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Chen L, Khamar P, Wang Y, Fu H, Shetty R. Evaluation of Higher-Order Aberrations After the Smooth Incision Lenticular Keratomileusis (SILK TM) Procedure Using the ELITA TM Femtosecond Platform for Correction of Myopic and Astigmatic Refractive Errors. Clin Ophthalmol 2024; 18:2155-2166. [PMID: 39070107 PMCID: PMC11283805 DOI: 10.2147/opth.s466932] [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: 04/23/2024] [Accepted: 07/10/2024] [Indexed: 07/30/2024] Open
Abstract
Purpose To evaluate the changes of higher-order wavefront aberrations following the Smooth Incision Lenticular Keratomileusis (SILKTM) procedure for correction of myopic refractive errors with and without astigmatism, using the ELITATM Femtosecond Platform. Methods This prospective study included 24 eyes that underwent SILK procedure using one ELITA femtosecond laser system for the correction of myopic refractive errors with and without astigmatism. Preoperative and postoperative 1-day, 1-week, 1-month, 3-month, and 9-month eye exams were measured with a commercial wavefront aberrometer (iDESIGN ® Refractive Studio, Johnson & Johnson Surgical Vision, Inc). Wavefront aberrations up to the 6th order Zernike coefficients, including coma Z(3, -1) and Z(3, 1), spherical aberration Z(4, 1), and the wavefront error of all higher-order aberrations (HOAs RMS), were evaluated across a 6 mm pupil. Results The mean manifest refractive spherical equivalent changed from the preoperative refractions -3.82 ± 1.26 D (range -6.00 to -2.25 D) to the postoperative refractions -0.20 ± 0.15 D (range -0.50 to 0.00 D) at the 9-month follow-up. Compared to baseline preoperative HOAs, the mean postoperative HOAs were significantly increased at the 1-day follow-up. On average, at the 9-month postoperative assessment the vertical coma Z(3, -1) was -0.054 ±0.186 µm, horizontal coma Z(3, 1) was 0.016 ± 0.124 µm, spherical aberration Z(4, 0) was 0.046 ± 0.163 µm, and HOAs RMS was 0.363 ± 0.115 µm across a 6 mm pupil. There is no significant difference in the mean HOAs starting at 1-week follow-up for the horizontal coma (P = 0.346) and spherical aberration (P = 0.095). Conclusions The visual outcomes demonstrated that the SILK procedure for refractive lenticule extraction using ELITA femtosecond laser system is effective and predictable for the correction of myopic refractive errors with and without astigmatism. The ELITA femtosecond laser system induced minimal HOAs in surgical eyes following the SILK procedures. These results demonstrate fast corneal recovery starting at 1-week follow-up, and spherical aberration was not induced.
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Affiliation(s)
- Li Chen
- Johnson & Johnson Surgical Vision, Inc., Milpitas, CA, USA
| | - Pooja Khamar
- Narayana Nethralaya Eye Hospital, Bangalore, India
| | - Ying Wang
- Johnson & Johnson Surgical Vision, Inc., Irvine, CA, USA
| | - Hong Fu
- Johnson & Johnson Surgical Vision, Inc., Milpitas, CA, USA
| | - Rohit Shetty
- Narayana Nethralaya Eye Hospital, Bangalore, India
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Urban B, Bakunowicz-Łazarczyk A. Refractive Surgery in Myopic Children. J Clin Med 2024; 13:4311. [PMID: 39124578 PMCID: PMC11313164 DOI: 10.3390/jcm13154311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/15/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
In this paper, we summarize the current knowledge on refractive surgery performed in the myopic pediatric population. We describe the main concerns about refractive surgery in myopic children and the indications for refractive surgery in this age group. We present a range of surgical procedures that are being used for the management of unilateral/bilateral myopia in children: corneal refractive surgery (PRK, LASEK, LASIK, FS-LASIK and SMILE) and intraocular refractive surgery (phakic intraocular lens implantation, refractive lens exchange or clear lens extraction), with both their advantages and drawbacks. We also describe the various complications and measures to prevent them.
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Affiliation(s)
- Beata Urban
- Department of Pediatric Ophthalmology and Strabismus, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland;
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Wan Q, He P, Wei R, Ma K, Yin H, Tang J, Deng YP. Long-term observation of V4c implantable collamer lenses implantation for moderate to extreme high myopia correction: five years follow-up. Eye (Lond) 2024; 38:1933-1940. [PMID: 38519715 PMCID: PMC11226664 DOI: 10.1038/s41433-024-03046-9] [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: 06/13/2023] [Revised: 03/06/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND This study aims to assess the long term effectiveness, safety, predictability and stability of V4c implantable collamer lenses (ICL) for correction of moderate to extreme high myopia. METHODS We reviewed 125 eyes from 64 patients who implanted V4c ICL at the Refractive Surgery Center of West China Hospital in Chengdu, China, between May 2015 and January 2017. The median spherical equivalent was -11.50 D (interquartile range [IQR]: -13.00 to -9.00 D). We followed up with the patients over five years and evaluated several parameters, including uncorrected visual acuity (UDVA), corrected visual acuity (CDVA), axial length, refractive error, endothelial cell density (ECD), intraocular pressure (IOP), white-to-white distance (WTW), and vault. We performed a correlation analysis to explore the potential impacts on vault following implantation. RESULTS The median safety index (postoperative CDVA/preoperative CDVA) during the last follow-up was 1.00 (interquartile range [IQR]: 1.00-1.20), and the efficacy indices (postoperative UDVA/preoperative CDVA) were 1.20 (IQR: 1.00-1.25), 1.20 (IQR: 1.00-1.33), and 0.8 (IQR: 0.65-1.00) at postoperative 1 week, 1 month, and 5 years, respectively. At the five-year mark, 16% of the eyes were within ±0.50 D of expected correction, and 73% were within ±2.00 D. No significant difference in ECD was observed between pre-operative and post-operative measurements. Compared to baseline, we observed a significant increase in IOP at the one-week follow-up, which decreased significantly at the one-month visit. Furthermore, we identified ICL size and spherical equivalent (SE) as independent variables in a multiple linear regression model that accurately predicted the five-year vault after surgery. CONCLUSION In conclusion, V4c ICL implantation is an effective and safe treatment for moderate to extreme high myopia with good predictability and stability over the long-term.
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Affiliation(s)
- Qi Wan
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Peiyuan He
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Department of Health Management & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Ran Wei
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ke Ma
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Hongbo Yin
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jing Tang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ying-Ping Deng
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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Lee CY, Lian IB, Chen HC, Huang CT, Huang JY, Yang SF, Chang CK. The Efficiency, Predictability, and Safety of First-Generation (Visumax 500) and Second-Generation (Visumax 800) Keratorefractive Lenticule Extraction Surgeries: Real-World Experiences. Life (Basel) 2024; 14:804. [PMID: 39063559 PMCID: PMC11278263 DOI: 10.3390/life14070804] [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: 06/01/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
We aimed to evaluate the postoperative visual and refractive outcomes between the first- and second-generation keratorefractive lenticule extraction (KLEx) surgeries. A retrospective cohort study was conducted and patients who had received first- and second-generation KLEx surgeries were enrolled. A total of 80 and 80 eyes were categorized into the first and second KLEx groups after exclusion, respectively. The primary outcomes were the postoperative uncorrected distance visual acuity (UDVA), spherical equivalent (SE), and safety indexes. An independent t-test and generalized estimate equation were implemented to compare the primary outcomes between the two groups. After the KLEx surgery, the UDVA showed no significant difference between the two groups throughout the study period (all p > 0.05), and the postoperative SE and safety index were also statistically identical between the two groups during the follow-up interval (all p > 0.05). There was a similar trend of visual recovery between the two groups (aOR: 0.967; 95% CI: 0.892-1.143; p = 0.844), while the amplitude of the SE change was significantly lower in the second KLEx group (aOR: 0.760; 95% CI: 0.615-0.837; p = 0.005). Nine and two unintended initial dissection of the posterior plane (UIDPP) occurred intraoperatively in the first and second KLEx groups, respectively, and the second group showed a lower risk of UIDPP (p = 0.032). In conclusion, the efficiency, predictability, and safety are similar between first- and second-generation KLEx surgeries.
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Affiliation(s)
- Chia-Yi Lee
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Nobel Eye Institute, Taipei 115, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung 402, Taiwan
| | - Ie-Bin Lian
- Institute of Statistical and Information Science, National Changhua University of Education, Changhua 500, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou 333, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou 333, Taiwan
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan 333, Taiwan
| | - Chin-Te Huang
- Department of Ophthalmology, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Department of Ophthalmology, School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Chao-Kai Chang
- Nobel Eye Institute, Taipei 115, Taiwan
- Department of Optometry, Da-Yeh University, Chunghua 515, Taiwan
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Lee CY, Jeng YT, Yang SF, Huang CT, Chao CC, Lian IB, Huang JY, Chang CK. Topographic and Surgical Risk Factors for Early Myopic Regression between Small Incision Lenticule Extraction and Laser In Situ Keratomileusis. Diagnostics (Basel) 2024; 14:1275. [PMID: 38928690 PMCID: PMC11202549 DOI: 10.3390/diagnostics14121275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/06/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Our objective was to evaluate the topographic and surgical factors of early myopic regression between laser in situ keratomileusis (LASIK) and small-incision lenticule extraction (SMILE). A retrospective case-control study was conducted, and 368 and 92 eyes were enrolled in the LASIK and SMILE groups via propensity score matching (PSM). Visual acuity, refractive status, axial length, and topographic/surgical parameters were collected. Multiple linear regression was applied to the yield coefficient and the 95% confidence interval (CI) of the parameters. The cumulative incidence of early myopic regression was higher in the LASIK group (p < 0.001). In the SMILE group, a lower central corneal thickness (CCT) thinnest value and a higher corneal cylinder associated with early myopic regression were observed; meanwhile, in the LASIK group, a lower CCT thinnest value, a higher steep corneal curvature, a larger optic zone, and a lower flap thickness related to early myopic regression were observed (all p < 0.05). In the SMILE group, a higher CCT difference correlated with early myopic regression was observed compared to the LASIK group (p = 0.030), and higher steep corneal curvature and lower cap/flap thickness (both p < 0.05) correlated with early myopic regression were observed in the LASIK group compared to the SMILE group. In conclusion, CCT differences significantly influence early myopic regression in the SMILE group; meanwhile, corneal curvature and flap thickness affect early myopic regression principally in the LASIK group.
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Affiliation(s)
- Chia-Yi Lee
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Nobel Eye Institute, Taipei 115, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung 412, Taiwan
| | - Yu-Ting Jeng
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Chin-Te Huang
- Department of Ophthalmology, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Department of Ophthalmology, School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Chen-Cheng Chao
- Nobel Eye Institute, Taipei 115, Taiwan
- Department of Optometry, MacKay Junior College of Medicine, Nursing, and Management, Taipei 112, Taiwan
| | - Ie-Bin Lian
- Institute of Statistical and Information Science, National Changhua University of Education, Changhua 500, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Chao-Kai Chang
- Nobel Eye Institute, Taipei 115, Taiwan
- Department of Optometry, Da-Yeh University, Chunghua 515, Taiwan
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Aghdam HD, Zarei F, Mohammadi SF. Development of a web-based patient decision aid for myopia laser correction method. BMC Med Inform Decis Mak 2024; 24:156. [PMID: 38840124 PMCID: PMC11151511 DOI: 10.1186/s12911-024-02559-3] [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: 03/04/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND In the context of healthcare centered on the patient, Patient Decision Aids (PtDAs) acts as an essential instrument, promoting shared decision-making (SDM). Considering the prevalent occurrence of myopia, the objective of this study is to furnish exhaustive and easily comprehensible information to assist patients in making well-informed decisions about their options for myopia laser correction. METHOD The research team developed a decision guide for myopia patients considering laser correction, aiming to facilitate informed decisions. The study followed the first four stages of the IPDAS process model: "scope/scoping," "design," "prototype development," and "alpha testing." Ten semi-structured interviews with patients (n = 6) and corneal specialist ophthalmologists (n = 4) were conducted to understand the challenges in selecting a laser correction method. Online meetings with 4 corneal specialists were held to discuss challenging cases. A comparison table of harms and benefits was created. The initial prototype was developed and uploaded on the internet portal. User feedback on software and text aspects was incorporated into the final web software, which was reviewed by a health education expert for user-friendliness and effectiveness. RESULT Educational needs assessment revealed concerns such as pain, daily life activities, return to work, the potential need for glasses ('number return'), eye prescription stability, and possible complications. These shaped the decision aid tool's content. Expert consensus was achieved in several areas, with some items added or extended. In areas lacking consensus, comments were added for clarity. Five clients assessed the web app (PDAIN), rating it 46/50 in user-centricity, 47/50 in usability, and 45/50 in accuracy and reliability, totaling 138/150. Post-piloting, software errors were documented and rectified. During the trial phase, five myopic users interacted with the software, leading to modifications. User feedback indicated the tool effectively enhanced understanding and influenced decision-making. CONCLUSION PDAIN, serves as a facilitative tool in the process of selecting a corneal laser correction method for myopic patients. It enabling Nearsighted patients to make informed decisions.
