.02, respectively). The preoperative and postoperative 3rd month mean cylinder refraction values are -1.86 D, -1.00 D in group 1, -1.77 D, -0.70 D in group 2, and -1.95 D, -0.40 D in group 3. There is a statistically significant difference among the groups (p = 0.01). The surgically induced astigmatism values are statistically different among the groups [it was 0.46 ± 0.21 in group 1, 0.91 ± 0.44 in group 2, 0.33 ± 0.18 in group 3 (p < 0.001, respectively)]. CONCLUSION This study indicated that; CCI, paired OCCI, and toric intraocular lens implantation should be preferred and performed for the steepest meridian in low D, middle D, and high D astigmatism patients, respectively. CCI can easily be applied for low to medium D without needing extra skills and tools. On the other hand, toric intraocular lens implantation is a better option for a high astigmatism with proper and accurate planning before the surgery.
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Affiliation(s)
- Mehmet Icoz
- Department of Ophthalmology, Yozgat City Hospital, Yozgat, Turkey
| | - Busra Yildirim
- Department of Ophthalmology, Besni State Hospital, Adıyaman, Turkey
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Yang X, Liu Y, Xiao K, Song Q, Xu Y, Li J, Zhou Y. Effect of Cyclotorsion Compensation in Small Incision Lenticule Extraction Surgery for the Correction of Myopic Astigmatism: A Systematic Review and Meta-Analysis. Ophthalmol Ther 2024; 13:1271-1288. [PMID: 38498276 DOI: 10.1007/s40123-024-00921-2] [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: 12/28/2023] [Accepted: 02/29/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION Small incision lenticule extraction (SMILE) has made notable advancements in addressing myopic astigmatism. Nevertheless, the potential impact of cyclotorsion on surgical outcomes cannot be overlooked. This study aims to assess the effectiveness of cyclotorsion compensation technology in SMILE surgery for the correction of myopic astigmatism, examining its influence on postoperative visual quality. METHODS A systematic review and meta-analysis were conducted. A comprehensive literature search was performed using databases, including PubMed, Web of Science, EMBASE, Cochrane Library, EBSCO, Scopus, CNKI, VIP, and Wan Fang. Studies meeting the criteria were selected and included. Data were independently extracted by three authors. Clinical outcome parameters were analyzed using Review Manager version 5.3. RESULTS This meta-analysis included ten studies. The results showed that, compared with the control group (cyclotorsion compensation was not performed in SMILE), the following indicators in the cyclotorsion compensation group were: residual astigmatism (RA) [weighted mean difference (MD) = 0.73, 95% confidence interval (CI) + 0.26 to + 1.19, P = 0.002], spherical equivalent (SE) (MD = 1.99, 95% CI + 0.77 to + 3.21, P = 0.001), coma (MD = -0.06, 95% CI -0.08 to -0.04, P < 0.00001), higher-order aberrations (HOAs) (MD = -0.04, 95% CI -0.06 to -0.02, P < 0.0001), follow-up 6-month angle of error (AE) (MD = -2.67, 95% CI -3.71 to -1.63, P < 0.00001), and follow-up 6-month uncorrected distance visual acuity (UDVA) (MD = -0.05, 95% CI -0.08 to -0.01, P = 0.005), and the differences in results were statistically significant. However, the differences among correction index, index of success (IOS), targeted induced astigmatism (TIA), magnitude of error (ME), and spherical aberration (SA) were not statistically significant. CONCLUSION Cyclotorsion compensation proves to be effective and predictable for correcting myopic astigmatism. The cyclotorsion compensation group demonstrated advantages over the control group in terms of postoperative residual astigmatism, and it induced fewer coma aberrations. Whether cyclotorsion compensation can lead to better visual quality remains to be seen, and further research on correcting myopic astigmatism through cyclotorsion compensation is warranted.
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Affiliation(s)
- Xinwei Yang
- Eye College, Chengdu University of Traditional Chinese Medicine, No. 37, Twelve Bridge Road, Jinniu District, Chengdu, Sichuan, China.
- Refractive Surgery Department, Ineye Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Ying Liu
- Clinical School of Medicine, Chengdu University of Chinese Medicine, Chengdu, China
| | - Kaimin Xiao
- Eye College, Chengdu University of Traditional Chinese Medicine, No. 37, Twelve Bridge Road, Jinniu District, Chengdu, Sichuan, China
| | - Qiuyi Song
- Eye College, Chengdu University of Traditional Chinese Medicine, No. 37, Twelve Bridge Road, Jinniu District, Chengdu, Sichuan, China
| | - Yunxi Xu
- Eye College, Chengdu University of Traditional Chinese Medicine, No. 37, Twelve Bridge Road, Jinniu District, Chengdu, Sichuan, China
| | - Jialing Li
- Eye College, Chengdu University of Traditional Chinese Medicine, No. 37, Twelve Bridge Road, Jinniu District, Chengdu, Sichuan, China
| | - Yuehua Zhou
- Eye College, Chengdu University of Traditional Chinese Medicine, No. 37, Twelve Bridge Road, Jinniu District, Chengdu, Sichuan, China.
- Refractive Surgery Department, Ineye Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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Einollahi B, Rezaei J, Sadoughi MM, Feizi S, Einollahi N, Veisi AR, Hassanpour K. Femtosecond thin-flap laser assisted in situ keratomileusis for correction of post-penetrating keratoplasty ametropia: long-term outcome. BMC Ophthalmol 2024; 24:174. [PMID: 38627647 PMCID: PMC11020473 DOI: 10.1186/s12886-024-03428-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE To evaluate the long-term clinical outcomes of femtosecond thin-flap LASIK (femto-LASIK) for correction of refractive error after penetrating keratoplasty in keratoconus-affected eyes. SETTING a private ophthalmology clinic. DESIGN Prospective interventional case series. METHODS This prospective interventional case series enrolled 22 eyes of 22 patients who underwent femto-LASIK for the management of post-penetrating keratoplasty ametropia. The refractive error, uncorrected (UDVA), and corrected (CDVA) distance visual acuities and vector analysis were reported in short-term and long-term period after surgery. RESULTS The mean age was 32.7 ± 7.5 years (range, 23 to 47 years) at the surgery time. The average time between PK and femto-LASIK was 42.5 ± 31.7 months. The average follow-up duration after femto-LASIK was 81.2 ± 18.6 months. The mean preoperative UDVA significantly improved from 0.47 ± 0.15 logMAR to 0.35 ± 0.14 logMAR at 12 months (P = 0.048) and 0.4 ± 0.17 at final follow-up exam (P = 0.007). CDVA was 0.22 ± 0.1 at baseline which improved to 0.18 ± 0.15 and 0.15 ± 0.1 logMAR at 12 and 81 months, respectively. (Ps = 0.027, 0.014). The mean cylinder before surgery was - 5.04 ± 1.4D which significantly decreased to -1.5 ± 0.8 D at 12 months postoperatively. (P < 0.001). There was a significant increase in refractive astigmatism from 12 months to 81 months postoperatively (-3.1 ± 2.0, P = 0.002). At the final visit, the efficacy index was 0.83, and the safety index was 1.16. CONCLUSIONS Despite the short-term outcome indicated that femo-LASIK was effective for correction of post-keratoplasty ametropia during short-term period, a notable regression in its effect was observed in the long-term follow-up. Therefore, the predictability of this technique might decrease in the long-term.
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Affiliation(s)
- Bahram Einollahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, 23rd PaidarFard St., Boostan 9, Pasdaran Ave, Tehran, 16666, Iran
| | - Javad Rezaei
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, 23rd PaidarFard St., Boostan 9, Pasdaran Ave, Tehran, 16666, Iran.
| | - Mohammad-Mehdi Sadoughi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, 23rd PaidarFard St., Boostan 9, Pasdaran Ave, Tehran, 16666, Iran
| | - Sepehr Feizi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, 23rd PaidarFard St., Boostan 9, Pasdaran Ave, Tehran, 16666, Iran
| | - Neda Einollahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, 23rd PaidarFard St., Boostan 9, Pasdaran Ave, Tehran, 16666, Iran
| | - Amir Reza Veisi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, 23rd PaidarFard St., Boostan 9, Pasdaran Ave, Tehran, 16666, Iran
| | - Kiana Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, 23rd PaidarFard St., Boostan 9, Pasdaran Ave, Tehran, 16666, Iran
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Yen WT, Weng TH, Lin TY, Tai MC, Chen YH, Chang YM. Femtosecond laser-assisted astigmatic keratotomy versus toric IOL implantation for correcting astigmatism in cataract patients: a systematic review and meta-analysis with trial sequential analysis. Br J Ophthalmol 2024:bjo-2024-325195. [PMID: 38575199 DOI: 10.1136/bjo-2024-325195] [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: 01/10/2024] [Accepted: 03/17/2024] [Indexed: 04/06/2024]
Abstract
AIMS To compare the refractive and visual outcomes of femtosecond laser-assisted astigmatic keratotomy (FSAK) and toric intraocular lens (IOL) implantation for correcting astigmatism in cataract patients. METHODS Studies were retrieved from the Ovid-Medline, EMBASE, Cochrane Central Register of Controlled Trials and Scopus which compared FSAK and toric IOL for astigmatism correction in cataract patients. Outcome measures included postoperative refractive cylinder, correction index, uncorrected distance visual acuity (UDVA), the proportion of patients achieving a residual refractive cylinder of 1.00 dioptre or less, target-induced astigmatism (TIA) and surgically induced astigmatism (SIA). The trial sequential analysis (TSA) was used to collect firm evidence supporting our conclusion. RESULTS 9 studies encompassing 590 participants were analysed. The meta-analysis revealed that toric IOLs could result in less postoperative refractive cylinder and provide better UDVA compared with FSAK. The TSA disclosed strong evidence of lower postoperative refractive cylinder in the toric IOL group compared with that of the FSAK group. FSAK showed a smaller correction index and lower mean TIA and SIA compared with toric IOLs. CONCLUSIONS For cataract patients, both FSAK and toric IOLs are effective methods for correcting astigmatism. However, toric IOLs offer less postoperative astigmatism and result in better postoperative UDVA compared with FSAK. In vector analysis of astigmatism, toric IOLs can also produce higher TIA and SIA. Additionally, neither method is associated with severe untreatable complications. Therefore, the conclusion is that toric IOLs are the preferred choice for astigmatism correction in cataract patients and FSAK serves as a viable alternative when toric IOLs are contraindicated.
