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Miao AO, Lin P, Qian D, Xu J, Lu YI, Zheng T. Association Between Endothelial Cell Density and Corneal Thickness in Medium, Short, and Long Eyes of Han Chinese Cataract Patients. Am J Ophthalmol 2024; 262:10-18. [PMID: 38316200 DOI: 10.1016/j.ajo.2024.01.036] [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: 08/20/2022] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE To evaluate the association between the endothelial cell density (ECD) and central corneal thickness (CCT) in medium, short, and long eyes of preoperative Han Chinese cataract patients. DESIGN Retrospective cross-sectional study. METHODS We consecutively enrolled 410 eyes, namely, 50 short eyes (axial length [AL]<22.0 mm), 150 medium eyes (22.0≤AL<24.0 mm), 120 medium-long eyes (24.0≤AL<26.0 mm), and 90 long eyes (AL≥26.0 mm), of 410 adult patients scheduled for cataract surgery. The ECD and CCT were determined preoperatively with a noncontact specular microscope. The association between the CCT and ECD was identified by using a multivariable regression analysis. A thin cornea was defined as having a CCT less than 500 µm. RESULTS After adjusting for age, the presence of arterial hypertension, the presence of diabetes mellitus, intraocular pressure, and AL, a positive association between the CCT and ECD was identified in short eyes (linear regression coefficient [B]=3.40; standardized B [β]=0.52; P = .03), medium eyes (B = 2.33; β=0.28; P = .002), medium-long eyes (B = 1.84; β=0.25; P = .02), and long eyes (B = 2.69; β=0.41; P = .04). In the total group, the multivariable logistic analysis showed a significant link between the presence of a thin cornea and a lower ECD (odds ratio [OR]=0.80 per 100 cells/mm2 increase; P = .001). CONCLUSIONS For cataract patients of Han ethnicity, a significant association between a thin CCT and a lower ECD was shown across the AL spectrum and was most prominent in short eyes. Eyes with a thin cornea are more likely to have a lower ECD.
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Affiliation(s)
- A O Miao
- From the Eye Institute and Department of Ophthalmology (A.M., P.L., D.Q., J.X., Y.L., T.Z.), Eye & ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia (A.M., P.L., D.Q., J.X., Y.L., T.Z.), Chinese Academy of Medical Sciences, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration (A.M., P.L., D.Q., J.X., Y.L., T.Z.), Shanghai, China
| | - Peimin Lin
- From the Eye Institute and Department of Ophthalmology (A.M., P.L., D.Q., J.X., Y.L., T.Z.), Eye & ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia (A.M., P.L., D.Q., J.X., Y.L., T.Z.), Chinese Academy of Medical Sciences, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration (A.M., P.L., D.Q., J.X., Y.L., T.Z.), Shanghai, China
| | - Dongjin Qian
- From the Eye Institute and Department of Ophthalmology (A.M., P.L., D.Q., J.X., Y.L., T.Z.), Eye & ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia (A.M., P.L., D.Q., J.X., Y.L., T.Z.), Chinese Academy of Medical Sciences, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration (A.M., P.L., D.Q., J.X., Y.L., T.Z.), Shanghai, China
| | - Jie Xu
- From the Eye Institute and Department of Ophthalmology (A.M., P.L., D.Q., J.X., Y.L., T.Z.), Eye & ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia (A.M., P.L., D.Q., J.X., Y.L., T.Z.), Chinese Academy of Medical Sciences, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration (A.M., P.L., D.Q., J.X., Y.L., T.Z.), Shanghai, China
| | - Y I Lu
- From the Eye Institute and Department of Ophthalmology (A.M., P.L., D.Q., J.X., Y.L., T.Z.), Eye & ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia (A.M., P.L., D.Q., J.X., Y.L., T.Z.), Chinese Academy of Medical Sciences, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration (A.M., P.L., D.Q., J.X., Y.L., T.Z.), Shanghai, China
| | - Tianyu Zheng
- From the Eye Institute and Department of Ophthalmology (A.M., P.L., D.Q., J.X., Y.L., T.Z.), Eye & ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia (A.M., P.L., D.Q., J.X., Y.L., T.Z.), Chinese Academy of Medical Sciences, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration (A.M., P.L., D.Q., J.X., Y.L., T.Z.), Shanghai, China.
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Jiao YD, Yan Z, Zhao TQ, Zhao HX. Comparison of errors in ablation depth calculation after myopic femtosecond laser in situ keratomileusis in patients with different degrees of myopia: a prospective study. BMC Ophthalmol 2023; 23:453. [PMID: 37957578 PMCID: PMC10642044 DOI: 10.1186/s12886-023-03200-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/06/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND To investigate the difference between the predicted preoperative corneal ablation depth and the measured ablation depth for femtosecond laser in situ keratomileusis (FS-LASIK) in patients with different degrees of myopia, and to analyze the source of the difference. METHODS A total of 55 patients (109 eyes) were included in this study. Multiple logistics regression was applied to analyze the sources affecting postoperative refractive outcomes. The difference between the preoperative predicted corneal ablation depth and the 1-day postoperative ablation depth in patients with different degrees of myopia was explored using linear regression. Corneal biomechanical parameters influencing error in ablation depth calculation were examined using multiple linear regression. RESULTS One hundred and nine eyes were divided into low to moderate myopia (55 eyes, myopia of 6 D or less), high myopia (45 eyes, myopia ranging from 6 D to a maximum of 9 D), and very high myopia group (9 eyes, myopia greater than 9 D) based on preoperative refractive error (spherical equivalent). Postoperative visual outcomes were comparable among the three groups of patients, with no significant difference in uncorrected visual acuity (UCVA). We did find notable disparities in spherical equivalent (SE) and central corneal thickness (CCT) in patients with different degrees of myopia at 1 day postoperatively (all p < 0.001). Logistic regression analysis showed that error in ablation depth calculation was an independent risk factor for refractive outcomes one day after surgery (OR = 1.689, 95% CI: 1.366 - 2.089). There was a substantial discrepancy in error in ablation depth calculation at 1 day postoperatively between the three groups. The measured ablation depth of the laser platform was lower than the predicted ablation depth in the low to moderate myopia and very high myopia groups, but the opposite was true in the high myopia group. Pre-operative SE (p < 0.001) and corneal front minimum radius of curvature (Front Rmin) (p = 0.007) obviously influenced the error in ablation depth calculation. CONCLUSIONS Error in ablation depth calculation values vary significantly between patients with different degrees of myopia and correlate highly with preoperative SE and Front Rmin. At the same time, the available evidence suggests that error in ablation depth calculation is an influential factor in postoperative refractive status, so it is imperative to control error in ablation depth calculation.