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Affiliation(s)
- Hanieh Delshad Aghdam
- Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University, Tehran Jalal AleAhmad Nasr, P.O.Box: 14115-111, Teharn, Iran
| | - Fatemeh Zarei
- Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University, Tehran Jalal AleAhmad Nasr, P.O.Box: 14115-111, Teharn, Iran.
| | - Seyed Farzad Mohammadi
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Huang Y, Zhan B, Han T, Zhou X. Effective optical zone following small incision lenticule extraction: a review. Graefes Arch Clin Exp Ophthalmol 2024; 262:1657-1665. [PMID: 37851133 DOI: 10.1007/s00417-023-06263-2] [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: 04/14/2023] [Revised: 08/18/2023] [Accepted: 10/01/2023] [Indexed: 10/19/2023] Open
Abstract
Small incision lenticule extraction (SMILE) is a "flapless" keratorefractive surgery with excellent safety, efficacy, stability, and predictability for myopia correction. A recent global multicenter study also reported good refractive outcomes for hyperopic SMILE. SMILE has shown advantages including improved biomechanical strength, fewer dry eye symptoms, less corneal denervation, and fewer surgery-induced higher-order aberrations over laser in situ keratomileusis (LASIK). However, night vision complaints, including glare, halos, and starbursts, could still occur after SMILE. These symptoms have been proven to be closely related to the effective optical zone (EOZ), which is defined as the achieved area of corneal ablation. A larger postoperative EOZ may indicate better visual quality, making EOZ an important safety parameter for keratorefractive surgeries. As SMILE has gained wider application globally, the EOZ following SMILE has also been increasingly studied in the field of refractive surgery. This review provides an update on topics related to the EOZ after SMILE, including its measurement and influencing factors, aiming to benefit the personalization of the surgical algorithm and ultimately improve the visual quality after the SMILE procedure.
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Affiliation(s)
- Yangyi Huang
- Eye Institute and Department of Ophthalmology and Vision Science, 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, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Biyun Zhan
- Eye Institute and Department of Ophthalmology and Vision Science, 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, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Tian Han
- Eye Institute and Department of Ophthalmology and Vision Science, 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, 200031, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China.
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology and Vision Science, 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, 200031, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China.
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Lin F, Han X, Liu S, Wei R, Zhou X, Li M. Lenticule Intrastromal Keratoplasty for the Correction of Iatrogenic High Hyperopia. Cornea 2024; 43:734-739. [PMID: 37824192 DOI: 10.1097/ico.0000000000003406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE The aim of this study was to evaluate the safety, efficacy, and predictability of lenticule intrastromal keratoplasty (LIKE) for the correction of iatrogenic high hyperopia. METHODS Three patients (4 eyes) were referred to our department because of overcorrection of myopia induced by femtosecond laser-assisted in situ keratomileusis. All eyes exhibited hyperopia (between +4.00 and +8.00 D) and thin corneas ranging from 307 to 378 μm. Because of the regression of the use of laser ablation to correct high hyperopia and thin corneas, we initially adopted LIKE to correct iatrogenic high hyperopia in all 4 eyes. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, corneal topography, and anterior segment optical coherence tomography findings were recorded during each follow-up evaluation. RESULTS No postoperative complications, such as interface haze and opacification, were observed in the 4 eyes during each follow-up evaluation, with an average follow-up of 9.50 months. All eyes had significantly improved UDVA postoperatively. A total of 3 eyes achieved an UDVA of 20/25 or better while the other 1 eye had an UDVA of 20/40 postoperatively. In addition, 2 of the 4 eyes had a postoperative UDVA equal to or better than preoperative CDVA. No eyes lost any CDVA lines. All 4 eyes were within ±0.50 D of the spherical power (intended target of 0). The central corneal thickness and curvature of the anterior corneal surface in all 4 eyes increased postoperatively. Anterior segment optical coherence tomography revealed that the lenticule was transparent, with no wrinkles or offsets, during each follow-up evaluation. CONCLUSIONS LIKE for the correction of iatrogenic hyperopia has good efficacy and safety. Although an extremely thin cornea after overcorrection may not be suitable for hyperopic laser enhancement, LIKE is a good choice because of its good predictability and ability to restore the normal corneal structure.
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Affiliation(s)
- Feng Lin
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Xiaosong Han
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Shengtao Liu
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Ruoyan Wei
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Meiyan Li
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
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Du Y, Di Y, Yang S, Mo F, Cui G, Chen D, Li Y. Association of myopia and astigmatism with postoperative ocular high order aberration after small incision lenticule extraction. BMC Ophthalmol 2024; 24:211. [PMID: 38741093 DOI: 10.1186/s12886-024-03475-w] [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: 02/08/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVE To investigate the correlation between higher-order aberrations (HOA) after small incision lenticule extraction (SMILE) and the severity of myopia and astigmatism, along with the relevant factors. These findings will provide valuable insights for decreasing the occurrence of HOA after SMILE and enhancing visual quality. METHODS A total of 75 patients (150 eyes) with myopia and astigmatism who underwent SMILE were categorized into four groups based on the severity of myopia and astigmatism: Myopia Group 1 (Group M1, spherical diopter ranged from -1.00 D to -4.00 D), Myopia Group 2 (Group M2, spherical diopter ranged from -4.10 D to -10.00 D), Astigmatism Group 1 (Group A1, cylindrical diopter ranged from 0 D to -1.00 D), and Astigmatism Group 2 (Group A2, cylindrical diopter ranged from -1.10 D to -3.00 D). A comprehensive assessment was performed to examine the association between HOA and various relevant factors, including a detailed analysis of the subgroups. RESULTS Group M1 had significantly lower levels of total eye coma aberration (CA), corneal total HOA (tHOA), internal tHOA, and vertical CA ( Z 3 - 1 ) after SMILE than Group M2 (P < 0.05). Similarly, Group A1 had significantly lower levels of total eye tHOA, CA, trefoil aberration (TA), corneal tHOA, TA, and vertical TA ( Z 3 - 3 ) after SMILE than Group A2 (P < 0.05). Pearson correlation analysis indicated a statistically significant positive relationship between the severity of myopia/astigmatism and most HOA (P < 0.05). Subgroup evaluations demonstrated a notable increase in postoperative HOA associated with myopia and astigmatism in Groups M2 and A2 compared with the control group. Lenticule thickness, postoperative central corneal thickness (CCT), postoperative uncorrected distance visual acuity (UDVA), and postoperative corneal Km and Cyl were strongly correlated with most HOA. Age, eyes, and postoperative intraocular pressure (IOP) were only associated with specific HOA. CONCLUSION HOA positively correlated with the severity of myopia and astigmatism after SMILE. However, this relationship was not linear. HOA after SMILE was influenced by various factors, and additional specialized investigations are required to establish its clinical importance.
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Affiliation(s)
- Yifan Du
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Yu Di
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Shan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Fei Mo
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Ge Cui
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Di Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Ying Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China.
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10
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Talens-Estarelles C, Talens-Estarelles C, García-Lázaro S. Ocular surface changes following computer use in post-LASIK patients. Ophthalmic Physiol Opt 2024; 44:554-563. [PMID: 38386250 DOI: 10.1111/opo.13297] [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: 12/13/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE To assess the impact of computer use on the ocular surface of individuals after laser in situ keratomileusis (LASIK). METHODS The dry eye symptoms and ocular surface of 18 post-LASIK young individuals and 18 controls were evaluated before and after performing a 30-min task on a computer without (Visit 1) and with (Visit 2) initial instillation of artificial tears. Symptoms were assessed using the Ocular Surface Disease Index (OSDI), Symptom Assessment in Dry Eye questionnaire version two (SANDE II) and Computer Vision Syndrome Questionnaire (CVS-Q). The ocular surface was assessed by measuring corneal higher order aberrations, tear meniscus height (TMH), conjunctival redness, blink rate and incomplete blinking, lipid layer thickness (LLT) and non-invasive keratograph break-up time (NIKBUT). RESULTS SANDE II scores were >0 after the computer task in both groups (p ≤ 0.01). SANDE II and CVS-Q scores did not differ between LASIK and controls (p ≥ 0.43). Greater bulbar-temporal conjunctival redness, TMH and LLT and shorter NIKBUT were found after computer use in the LASIK group (p ≤ 0.04), whereas no changes were observed in the controls (p ≥ 0.20). Lower SANDE II and CVS-Q scores were reported at Visit 2 compared with Visit 1 in both groups (p ≤ 0.01). Likewise, no worsening of dry eye signs was observed at Visit 2 (p ≥ 0.11). CONCLUSIONS Ocular symptoms reported during computer use were comparable between the groups. However, a worsening of dry eye signs was mostly observed in post-LASIK individuals. The instillation of artificial tears was effective in preventing the effects of computer use on the ocular surface in post-LASIK patients.
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Affiliation(s)
| | | | - Santiago García-Lázaro
- Department of Optics & Optometry & Vision Science, University of Valencia, Valencia, Spain
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11
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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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12
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Fantaci B, Calvo B, Barraquer R, Picó A, Ariza-Gracia MÁ. Establishing Standardization Guidelines For Finite-Element Optomechanical Simulations of Refractive Laser Surgeries: An Application to Photorefractive Keratectomy. Transl Vis Sci Technol 2024; 13:11. [PMID: 38748408 PMCID: PMC11103740 DOI: 10.1167/tvst.13.5.11] [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: 11/09/2023] [Accepted: 04/02/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose Computational models can help clinicians plan surgeries by accounting for factors such as mechanical imbalances or testing different surgical techniques beforehand. Different levels of modeling complexity are found in the literature, and it is still not clear what aspects should be included to obtain accurate results in finite-element (FE) corneal models. This work presents a methodology to narrow down minimal requirements of modeling features to report clinical data for a refractive intervention such as PRK. Methods A pipeline to create FE models of a refractive surgery is presented: It tests different geometries, boundary conditions, loading, and mesh size on the optomechanical simulation output. The mechanical model for the corneal tissue accounts for the collagen fiber distribution in human corneas. Both mechanical and optical outcome are analyzed for the different models. Finally, the methodology is applied to five patient-specific models to ensure accuracy. Results To simulate the postsurgical corneal optomechanics, our results suggest that the most precise outcome is obtained with patient-specific models with a 100 µm mesh size, sliding boundary condition at the limbus, and intraocular pressure enforced as a distributed load. Conclusions A methodology for laser surgery simulation has been developed that is able to reproduce the optical target of the laser intervention while also analyzing the mechanical outcome. Translational Relevance The lack of standardization in modeling refractive interventions leads to different simulation strategies, making difficult to compare them against other publications. This work establishes the standardization guidelines to be followed when performing optomechanical simulations of refractive interventions.