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Affiliation(s)
- Wei-Ting Yen
- Department of Ophthalmology, Tri-Service General Hospital, Taipei City, Taiwan
- National Defense Medical Center, Taipei City, Taiwan
| | - Tzu-Heng Weng
- Department of Ophthalmology, Tri-Service General Hospital, Taipei City, Taiwan
- National Defense Medical Center, Taipei City, Taiwan
| | - Ting-Yi Lin
- Department of Ophthalmology, Tri-Service General Hospital, Taipei City, Taiwan
- National Defense Medical Center, Taipei City, Taiwan
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-Service General Hospital, Taipei City, Taiwan
- National Defense Medical Center, Taipei City, Taiwan
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital, Taipei City, Taiwan
- National Defense Medical Center, Taipei City, Taiwan
| | - Yu-Min Chang
- Department of Ophthalmology, Tri-Service General Hospital, Taipei City, Taiwan
- National Defense Medical Center, Taipei City, Taiwan
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Wei C, Liu J, Zhang C, Liu JY, Lu YM. Clinical outcomes of SMILE and WFG-LASIK used to treat myopia and astigmatism: A systematic review and meta-analysis. J Fr Ophtalmol 2024; 47:104085. [PMID: 38377878 DOI: 10.1016/j.jfo.2024.104085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/18/2023] [Indexed: 02/22/2024]
Abstract
PURPOSE To evaluate the safety, efficacy and postoperative visual quality of small incision lenticule extraction (SMILE) and Wavefront-Guided Laser in situ keratomileusis (WFG-LASIK) and to analyze their efficacy in correcting astigmatism. METHODS A systematic literature search was performed using Cochrane Collaboration methodology. Databases searched included PubMed, Embase, the Cochrane Library and Web of Science. RevMan software version 5.3.0 was used for meta-analysis. RESULTS A total of 976 eyes were included in 8 studies, of which 539 eyes underwent SMILE and 437 eyes underwent WFG-LASIK. There were no statistically significant differences in the proportion of eyes achieving uncorrected distance visual acuity of 20/20 or better (P=0.18), the proportion of eyes within±0.50 diopter of target refraction postoperatively (P=0.10), or the postoperative magnitude of cylinder (P=0.10). Regarding the Alpins vector analysis of astigmatism, there was no statistically significant difference in the surgical magnitude of error (P=0.09) between the two groups. WFG-LASIK has a lower surgical angle of error (P= 0.002) and higher surgical correction index of cylinder (P=0.03) than SMILE. In terms of aberrations, higher order aberrations (P=0.46), spherical aberrations (P=0.22) and trefoil (P=0.56) were not statistically different, while WFG-LASIK induced less coma than SMILE surgery (P=0.02). CONCLUSION Both SMILE and WFG-LASIK are safe and effective ways to correct myopia and astigmatism. Compared with SMILE, WFG-LASIK has a lower surgical angle of error, higher surgical correction index of cylinder and induces less coma.
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Affiliation(s)
- C Wei
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China
| | - J Liu
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China
| | - C Zhang
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China
| | - J Y Liu
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China
| | - Y M Lu
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China.
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Langenbucher A, Hoffmann P, Cayless A, Wendelstein J, Szentmáry N. Evaluation of statistical correction strategies for corneal back surface astigmatism with toric lenses: a vector analysis. J Cataract Refract Surg 2024; 50:385-393. [PMID: 38015426 DOI: 10.1097/j.jcrs.0000000000001370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE To compare actual and formula-predicted postoperative refractive astigmatism using measured posterior corneal power measurements and 4 different empiric posterior corneal astigmatism correction models. SETTING Tertiary care center. DESIGN Single-center retrospective consecutive case series. METHODS Using a dataset of 211 eyes before and after tIOL implantation (Hoya Vivinex), IOLMaster 700 (IOLM) or Casia2 (CASIA) keratometric and front/back surface corneal power measurements were converted to power vector components C0 (0/90 degrees) and C45 (45/135 degrees). Differences between postoperative and Castrop formula predicted refraction at the corneal plane using the labeled parameters of the tIOL and the keratometric or front/back surface corneal powers were recorded as the effect of corneal back surface astigmatism (BSA). RESULTS Generally, the centroid of the difference shifted toward negative C0 values indicating that BSA adds some against the rule corneal astigmatism (ATR). From IOLM/CASIA keratometry, the average difference in C0 was 0.39/0.32 diopter (D). After correction with the Abulafia-Koch, Goggin, La Hood, and Castrop nomograms, it was -0.18/-0.24 D, 0.27/0.18 D, 0.13/0.08 D, and 0.17/0.10 D. Using corneal front/back surface data from IOLM/CASIA, the difference was 0.18/0.12 D. CONCLUSIONS The Abulafia-Koch method overcorrected the ATR, while the Goggin, La Hood, and Castrop models slightly undercorrected ATR, and using measurements from the CASIA tomographer seemed to produce slightly less prediction error than IOLM.
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Affiliation(s)
- Achim Langenbucher
- From the Department of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany (Langenbucher, Wendelstein); Augen- und Laserklinik Castrop-Rauxel, Castrop-Rauxel, Germany (Hoffmann); School of Physical Sciences, The Open University, Milton Keynes, United Kingdom (Cayless); Department of Ophthalmology, Kepler University Hospital and Johannes Kepler University Linz, Austria (Wendelstein); Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg/Saar, Germany (Szentmáry); Department of Ophthalmology, Semmelweis-University, Budapest, Hungary (Szentmáry)
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Qian Y, Ding L, Ding Y, Jiang L, Liu Z, Zhou X. Measurement of the distance between corneal apex and pupil center in patients following small-incision lenticule extraction or implantable collamer lens implantation and its correlation with the surgical-induced astigmatism. BMC Ophthalmol 2024; 24:110. [PMID: 38454381 PMCID: PMC10918991 DOI: 10.1186/s12886-024-03352-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 02/15/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND To investigate the change in the distance between corneal apex and pupil center after small-incision lenticule extraction (SMILE) or implantable collamer lens (ICL) implantation and its correlation with surgical-induced astigmatism (SIA). METHODS This study included patients who had undergone SMILE (n = 112) or ICL implantation (n = 110) to correct myopia and myopic astigmatism. The angle kappa was measured using a Scheimpflug imaging device (Pentacam) and represented as Cartesian values between the pupil center and the corneal vertex (X, Y) and chord u ([Formula: see text]orientation), and was compared pre- and post-operative. RESULTS Following SMILE, the magnitude of chord u[Formula: see text]) significantly increased in both eyes (Wilcoxon signed-rank test, OD: P<0.001; OS: P=0.007), while no significant change was observed in the orientation. A significant correlation was found between the J0 component of SIA and the change in the magnitude of chord u for both eyes (OD: R2=0.128, P<0.001; OS: R2=0.033, P=0.004). After ICL implantation, the orientation of the chord u was significantly different in the right eye (Wilcoxon signed-rank test, P = 0.008), and the Y-intercept significantly decreased in both eyes (Wilcoxon signed-rank test, P<0.001). A significant correlation was found between J0 of SIA and the change in the magnitude of chord u for the right eyes (R2=0.066, P=0.002). A significant correlation was found between J45 of SIA and the change in the magnitude of chord u for the left eyes (R2=0.037, P=0.044). CONCLUSIONS The magnitude of the chord u increased following the SMILE procedure, whereas the Y-intercept significantly decreased after ICL implantation. SIA was related to the change in the magnitude of chord u.
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Affiliation(s)
- Yishan Qian
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China.
- NHC Key Laboratory of Myopia, Fudan University, 83th Fenyang Rd, Shanghai, 200031, People's Republic of China.
| | - Lan Ding
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Myopia, Fudan University, 83th Fenyang Rd, Shanghai, 200031, People's Republic of China
| | - Yanlan Ding
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Myopia, Fudan University, 83th Fenyang Rd, Shanghai, 200031, People's Republic of China
| | - Lin Jiang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Myopia, Fudan University, 83th Fenyang Rd, Shanghai, 200031, People's Republic of China
| | - Zesheng Liu
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Myopia, Fudan University, 83th Fenyang Rd, Shanghai, 200031, People's Republic of China
| | - Xingtao Zhou
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China.
- NHC Key Laboratory of Myopia, Fudan University, 83th Fenyang Rd, Shanghai, 200031, People's Republic of China.
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Gabrić K, Gabrić N, Piñero DP, Gabrić I. Comparative Analysis of the Clinical Outcomes of Two Toric Presbyopia-Correcting Intraocular Lenses. Ophthalmol Ther 2024; 13:775-790. [PMID: 38240999 PMCID: PMC10853117 DOI: 10.1007/s40123-023-00878-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/20/2023] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION To evaluate and compare the clinical outcomes of two toric presbyopia-correcting intraocular lenses (IOLs). METHODS Non-randomized prospective comparative study including 86 eyes of 51 patients (age 43-83 years) that underwent cataract surgery with implantation of one of the following two IOLs: TECNIS Toric Synergy (Johnson & Johnson Vision) (Synergy group) or AT LISA tri toric 939MP (Carl Zeiss Meditec) (ATLISA group). Visual and refractive outcomes were evaluated during a 6-month follow-up. RESULTS At 6 months after surgery, all eyes achieved uncorrected distance visual acuity 20/25 or better in both groups, whereas 96.2% and 100% of eyes achieved uncorrected near visual acuity (UNVA) 20/25 or better in the ATLISA and Synergy groups, respectively. All eyes achieved postoperative mesopic UNVA 20/30 or better in both IOL groups; 96.2% and 100% of eyes had a manifest cylinder ≤ 0.50 D at 6 months in ATLISA and Synergy groups, respectively. Mean magnitude of error was 0.04 ± 0.20 and - 0.04 ± 0.09 D in ATLISA and Synergy groups, respectively (p = 0.05). In the defocus curve, significant differences were found between IOL groups for most of distance-corrected visual acuities, except those corresponding to defocus of 0 D (p = 0.268) and - 1 D (p = 0.361). CONCLUSIONS The two toric presbyopia-correcting IOLs evaluated provide an efficacious astigmatic correction combined with a successful distance, intermediate and near visual rehabilitation. The visual performance seems to be better for most visual demands with the TECNIS Toric Synergy IOL, especially for distances closer than 40 cm.