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Affiliation(s)
- Benedetta Fantaci
- Aragon Institute of Engineering Research (i3A), Universidad de Zaragoza, Spain
| | - Begoña Calvo
- Aragon Institute of Engineering Research (i3A), Universidad de Zaragoza, Spain
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Rafael Barraquer
- Centro de Oftalmología Barraquer, Barcelona, Spain
- Institut Universitari Barraquer, Universitat Autónoma de Barcelona, Barcelona, Spain
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - Andrés Picó
- Centro de Oftalmología Barraquer, Barcelona, Spain
- Institut Universitari Barraquer, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Miguel Ángel Ariza-Gracia
- Bioengineering, Biomaterials and Nanomedicine Networking Biomedical Research Centre (CIBER-BBN), Universidad de Zaragoza, Zaragoza, Spain
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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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Li LP, Yuan LY, Mao DS, Hua X, Yuan XY. Systematic bibliometric analysis of research hotspots and trends on the application of premium IOLs in the past 2 decades. Int J Ophthalmol 2024; 17:736-747. [PMID: 38638264 PMCID: PMC10988063 DOI: 10.18240/ijo.2024.04.19] [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: 12/05/2023] [Accepted: 01/17/2024] [Indexed: 04/20/2024] Open
Abstract
AIM To analysis of research hotspots and trends on the application of premium intraocular lens (PIOLs) in the past 2 decades. METHODS The literature search was performed on the Web of Science and included PIOLs studies published between January 2000 and December 2022. The retrieved literature was collated and analyzed by R-tool's Bibliometrix package, CitNetExplorer, CiteSpace and other software. RESULTS A total of 1801 articles about PIOLs were obtained, most of which were published in Spain and the United States. The organization that published the most articles was the University of Valencia in Spain. Alió JL, and Montés-Micó R, from Spain were the most influential authors in this field. The Journal of Cataract and Refractive Surgery and Journal of Refractive Surgery were the core journals for this field; the top 10 cited articles mainly focus on postoperative satisfaction with multifocal intraocular lens (IOLs) and postoperative results of toric IOLs. Through the keyword analysis, we found that trifocal IOLs, astigmatism and extended depth of focus (EDoF) IOLs are the most discussed topics at present, and the importance of astigmatism and the clinical application of the new generation of PIOLs are the emerging research trends. CONCLUSION Bibliometric analysis can effectively help to identify multilevel concerns in PIOLs research and the prevailing research trends in the realm of PIOLs encompass the adoption of EDoF IOLs, trifocal IOLs, and their respective Toric models.
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Affiliation(s)
- Liang-Pin Li
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300020, China
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin 300020, China
| | - Li-Yun Yuan
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin 300020, China
- School of Medicine, Nankai University, Tianjin 300071, China
| | - De-Shen Mao
- Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Xia Hua
- Tianjin Aier Eye Hospital, Tianjin University, Tianjin 300190, China
| | - Xiao-Yong Yuan
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300020, China
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin 300020, China
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Lee CY, Jeng YT, Chao CC, Lian IB, Huang JY, Yang SF, Chang CK. Refraction and topographic risk factors for early myopic regression after small-incision lenticule extraction surgery. Sci Rep 2024; 14:8732. [PMID: 38627567 PMCID: PMC11021515 DOI: 10.1038/s41598-024-59327-6] [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: 09/19/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
We sought to evaluate the topographic risk factors for early myopic regression after small-incision lenticule extraction (SMILE). A retrospective case‒control study was conducted, and individuals who underwent SMILE surgery were enrolled. Among them, 406 and 14 eyes were categorized into the nonregression and regression groups, respectively. The preoperative and postoperative parameters in the two groups were collected, including spherical refraction (SE), axial length (AXL) and topographic data. A generalized linear model was adopted to analyze the difference in each parameter between the two groups. After 6 months, UCVA decreased in the regression group, and SE increased in the regression group (both P < 0.05). The increase in the CCT at the thinnest point (P = 0.044), flat corneal curvature (P = 0.012) and TCRP (P = 0.001) were significantly greater in the regression group. Regarding the risk factors for myopic regression, preoperative SE, preoperative sphere power, preoperative AXL, preoperative flat corneal curvature, preoperative SA, early postoperative SE, early postoperative sphere power, early postoperative AXL and early postoperative CCT difference were significantly greater in the regression group (all P < 0.05). The SE, sphere power, AXL, preoperative flat corneal curvature, preoperative SA, and postoperative CCT difference correlate with early myopic regression after SMILE.
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Affiliation(s)
- Chia-Yi Lee
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist., Taipei, 100008, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan
| | - Yu-Ting Jeng
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist., Taipei, 100008, Taiwan
| | - Chen-Cheng Chao
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist., Taipei, 100008, Taiwan
- Department of Optometry, MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Ie-Bin Lian
- Institute of Statistical and Information Science, National Changhua University of Education, Changhua, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
| | - Chao-Kai Chang
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist., Taipei, 100008, Taiwan.
- Department of Optometry, Da-Yeh University, Chunghua, Taiwan.
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16
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Du Y, Di Y, Yang S, Mo F, Cui G, Chen D, Li Y. Differences in ocular high order aberrations before and after small incision lenticule extraction for correction of myopia: a systematic review and meta-analysis. Front Med (Lausanne) 2024; 11:1274101. [PMID: 38601117 PMCID: PMC11004322 DOI: 10.3389/fmed.2024.1274101] [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: 08/07/2023] [Accepted: 03/13/2024] [Indexed: 04/12/2024] Open
Abstract
Objective To examine the causes and factors that lead to high order aberration (HOA) during the treatment of myopia using small incision lenticule extraction (SMILE), as well as the differences between SMILE and other corneal refractive surgeries through a systematic review and meta-analysis. Methods A systematic search was conducted from January 2015 to February 2023 in Pubmed, Embase, Web of Science, and Google Scholar databases to gather relevant studies on SMILE and HOA. Studies meeting specific criteria were chosen, and clinical data was retrieved for analysis. Results This meta-analysis resulted in the inclusion of 19 studies involving 1,503 eyes. Pooled results showed significant induction of total HOA (tHOA, d = -0.21, p < 0.001), spherical aberration (SA, d = -0.11, p < 0.001) and coma aberration (CA, d = -0.18, p < 0.001) after SMILE compared to pre-SMILE, while no significant change in trefoil aberration (TA) was observed (d = -0.00, p = 0.91). There was a significantly lower induction of tHOA after SMILE compared to femtosecond laser-assisted in situ keratomileusis (FS-LASIK, d = 0.04, p < 0.001), and no significant difference was observed compared to wavefront aberration-guided (WFG) refractive surgery (d = 0.00, p = 0.75). There was also a significant association between different levels of myopia and astigmatism, duration of follow-up, lenticule thickness, and preoperative central corneal thickness (CCT) on the induction of tHOA after SMILE (p < 0.05), while the higher preoperative myopia group (sphere > -5D), lower preoperative astigmatism group (cylinder ≤ -1D), larger lenticule thickness group (lenticule thickness > 100 μm), shorter follow-up group (follow-up 1 month postoperatively) and the thicker CCT group (CCT > 550 μm) brought a significant induction of tHOA compared to the opposite comparison group (p < 0.001). Conclusion While SMILE can induce HOA significantly, it induces less HOA than FS-LASIK. Postoperative HOA following SMILE can be affected by factors such as myopia, astigmatism, lenticule thickness, CCT, and duration of follow-up. Future research should continue to explore techniques to decrease the induction of HOA by using this methodology. Systematic review registration https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
| | | | | | | | | | | | - Ying Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Chandran C, Santra M, Rubin E, Geary ML, Yam GHF. Regenerative Therapy for Corneal Scarring Disorders. Biomedicines 2024; 12:649. [PMID: 38540264 PMCID: PMC10967722 DOI: 10.3390/biomedicines12030649] [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: 02/15/2024] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 05/09/2024] Open
Abstract
The cornea is a transparent and vitally multifaceted component of the eye, playing a pivotal role in vision and ocular health. It has primary refractive and protective functions. Typical corneal dysfunctions include opacities and deformities that result from injuries, infections, or other medical conditions. These can significantly impair vision. The conventional challenges in managing corneal ailments include the limited regenerative capacity (except corneal epithelium), immune response after donor tissue transplantation, a risk of long-term graft rejection, and the global shortage of transplantable donor materials. This review delves into the intricate composition of the cornea, the landscape of corneal regeneration, and the multifaceted repercussions of scar-related pathologies. It will elucidate the etiology and types of dysfunctions, assess current treatments and their limitations, and explore the potential of regenerative therapy that has emerged in both in vivo and clinical trials. This review will shed light on existing gaps in corneal disorder management and discuss the feasibility and challenges of advancing regenerative therapies for corneal stromal scarring.
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Affiliation(s)
- Christine Chandran
- Corneal Regeneration Laboratory, Department of Ophthalmology, Mercy Vision Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA; (C.C.); (M.S.); (E.R.); (M.L.G.)
| | - Mithun Santra
- Corneal Regeneration Laboratory, Department of Ophthalmology, Mercy Vision Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA; (C.C.); (M.S.); (E.R.); (M.L.G.)
| | - Elizabeth Rubin
- Corneal Regeneration Laboratory, Department of Ophthalmology, Mercy Vision Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA; (C.C.); (M.S.); (E.R.); (M.L.G.)
| | - Moira L. Geary
- Corneal Regeneration Laboratory, Department of Ophthalmology, Mercy Vision Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA; (C.C.); (M.S.); (E.R.); (M.L.G.)
| | - Gary Hin-Fai Yam
- Corneal Regeneration Laboratory, Department of Ophthalmology, Mercy Vision Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA; (C.C.); (M.S.); (E.R.); (M.L.G.)
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA
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18
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Miki A, Fuse N, Fujimoto S, Taira M, Saito T, Okazaki T, Shiraki A, Sato S, Kawasaki R, Nakamura T, Kinoshita K, Nishida K, Yamamoto M. Prevalence, Associated Factors, and Inter-Eye Differences of Refractive Errors in a Population-Based Japanese Cohort: The Tohoku Medical Megabank Eye Study. Ophthalmic Epidemiol 2024; 31:46-54. [PMID: 37095711 DOI: 10.1080/09286586.2023.2203226] [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: 07/07/2022] [Accepted: 04/09/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE To investigate the prevalence, associated factors, and inter-eye differences of myopia and astigmatism in an adult Japanese population-based cohort. METHODS A total of 4282 participants from the Tohoku Medical Megabank Organization Eye Study (ToMMo Eye Study) underwent comprehensive ocular examinations as well as extensive physiological tests and a lifestyle questionnaire. The spherical equivalent (SE) and cylinder power were obtained as refractive parameters. The age- and gender-stratified prevalences of high myopia (SE < -5D), myopia (SE < -0.5D), hyperopia (SE > 0.5D), astigmatism (cylinder power < -0.5D), and anisometropia (SE difference >1D) were calculated. Multivariable analyses were performed to identify associated factors for refractive error (RE). Distribution and associated factors of the inter-eye difference in RE were also investigated. RESULTS The age-adjusted prevalence of high myopia, myopia, hyperopia, astigmatism, and anisometropia was 15.9%, 63.5%, 14.7%, 51.1%, and 14.7%, respectively. Both myopia and high myopia were more prevalent in the younger age group, while astigmatism was more prevalent in the older age group. Age, education, blood pressure, intraocular pressure, and corneal thickness are significantly associated with myopic refraction. Age, gender, intraocular pressure, and corneal thickness are correlated with astigmatism. Older age was associated with against-the-rule astigmatism. Older age, myopia, and longer education showed a significant correlation with large inter-eye differences in SERE. CONCLUSIONS This study demonstrated the high prevalence of myopia in young Japanese, which may be caused by a generational shift. This study also confirmed the influence of age and education on both the prevalence and inter-eye differences of RE.
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Affiliation(s)
- Atsuya Miki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Myopia Control Resaerch, Aichi Medical University, Aichi, Japan
| | - Nobuo Fuse
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Satoko Fujimoto
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
- Hawaii Macula and Retina Institute, Aiea, HI, USA
| | - Makiko Taira
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomo Saito
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Tomoyuki Okazaki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akihiko Shiraki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Sato
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
- Laboratory of Regenerative Medicine and Development, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Applied Information Science, Tohoku University Graduate School of Information Sciences, Sendai, Japan
| | - Ryo Kawasaki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Vision Informatics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomohiro Nakamura
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Kengo Kinoshita
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Department of Applied Information Science, Tohoku University Graduate School of Information Sciences, Sendai, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Osaka, Japan
| | - Masayuki Yamamoto
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Tohoku University Graduate School of Medicine, Sendai, Japan
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19
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Lee CY, Shen JH, Chao CC, Lian IB, Huang JY, Yang SF, Chang CK. Topographic and surgical risk factors for high postoperative residual astigmatism after small incision lenticule extraction in patients with different degrees of myopia: a retrospective cohort study. BMC Ophthalmol 2024; 24:45. [PMID: 38287289 PMCID: PMC10826184 DOI: 10.1186/s12886-024-03296-x] [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: 09/19/2023] [Accepted: 01/15/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND To evaluate the possible topographic and surgical risk factors for high postoperative residual astigmatism in patients who undergo small-incision lenticule extraction (SMILE) surgery and have different myopia degrees. METHODS A retrospective cohort study was conducted, and patients who underwent SMILE surgery were enrolled. A total of 80 and 150 eyes from 40 to 75 individuals, respectively, were selected as the low myopia and high myopia groups. The demographic data, visual acuity, refraction, topographic parameters and surgical settings were recorded. Multiple linear regression with interaction tests were performed to survey the risk factors for high postoperative residual astigmatism in each group. RESULTS Five (6.25%) and 9 (6.00%) eyes presented with high postoperative residual astigmatism in the low myopia and high myopia groups, respectively, but these differences were not significant (P = 0.569). A steep corneal curvature was correlated with a greater risk of high postoperative residual astigmatism in the low myopia group (P = 0.015), while a higher degree of cycloplegic cylinder power, steeper corneal curvature, greater topographic cylinder power, smaller optic zone and longer incision length were associated with a high rate of postoperative residual astigmatism in the high myopia group (all P < 0.05). In addition, the interaction effects of cycloplegic and topographic cylinder power and longer incision length on the incidence of high postoperative residual astigmatism development were more evident in the high myopia group than in the low myopia group (all P < 0.05). CONCLUSIONS A steep corneal curvature correlates with a high risk of high postoperative residual astigmatism after SMILE surgery, and a higher degree of cycloplegic and topographic cylinder and longer incision are associated with high postoperative residual astigmatism in individuals with high myopia.
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Affiliation(s)
- Chia-Yi Lee
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist, 100008, Taipei, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan
| | - Jen-Hsiang Shen
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist, 100008, Taipei, Taiwan
| | - Chen-Cheng Chao
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist, 100008, Taipei, Taiwan
- Department of Optometry, Nursing, and Management, MacKay Junior College of Medicine, Taipei, Taiwan
| | - Ie-Bin Lian
- Institute of Statistical and Information Science, National Changhua University of Education, Changhua, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chao-Kai Chang
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist, 100008, Taipei, Taiwan.
- Department of Optometry, Da-Yeh University, Changhua, Taiwan.
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20
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Di Y, Fang H, Luo Y, Li Y, Xu Y. Predicting Implantable Collamer Lens Vault Using Machine Learning Based on Various Preoperative Biometric Factors. Transl Vis Sci Technol 2024; 13:8. [PMID: 38224328 PMCID: PMC10793387 DOI: 10.1167/tvst.13.1.8] [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: 08/30/2023] [Accepted: 12/06/2023] [Indexed: 01/16/2024] Open
Abstract
Purpose To predict the vault size after Implantable Collamer Lens (ICL) V4c implantation using machine learning methods and to compare the predicted vault with the conventional manufacturer's nomogram. Methods This study included 707 patients (707 eyes) who underwent ICL V4c implantation at the Department of Ophthalmology, Peking Union Medical College Hospital, from September 2019 to January 2022. Random Forest Regression (RFR), XGBoost, and linear regression (LR) were used to predict the vault size 1 week after ICL V4c implantation. The mean absolute error (MAE), median absolute error (MedAE), root mean square error (RMSE), symmetric mean absolute percentage error (SMAPE), and Bland-Altman plot were utilized to compare the prediction performance of these machine learning methods. Results The dataset was divided into a training set of 180 patients (180 eyes) and a test set of 527 patients (527 eyes). XGBoost had the lowest prediction error, with mean MAE, RMSE, and SMAPE values of 121.70 µm, 148.87 µm, and 19.13%, respectively. The Bland‒Altman plots of RFR and XGBoost showed better prediction consistency than LR. However, XGBoost showed narrower 95% limits of agreement (LoA) than RFR, ranging from -307.12 to 256.59 µm. Conclusions XGBoost demonstrated better predictive performance than RFR and LR, as it had the lowest prediction error and the narrowest 95% LoA. Machine learning may be applicable for vault prediction, and it might be helpful for reducing the complications and the secondary surgery rate. Translational Relevance Using the proposed machine learning model, surgeons can consider the postoperative vault to reduce the surgical complications.
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Affiliation(s)
- Yu Di
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Huihui Fang
- School of Future Technology, South China University of Technology, Guangzhou, China
- Pazhou Lab, Guangzhou, China
| | - Yan Luo
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanwu Xu
- School of Future Technology, South China University of Technology, Guangzhou, China
- Pazhou Lab, Guangzhou, China
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Chen H, Yang S, Lee C, Hsueh Y, Huang J, Chang C. Differences in change of post-operative antioxidant levels between laser-assisted lenticule extraction and femtosecond laser in situ keratomileusis. J Cell Mol Med 2024; 28:e18069. [PMID: 38051678 PMCID: PMC10826428 DOI: 10.1111/jcmm.18069] [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: 06/28/2023] [Revised: 10/31/2023] [Accepted: 11/22/2023] [Indexed: 12/07/2023] Open
Abstract
To evaluate the change of total antioxidant capacity (TAC) and ascorbic acid (AA) between femtosecond laser in situ keratomileusis (FS-LASIK) and laser-assisted lenticule extraction (LALEX). A prospective non-randomized study was conducted, and 33 and 75 eyes that had undergone FS-LASIK or LALEX surgeries were enrolled, respectively. The tear films near corneal incisions were collected, and the concentrations of TAC and AA were determined. The generalized linear mixed model was adopted to calculate the adjusted odds ratio (aOR) with 95% confidence interval (CI) of TAC and AA between the two groups. The AA reduction was significant 1 month after the LALEX and FS-LASIK procedures (both p < 0.05), and the decrement in AA level was significantly larger in the FS-LASIK group compared to the LALEX group (p = 0.0002). In the subgroup analysis, the LALEX group demonstrated a lower decrement in TAC level in the individuals with dry eye disease (DED) than the FS-LASIK group (p = 0.0424), and the LALEX group demonstrated a significantly lower AA decrement in the participants with high myopia (p = 0.0165) and DED (p = 0.0043). The LALEX surgery causes lesser AA decrement compared to FS-LASIK surgery especially for the patients with DED.
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Affiliation(s)
- Hung‐Chi Chen
- Department of OphthalmologyChang Gung Memorial HospitalLinkouTaiwan
- Department of MedicineChang Gung University College of MedicineTaoyuanTaiwan
- Center for Tissue EngineeringChang Gung Memorial HospitalLinkouTaiwan
| | - Shun‐Fa Yang
- Institute of Medicine, Chung Shan Medical UniversityTaichungTaiwan
- Department of Medical ResearchChung Shan Medical University HospitalTaichungTaiwan
| | - Chia‐Yi Lee
- Institute of Medicine, Chung Shan Medical UniversityTaichungTaiwan
- Nobel Eye InstituteTaipeiTaiwan
- Department of Ophthalmology, Jen‐Ai Hospital Dali BranchTaichungTaiwan
| | - Yi‐Jen Hsueh
- Department of OphthalmologyChang Gung Memorial HospitalLinkouTaiwan
- Center for Tissue EngineeringChang Gung Memorial HospitalLinkouTaiwan
| | - Jing‐Yang Huang
- Department of Medical ResearchChung Shan Medical University HospitalTaichungTaiwan
| | - Chao‐Kai Chang
- Nobel Eye InstituteTaipeiTaiwan
- Department of OptometryDa‐Yeh UniversityChunghuaTaiwan
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Ting DSJ, Gatinel D, Ang M. Cataract surgery after corneal refractive surgery: preoperative considerations and management. Curr Opin Ophthalmol 2024; 35:4-10. [PMID: 37962882 DOI: 10.1097/icu.0000000000001006] [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: 11/15/2023]
Abstract
PURPOSE OF REVIEW Corneal refractive surgery (CRS) is one of the most popular eye procedures, with more than 40 million cases performed globally. As CRS-treated patients age and develop cataract, the number of cases that require additional preoperative considerations and management will increase around the world. Thus, we provide an up-to-date, concise overview of the considerations and outcomes of cataract surgery in eyes with previous CRS, including surface ablation, laser in-situ keratomileusis (LASIK), and small-incision lenticule extraction (SMILE). RECENT FINDINGS Challenges associated with accurate biometry in eyes with CRS have been mitigated recently through total keratometry, ray tracing, intraoperative aberrometry, and machine learning assisted intraocular lens (IOL) power calculation formulas to improve prediction. Emerging studies have highlighted the superior performance of ray tracing and/or total keratometry-based formulas for IOL power calculation in eyes with previous SMILE. Dry eye remains a common side effect after cataract surgery, especially in eyes with CRS, though the risk appears to be lower after SMILE than LASIK (in the short-term). Recent presbyopia-correcting IOL designs such as extended depth of focus (EDOF) IOLs may be suitable in carefully selected eyes with previous CRS. SUMMARY Ophthalmologists will increasingly face challenges associated with the surgical management of cataract in patients with prior CRS. Careful preoperative assessment of the ocular surface, appropriate use of IOL power calculation formulas, and strategies for presbyopia correction are key to achieve good clinical and refractive outcomes and patient satisfaction. Recent advances in CRS techniques, such as SMILE, may pose new challenges for such eyes in the future.
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Affiliation(s)
- Darren S J Ting
- Birmingham and Midland Eye Centre, Birmingham
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Damien Gatinel
- Department of Anterior Segment and Refractive Surgery, Rothschild Foundation Hospital, Paris, France
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
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Xu Y, Han Y, Lv X, Li J, Zhai C, Zhang F. Associations of Near Work, Time Outdoors, and Sleep Duration With Myopic Regression 5 Years After SMILE and FS-LASIK: A Cross-sectional Study. J Refract Surg 2024; 40:e10-e19. [PMID: 38190564 DOI: 10.3928/1081597x-20231212-04] [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: 01/10/2024]
Abstract
PURPOSE To investigate the association of near work, time outdoors, and sleep duration with myopic regression 5 years after small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) . METHODS This cross-sectional study included patients who received SMILE or FS-LASIK at Beijing Tongren Hospital 5 years ago. The patients underwent ophthalmic examinations including visual acuity, intraocular pressure, subjective refraction, slit-lamp examination, keratometry, corneal topography, optical coherence tomography, and fundus examination from January 2020 to March 2023. Fluorescein break-up time was measured and the Ocular Surface Disease Index questionnaire was completed to exclude dry eye. A self-administered questionnaire was used to collect data on near work exposure, physical activities, and sleep duration. RESULTS A total of 323 eyes were included in the analysis, with a 5-year incidence rate of myopic regression after SMILE or FSLASIK of 16.1%. After adjusted for all confounders, total near work more than 8 hours/day revealed a significant association with myopic regression (odds ratio: 2.461; 95% CI: 1.143 to 5.298, P = .021), particularly in younger adults, women, and patients with high myopia and FS-LASIK treatment. The significant association between sleep duration 8 hours/day or more and myopic regression was restricted to women and patients with FS-LASIK (near significant). However, no significant associations were observed between continuous near work or time outdoors and myopic regression. CONCLUSIONS Excessive near work exposure was associated with greater myopic regression 5 years after SMILE or FS-LASIK. It is crucial to maintain good visual behavior and care for preventing regression after SMILE or FS-LASIK, especially for younger patients and eyes with high myopia. [J Refract Surg. 2024;40(1):e10-e19.].
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Sun S, Sun M, Tang J, Yang F, Liu Z, Zhao S, Huang Y. A comparative study of pupil offset measurement using Pentacam and Keratron Scout in myopic young adults. Clin Exp Optom 2024; 107:40-46. [PMID: 37156100 DOI: 10.1080/08164622.2023.2203316] [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: 02/09/2023] [Accepted: 04/11/2023] [Indexed: 05/10/2023] Open
Abstract
CLINICAL RELEVANCE Assessing the consistency of pupil offset measurements between the Pentacam and Keratron Scout is essential for the refractive surgery design of young myopic patients. BACKGROUND Accurate preoperative measurement of pupil offset is critical to achieving a better quality of vision after refractive surgery. The Pentacam and Keratron Scout are commonly used in hospitals, and evaluating their consistency is essential for accurate measurement of pupil offset. METHODS Six hundred eyes (600 subjects) were included in this study. Pupil offset and its X, Y-component were measured by Pentacam and Keratron Scout, respectively. Agreement and repeatability between the two devices were identified by intraclass correlation coefficient and Bland-Altman plots with 95% limits of agreement. Paired t-tests and Pearson analysis were used to compare the differences and correlations between the two devices. RESULTS The mean age of all subjects was 23 ± 5 years. The mean pupil offset magnitude obtained from Pentacam and Keratron Scout was 0.16 ± 0.08 mm and 0.15 ± 0.07 mm. The 95% limits of agreement (-0.11-0.13, -0.09-0.11, and -0.11-0.12) and intraclass correlation coefficient (0.82, 0.84, and 0.81) demonstrated good agreement and repeatability of the two devices in measuring pupil offset and its X, Y-component. A significant correlation between the two devices was found (r = 0.71, 0.73, and 0.70). The direction of pupil offset measured by the devices was both predominately towards the superonasal quadrant. CONCLUSION Pentacam and Keratron Scout showed good agreement in measuring pupil offset and its X, Y-component, which can be used interchangeably in clinical practice.