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Affiliation(s)
- Krešimir Gabrić
- University Eye Clinic Svjetlost, Heinzelova Ul. 39, 10000, Zagreb, Croatia
| | - Nikica Gabrić
- University Eye Clinic Svjetlost, Heinzelova Ul. 39, 10000, Zagreb, Croatia
| | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Ivan Gabrić
- University Eye Clinic Svjetlost, Heinzelova Ul. 39, 10000, Zagreb, Croatia.
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Sun X, Shen D, Jiang H, Wang Y, Wang R, Wei W. Clinical outcomes of stromal lenticule rotation to correct mixed astigmatism. Eur J Ophthalmol 2024; 34:574-582. [PMID: 38099818 DOI: 10.1177/11206721231221165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
PURPOSE To describe a stromal lenticule rotation surgical technique to correct mixed astigmatism and evaluate the initial clinical outcomes of this innovative approach. METHODS This retrospective case series included five eyes from five patients with mixed astigmatism that underwent intrastromal lenticule rotation surgery. The eyes were evaluated for uncorrected visual acuity, corrected distance visual acuity, manifest refraction, central corneal thickness, corneal volume, anterior and posterior K readings, and corneal higher order aberrations (HOAs) (including total HOAs, spherical aberrations, coma, and trefoil) using the Scheimpflug-Placido topographer before and 3 months after surgery. The corneal epithelium and stroma were imaged using anterior segment optical coherence tomography (AS-OCT) postoperatively. A paired-sample t-test was used to analyse the data. RESULTS Clinical improvement was found in the uncorrected distance visual acuity (0.64 ± 0.11 logMAR vs. 0.20 ± 0.17 logMAR) and spherical and cylindrical diopters (D) (+2.65 ± 1.32 D vs. -0.05 ± 0.51 D and -4.95 ± 0.94 D vs. -1.10 ± 0.78 D, respectively). Anterior flat keratometry readings showed a steep trend (40.65 ± 1.24 D vs. 42.73 ± 0.63 D). Anterior corneal astigmatism decreased from 4.50 ± 0.55 D to 2.05 ± 0.73 D. According to the AS-OCT images, no significant epithelial remodelling was observed postoperatively. Although no significant differences were found among the increased corneal HOAs, the coma and trefoil changed much more than spherical aberrations 3 months postoperatively. CONCLUSIONS The results for these five eyes suggest that the autologous stromal lenticule rotation technique is safe and effective; it may be an economical and feasible surgical option for correcting mixed astigmatism.
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Affiliation(s)
- Xiyu Sun
- Department of Ophthalmology, The First Affiliated Hospital of Northwest University, Xi'an, Shaanxi, China
- Laser Vision Center, Xi'an No. 1 Hospital, Xi'an, Shaanxi, China
- Shaanxi Institute of Ophthalmology, Xi'an, Shaanxi, China
| | - Di Shen
- Department of Ophthalmology, The First Affiliated Hospital of Northwest University, Xi'an, Shaanxi, China
- Laser Vision Center, Xi'an No. 1 Hospital, Xi'an, Shaanxi, China
- Shaanxi Institute of Ophthalmology, Xi'an, Shaanxi, China
| | | | - Yani Wang
- Department of Ophthalmology, The First Affiliated Hospital of Northwest University, Xi'an, Shaanxi, China
- Laser Vision Center, Xi'an No. 1 Hospital, Xi'an, Shaanxi, China
- Shaanxi Institute of Ophthalmology, Xi'an, Shaanxi, China
| | - Rui Wang
- Department of Ophthalmology, The First Affiliated Hospital of Northwest University, Xi'an, Shaanxi, China
- Laser Vision Center, Xi'an No. 1 Hospital, Xi'an, Shaanxi, China
- Shaanxi Institute of Ophthalmology, Xi'an, Shaanxi, China
| | - Wei Wei
- Department of Ophthalmology, The First Affiliated Hospital of Northwest University, Xi'an, Shaanxi, China
- Laser Vision Center, Xi'an No. 1 Hospital, Xi'an, Shaanxi, China
- Shaanxi Institute of Ophthalmology, Xi'an, Shaanxi, China
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Schultz T, Hoffmann S, Dick HB. Comparison of toric intraocular lens alignment between femtosecond laser-assisted capsular marking and digital marking. J Cataract Refract Surg 2024; 50:230-235. [PMID: 37847149 PMCID: PMC10878466 DOI: 10.1097/j.jcrs.0000000000001344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE To compare the accuracy of toric intraocular lens (IOL) alignment between femtosecond laser-assisted capsular marking and digital marking. SETTING Ruhr University Eye Clinic, Bochum, Germany. DESIGN Prospective clinical trial. METHODS In this study, 28 eyes of 23 patients, who underwent femtosecond laser-assisted cataract surgery with implantation of a toric IOL, were included. Intraoperatively, both femtosecond laser-assisted capsular marking and digital marking were applied simultaneously and compared in every case. The toric IOL was aligned to the capsular markings. Postoperatively, the axis of the capsular markings and toric IOL alignment was examined. Visual acuity and refractive outcomes were evaluated. RESULTS Both alignment methods were performed without intraoperative complications in all cases. 25 eyes were included in the final analysis. Misalignment was significantly lower with femtosecond laser-assisted capsular marking than with digital marking (1.71 ± 1.25 degrees vs 2.64 ± 1.70 degrees, P = .016). Deviation from the target axis of the toric IOL was 1.62 ± 1.24 degrees 4 to 6 weeks postoperatively. Postoperative uncorrected distance visual acuity was 0.14 ± 0.13 logMAR, and residual astigmatism was 0.3 ± 0.23 diopter (D) with an astigmatism ≤0.5 D in 93% of eyes. CONCLUSIONS Both methods showed excellent results for the alignment of toric IOLs. However, femtosecond laser-assisted capsular marking was significantly more precise than digital marking and showed good refractive results. In addition, capsular marking offers the possibility to avoid parallax error and evaluating postoperative IOL rotation.
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Affiliation(s)
- Tim Schultz
- From the Ruhr University Eye Hospital, Bochum, Germany
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Mao X, Chen H, Zhao Y, Ji S, Dai J. Impact of the preoperative cylinder on astigmatism correction in femtosecond lenticule extraction (FLEX): a prospective observational study. Graefes Arch Clin Exp Ophthalmol 2024; 262:631-639. [PMID: 37725147 DOI: 10.1007/s00417-023-06211-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 09/21/2023] Open
Abstract
PURPOSE To explore the impact of the preoperative manifest cylinder on astigmatism correction via femtosecond lenticule extraction (FLEX), or small incision lenticule extraction (SMILE). METHODS This was a prospective observational study. Eyes were categorized into mild (n = 88), moderate (n = 46), and severe (n = 53) astigmatism groups, based on the preoperative manifest cylinder. Vector analysis was conducted with the back vertex distance set at 12 mm. The primary outcome was the correction index (CI), with secondary outcomes including the safety, efficacy, predictability, and vectoral alterations related to FLEX. RESULTS The average target-induced astigmatism was 0.45 ± 0.20 D, 0.95 ± 0.17 D, and 1.99 ± 0.65 D in the three groups (P < 0.001), and the average CI was 1.12± 0.05, 1.01 ± 0.03, and 0.95 ± 0.02 (P = 0.020), with the severe astigmatism group displaying a notably lower CI. The efficacy, safety, predictability, or stability of FLEX did not demonstrate any significant differences among the three groups. The CIs exhibited a significant difference in eyes with with-the-rule (WTR) astigmatism and against-the-rule (ATR) astigmatism from the mild to severe astigmatism group. In eyes with oblique astigmatism, the average CI exceeded one. CONCLUSION Patients with manifest cylinder exceeding 1.25 D have a heightened risk of under-correction in WTR and ATR astigmatism compared to those with mild astigmatism, and mild over-correction may occur in cases of oblique astigmatism.
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Affiliation(s)
- Xiuyu Mao
- Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200032, China
- Department of Ophthalmology, Eye & ENT Hospital Affiliated to Fudan University, Shanghai, 200031, China
| | - Han Chen
- Department of Ophthalmology, Eye & ENT Hospital Affiliated to Fudan University, Shanghai, 200031, China
- Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Yinzhen Zhao
- Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200032, China
| | - Shunmei Ji
- Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200032, China
- Department of Ophthalmology, Eye & ENT Hospital Affiliated to Fudan University, Shanghai, 200031, China
| | - Jinhui Dai
- Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200032, China.