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Affiliation(s)
| | | | | | | | | | - Shaozhen Zhao
- Tianjin Medical University Eye Hospital, College of Optometry, Institute of Ophthalmology, National Clinical Medical Research Center for Eye, Ear, Nose and Throat Diseases, Tianjin Branch, Tianjin Key Laboratory of Retinal Function and Diseases, Tianjin 300384, China
| | - Yue Huang
- Tianjin Medical University Eye Hospital, College of Optometry, Institute of Ophthalmology, National Clinical Medical Research Center for Eye, Ear, Nose and Throat Diseases, Tianjin Branch, Tianjin Key Laboratory of Retinal Function and Diseases, Tianjin 300384, China
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25
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Kanclerz P, Khoramnia R, Atchison D. Applications of the pinhole effect in clinical vision science. J Cataract Refract Surg 2024; 50:84-94. [PMID: 38133648 DOI: 10.1097/j.jcrs.0000000000001318] [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: 12/19/2022] [Accepted: 09/09/2023] [Indexed: 12/23/2023]
Abstract
The pinhole effect is commonly used to discriminate uncorrected refractive error from ocular diseases. A small aperture limits the width of light beams entering the eye, thus increasing the depth of focus. The pinhole effect has also been used in spectacles, contact lenses, corneal inlays, and intraocular lenses (IOLs) to improve reading by compensating for loss of accommodative function. Pinhole spectacles improve near visual acuity, but reduce reading speed, increase interblink interval, and decrease tear break-up time. For contact lenses and IOLs, pinhole devices are usually used in the nondominant eye, which allow compensation of various refractive errors and decrease spectacle dependence. Pinhole corneal inlays are implanted during laser in situ keratomileusis or as a separate procedure. Pinhole IOLs are gaining popularity, particularly as they do not bring a risk of a local inflammatory reaction as corneal inlays do. Disadvantages of using the pinhole effect include high susceptibility to decentration, decrease in retinal luminance levels, and difficulties in performing fundus examinations or surgery in eyes with implanted devices. There are also concerns regarding perceptive issues with different retinal illuminances in the 2 eyes (the Pulfrich effect).
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Affiliation(s)
- Piotr Kanclerz
- From the Helsinki Retina Research Group, University of Helsinki, Finland (Kanclerz); Department of Ophthalmology, Hygeia Clinic, Gdansk, Poland (Kanclerz); The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany (Khoramnia); Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Australia (Atchison)
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Yu Y, Zhang Z, Xia F, Sun B, Liu S, Wang X, Zhou X, Zhao J. Exploration of the pathophysiology of high myopia via proteomic profiling of human corneal stromal lenticules. Exp Eye Res 2024; 238:109726. [PMID: 37979904 DOI: 10.1016/j.exer.2023.109726] [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: 06/25/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 11/20/2023]
Abstract
This study aimed to investigate the underlying pathophysiology of high myopia by analyzing the proteome of human corneal stromal lenticule samples obtained through small incision lenticule extraction (SMILE). A total of thirty-two patients who underwent SMILE were included in the study. Label-free quantitative proteomic analysis was performed on corneal stromal lenticule samples, equally representing high myopia (n = 10) and low myopia (n = 10) groups. The identified and profiled lenticule proteomes were analyzed using in silico tools to explore biological characteristics of differentially expressed proteins (DEPs). Additionally, LASSO regression and random forest model were employed to identify key proteins associated with the pathophysiology of high myopia. The DEPs were found to be closely linked to immune activation, extracellular matrix, and cell adhesion-related pathways according to gene ontology analysis. Specifically, decreased expression of COL1A1 and increased expression of CDH11 were associated with the pathogenesis of high myopia and validated by western blotting (n = 6) and quantitative real time polymerase chain reaction (n = 6). Overall, this study provides evidence that COL1A1 and CDH11 may contribute to the pathophysiology of high myopia based on comparative proteomic profiling of human corneal stromal lenticules obtained through SMILE.
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Affiliation(s)
- Yanze Yu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Shanghai, China; Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China; Fudan University Shanghai Medical College, Shanghai 200032, China
| | - Zhe Zhang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Shanghai, China; Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Fei Xia
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Shanghai, China; Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Bingqing Sun
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Shanghai, China; Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Shengtao Liu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Shanghai, China; Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xiaoying Wang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Shanghai, China; Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Shanghai, China; Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
| | - Jing Zhao
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Shanghai, China; Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
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Levinger E, Arnon R, Pikkel J, Yahalomi T, Sela T, Munzer G, Mimouni M. Photorefractive keratectomy in flat, normal, and steep corneas. J Cataract Refract Surg 2024; 50:51-56. [PMID: 38048136 DOI: 10.1097/j.jcrs.0000000000001307] [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: 06/20/2023] [Accepted: 08/31/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE To compare photorefractive keratectomy (PRK) outcomes in patients with different corneal steepness. SETTING Care-Vision Laser Center, Tel-Aviv, Israel. DESIGN Retrospective comparative chart review. METHODS Patients included in this study underwent wavefront optimized myopic PRK between January 2013 and December 2019. Patients were divided into 3 groups based on the steepness of the cornea (steep keratometry) (flat: <42 diopters [D], normal: 42 to 46 D and steep: >46 D). One to one matching was performed to verify that baseline parameters (age, preoperative visual acuity and refractive error) were similar between groups. Primary outcome measures were: postoperative corrected/uncorrected distance visual acuity (CDVA/UDVA), efficacy index (postoperative UDVA/preoperative CDVA), safety index (postoperative CDVA/preoperative CDVA), spherical equivalence (SEQ) and cylinder. RESULTS After matching, 650 eyes were included in each group, which were similar in baseline parameters. There were no significant postoperative differences between flat, normal, and steep corneas in terms of safety index (1.02 vs 1.03 vs 1.03, P = .28), efficacy index (1.01 vs 1.01 vs 1.02, P = .57), logMAR CDVA (0.01 vs 0.02 vs 0.01, P = .76), logMAR UDVA (0.02 vs 0.03 vs 0.02, P = .68), %SEQ within 0.50 D (73.9% vs 74.2% vs 74.6%, P = .95) or 1.00 D of target (91.9% vs 92.5% vs 92.2%, P = .92), %cylinder within 0.50 D (82.8% vs 82.2% vs 81.4%, P = .81) or 1.00 D of target (96.9% vs 97.1% vs 97.2%, P = .95). CONCLUSIONS No significant differences were found between flat, normal and steep corneas following wavefront-optimized myopic PRK. Thus, this procedure may be safely and effectively performed in both flat and steep corneas.
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Affiliation(s)
- Eliya Levinger
- From the Department of Ophthalmology, Tel Aviv Medical Center affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Levinger); Department of Ophthalmology, Assuta-Samson Ashdod Hospital affiliated with the Faculty of Medicine, Ben Gurion University, Beer-Sheva, Israel (Arnon, Pikkel, Yahalomi); Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel (Mimouni); Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Mimouni); Care-Vision Laser Centers, Tel-Aviv, Israel (Sela, Munzer, Mimouni)
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Niazi S, Gatzioufas Z, Doroodgar F, Findl O, Baradaran-Rafii A, Liechty J, Moshirfar M. Keratoconus: exploring fundamentals and future perspectives - a comprehensive systematic review. Ther Adv Ophthalmol 2024; 16:25158414241232258. [PMID: 38516169 PMCID: PMC10956165 DOI: 10.1177/25158414241232258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 01/22/2024] [Indexed: 03/23/2024] Open
Abstract
Background New developments in artificial intelligence, particularly with promising results in early detection and management of keratoconus, have favorably altered the natural history of the disease over the last few decades. Features of artificial intelligence in different machine such as anterior segment optical coherence tomography, and femtosecond laser technique have improved safety, precision, effectiveness, and predictability of treatment modalities of keratoconus (from contact lenses to keratoplasty techniques). These options ingrained in artificial intelligence are already underway and allow ophthalmologist to approach disease in the most non-invasive way. Objectives This study comprehensively describes all of the treatment modalities of keratoconus considering machine learning strategies. Design A multidimensional comprehensive systematic narrative review. Data sources and methods A comprehensive search was done in the five main electronic databases (PubMed, Scopus, Web of Science, Embase, and Cochrane), without language and time or type of study restrictions. Afterward, eligible articles were selected by screening the titles and abstracts based on main mesh keywords. For potentially eligible articles, the full text was also reviewed. Results Artificial intelligence demonstrates promise in keratoconus diagnosis and clinical management, spanning early detection (especially in subclinical cases), preoperative screening, postoperative ectasia prediction after keratorefractive surgery, and guiding surgical decisions. The majority of studies employed a solitary machine learning algorithm, whereas minor studies assessed multiple algorithms that evaluated the association of various keratoconus staging and management strategies. Last but not least, AI has proven effective in guiding the implantation of intracorneal ring segments in keratoconus corneas and predicting surgical outcomes. Conclusion The efficient and widespread clinical translation of machine learning models in keratoconus management is a crucial goal of potential future approaches to better visual performance in keratoconus patients. Trial registration The article has been registered through PROSPERO, an international database of prospectively registered systematic reviews, with the ID: CRD42022319338.
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Affiliation(s)
- Sana Niazi
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zisis Gatzioufas
- Department of Ophthalmology, University Eye Hospital Basel, Basel, Switzerland
| | - Farideh Doroodgar
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran Province, Tehran, District 6, Pour Sina St, P94V+8MF, Tehran 1416753955, Iran
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Oliver Findl
- Department of Ophthalmology, Hanusch Hospital, Vienna Institute for Research in Ocular Surgery (VIROS), Vienna, Austria
| | - Alireza Baradaran-Rafii
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jacob Liechty
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Majid Moshirfar
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
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Antonov AA, Klinicheva EA, Volzhanin AV, Makarova AS. [Effect of refractive surgery on Maklakov tonometry results]. Vestn Oftalmol 2024; 140:51-59. [PMID: 38739131 DOI: 10.17116/oftalma202414002251] [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: 05/14/2024]
Abstract
PURPOSE The study investigates the influence of changes in keratometric parameters after refractive surgery on the results of Maklakov tonometry. MATERIAL AND METHODS The study examined a total of 61 people (121 eyes). The patients were divided into a control group with no history of surgery (16 people, 31 eyes), a LASIK group (13 people, 26 eyes), a femtosecond-assisted LASIK (FS-LASIK) group (16 people, 32 eyes), and a photorefractive keratectomy (PRK) group (16 people, 32 eyes). The patients underwent standard examination, keratometry (Km), Maklakov tonometry with a 10 g weight, and elastotonometry with 5, 7.5, and 15 g weights. RESULTS In the LASIK group, the indentation diameter with 5 and 7.5 g weights correlated with Km in the central and near-paracentral zone (r=0.3-0.5). Tonometry with a 10 g weight did not correlate with anything. Tonometry with a 15 g weight inversely correlated with Km in the paracentral points (4 mm) of the strong meridian (r= -0.5 ... -0.7). In the FS-LASIK group, a significant inverse correlation with Km was observed only for the indentation diameter with a 10 g weight in the paracentral (3-4 mm) zone (r= -0.4 ... -0.5). In the PRK group, weak (r<0.4) correlations were found between Km and the indentation diameter of the 7.5 and 10 g weights for the central zone (1-2 mm). No significant correlations were found for 5 and 15 g weights. In the control group, there were practically no correlations for 5 and 7.5 g weights. The indentation diameter of the 10 g weight evenly correlated with Km at all points (r= -0.38 ... -0.60), the indentation of the 15 g weight correlated mainly with the curvature of the horizontal meridian (r= -0.37 ... -0.49). CONCLUSION Tonometry readings with the 10 g weight are the most dependent on Km in different groups, and the readings with the 5 g weight are the least dependent. LASIK is characterized by the largest scatter of dependencies for weights of different masses, FS-LASIK - by the smallest. Tonometry readings with the 5 g weight correlated with Km only in the LASIK group, and this was the only direct correlation. Considering the inverse nature of most correlations, higher Km may be associated with an overestimation of tonometry results, and lower Km - with its underestimation.
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Affiliation(s)
- A A Antonov
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - E A Klinicheva
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - A V Volzhanin
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - A S Makarova
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
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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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Gurtler N, Bughin A, Vaclavik V, Kaisari E, Guex-Crosier Y. Acute bilateral blindness due to diffuse outer retinopathy following clear lens exchange: a case report. BMC Ophthalmol 2023; 23:428. [PMID: 37872478 PMCID: PMC10594781 DOI: 10.1186/s12886-023-03171-1] [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: 07/24/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND As the trend of refractive lens exchange for presbyopia continues to grow, our case report shows the first occurrence of an acute bilateral outer retinopathy following uncomplicated sequential clear lens extraction in an otherwise healthy individual. CASE PRESENTATION A 54-year-old male without significant medical history benefited from a sequential bilateral lens exchange for presbyopia. He then experienced a rapid vision loss in both eyes, accompanied by photopsias and myodesopsias, with symptoms appearing respectively 4 and 3 weeks after the surgeries. Multimodal imaging revealed a fulminant outer retinopathy, leading to a total loss of light perception within a few days. Immediate intravenous corticosteroid therapy was administered, permitting to recover a small area of central visual function in both eyes, enabling shape and color distinction. The primary diagnostic hypothesis is a presumed autoimmune retinopathy, triggered by the cataract extraction, while an alternative diagnosis could be a toxic reaction secondary to the use of intracameral cefuroxime and lidocaine during the surgery. CONCLUSION In this report, the authors describe the first recorded instance of outer retinopathy following cataract surgery. This occurrence raises the possibility of auto-immunization leading to retinal atrophy and vision loss as a potential outcome after undergoing cataract surgery.
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Affiliation(s)
- Nicolas Gurtler
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Avenue de France 15, 1002, Lausanne, Switzerland
| | - Alice Bughin
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Avenue de France 15, 1002, Lausanne, Switzerland
| | - Veronika Vaclavik
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Avenue de France 15, 1002, Lausanne, Switzerland
| | - Eirini Kaisari
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Avenue de France 15, 1002, Lausanne, Switzerland
| | - Yan Guex-Crosier
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Avenue de France 15, 1002, Lausanne, Switzerland.
- Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1005, Lausanne, Switzerland.
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Zheng K, Wang J, Zheng X, Han Y, Zhou X. Three patterns for identifying the posterior plane of a lenticule during SMILE. Int Ophthalmol 2023; 43:3533-3538. [PMID: 37354360 PMCID: PMC10504096 DOI: 10.1007/s10792-023-02760-9] [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: 12/09/2022] [Accepted: 05/21/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To describe three patterns of posterior plane edge identification in small-incision lenticule extraction and to prevent lenticule mis-dissection. METHODS Femtosecond laser application was performed for small-incision lenticule extraction (SMILE) by one surgeon. The surgical videos of SMILE were recorded and re-watched by the surgeon after operation. RESULTS Small-incision lenticule extraction was performed in 52 eyes of 28 patients, and no patient had cap-lenticular adhesion. Three patterns of posterior plane of lenticule were noticed when the surgical videos were re-watched. A "double lines" attached to the dissector were visible, signifying the reflective tape of the edge of the lenticule and the cap. During the expansion of the posterior lamellar separation, a fusiform opening between the lenticule edge and the underlying matrix layer was assumed to be a "leaf sign." With some unintentional operation, the posterior lamella was pushed away from the surgeon. The edge of the lenticule away from the anatomical part, the marking of the femtosecond laser cut, and the edge of the cap layer showed three reflective bands, which formed a "triple lines." The "double lines," "leaf sign," and "triple lines" were observed in 30 eyes (57.7%), 21 eyes (40.4%), and 1 eye (1.9%), respectively. CONCLUSION These three signs cover possible situations and provide visual landmarks to identify the correct dissection of the posterior plane, which can help shorten the learning curve of novice doctors.
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Affiliation(s)
- Ke Zheng
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Beijing, China
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jing Wang
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Beijing, China
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaohong Zheng
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Beijing, China
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yinan Han
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, 200031, China.
| | - Xingtao Zhou
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Beijing, China.
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, 200031, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, Shanghai, China.
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Yuan DQ, Tang FN, Yang CH, Zhang H, Wang Y, Zhang WW, Gu LW, Liu QH. Prediction of SMILE surgical cutting formula based on back propagation neural network. Int J Ophthalmol 2023; 16:1424-1430. [PMID: 37724263 PMCID: PMC10475637 DOI: 10.18240/ijo.2023.09.08] [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: 04/11/2023] [Accepted: 06/14/2023] [Indexed: 09/20/2023] Open
Abstract
AIM To predict cutting formula of small incision lenticule extraction (SMILE) surgery and assist clinicians in identifying candidates by deep learning of back propagation (BP) neural network. METHODS A prediction program was developed by a BP neural network. There were 13 188 pieces of data selected as training validation. Another 840 eye samples from 425 patients were recruited for reverse verification of training results. Precision of prediction by BP neural network and lenticule thickness error between machine learning and the actual lenticule thickness in the patient data were measured. RESULTS After training 2313 epochs, the predictive SMILE cutting formula BP neural network models performed best. The values of mean squared error and gradient are 0.248 and 4.23, respectively. The scatterplot with linear regression analysis showed that the regression coefficient in all samples is 0.99994. The final error accuracy of the BP neural network is -0.003791±0.4221102 µm. CONCLUSION With the help of the BP neural network, the program can calculate the lenticule thickness and residual stromal thickness of SMILE surgery accurately. Combined with corneal parameters and refraction of patients, the program can intelligently and conveniently integrate medical information to identify candidates for SMILE surgery.
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Affiliation(s)
- Dong-Qing Yuan
- Department of Ophthalmology, Jiangsu Province Hospital (the First Affiliated Hospital with Nanjing Medical University), Nanjing 210029, Jiangsu Province, China
| | - Fu-Nan Tang
- Clinical Medical Engineering Department, Jiangsu Province Hospital (the First Affiliated Hospital with Nanjing Medical University), Nanjing 210029, Jiangsu Province, China
| | - Chun-Hua Yang
- Clinical Medical Engineering Department, Jiangsu Province Hospital (the First Affiliated Hospital with Nanjing Medical University), Nanjing 210029, Jiangsu Province, China
| | - Hui Zhang
- Clinical Medical Engineering Department, Jiangsu Province Hospital (the First Affiliated Hospital with Nanjing Medical University), Nanjing 210029, Jiangsu Province, China
| | - Ying Wang
- Clinical Medical Engineering Department, Jiangsu Province Hospital (the First Affiliated Hospital with Nanjing Medical University), Nanjing 210029, Jiangsu Province, China
| | - Wei-Wei Zhang
- Department of Ophthalmology, Jiangsu Province Hospital (the First Affiliated Hospital with Nanjing Medical University), Nanjing 210029, Jiangsu Province, China
| | - Liu-Wei Gu
- Department of Ophthalmology, Jiangsu Province Hospital (the First Affiliated Hospital with Nanjing Medical University), Nanjing 210029, Jiangsu Province, China
| | - Qing-Huai Liu
- Department of Ophthalmology, Jiangsu Province Hospital (the First Affiliated Hospital with Nanjing Medical University), Nanjing 210029, Jiangsu Province, China
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Gomes JAP, Azar DT, Baudouin C, Bitton E, Chen W, Hafezi F, Hamrah P, Hogg RE, Horwath-Winter J, Kontadakis GA, Mehta JS, Messmer EM, Perez VL, Zadok D, Willcox MDP. TFOS Lifestyle: Impact of elective medications and procedures on the ocular surface. Ocul Surf 2023; 29:331-385. [PMID: 37087043 DOI: 10.1016/j.jtos.2023.04.011] [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: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Abstract
The word "elective" refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE refractive surgery seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.
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Affiliation(s)
- José Alvaro P Gomes
- Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), Sao Paulo, SP, Brazil.
| | - Dimitri T Azar
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Christophe Baudouin
- Quinze-Vingts National Eye Hospital & Vision Institute, IHU FOReSIGHT, Paris, France
| | - Etty Bitton
- Ecole d'optométrie, Université de Montréal, Montréal, Canada
| | - Wei Chen
- Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | - Pedram Hamrah
- Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ruth E Hogg
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | | | | | | | | | - Victor L Perez
- Foster Center for Ocular Immunology, Duke University Eye Center, Durham, NC, USA
| | - David Zadok
- Shaare Zedek Medical Center, Affiliated to the Hebrew University, School of Medicine, Jerusalem, Israel
| | - Mark D P Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Arboleda N, Yi J, Kang JJ. The evolution of refractive surgery training. Curr Opin Ophthalmol 2023; 34:275-279. [PMID: 37070524 DOI: 10.1097/icu.0000000000000958] [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: 04/19/2023]
Abstract
PURPOSE OF REVIEW Although refractive surgery is one of the most commonly performed ophthalmic procedures, there is a relative paucity of literature on residency and fellowship refractive surgery education. The purpose of this article is to review the current state and recent updates to refractive surgery education and to evaluate the safety and visual outcomes of trainee performed refractive procedures. RECENT FINDINGS Currently, there is no standard refractive surgery curriculum in the United States apart from required mandatory minimum refractive requirements for residents and fellows. Our survey of residency programs confirms that refractive training is extremely varied, ranging from a dedicated refractive rotation with direct surgical experience to only didactics or observation of procedures. There is a proposed standardized framework for refractive surgery training for the military, which may be a starting point in developing a more comprehensive refractive surgery curriculum in residency education. Multiple studies have reinforced the safety of resident and fellow performed refractive surgery. SUMMARY Refractive surgery is an increasingly popular procedure and a more comprehensive refractive education is paramount. Future studies are needed to determine how best to provide the fundamental training and surgical experience for trainees in the fast-changing landscape of refractive surgery.
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Affiliation(s)
- Nathan Arboleda
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Di Y, Li Y, Luo Y. Prediction of Implantable Collamer Lens Vault Based on Preoperative Biometric Factors and Lens Parameters. J Refract Surg 2023; 39:332-339. [PMID: 37162400 DOI: 10.3928/1081597x-20230207-03] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE To establish and validate the accuracy of implantable collamer lens (ICL) vault size prediction formula based on preoperative biometric factors and lens parameters. METHODS This study included 300 patients (300 eyes) with Visian ICL V4c (STAAR Surgical) implantation. They were randomly divided into the formula establishment group and formula validation group. Anterior segment measurements, ICL V4c size and power, and vault 1 week postoperatively were collected from all patients. Multiple linear regression analysis was performed to establish the prediction formula. Mean absolute error (MAE), median absolute error (MedAE), root mean square error (RMSE), and Bland-Altman diagrams were used to evaluate the prediction formula. RESULTS Anterior chamber depth (ACD) had the greatest influence on vault 1 week after ICL V4c implantation, followed by ICL V4c size and angle-to-angle distance (ATA). The prediction formula was obtained according to the partial regression coefficient, which was vault (mm) = -1.279 + 0.291 × ACD (mm) + 0.210 × ICL V4c size (mm) - 0.144 × ATA (mm) (R2 = 0.661). In the formula validation group, the mean predictive vault, MAE, MedAE, and RMSE were 628.10, 135.09, 130.42, and 150.46 µm, respectively. The Bland-Altman diagram showed the predictive vault was in good agreement with the actual vault. CONCLUSIONS A novel ICL V4c vault prediction formula was developed and shown to be an effective method for predicting the vault to reduce surgical complications. [J Refract Surg. 2023;39(5):332-339.].
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Wu J. Retrospective diagnosis of naked eye visual acuity (UCVA) variations in patients with refractive errors treated with SMILE, LASIK, and WF-LASIK refractive surgery. Biotechnol Genet Eng Rev 2023:1-10. [PMID: 37040470 DOI: 10.1080/02648725.2023.2199230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
A retrospective assessment of the visual acuity (UCVA) variations in bare eyes of the refractive error cases treated with SMILE, LASIK and WF-LASIK. A retrospective selection of 126 patients with refractive error treated by refractive surgery admitted to our hospital between January 2019 and December 2021 were divided into three separate sets of patients according to their surgical methods: the SMILE cohort, the LASIK cohort, and the WF-LASIK cohort, and the three sets of patients were analyzed for bare eye visual acuity, refraction, higher-order aberration, BUT, SIt index, and complications, and the recovery effects of patients with the three surgical procedures. All three types of refractive surgery, SMILE, LASIK and WF-LASIK, can yield good surgical results in the reduction of refractive error, and patients with SMILE have better postoperative tear film stability, while patients with WF-LASIK have the best postoperative visual quality.