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Mohaseb K, Tischler A, Hall B, Isbister C, Godinho D, Goldberg A, Fine D. Refractive outcomes following bilateral implantation of a diffractive toric intraocular lens in a multisurgeon hospital setting. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e1-e6. [PMID: 36436668 DOI: 10.1016/j.jcjo.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/25/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess residual postoperative refractive astigmatism following bilateral implantation of a trifocal toric intraocular lens (IOL) in a real-world multisurgeon setting. DESIGN Prospective multisurgeon study (6 surgeons at 2 sites). METHODS Bilateral implantation of a trifocal toric IOL (AcrySof PanOptix IOL; Alcon Vision LLC, Fort Worth, TX, USA) was performed in 140 eyes of 70 patients. Patients were assessed on day 1 and 3 months postoperatively. The primary outcome measure was residual astigmatism. Secondary endpoints included absolute prediction error, IOL rotation, binocular uncorrected and distance-corrected visual acuities at near (40 cm), intermediate (60 cm), and distance (6 m) and spectacle independence evaluated with the validated Intraocular Lens Satisfaction questionnaire. RESULTS Mean preoperative cylinder was 1.25 ± 0.72 D and was 0.39 ± 0.28 D at 3 months postoperatively. At 3 months postoperatively, mean residual astigmatism was 0.39 ± 0.28 D (range, 0-1.25 D), and 118 eyes (84.3%) had postoperative astigmatism of 0.5 D or less. Mean absolute prediction error was 0.25 ± 0.21 D (range, 0-1.13 D), and 124 eyes (88.6%) had absolute prediction error of 0.5 D or less. At 3 months postoperatively, mean absolute rotation was 2.0 ± 2.7 degrees compared with baseline (range, 0-15 degrees), and 133 IOLs (95.0%) were within 5 degrees of the implanted axis. Additionally, 55 patients (79%) reported never or rarely using spectacles at near, 66 (94%) at intermediate, and 67 (96%) at distance. CONCLUSIONS The results of this study demonstrate that implantation with the PanOptix toric IOL can provide excellent refractive and visual outcomes with minimal residual astigmatism.
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Affiliation(s)
- Kam Mohaseb
- Division of Ophthalmology, Lions Gate Hospital, North Vancouver, BC; and
| | - Aron Tischler
- Division of Ophthalmology, Lions Gate Hospital, North Vancouver, BC; and.
| | | | - Carolyn Isbister
- Division of Ophthalmology, Lions Gate Hospital, North Vancouver, BC; and
| | - Derek Godinho
- Division of Ophthalmology, Lions Gate Hospital, North Vancouver, BC; and
| | - Aron Goldberg
- Division of Ophthalmology, Lions Gate Hospital, North Vancouver, BC; and
| | - David Fine
- Division of Ophthalmology, Lions Gate Hospital, North Vancouver, BC; and
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Icoz M, Gurturk Icoz SG. Comparison of dominant- and non-dominant-hand cateract surgery outcomes by a single surgeon. Photodiagnosis Photodyn Ther 2024; 45:103895. [PMID: 37977225 DOI: 10.1016/j.pdpdt.2023.103895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To compare dominant and non-dominant hand phacoemulsification surgery outcomes. METHODS This retrospective, single-center study included 300 patients who underwent phacoemulsification surgery by a single, right-handed surgeon. The patients were divided into two groups according to whether the surgeon used his dominant or non-dominant hand during surgery. Right eye operations were performed with the right hand, and left eye operations were performed with the left hand. Detailed ophthalmological examinations were performed on all patients preoperatively and postoperatively. Intraoperative phacoemulsification parameters, the presence of intraoperative and postoperative complications, postoperative refractive errors, visual acuity, and surgically induced astigmatism values were compared between the groups. RESULTS There were 171 patients in the dominant hand phacoemulsification group and 129 patients in the non-dominant hand phacoemulsification group. The distributions of age, gender, systemic diseases, and lens opacification were similar between the groups (p>0.05, for all). No statistically significant difference was observed between the two groups in terms of total operation time, phaco power, ellips fx, or ultrasonic time (p>0.05, for all). There was also no significant difference in relation to intraoperative and postoperative complication distributions, postoperative third-month refractive errors, visual acuity, or surgically induced astigmatism values (p>0.05, for all). CONCLUSION This study demonstrated that cataract surgery performed by a single surgeon can be effectively and safely performed using both hands on patients in a real operating theater environment. More objective results can be obtained with surgeries performed by a larger number of experienced surgeons.
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Affiliation(s)
- Mehmet Icoz
- Department of Ophthalmology, Yozgat City Hospital, Yozgat, Turkey.
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Moreno-Martínez A, Martín-Melero O, Andrés-Pretel F, Gómez-Cortés A, Granados-Centeno JM. Outcomes of Phacoemulsification With Toric Intraocular Lenses in Addressing Postkeratoplasty Astigmatism. Cornea 2024; 43:76-82. [PMID: 37099688 DOI: 10.1097/ico.0000000000003288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/13/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE The aim of this study was to assess the short-term and long-term effectiveness of toric intraocular lenses (IOLs) as a treatment for significant postkeratoplasty astigmatism. METHODS This was a retrospective case review study that analyzes postkeratoplasty eyes after phacoemulsification with toric IOL implantation. RESULTS Seventy-five eyes were included. Previous surgery was penetrating keratoplasty (50.6%), deep anterior lamellar keratoplasty (34.6%), or automated anterior lamellar therapeutic keratoplasty (14.6%). The mean age at phacoemulsification with toric IOL implantation was 55.0 years (SD: ±14.4). The mean follow-up time was 48.2 ± 26.6 months. Preoperative mean topographic astigmatism was 6.34 ± 2.70 D (range 2-13.2 D). The mean IOL cylinder power was 6.00 ± 4.75 D (range 2-12 D). Both mean refractive astigmatism and mean refractive spherical equivalent decreased significantly from -5.30 ± 1.86 D to -1.62 ± 1.94 D ( P < 0.001) and from -4.00 ± 4.46 D to -0.25 ± 1.25 D ( P < 0.001), respectively. From preoperative to the last visit, there was a significant improvement in mean uncorrected distance visual acuity (UCVA) (from 1.3 ± 1.0 logMAR to 0.4 ± 0.3 logMAR, P < 0.001) and mean corrected distance visual acuity (CDVA) (from 0.7 ± 0.6 logMAR to 0.2 ± 0.3 logMAR, P < 0.001). Postoperative UDVA was 20/40 and 20/30 or better in 34% and 21% of eyes, respectively. Postoperative CDVA was 20/40 and 20/30 or better in 70% and 58% of eyes, respectively. CONCLUSIONS Phacoemulsification and toric IOL implantation can effectively reduce moderate to high postkeratoplasty astigmatism, with a corresponding significant visual improvement.
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Affiliation(s)
- Almudena Moreno-Martínez
- Department of Ophthalmology (Cornea Unit), Albacete University Hospital Complex, Albacete, Castilla-La Mancha, Spain
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Paredes B, Mora J, Martín MD, Larrosa A, Piñero DP. Short-term clinical results with a trifocal diffractive toric intraocular lens using an optimized preoperative and intraoperative protocol. Eur J Ophthalmol 2024; 34:146-153. [PMID: 37093755 DOI: 10.1177/11206721231171427] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
PURPOSE To evaluate the short-term clinical outcomes of a specific toric diffractive trifocal intraocular lens (IOL) implanted following an optimized clinical protocol in a large population. METHODS Retrospective analysis of 337 eyes of 231 patients (mean age, 62.2 years) undergoing cataract surgery with implantation of the trifocal diffractive IOL AT.LISA tri toric 939M/MP (Carl Zeiss Meditec). A strict and careful clinical protocol was followed, including an accurate measurement of corneal astigmatism, use of a latest generation IOL power calculator, photography-based method intraoperative control of IOL alignment and IOL reposition at 1 week postoperatively if needed. Clinical outcomes in terms of visual acuity, refraction, efficacy of astigmatic correction analysed by vector analysis and patient satisfaction were evaluated during a 3-month follow-up. RESULTS A total of 82% and 98% of eyes achieved a postoperative uncorrected distance visual acuity of 0.00 and 0.10 logMAR or better, respectively. Furthermore, 99.7%, and 100.0% of eyes showed a postoperative spherical equivalent within ± 0.50 D and ± 1.00 D, with 97.9% of eyes having a postoperative cylinder ≤ 0.50 D. Uncorrected near and intermediate visual acuities were 0.2 logMAR or better in 89.0% and 99.1% of eyes, respectively. Mean difference vector, magnitude of error and angle of error were 0.02 ± 0.14 D, 0.02 ± 0.13 D and 0.11 ± 1.18°. Patient satisfaction was referred as high or very high by 97.6% of patients. CONCLUSIONS The implantation of the trifocal toric IOL evaluated following a careful clinical protocol provides an efficacious visual rehabilitation and astigmatic correction, leading to high levels of patient satisfaction.
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Affiliation(s)
| | | | | | | | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
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Zhou J, Wang X, Wei Y, Li X, Rui Y, Mao K, Cai J. The Efficacy of Paired Opposite Clear Corneal Incisions Correcting Preexisting Low-to-Moderate Astigmatism in Implantable Collamer Lens Surgery. J Refract Surg 2024; 40:e20-e29. [PMID: 38190562 DOI: 10.3928/1081597x-20231212-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE To evaluate the efficacy of paired opposite clear corneal incisions (OCCIs) in Implantable Collamer Lens (ICL; STAAR Surgical) implantation surgery for correcting preexisting low-to-moderate astigmatism and observe their influence on corneal aberration. METHODS This prospective controlled randomized study included 123 eyes: 73 eyes in the ICL surgery group (control group) and 50 eyes in the ICL combined with OCCI group (OCCI group). All patients had corneal astigmatism between 0.50 and 3.00 D. Parameters considered included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction, keratometry, slit-lamp biomicroscopy, indirect ophthalmoscopy, corneal topography, and higher order aberrations (HOAs). The Alpins method was used to analyze the correction of astigmatism. The follow-up period lasted for 12 months. RESULTS Both groups showed a statistically significant improvement in mean UDVA and CDVA after surgery. At 1 and 12 months, the OCCI group had statistically better UDVA than the control group (P = .021 and .01). The OCCI group showed a significant reduction in mean refractive astigmatism from -0.835 ± 0.274 to -0.535 ± 0.353 and -0.450 ± 0.346 D postoperatively (P < .05) after 1 and 12 months. No significant change was observed in the control group (P > .05). The average magnitude of surgically induced astigmatism (SIA) was 0.911 ± 0.442 and 0.811 ± 0.397 D at 1 and 12 months postoperatively, respectively, in the OCCI group, which was slightly lower than the target induced astigmatism. The difference in SIA between the OCCI and control groups was significant by the end of 1 and 12 months postoperatively (P < .0001). The mean correction index was below 1, suggesting an undercorrection effect caused by clear corneal incisions in the opposite direction. HOAs increased in both the control and OCCI groups after surgery (t = 5.668, P < .0001, t = 3.773, P = .0003, respectively), with oblique trefoil only significantly increasing in the OCCI group. CONCLUSIONS This study demonstrated that OCCIs represent a secure, efficient, reliable, and long-term technique for reducing preexisting low-to-moderate corneal astigmatism during ICL surgery. However, OCCIs did not show any advantageous impact in terms of wavefront aberrations when compared to the traditional single-incision method. The presence of oblique trefoil may be the main contributor to the alteration of HOAs during OCCI surgery. [J Refract Surg. 2024;40(1):e20-e29.].