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Affiliation(s)
- Juan Wu
- ophthalmology department, Xining No.1 People's Hospital Ophthalmology, Xining, Qinghai, China
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38
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He Y, Ma BS, Zeng JH, Ma DJ. Corneal optical density: Structural basis, measurements, influencing factors, and roles in refractive surgery. Front Bioeng Biotechnol 2023; 11:1144455. [PMID: 37091331 PMCID: PMC10117965 DOI: 10.3389/fbioe.2023.1144455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
The cornea is the main refractive medium of the human eye, and its clarity is critical to visual acuity. Corneal optical density (COD) is an important index to describe corneal transparency. Intact corneal epithelial and endothelial cells, regular arrangement of collagen fibers in the stroma, and normal substance metabolism are all integral for the cornea to maintain its transparency. In the last two decades, the Pentacam Scheimpflug imaging system has emerged as a breakthrough for the measurement of COD (also called corneal densitometry). It has been found that a wide variety of factors such as age, refractive status, and corneal diseases can affect COD. Different corneal refractive surgery methods also change COD in different corneal regions and layers and affect visual acuity following the surgery. Thus, COD has gradually become a significant indicator to evaluate corneal health, one on which the attention of clinicians has been increasingly focused.
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Affiliation(s)
- Ye He
- Changsha Aier Eye Hospital, Changsha, China
| | - Bo-Sheng Ma
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jun-Hao Zeng
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Dai-Jin Ma
- Changsha Aier Eye Hospital, Changsha, China
- *Correspondence: Dai-Jin Ma,
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Abdel-Radi M, Rateb M, Saleh MGA, Aly MOM. Twelve-month outcomes of single-step transepithelial photorefractive keratectomy for moderate hyperopia and hyperopic astigmatism. EYE AND VISION (LONDON, ENGLAND) 2023; 10:7. [PMID: 36855211 PMCID: PMC9976533 DOI: 10.1186/s40662-023-00327-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/08/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Conventional mechanical or alcohol-assisted photorefractive keratectomy (PRK) techniques for correction of hyperopia and hyperopic astigmatism were associated with inconsistent results. The aim of this study is to evaluate the 12-month visual and refractive outcomes of the relatively new single-step transepithelial photorefractive keratectomy (TE-PRK) for moderate hyperopia and hyperopic astigmatism. METHODS This is a prospective interventional study. Forty-eight eyes of 30 patients with moderate hyperopia or hyperopic astigmatism with a cycloplegic spherical equivalent refraction (SEQ) between 2.0 and 4.5 diopters (D) underwent single-step StreamLight® TE-PRK using EX500 excimer laser (Alcon Laboratories, USA). The main outcome measures were recorded at 6 and 12 months postoperatively including assessment of logarithm of the minimum angle resolution (logMAR) uncorrected and corrected distance visual acuity (UDVA, CDVA), cycloplegic refraction, corneal topographic changes as well as post-PRK peripheral haze grading. RESULTS The mean preoperative cycloplegic SEQ was significantly reduced from 3.21 ± 0.61 D to 0.35 ± 0.04 D and 0.41 ± 0.04 D at 6 and 12 months, respectively (P < 0.001). The mean preoperative UDVA significantly improved from 0.53 ± 0.02 logMAR to 0.07 ± 0.01 logMAR and 0.08 ± 0.01 logMAR at 6 and 12 months, respectively (P < 0.001) while the mean preoperative logMAR CDVA showed non-significant change over time throughout the study (P = 0.135). At the end of the study, 41 eyes (85.4%) achieved UDVA of 20/25 or better and no eye lost any lines of CDVA. Thirty-eight eyes (79.1%) had a postoperative cycloplegic cylinder of 0.5 D or less at 12 months. The mean preoperative mean keratometry showed significant increase at 6 and 12 months postoperatively (P < 0.001) while there was no significant change between the two postoperative visits denoting topographic stability (P = 0.058). The mean postoperative Q value at 6 and 12 months showed a significant prolate shift (P < 0.001). No haze was observed in 62.5% and 85.4% of the enrolled eyes at 6 and 12 months, respectively. CONCLUSIONS Single-step StreamLight® TE-PRK for moderate hyperopia and hyperopic astigmatism achieved acceptable visual and refractive outcomes. TRIAL REGISTRATION (Clinicaltrials.gov): NCT05261685, 2 March 2022, retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05261685.
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Affiliation(s)
- Mahmoud Abdel-Radi
- Department of Ophthalmology, Assiut University, Assiut University Hospital, 6th Floor, 71516, Assiut, Egypt.
| | - Mahmoud Rateb
- grid.411437.40000 0004 0621 6144Department of Ophthalmology, Assiut University, Assiut University Hospital, 6th Floor, 71516 Assiut, Egypt
| | - Mohamed G. A. Saleh
- grid.411437.40000 0004 0621 6144Department of Ophthalmology, Assiut University, Assiut University Hospital, 6th Floor, 71516 Assiut, Egypt
| | - Mohamed Omar M. Aly
- grid.411437.40000 0004 0621 6144Department of Ophthalmology, Assiut University, Assiut University Hospital, 6th Floor, 71516 Assiut, Egypt
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Gan ATL, Fenwick EK, Ang M, Mehta JS, Lamoureux EL. Bilateral sequential small-incision lenticule extraction and LASIK result in similar short-term quality-of-life outcomes. J Cataract Refract Surg 2023; 49:305-311. [PMID: 36730347 DOI: 10.1097/j.jcrs.0000000000001103] [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: 04/04/2022] [Accepted: 11/16/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE To compare quality of life (QoL) between patients who receive bilateral small-incision lenticule extraction (SMILE) or laser in situ keratomileusis (LASIK) vs bilateral sequential SMILE-LASIK (BSSL) surgery. SETTING Singapore National Eye Centre, Singapore. DESIGN Retrospective cohort study. METHODS 2 patient cohorts were recruited (2010-2012; 2014-2016). The bilateral SMILE (BS) and bilateral LASIK (BL) groups comprised patients (mean ± SD age: 30.3 ± 6.5, 50% male) from a prospective nonrandomized study who chose SMILE and LASIK, respectively. The BSSL group comprised patients (mean ± SD age: 28.6 ± 6.2, 64.3% male) randomized to receive SMILE in 1 eye and LASIK in the other. Rasch-scaled scores of the QoL Impact of Refractive Correction questionnaire between groups postoperatively at 1 and 3 months were compared. RESULTS At month 1, scores on 3 QoL without emotional well-being items were worse in the BSSL (n = 70) compared with the BL group (n = 25), specficially, "using sunglasses" (β: -20.6, 95% CI, -34.3 to -6.9), "reliance on refractive correction" (-23.1, 95% CI, -40.9 to -5.4), and "medical complications from optical correction" (β: -14.8, 95% CI, -27.9 to -1.7). Emotional well-being (overall), and items "feeling able to do things" (β: 11.0, 95% CI, 1.6-20.4) and "feeling eager to try new things" (β: 14.1, 95% CI, 3.6-24.6) were better in the BSSL compared with the BS group (n = 25). No substantive differences were observed at month 3. CONCLUSIONS Refractive correction-related QoL differences at month 1 between BSSL and BS/BL patients attenuated by month 3. Bilateral sequential SMILE-LASIK surgery appeared unlikely to negatively affect QoL beyond 3 months.
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Affiliation(s)
- Alfred T L Gan
- From the Singapore Eye Research Institute and Singapore National Eye Centre, Singapore (Gan, Fenwick, Ang, Mehta, Lamoureux); Duke-NUS Medical School, Singapore (Fenwick, Ang, Mehta, Lamoureux); National University of Singapore, Singapore (Lamoureux); Faculty of Medicine, Dentistry and Health Sciences University of Melbourne, Australia (Lamoureux)
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41
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Zhang R, Zhang Y, Yuan Y, Chen Y. Comparison of objective and subjective visual quality after flapless laser vision correction for mild to moderate myopia: SMILE vs PRK. Graefes Arch Clin Exp Ophthalmol 2023; 261:1731-1741. [PMID: 36652015 DOI: 10.1007/s00417-022-05937-7] [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: 07/04/2022] [Revised: 11/06/2022] [Accepted: 12/07/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To investigate the differences in surgical results and the objective and subjective quality of vision (QoV) of patients after small incision lenticule extraction (SMILE) versus alcohol-assisted photorefractive keratectomy (PRK). METHODS Medical records of patients treated with SMILE and PRK were retrospectively examined. Visual quality, biometric parameters, Strehl ratio (SR), and corneal higher-order aberrations (HOAs) within a 6.0 mm area were recorded. The effective optical zone (EOZ) and decentration were measured using a tangential pre-post operation difference map. Subjective QoV and operation satisfaction were evaluated 6 months postoperatively using the Quality of Vision questionnaire. RESULTS The study comprised 100 eyes treated with SMILE (preoperative mean spherical equivalent (SE), - 4.52 ± 0.81 dioptres (D)) and 69 eyes with PRK (mean SE, - 4.21 ± 1.25 D). Six months postoperatively, the EOZ reduction was significantly larger in the PRK group (P < 0.001). Decentrations were comparable between the groups. Regarding visual symptoms, monocular diplopia was more common following PRK (P = 0.02), and 98 (98.00%) SMILE-treated and 67 (97.10%) PRK-treated patients were satisfied with the QoV. Both groups demonstrated significant increases in total HOAs, coma, and spherical aberration (SA) at 6 months postoperatively compared to preoperatively (P < 0.001); these values were significantly higher in the PRK (P < 0.05) compared to the SMILE group. SR increased significantly only in the PRK group (P < 0.05). CONCLUSION Although EOZ was more consistent with anticipated treatment and HOAs were fewer in SMILE, high patient-reported satisfaction and good corneal optical quality were achieved in both groups, indicating that both SMILE and alcohol-assisted PRK are excellent options for mild to moderate myopia correction.
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Affiliation(s)
- Ruiyu Zhang
- Department of Ophthalmology, Peking University Third Hospital, No 49 Huayuan North Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Beijing, China
| | - Yu Zhang
- Department of Ophthalmology, Peking University Third Hospital, No 49 Huayuan North Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Beijing, China
| | - Yifei Yuan
- Department of Ophthalmology, Peking University Third Hospital, No 49 Huayuan North Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Beijing, China
| | - Yueguo Chen
- Department of Ophthalmology, Peking University Third Hospital, No 49 Huayuan North Road, Haidian District, Beijing, 100191, China.
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Beijing, China.
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42
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Cortina ME, Benozzi G, Orman B. Hyperopic LASIK Enhanced by Pharmacological Treatment of Presbyopia. J Ocul Pharmacol Ther 2023; 39:48-54. [PMID: 36318813 DOI: 10.1089/jop.2022.0095] [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] [Indexed: 11/06/2022] Open
Abstract
Purpose: Regression of the refractive outcome is a major concern of LASIK procedures mainly in presbyopic patients. The purpose of this study was to evaluate the long-term efficacy of the pharmacological treatment of presbyopia performed with Benozzi's method, in combination with hyperopic LASIK surgery in presbyopic population. Methods: A nonrandomized case series was developed, including presbyopic patients who underwent bilateral "Hyperopic LASIK surgery" and were pharmacologically treated with Benozzi's Method from January 2011 to August 2018, with at least 2 years of follow-up, at two private ophthalmological clinics of Argentina. Main outcomes were spherical equivalent (SE), uncorrected distance visual acuity (UDVA), and uncorrected near visual acuity (UNVA). Measurements were evaluated at baseline and postoperative at 1 month (without Benozzi's treatment), 2 months (starting with Benozzi's treatment), and 2 years. The SE stability across the time was statistically compared. Results: A total of 84 eyes of 42 patients, with a mean age at the time of the surgery of 51.07 ± 4.5 (42-59), were found following 2 years of follow-up. Patients have improved and maintained UDVA, achieving Jaeger 1 in the second postoperative month, which was maintained up to the last year of follow-up. Refractive stability across the time is observed comparing first month after surgery with the last year of follow-up, without statistical significant difference (p: 0.11). Conclusion: Hyperopic presbyopic patients that underwent LASIK surgery and 1 month after surgery started with the pharmacological treatment of presbyopia (Benozzi's method) results in excellent UNVA and UDVA that is stable over time without refractive regression.
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Affiliation(s)
| | - Giovanna Benozzi
- Centro de Investigación Avanzada Para la Presbicia, Buenos Aires, Argentina.,Cátedra de Farmacología, Facultad de Odontología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Betina Orman
- Cátedra de Farmacología, Facultad de Odontología, Universidad de Buenos Aires, Buenos Aires, Argentina
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Megiddo-Barnir E, Alió JL. Latest Development in Extended Depth-of-Focus Intraocular Lenses: An Update. Asia Pac J Ophthalmol (Phila) 2023; 12:58-79. [PMID: 36706334 DOI: 10.1097/apo.0000000000000590] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/06/2022] [Indexed: 01/28/2023] Open
Abstract
In recent years, there has been an overwhelming influx of different types of intraocular lenses (IOLs) as treatment for presbyopia. The extended depth-of-focus (EDOF) technology creates a single elongated focal point to enhance depth of focus, in contrast to the multiple foci of multifocal (MF) lenses. In this way, the EDOF lenses aim to reduce photic phenomena, glare, and halos, which have been reported in MF IOLs. A potential disadvantage of this is a blur due to decreased retinal image quality when the amount of the aberrations is increased excessively. Multifocality and EDOF characteristics are not exclusive of each other. Frequently, EDOF IOLs are combined with MF optical designs, a bifocal IOL may exhibit EDOF characteristics, likewise an aspheric monofocal IOL or a diffractive or refractive trifocal IOL. Thus, EDOF lenses are commonly subjected to confusion. A wide range of different types of EDOF lenses are available on the market to surgeons. In this practical update, we aim to clarify what is a true EDOF lens, classify the different types of the EDOF lenses based on their optical principle and review their recently reported outcomes. Comprehensive patient examination and selection, combined with knowledge of the most updated options and adequate patient counseling, can avoid dissatisfaction and yield the desired outcomes.
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Affiliation(s)
| | - Jorge L Alió
- Cornea, Cataract & Refractive Surgery Unit, VISSUM (Miranza Group), Alicante, Spain
- Department of Ophthalmology, Miguel Hernandez University, Alicante, Spain
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Advanced Optical Wavefront Technologies to Improve Patient Quality of Vision and Meet Clinical Requests. Polymers (Basel) 2022; 14:polym14235321. [PMID: 36501713 PMCID: PMC9741482 DOI: 10.3390/polym14235321] [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: 10/14/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/09/2022] Open
Abstract
Adaptive optics (AO) is employed for the continuous measurement and correction of ocular aberrations. Human eye refractive errors (lower-order aberrations such as myopia and astigmatism) are corrected with contact lenses and excimer laser surgery. Under twilight vision conditions, when the pupil of the human eye dilates to 5-7 mm in diameter, higher-order aberrations affect the visual acuity. The combined use of wavefront (WF) technology and AO systems allows the pre-operative evaluation of refractive surgical procedures to compensate for the higher-order optical aberrations of the human eye, guiding the surgeon in choosing the procedure parameters. Here, we report a brief history of AO, starting from the description of the Shack-Hartmann method, which allowed the first in vivo measurement of the eye's wave aberration, the wavefront sensing technologies (WSTs), and their principles. Then, the limitations of the ocular wavefront ascribed to the IOL polymeric materials and design, as well as future perspectives on improving patient vision quality and meeting clinical requests, are described.
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Lin Q, Yang D, Zhou X. Early outcomes of anterior segment parameters after implantable collamer lens V4c implantation. BMC Ophthalmol 2022; 22:429. [PMID: 36357865 PMCID: PMC9650857 DOI: 10.1186/s12886-022-02656-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/28/2022] [Indexed: 11/12/2022] Open
Abstract
Background This study investigated the early outcomes of anterior segment parameters after implanting an implantable collamer lens with a central hole (ICL V4c) in patients with myopia and determined the earliest follow-up time for detecting potential complications. Methods Sixty-two patients were included, and the following parameters were measured at baseline (preoperative), 1 day, 1 week, and 1, 3, and 6 months after the operation: intraocular pressure (IOP), endothelial cell density (ECD), central anterior chamber depth (CACD), anterior chamber volume (ACV), nasal and temporal anterior chamber angle (n-ACA and t-ACA), horizontal corneal diameter (white-to-white, WTW), and axial length (AL). The vault was measured at each post-operative timepoint. Results The postoperative IOP and ECD at the 6 months were both statistically similar to the baseline. The post-operative CACD and ACV were significantly less at all timepoints compared with the baseline (P < 0.001) and stayed stable from 1 day and 1 month after the operation, respectively. Postoperative n-ACA and t-ACA decreased significantly at 1 day and 1 week compared with the baseline (P < 0.001), while tended to stabilization at 1, 3, and 6 months. The vault kept decreasing significantly at 1 day, 1 week, and 1 month, but stayed stable at 3 and 6 months. The postoperative n-ACA and t-ACA positively correlated with the baseline ACA, CACD, and ACV. Conclusions The anterior chamber parameters tended to stabilization early after the operation. Thus, it is essential to evaluate patients’ anterior segment status at earlier timepoints and prevent complications with prompt and non-invasive intervention.
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Li K, Wang Z, Wang MX. Implantable collamer lens implantation (ICL) versus small incision lenticule extraction (SMILE) in low to moderate myopia: study protocol for a randomized, non-inferiority trial. Trials 2022; 23:910. [PMID: 36307873 PMCID: PMC9617386 DOI: 10.1186/s13063-022-06851-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implantable collamer lens implantation (ICL) is a form of 'foldable' posterior chamber phakic intraocular lens refractive surgery that generally does not impair cornea and natural accommodation. The potential advantages of the ICL over keratorefractive laser procedures include less induction of higher-order aberrations (HOAs) and enhanced retinal image magnification. On the other hand, small incision lenticule extraction (SMILE), currently, one of the most popular refractive surgery procedures, also offers excellent visual outcomes, particularly for eyes with low to moderate amounts of myopia. The aim of this study is to evaluate whether ICL/TICL (toric ICL) is comparable to SMILE for low to moderate myopia in terms of refractive outcomes at 3 and 18 months post-operatively. METHODS/DESIGN This is a prospective randomized study. A total of 300 participants will be randomized into two groups, the ICL/TICL group and SMILE group. Eligible participants with spherical equivalent (SE) less than - 6.0 diopter (D) will be recruited. Following randomization, participants will be followed at 1, 3, 6, 12, and 18 months. The primary outcome is the refractive predictability at every postoperative point after surgery, which is the proportion of the number of eyes achieving a postoperative SE within ± 0.5 D and ± 1.0 D of the intended target. Secondary outcome parameters include visual acuity, refraction, adverse events, and quality of vision measurements. DISCUSSION This trial will provide information on whether ICL has comparable, if not superior, refractive outcomes compared to the established SMILE for low to moderate myopia, thus providing evidence for translation into clinical practice. TRIAL REGISTRATION Chinese clinical trial registry (ChiCTR) 2200055372. Registered on 08 January 2022.
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Affiliation(s)
- Kangjun Li
- The AIER School of Ophthalmology of Central, South University, Hunan Province, Changsha, China. .,The AIER Eye and Refractive Institute of Central, South University, Hunan Province, Changsha, China. .,Xi'an AIER Eye Hospital, Shaan'xi Province, Xi'an, 710000, China.
| | - Zheng Wang
- The AIER School of Ophthalmology of Central, South University, Hunan Province, Changsha, China.,The AIER Eye and Refractive Institute of Central, South University, Hunan Province, Changsha, China
| | - Ming X Wang
- Wang Vision Institute and Aier-USA, 1801 West End Ave, Ste 1150, Nashville, TN, USA
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Riazi Esfahani P, Reddy AJ, Sommer DA, Ghauri MS, Mazboudi P, Guirgus ME, Abdalnour DS, Curow CA, Nawathey N, Bachir M, Brahmbhatt H. A Review of the Usage and Post-surgical Outcomes of Anesthesia for Laser In Situ Keratomileusis (LASIK) Procedure. Cureus 2022; 14:e30241. [DOI: 10.7759/cureus.30241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 11/07/2022] Open
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48
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Han T, Zhao L, Shen Y, Chen Z, Yang D, Zhang J, Sekundo W, Shah R, Tian J, Zhou X. Twelve-year global publications on small incision lenticule extraction: A bibliometric analysis. Front Med (Lausanne) 2022; 9:990657. [PMID: 36160168 PMCID: PMC9493269 DOI: 10.3389/fmed.2022.990657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To analyze the development process of small incision lenticule extraction (SMILE) surgery in a 12-year period. Methods We conducted a literature search for SMILE research from 2011 to 2022 using the Science Citation Index Expanded (SCIE) of the Web of Science Core Collection (WoSCC). The VOS viewer, and CiteSpace software were used to perform the bibliometric analysis. Publication language, annual growth trend, countries/regions and institutions, journals, keywords, references, and citation bursts were analyzed. Results A total of 731 publications from 2011 to 2022 were retrieved. Annual publication records grew from two to more than 100 during this period. China had the highest number of publications (n = 326). Sixty-five keywords that appeared more than four times were classified into six clusters: femtosecond laser technology, dry eye, biomechanics, visual quality, complications, and hyperopia. Conclusion The number of literatures has been growing rapidly in the past 12 years. Our study provides a deep insight into publications on SMILE for researchers and clinicians with bibliometric analysis for the first time.
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Affiliation(s)
- Tian Han
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Liang Zhao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- The School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Yang Shen
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Zhi Chen
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Dong Yang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Jiaoyan Zhang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- The School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Walter Sekundo
- The Department of Ophthalmology, Philipps University of Marburg, Marburg, Germany
| | - Rupal Shah
- New Vision Laser Centers, Vadodara, Gujarat, India
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- *Correspondence: Jinhui Tian,
| | - Xingtao Zhou
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
- Xingtao Zhou,
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Transepithelial Photorefractive Keratectomy Compared to Conventional Photorefractive Keratectomy: A Meta-Analysis. J Ophthalmol 2022; 2022:3022672. [PMID: 36051276 PMCID: PMC9427238 DOI: 10.1155/2022/3022672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/30/2022] [Indexed: 12/01/2022] Open
Abstract
This meta-analysis review compares the primary and secondary outcomes of transepithelial photorefractive keratectomy (TPRK) to the conventional photorefractive keratectomy (PRK), in terms of efficacy, predictability, safety, and patient perspectives. A total of 1711 eyes with PRK (811 eyes) and TPRK (900 eyes) from 12 studies were included through bibliographic searches. The main outcomes were efficacy, predictability, and safety parameters, and the secondary outcomes included visual and patient-reported parameters. The effect measures were weighted mean differences with 95% confidence intervals (CI) which were derived from the random-effects model of the meta-analysis to account for possible heterogeneity. TPRK procedure presents a comparable status in the main outcome and a very dominant significance in all the secondary outcomes in this meta-analysis. This study updates the evidence of the accuracy of TPRK procedure for surgical correction of all refractive errors and was deemed safer with less surgical time required and an early healing time.
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50
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Results of the Pinhole Test Correlate with Hybrid Contact Lens Visual Acuity in Patients with Visual Impairment due to Corneal Diseases. J Ophthalmol 2022; 2022:4932856. [PMID: 35783341 PMCID: PMC9249474 DOI: 10.1155/2022/4932856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/03/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction. Trial rigid lens fitting is considered the best approach to determine whether the correction of residual defocus and irregular astigmatism might improve the visual acuity in patients with corneal disorders including keratoconus. This study aimed to analyze the correlation between hybrid lenses and pinhole visual acuity (VA). Methods. Patients undergoing hybrid contact lens fitting at the Hygeia Clinic, Poland, were included. The VA of each patient was assessed as decimal Snellen fractions under the following conditions: (i) uncorrected VA, (ii) VA with spherocylindrical correction (i.e., corrected distance VA), (iii) VA with a single 1.2 mm pinhole occluder, and (iv) VA with the best-fitted hybrid contact lens. Pearson’s correlation coefficient r was used to assess correlations among variables. Results. This study involved 29 eyes of 19 patients, mainly with advanced keratoconus. The uncorrected VA was 0.11 ± 0.10. The pinhole test provided significantly improved VA over corrected distance VA (0.51 ± 0.29 vs. 0.31 ± 0.20, respectively;
). Similarly, the fitted hybrid contact lenses provided improved VA over corrected distance VA (0.66 ± 0.26 vs. 0.31 ± 0.20, respectively;
). The pinhole VA was strongly correlated with the hybrid contact lens VA (r = 0.8135; 95% CI: 0.61–0.92;
). The improvement in the pinhole test over corrected distance VA was moderately correlated with the improvement with the fitted lens over corrected distance VA (r = 0.6269; 95% confidence interval (CI): 0.32–0.80;
). Conclusions. A significant improvement in VA with the pinhole test is a simple predictor of general improvement with hybrid contact lenses. The pinhole test should be used in patients with corneal diseases such as keratoconus to determine whether optical aberrations associated with the disease cause their visual impairment.
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