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Lei CS, Lin X, Ning R, Yu J, Huang X, Li K, Wang Y, Savini G, Schiano-Lomoriello D, Zhou X, Huang J. Repeatability and Interobserver Reproducibility of a Swept-Source Optical Coherence Tomography for Measurements of Anterior, Posterior, and Total Corneal Power. Ophthalmol Ther 2023; 12:3263-3279. [PMID: 37787889 PMCID: PMC10640522 DOI: 10.1007/s40123-023-00815-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/05/2023] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION The aim of this work is to evaluate the intraobserver repeatability and interobserver reproducibility of corneal power measurements obtained with a swept-source optical coherence tomographer (CASIA 2, Tomey, Japan) in healthy subjects. METHODS A total of 67 right eyes from 67 healthy subjects were enrolled. Two experienced observers measured each eye three times consecutively with the CASIA 2. Corneal power values were recorded as simulated keratometry, anterior, posterior, and total corneal power. Parameters were flattest keratometry (Kf), steepest keratometry (Ks), mean keratometry (Km), astigmatism magnitude, astigmatism power vectors J0 and J45. Intraobserver repeatability and interobserver reproducibility of the CASIA 2 were assessed by the within-subject standard deviation (Sw), test-retest repeatability (TRT), coefficients of variation (CoV), and intraclass correlation coefficients (ICCs). Double-angle plots were used for astigmatism vector analysis. RESULTS The CASIA 2 had high repeatability for all corneal power values, with Sw values ≤ 0.17 diopters (D), TRT ≤ 0.46 D, and ICCs ranging from 0.866 to 0.998. Interobserver reproducibility was also high, showing all Sw values ≤ 0.10 D, TRT ≤ 0.27 D, and ICCs ≥ 0.944. The reproducibility of the average of three consecutive measurements (Sw 0.01-0.10 D, TRT 0.03-0.27 D, ICC 0.944-0.998) was higher than the reproducibility of single measurements (Sw 0.01-0.17 D, TRT 0.03-0.47 D, ICC 0.867-0.996). CONCLUSIONS The CASIA 2 showed high intraobserver repeatability and interobserver reproducibility for anterior, posterior, and total corneal power measurements in 6.0-mm diameter area. In addition, we suggest that using the average of three consecutive measurements can improve reproducibility between observers, compared to single measurements only.
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Affiliation(s)
- Chak Seng Lei
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, No. 19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xuanqiao Lin
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Rui Ning
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, No. 19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jinjin Yu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, No. 19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaomin Huang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, No. 19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Kexin Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, No. 19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yiran Wang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, No. 19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | | | | | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, No. 19 Baoqing Road, Xuhui District, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
| | - Jinhai Huang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, No. 19 Baoqing Road, Xuhui District, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
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Moshirfar M, Herron MS, Cha DS, Santos J, Payne CJ, Hoopes PC. Comparing Effective Optical Zones After Myopic Ablation Between LASIK, PRK, and SMILE With Correlation to Higher Order Aberrations. J Refract Surg 2023; 39:741-750. [PMID: 37937754 DOI: 10.3928/1081597x-20231016-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
PURPOSE To explore size, decentration, and eccentricity of effective optical zones (EOZs) in laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and small incision lenticule extraction (SMILE) and correlate them to higher order aberrations (HOAs). METHODS This was a retrospective chart review of 188 eyes that underwent refractive surgery for compound myopia (61 LASIK, 84 PRK, 43 SMILE). EOZ measurements were determined using 1-year postoperative Pentacam (Oculus Optikgeräte GmbH) tangential difference maps. HOA data were measured using Pentacam wavefront aberration Zernike polynomials. Correlations between EOZs and HOAs were analyzed. RESULTS The EOZs of LASIK and PRK are smaller than SMILE at 19.54 ± 1.44, 19.39 ± 1.66, and 22.18 ± 2.61 mm2, respectively (P < .001). No difference existed in absolute decentration from corneal vertex (P = .078) or pupil center (P = .131), but horizontal and vertical components differed significantly (P < .001). Smaller EOZ areas were correlated with greater spherical aberration induction (rLASIK = -0.378, rPRK = -0.555, rSMILE = -0.501) and total HOA induction in all groups. Absolute decentration from corneal vertex positively correlated with total HOA (rLASIK = 0.396, rPRK = 0.463, rSMILE = 0.399) and directional vertical coma induction negatively correlated with vertical decentration from the corneal vertex (rLASIK = -0.776, rPRK = -0.665, rSMILE = -0.576) in all groups. CONCLUSIONS SMILE results in a larger EOZ than LASIK and PRK, and absolute decentration remains comparable regardless of surgical reference center, despite horizontal/vertical differences. Surgical planning to ensure adequate EOZ size and centration may reduce induction of HOAs, including spherical aberrations and vertical coma. [J Refract Surg. 2023;39(11):741-750.].
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Hashemi H, Asgari S, Khabazkhoob M, Heidari Z. Vector analysis of astigmatism correction after PRK, FS-LASIK, and SMILE for myopic astigmatism. Int Ophthalmol 2023; 43:3999-4009. [PMID: 37405568 DOI: 10.1007/s10792-023-02804-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE To compare astigmatic correction among photorefractive keratectomy (PRK), femtosecond laser-assisted in situ keratomileusis (FS-LASIK), and small-incision lenticule extraction (SMILE). METHODS This prospective study enrolled 157 eyes that underwent three procedures (59 PRK, 47 FS-LASIK, and 51 SMILE) for the treatment of myopia with low to high astigmatism (- 0.25 to - 4.50 D). Ocular residual astigmatism (ORA) was calculated by vector analysis using refractive (RA) and corneal astigmatism. Vector analysis results were compared in different procedures in the two RA groups (low ≤ 1.00 D and high > 1.00 D) at 3 and 12 months postoperatively. RESULTS There were no significant between-group differences in postoperative safety and efficacy outcomes (all P > 0.05). No significant differences were found in postoperative cylinders between all surgical groups (all p > 0.05), except for 3 months postoperative ORA in FS-LASIK (P = 0.004). At 12 months, 77%, 59.2%, and 50% of eyes attain emmetropia in the FS-LASIK, SMILE, and PRK groups, respectively. Vector analysis showed comparable values for surgical induced astigmatism, target induced astigmatism, mean error, and angle of error between groups at 12 months. Significant differences were observed only in the correction index and difference vector parameters in the astigmatic > 1.00 D group at 3 months (P < 0.001), and FS-LASIK was preferable. CONCLUSIONS One-year outcomes revealed that PRK, FS-LASIK, and SMILE were all equally effective in correcting myopic astigmatism. However, FS-LASIK demonstrated more favorable astigmatism correction in eyes with astigmatism > 1.00D in early postoperatively.
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Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Soheila Asgari
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Heidari
- Department of Ophthalmology, Bu-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran; Psychiatry and Behavioral Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
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Yang S, Huang T, Wang Y, Ning K, Long Q, Wang Z, Li Y, Chen D. Short-Term Impact of Different Corneal Incision Positions on Postoperative Astigmatism and Visual Quality After SMILE Surgery. Ophthalmol Ther 2023; 12:2453-2464. [PMID: 37328617 PMCID: PMC10441924 DOI: 10.1007/s40123-023-00748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION This study aimed to evaluate the short-term impact of different incision positions on astigmatism and visual quality after small incision lenticule extraction (SMILE) surgery. METHODS This prospective study enrolled patients who decided to have SMILE to correct myopia. Patients were randomly allocated into three groups of different incision positions (group A, B, and C with incision position at 90°, 120°, and 150° respectively). Preoperative and postoperative visual acuity, spherical equivalent, and high-order aberrations (HOAs) were measured and compared among groups. Astigmatism was analyzed with the ASSORT Group Analysis Calculator based on the Alpins method. RESULTS A total of 148 eyes were included for analysis (48 eyes in group A, 50 eyes in group B, and 50 eyes in group C). At 1 month postoperatively, the mean uncorrected distance visual acuity (UDVA) logMAR in group A, B, and C was - 0.03, - 0.03, and - 0.04, respectively. The mean corrected distance visual acuity (CDVA) logMAR in group A, B, and C was - 0.03, - 0.04, and - 0.04, respectively (P > 0.05). The mean postoperative spherical equivalent (SE) values were - 0.01 ± 0.38, - 0.07 ± 0.39, and - 0.16 ± 0.49 (D) in group A, B, and C, respectively (P > 0.05). There was no statistically significant difference in preoperative and postoperative magnitude of astigmatism among different groups (P > 0.05). Significant differences were found in the distribution of astigmatism axis among the three groups at 1 day (P = 0.02) and 1 week (P = 0.02) postoperatively. However, such differences were no longer significant at 1 month after surgery (P > 0.05). No significant differences were found in HOAs among different groups 1 month after surgery (P > 0.05). CONCLUSION Different incision positions have no effect on postoperative astigmatism and visual quality 1 month after SMILE surgery, though differences were found in the distribution of the astigmatism axis within 1 week after the surgery.
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Affiliation(s)
- Shan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Tianze Huang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Yuchen Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Ken Ning
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Qing Long
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Zhonghai Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Ying Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Di Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China.
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Chao CC, Lin MY, Chang CK. The Association Between Ocular Residual Astigmatism and the Efficacy of Astigmatism Correction Via Small Incision Lenticule Extraction (SMILE). Ophthalmol Ther 2023; 12:2631-2640. [PMID: 37470969 PMCID: PMC10441899 DOI: 10.1007/s40123-023-00766-1] [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: 04/27/2023] [Accepted: 06/26/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION Astigmatism correction after small-incision lenticule extraction (SMILE) surgery is affected by several factors, including ocular residual astigmatism (ORA), which accounts for the vector difference between refractive and corneal astigmatism. Previous studies revealed the relationship between ORA and astigmatism correction after laser-assisted in situ keratomileusis (LASIK). However, in SMILE surgery, no comprehensive study exploring the link between these two variables has been performed. We have therefore assessed the association between ORA and astigmatism correction after SMILE. METHODS This was a retrospective, single-centered study. Patients with myopia or myopic astigmatism who underwent SMILE surgery using the 500-kHz Visumax laser platform and were followed up for at least 3 months were included. Patients' demographic and clinical characteristics, such as visual acuity, refractive status and corneal tomography, were recorded. ORA was calculated using Alpins Statistical System for Ophthalmic Refractive Surgery Techniques (ASSORT) Ocular Residual Astigmatism calculator. RESULTS A total of 888 eyes (408 eyes from males and 480 eyes from females) from 444 patients (mean age [standard deviation] 32.4 ± 7.1 years) were included in our study. Mean (± SD) preoperative sphere and cylinder were - 5.45 ± 1.98 (range - 10.00-0.00) diopter (D) and - 0.89 ± 0.70 (range - 4.00-0.00) D, respectively. Calculated mean ORA was 0.68 ± 0.35 (range 0.07-3.53) D. Postoperative logMAR uncorrected visual acuity was 0.03 ± 0.31. Mean postoperative sphere and cylinder were - 0.10 ± 0.56 (range - 1.5 to 1.0) D and - 0.51 ± 0.37 (- 1.5 to 0.0) D, respectively. The Pearson correlation test revealed preoperative sphere, steep keratometry (steep-K) and ORA were statistically correlated with the amplitude of astigmatism correction (P < 0.001), and the generalized estimating equations analysis showed that ORA was negatively correlated with the amplitude of astigmatism correction (P < 0.001). CONCLUSION The results of our study suggest that preoperative higher ORA may be associated with a lower magnitude of astigmatism correction after SMILE surgery in patients with all levels of astigmatism preoperative. TRIAL REGISTRATION ClinicalTrials.gov: NCT05604872. Registered 3 November 2022-Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT05604872.
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Affiliation(s)
- Chen-Cheng Chao
- Nobel Eye Institute, Taipei, Taiwan
- Department of Optometry, MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Meng-Yin Lin
- Department of Ophthalmology, Shuang Ho Hospital-Taipei Medical University, New Taipei City, Taiwan
- Department of Ophthalmology, School of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Chao-Kai Chang
- Nobel Eye Institute, Taipei, Taiwan.
- Department of Optometry, Da-Yeh University, Chunghua, Taiwan.
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Chuckpaiwong V, Chansue E, Lekhanont K, Tanehsakdi M, Jongkhajornpong P, Nonpassopon M. 12-Month Outcomes of Small Incision Lenticule Extraction With Proper Head Positioning but No Reference Marking for the Correction of Astigmatism. J Refract Surg 2023; 39:683-692. [PMID: 37824301 DOI: 10.3928/1081597x-20230824-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
PURPOSE To investigate the 12-month outcomes of small incision lenticule extraction (SMILE) with proper head positioning but no reference marking for correcting astigmatism. METHODS This was a retrospective cohort study of 3,541 patients (5,953 eyes) who underwent SMILE between July 2010 and April 2021. Patient positioning on the treatment bed was meticulously done in every patient to avoid face turn, head tilt, and chin-up or chin-down posture. The corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), manifest refraction, astigmatic outcomes, and adverse events were evaluated at 1, 3, and 12 months postoperatively. RESULTS The mean preoperative manifest spherical equivalent and manifest cylinder were -5.15 ± 2.24 diopters (D) (range: -0.13 to -12.88 D) and -1.00 ± 0.77 D (range: -0.25 and -6.00 D), respectively. Of all eyes, 88.4% and 98.6% had the spherical equivalent within ±0.50 and ±1.00 D of emmetropia at 12 months. The percentage of eyes with UDVA of 20/20 or better was 92.5%. Six eyes (0.1%) lost two or more lines of CDVA at the 12-month visit. The predictability of cylinder correction was excellent, with 88.1% within ±0.50 D and 98.9% within ± 1.00 D of astigmatism correction at 12 months. The mean correction index (CI) at 12 months was 1.09 ± 0.45 (range: 0.17 to 4.99), indicating a slight astigmatism overcorrection. The high cylinder group tended to have undercorrection with greater residual astigmatism, whereas the low cylinder group was likely to have overcorrection with lesser residual astigmatism (P < .001). No serious adverse events were observed. CONCLUSIONS SMILE with proper head positioning but no reference marking produces safe, efficient, predictable, and stable outcomes for astigmatism correction over a 12-month period. [J Refract Surg. 2023;39(10):683-692.].
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Wendelstein J, Casazza M, Riaz KM, Fischinger I, Fuchs B, Bolz M, Seiler TG, Kohnen T, Langenbucher A. Characteristics of surgically induced astigmatism after standardized microincisional cataract surgery with a superior limbal incision. J Cataract Refract Surg 2023; 49:1025-1035. [PMID: 37532255 DOI: 10.1097/j.jcrs.0000000000001271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/21/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE To determine (1) if measurements of surgically induced astigmatism (SIA) as measured by keratometry (K) and total keratometry (TK) differ (2) if SIA affects the magnitude and/or meridian of keratometric astigmatism (3) if SIA evolves over time. SETTING Tertiary care center. DESIGN Retrospective data analysis. METHODS A swept-source optical coherence tomography biometry dataset (IOLMaster700) consisting of 498 eyes (327 patients) from a tertiary care center was analyzed. For all eyes preoperative and postoperative biometric measurements at 1-month, 3-month, and 6-months postoperative visits were considered for vector analysis of SIA K and SIA TK . RESULTS Centroids in right and left eyes were 0.26 diopters (D) @5 degrees/0.31 D @1 degree for SIA K and 0.27 D @4 degrees/0.34 D @1 degree for SIA TK . Centroids for difference vectors K-TK in right and left eyes were 0.02 D @ 176 degrees/0.03 D @6 degrees. The mean SIA magnitudes in right and left eyes were 0.48 ± 0.41 D and 0.50 ± 0.37 D for SIA K and 0.53 ± 0.42 D and 0.54 ± 0.40 D for SIA TK . In eyes with ATR astigmatism, an increase in postoperative astigmatism magnitude was more common than a decrease. More than 30% of eyes showed changes in the meridian of more than 15 degrees. CONCLUSIONS Overall, we observed differences in K- and TK-derived SIA, and changes in SIA magnitude over time. For postsurgical interventions, postoperative astigmatism meridian values should be measured to base treatments. Astigmatism magnitude showed a tendency to decrease for steep-meridian incisions and to increase in flat-meridian incisions.
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Affiliation(s)
- Jascha Wendelstein
- From the Department of Ophthalmology and Optometry, Kepler University Hospital GmbH, Linz, Austria (Wendelstein, Casazza, Fischinger, Fuchs, Bolz); Johannes Kepler University Linz, Medical Faculty, Linz, Austria (Wendelstein, Casazza, Fischinger, Fuchs, Bolz); Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany (Wendelstein, Langenbucher); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Ophthalmology, Augentagesklinik Spreebogen Berlin, Berlin, Germany (Fischinger); Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zurich, Switzerland (Wendelstein, Seiler); Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Duesseldorf, Germany (Seiler); Universitätsklinik für Augenheilkunde, Inselspital Bern, Bern, Switzerland (Seiler); Department of Ophthalmology, Goethe University, Frankfurt, Germany (Kohnen)
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Rush SW, Pickett CJ, Wilson BJ, Rush RB. Topography-Guided LASIK: A Prospective Study Evaluating Patient-Reported Outcomes. Clin Ophthalmol 2023; 17:2815-2824. [PMID: 37781320 PMCID: PMC10540697 DOI: 10.2147/opth.s429991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023] Open
Abstract
Purpose To evaluate patient-reported outcomes with a validated patient questionnaire following topography-guided LASIK (TG-LASIK). Methods Patients undergoing TG-LASIK using Phorcides analytic software were prospectively enrolled to receive an adapted Patient-Reported Outcomes with LASIK Symptoms and Satisfaction (PROWL) questionnaire before and 26-weeks after treatment. The main study outcome was the change in the Global Vision Satisfaction Index from the PROWL questionnaire. Results Forty-six patients underwent treatment and completed the modified PROWL questionnaire before and 26-weeks after TG-LASIK. The Global Vision Satisfaction Index from the modified PROWL questionnaire improved from 4.07 (3.87-4.26) to 5.00 (4.81-5.19) after the TG-LASIK treatment (p < 0.0001). The study population's binocular uncorrected distance visual acuity was 20/16, 20/12.5, and 20/10 or better in 100%, 87.0%, and 15.2% at 26 weeks post TG-LASIK, respectively. Conclusion Patient satisfaction as assessed with the modified PROWL questionnaire is very high after undergoing TG-LASIK using Phorcides analytic software. Patient-reported outcomes add another dimension when assessing treatment efficacy beyond change in visual acuity and corneal architecture, and specialists may consider incorporating such assessments into the consenting process and patient education at large.
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Affiliation(s)
- Sloan W Rush
- Rush Eye Associates, Amarillo, TX, USA
- Department of Surgery, Texas Tech University Health Science Center, Amarillo, TX, USA
| | | | | | - Ryan B Rush
- Department of Surgery, Texas Tech University Health Science Center, Amarillo, TX, USA
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Langenbucher A, Szentmáry N, Cayless A, Wendelstein J, Hoffmann P. Prediction of corneal power vectors after cataract surgery with toric lens implantation-A vector analysis. PLoS One 2023; 18:e0288316. [PMID: 37682881 PMCID: PMC10490976 DOI: 10.1371/journal.pone.0288316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/25/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Intraocular lenses are typically calculated based on a pseudophakic eye model, and for toric lenses (tIOL) a good estimate of corneal astigmatism after cataract surgery is required in addition to the equivalent corneal power. The purpose of this study was to investigate the differences between the preoperative IOLMaster (IOLM) and the preoperative and postoperative Casia2 (CASIA) tomographic measurements of corneal power in a cataractous population with tIOL implantation, and to predict total power (TP) from the IOLM and CASIA keratometric measurements. METHODS The analysis was based on a dataset of 88 eyes of 88 patients from 1 clinical centre before and after tIOL implantation. All IOLM and CASIA keratometric and total corneal power measurements were converted to power vector components, and the differences between preoperative IOLM or CASIA and postoperative CASIA measurements were assessed. Feedforward neural network and multivariate linear regression prediction algorithms were implemented to predict the postoperative total corneal power (as a reference for tIOL calculation) from the preoperative IOLM and CASIA keratometric measurements. RESULTS On average, the preoperative IOLM keratometric / total corneal power under- / overestimates the postoperative CASIA keratometric / real corneal power by 0.12 dpt / 0.21 dpt. The prediction of postoperative CASIA real power from preoperative IOLM or CASIA keratometry shows that postoperative total corneal power is systematically (0.18 dpt / 0.27 dpt) shifted towards astigmatism against the rule, which is not reflected by keratometry. The correlation of postoperative CASIA real power to the corresponding preoperative CASIA values is better than those as compared to the preoperative IOLM keratometry. However, there is a large variation from preoperative IOLM or CASIA keratometry to the postoperative CASIA real power of up to 1.1 dpt (95% confidence interval). CONCLUSION One of the challenges of tIOL calculation is the prediction of postoperative total corneal power from preoperative keratometry. Keratometric power restricted to a front surface measurement does not fully reflect the situation of corneal back surface astigmatism, which typically adds some extra against the rule astigmatism.
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Affiliation(s)
- Achim Langenbucher
- Department of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
| | - Nóra Szentmáry
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg/Saar, Germany
- Department of Ophthalmology, Semmelweis-University, Budapest, Hungary
| | - Alan Cayless
- School of Physical Sciences, The Open University, Milton Keynes, United Kingdom
| | - Jascha Wendelstein
- Department of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
- Department of Ophthalmology, Johannes Kepler University Linz, Linz, Austria
| | - Peter Hoffmann
- Augen- und Laserklinik Castrop-Rauxel, Castrop-Rauxel, Germany
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Liu S, Wang X, Chen X, Wang X, Zhao J, Zhou X. Efficacy Comparison Between Toric Posterior Chamber Phakic IOL and Posterior Chamber Phakic IOL Plus Modified Steep Meridian Corneal Relaxing Incision for Moderate to High Astigmatism Corrections. J Refract Surg 2023; 39:539-545. [PMID: 37578173 DOI: 10.3928/1081597x-20230717-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
PURPOSE To compare posterior chamber phakic intraocular lens (Implantable Collamer Lens [STAAR Surgical]) (ICL) plus modified steep meridian corneal relaxing incision (MS-CRI) to toric posterior chamber phakic intraocular lens (Toric Implantable Collamer Lens [STAAR Surgical]) (TICL) implantation for the correction of moderate to high astigmatism. METHODS In this prospective, randomized clinical trial, patients with myopia who had moderate to high astigmatism (200 eyes) were enrolled and divided into TICL (n = 100) and MSCRI (n = 100) groups. All patients underwent examinations for uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and subjective refraction before surgery and at the 1- and 6-month follow-up visits. Vector astigmatism analysis was evaluated using the Alpins method. RESULTS The mean UDVA and CDVA demonstrated significant improvement after surgery in both groups. During the 6-month follow-up, the MS-CRI group showed a slight regression tendency (P < .001) and the TICL group was stable for the astigmatism correction (P = .510). At 6 months postoperatively, the mean magnitudes of the surgically induced astigmatism were 1.46 ± 0.53 and 1.10 ± 0.48 diopters (P < .001). The correction index of the TICL group was closer to 1 compared to that of the MS-CRI group (0.95 vs 0.76). Approximately 99% of eyes in the TICL group had angle of error within ±15°, whereas 89% eyes in the MS-CRI group were within that range. A significant relationship between the magnitudes of target induced astigmatism and correction index was noted in the MS-CRI group (P < .001), but not in the TICL group (P = .592). CONCLUSIONS TICL implantation could achieve better visual outcomes for correcting moderate to high astigmatism compared to ICL implantation plus MS-CRI. [J Refract Surg. 2023;39(8):539-545.].
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Chen X, Miao H, Cheng M, Lin IC, Li B, Jiang Y, Lei Y, Wang X, Zhou X. Effect of long-term rotation on astigmatism following EVO-toric intraocular collamer lens implantation. Front Med (Lausanne) 2023; 10:1194006. [PMID: 37521343 PMCID: PMC10375410 DOI: 10.3389/fmed.2023.1194006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023] Open
Abstract
Objective To evaluate the effect of long-term rotation on astigmatism following Evolution-toric intraocular collamer lens (EVO-TICL) implantation. Methods Forty eyes of 22 patients were enrolled in this prospective study. Visual acuity, refractive parameters, and axial position of the EVO-TICL by OPD-Scan III aberrometer were measured preoperatively, 1 month and 3 years postoperatively. Results Last visit, the safety index was 1.32 ± 0.15 and the efficacy index was 1.01 ± 0.23. The best-fitting curve of the attempted versus achieved correction was y = 0.9751x + 0.001. The mean spherical equivalent (SE) decreased from -8.94 ± 2.72D preoperatively to 0.06 ± 0.24D and - 0.36 ± 0.46D 1 month and 3 years postoperatively, respectively. The mean target and surgical induced astigmatism were 1.55 ± 0.61D and 1.67 ± 0.94D 3 years postoperatively. The average expected axis of the TICL was-1.15 ± 9.07 (-21-19°). One month and 3 years postoperatively, the average actual axis was -0.70 ± 9.86 (-20-20°) and - 0.35 ± 11.72 (-25-30°), respectively. The absolute rotation of the TICL was 3.70 ± 4.42 (0-22°) and 6.00 ± 6.70 (0-32°) 1 month and 3 years postoperatively, respectively (p < 0.001). The expected astigmatism was -0.10 ± 0.12D, and the mean actual astigmatism was -0.21 ± 0.30D and - 0.44 ± 0.45D 1 month and 3 years postoperatively, respectively. The mean absolute rotation without postoperative astigmatism was 3.73 ± 2.69 (0-9°) and 1.67 ± 1.66 (0-5°) for low (<2D) and high (≥2D) astigmatic TICL, respectively (p < 0.05). Conclusion EVO-TICL implantation is safe and effective, with good predictability and stability. OPD-Scan is a fast device to detect the axial position of the TICL without mydriasis, and the axial position is relatively stable in the long term postoperatively. A slight rotation of low-astigmatic TICL may not cause postoperative astigmatism, whereas rotation of the high-astigmatic TICL may cause it.
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Affiliation(s)
- Xun Chen
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- National Health Commission Key Lab of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Huamao Miao
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- National Health Commission Key Lab of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Mingrui Cheng
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- National Health Commission Key Lab of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - I-Chun Lin
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- National Health Commission Key Lab of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Boliang Li
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- National Health Commission Key Lab of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Yinjie Jiang
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- National Health Commission Key Lab of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Yadi Lei
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- National Health Commission Key Lab of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Xiaoying Wang
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- National Health Commission Key Lab of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Xingtao Zhou
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- National Health Commission Key Lab of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
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Asroui L, Arba-Mosquera S, Torbey J, Ahmed MA, Fattah MA, Koaik M, Awwad ST. Long-term results of hyperopic ablations using alcohol-assisted PRK and FS-LASIK: comparative study. J Cataract Refract Surg 2023; 49:716-723. [PMID: 36913543 DOI: 10.1097/j.jcrs.0000000000001183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/04/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE To evaluate the long-term visual and refractive outcomes of hyperopic excimer ablation using alcohol-assisted photorefractive keratectomy (PRK) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). SETTING American University of Beirut Medical Center, Beirut, Lebanon. DESIGN Retrospective, matched comparative study. METHODS Eyes that underwent alcohol-assisted PRK were compared to matched eyes that underwent FS-LASIK. All patients were followed up for at least 3 years after surgery. The refractive and visual outcomes of each group were compared at different postoperative time points. The main outcome measures were spherical equivalent deviation from target (SEDT), manifest refraction, and visual acuity. RESULTS 83 eyes underwent alcohol-assisted PRK and 83 matched eyes underwent FS-LASIK. Preoperative manifest refraction spherical equivalent was 2.44 ± 1.18 diopters (D) and 2.20 ± 0.87 D ( P = .133) in the PRK and FS-LASIK groups, respectively. Preoperative manifest cylinder was -0.77 ± 0.89 D and -0.61 ± 0.59 D ( P = .175) for the PRK and LASIK groups, respectively. 3 years postoperatively, SEDT was 0.28 ± 0.66 D and 0.40 ± 0.56 D for the PRK and LASIK groups, respectively ( P = .222), whereas manifest cylinder was -0.55 ± 0.49 D and -0.30 ± 0.34 D for PRK and LASIK, respectively ( P < .001). The mean difference vector was 0.59 ± 0.46 for PRK and 0.38 ± 0.32 for LASIK ( P < .001). 13.3% of PRK eyes and 0% of LASIK eyes had >1 D of manifest cylinder ( P = .003). CONCLUSIONS Both alcohol-assisted PRK and FS-LASIK are safe and effective for the treatment of hyperopia. PRK induces slightly more postoperative astigmatism than LASIK. Larger optical zones and recently introduced ablation profiles that lead to a smoother ablation surface might improve the clinical results of hyperopic PRK.
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Affiliation(s)
- Lara Asroui
- From the Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon (Asroui, Torbey, Ahmed, Fattah, Koaik, Awwad); Department of Research and Development, SCHWIND eye-tech-solutions GmbH & Co. KG, Kleinostheim, Germany (Arba-Mosquera)
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Wallerstein A, Gauvin M, Trottier P, Cohen M, Lloyd J, Racine L, Albert D, Ahmed IIK, Mimouni M. Toric Trifocal Intraocular Lens for Refractive Lens Exchange: A Multi-center, Multi-surgeon Large Cohort Study. J Refract Surg 2023; 39:302-310. [PMID: 37162394 DOI: 10.3928/1081597x-20230308-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE To assess the outcomes of a novel toric trifocal intraocular lens (IOL) for refractive lens exchange (RLE) in a large series of eyes with corneal astigmatism. METHODS Consecutive eyes that underwent RLE with the PanOptix Toric IOL (Alcon Laboratories, Inc) were included. Outcomes measures included postoperative distance (UDVA), 60 cm intermediate (UIVA), and 40 cm near (UNVA) uncorrected visual acuity, manifest refraction, spherical and defocus equivalent, efficacy and safety indices, and vector analyses of refractive and toric IOL accuracy. RESULTS A total of 4,933 eyes had a median follow-up of 3 months. UDVA of 20/20 and 20/40 was obtained in 65% and 99% of eyes monocularly and 87% and 100% binocularly, respectively. UIVA at 60 cm of 20/25 and 20/40 was achieved in 70% and 99% of eyes monocularly and in 77% and 100% binocularly, respectively. UNVA at 40 cm of 20/25 and 20/40 was achieved in 85% and 96% of eyes monocularly and in 95% and 100% binocularly, respectively. A total of 67%, 89%, 97%, and 99% of eyes had a SEQ within 0.25, 0.50, 0.75, and 1.00 diopter (D) of intended target (R2 = 0.99). Postoperative refractive astigmatism of 0.50, 0.75, and 1.00 D or less was achieved in 86%, 95%, and 98% of eyes. The vector analysis correction index and index of success were 1.04 ± 0.35 and 0.41 ± 0.31 for toric IOL accuracy and 1.00 ± 0.46 and 0.36 ± 0.55 for refractive accuracy, respectively. The 3- and 12-month post-RLE excimer laser enhancement rates were 1.1% (95% CI: 0.8% to 1.4%) and 7.6% (95% CI: 6.9% to 8.3%), respectively. CONCLUSIONS The PanOptix Toric IOL performed well for a wide range of axial lengths and corneal astigmatism in eyes that had RLE. Most patients achieved effective uncorrected binocular near, intermediate, and distance vision for daily functioning. [J Refract Surg. 2023;39(5):302-310.].
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Gauvin M, Wallerstein A. mEYEstro software: an automatic tool for standardized refractive surgery outcomes reporting. BMC Ophthalmol 2023; 23:171. [PMID: 37085797 PMCID: PMC10120175 DOI: 10.1186/s12886-023-02904-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/04/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Standardization for reporting medical outcomes enables clinical study comparisons and has a fundamental role in research reproducibility. In this context, we present mEYEstro, a free novel standalone application for automated standardized refractive surgery graphs. mEYEstro can be used for single and multiple group comparisons in corneal and intraocular refractive surgery patients. In less than 30 s and with minimal user manipulation, mEYEstro automatically creates the required journal standard graphs while simultaneously performing valid statistical analyses. RESULTS The software produces the following 11 standard graphs; Efficacy: 1. Cumulative uncorrected (UDVA) and corrected visual acuity (CDVA), 2. Difference between UDVA and CDVA, Safety: 3. Change in line of CDVA, Accuracy: 4. Spherical equivalent (SEQ) to intended target, 5. Attempted vs. achieved SEQ, 6. Defocus equivalent (DEQ) accuracy, 7. Refractive astigmatism accuracy, 8. Target-induced astigmatism vs. Surgically-induced astigmatism, 9. Correction index histogram, 10. Angle of error histogram, Stability: 11. SEQ stability over time. Percent proportions, means, standard deviations, Cohen's d effect sizes, and p-values are calculated and displayed on each graph. All graphs can be easily exported as high-resolution TIFF images for figures to use in scientific manuscripts and presentations. CONCLUSIONS mEYEstro software enables clinicians, surgeons, and researchers, to easily and efficiently analyze refractive surgery outcomes using the standardized methodology required by several peer-reviewed ophthalmology journals.
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Affiliation(s)
- Mathieu Gauvin
- Department of Ophthalmology & Visual Sciences, Faculty of Medicine, McGill University, Montreal, QC, Canada
- LASIK MD, 1250 Rene-Levesque Blvd W, MD Level, Montreal, QC, H3B 4W8, Canada
| | - Avi Wallerstein
- Department of Ophthalmology & Visual Sciences, Faculty of Medicine, McGill University, Montreal, QC, Canada.
- LASIK MD, 1250 Rene-Levesque Blvd W, MD Level, Montreal, QC, H3B 4W8, Canada.
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Scheepers MA, Hall B. Randomized and double-blind comparison of clinical visual outcomes of 2 EDOF intraocular lenses. J Cataract Refract Surg 2023; 49:354-359. [PMID: 36975011 DOI: 10.1097/j.jcrs.0000000000001113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/29/2022] [Indexed: 03/29/2023]
Abstract
PURPOSE To assess and compare the visual disturbance profiles of 2 extended depth-of-focus (EDOF) intraocular lenses (IOLs). SETTING Private practice (West Kootenays, British Columbia, Canada). DESIGN Prospective, randomized, single-surgeon study. METHODS This was a double-blind prospective study of 138 eyes (69 patients) that underwent bilateral implantation of 1 of 2 EDOF IOLs. Participants were randomized to either the Symfony group or the Vivity group. Outcome measures included Questionnaire for Visual Disturbances; binocular corrected distance visual acuities at distance (6 m), intermediate (66 cm), and near (40 cm); and refractive outcomes. RESULTS At 3 months postoperatively, 21 patients (60%) reported not experiencing glare in the Symfony group compared with 30 (88%) in the Vivity group, a difference of 28% (P = .008). Reports of experiencing starbursts were also significantly different between the Symfony and Vivity groups (23 participants [66%] Symfony and 30 participants [88%] Vivity; P = .027). In addition, 12 participants (34%) reported "moderate" or "severe" starbursts in the Symfony group compared with 3 (9%) in the Vivity group, a difference of 25% (P = .019). Visual acuities and refractive outcomes were similar between groups. CONCLUSIONS Both EDOF lenses provide good visual outcomes at distance and intermediate with acceptable near vision. The Symfony group had increased reports of some visual disturbances, notably the frequency, severity, and bothersomeness of starbursts and glare.
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Affiliation(s)
- Marius A Scheepers
- From the University of British Columbia, Kelowna, British Columbia, Canada (Scheepers); Sengi, Penniac, New Brunswick, Canada (Hall)
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Jorge FA, Taguchi F, Campos M. The 18-Month Outcomes of a Contralateral, Randomized, Prospective Clinical Trial Comparing Photorefractive Keratectomy and SMILE for Myopia. J Refract Surg 2023; 39:180-186. [PMID: 36892242 DOI: 10.3928/1081597x-20230113-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
PURPOSE To compare clinical outcomes and patient satisfaction of photorefractive keratectomy (PRK) and small incision lenticule extraction (SMILE) for myopia. METHODS This contralateral, randomized, prospective clinical trial included 86 eyes of 43 patients diagnosed as having spherical equivalent (SE) from -1.00 to -8.00 diopters (D). One eye of each patient was randomly allocated to receive either PRK with 0.02% mitomycin C or SMILE. Visual acuity measurement, slit-lamp microscopy, manifest and cycloplegic refraction, Scheimpflug corneal tomography, contrast sensitivity assessment, ocular wavefront aberrometry, and a satisfaction questionnaire were performed preoperatively and during an 18-month follow-up. RESULTS Forty-three eyes of each group completed the study. After 18 months of follow-up, eyes treated with PRK and SMILE showed comparable results regarding uncorrected distance visual acuity (-0.12 ± 0.07 and -0.25 ± 0.09, respectively), safety, efficacy, contrast sensitivity, and ocular wavefront aberrometry. For predictability, eyes treated with PRK had a statistically lower residual spherical equivalent when compared with eyes treated with SMILE. Residual astigmatism of 0.50 D or less was achieved in 95% of the PRK group and 81% of the SMILE group. At the 1-month follow-up visit, the PRK group presented worse evaluation in relation to vision and foreign body sensation when compared to the SMILE group. CONCLUSIONS Both PRK and SMILE presented as safe and effective strategies for treating myopia with comparative clinical results. Eyes treated with PRK showed lower spherical equivalent and residual astigmatism. In the first month, eyes treated with SMILE showed less foreign body sensation and faster visual recovery. [J Refract Surg. 2023;39(3):180-186.].
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