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Affiliation(s)
- Yi-Dian Jiao
- Department of PRK Center, the Affiliated Hospital of Inner Mongolia Medical University, Tongdao North Street 1, Hohhot, 010050, China
| | - Zhi Yan
- School of Medical Laboratory, Tianjin Medical University, Guangdong Road, Tianjin, 300203, China
| | - Tian-Qi Zhao
- Department of PRK Center, the Affiliated Hospital of Inner Mongolia Medical University, Tongdao North Street 1, Hohhot, 010050, China
| | - Hai-Xia Zhao
- Department of PRK Center, the Affiliated Hospital of Inner Mongolia Medical University, Tongdao North Street 1, Hohhot, 010050, China.
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Mao X, Ji S, Chen H, Dai J. Comparison of Postoperative Safety, Efficacy, and Visual Quality after SMILE for Myopic Patients with Different Corneal Thicknesses. Curr Eye Res 2023; 48:18-24. [PMID: 36285731 DOI: 10.1080/02713683.2022.2117382] [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: 12/30/2022]
Abstract
PURPOSE To investigate the safety, efficacy, and visual quality of small incision lenticule extraction (SMILE) in different corneal thickness patients with myopia or myopic astigmatism. METHODS This prospective cohort study included 191 right eyes of 191 patients. Eyes were divided into three groups according to preoperative central corneal thickness (CCT) (Preoperative central corneal thickness (CCT) was the group indicator.) There were 31 eyes in the thin cornea group (CCT ≤500 um (μm), TC), 94 eyes in the moderate corneal thickness group (CCT ≥501 um (μm) and ≤550 um (μm), MD) and 66 eyes in the thick cornea group (CCT ≥550 um (μm), TK). Comparisons in uncorrected (UDVA) and best-corrected distance visual acuity (BDVA), manifest refractive spherical equivalent (SE), preoperative mesopic/photopic contrast sensitivity (CS), ocular higher-order aberrations (HOAs) at a 6mm analytical pupil diameter, and visual quality questionnaires were made (performed) among the three groups during the postoperative six months. Subgroup analyses were made based on preoperative SE. RESULTS The safety indices at six months were 1.15 ± 0.18, 1.14 ± 0.17, and 1.18 ± 0.17, respectively (p = 0.374), and the efficacy indices at six months were 1.07 ± 0.25, 1.12 ± 0.22, and 1.11 ± 0.21, respectively (p = 0.599). The postoperative SE was -0.07 ± 0.52D, -0.14 ± 0.38D, and -0.05 ± 0.46D after SMILE in the three groups, respectively (p = 0.376). No significant difference was found in mesopic/photopic CS, HOAs, and visual quality among different corneal thickness groups and SE groups. Postoperative SE and efficacy indices were the lowest in thin cornea eyes with ultra-high myopia (over -9.00 D). CONCLUSIONS SMILE provides comparable safety, efficacy, and visual quality results in different corneal thickness patients. Those with myopia higher than -9.00 D had less efficacy after surgery, especially in thin cornea patients.
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Affiliation(s)
- Xiuyu Mao
- Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.,Department of Ophthalmology, Eye & ENT Hospital Affiliated to Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences (Fudan University), Shanghai, China
| | - Shunmei Ji
- Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.,Department of Ophthalmology, Eye & ENT Hospital Affiliated to Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences (Fudan University), Shanghai, China
| | - Han Chen
- Department of Ophthalmology, Eye & ENT Hospital Affiliated to Fudan University, Shanghai, China.,Department of Ophthalmology, Fujian Provincial Hospital, Fujian, China
| | - Jinhui Dai
- Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.,Department of Ophthalmology, Eye & ENT Hospital Affiliated to Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences (Fudan University), Shanghai, China
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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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Liang S, Ji S, Liu X, Chen M, Lei Y, Hou J, Li M, Zou H, Peng Y, Ma Z, Liu Y, Jhanji V, Wang Y. Applying Information Gain to Explore Factors Affecting Small-Incision Lenticule Extraction: A Multicenter Retrospective Study. Front Med (Lausanne) 2022; 9:837092. [PMID: 35592861 PMCID: PMC9110865 DOI: 10.3389/fmed.2022.837092] [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: 12/16/2021] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose This retrospective study aimed to identify the key factors influencing postoperative refraction after small-incision lenticule extraction (SMILE) using information gain. Methods This study comprised 2,350 eyes of 1,200 patients who underwent SMILE using a Visumax 500-kHz femtosecond laser (Carl Zeiss Meditec AG) in three ophthalmic centers: Tianjin Eye Hospital (center A), Jinan Mingshui Eye Hospital (center B), and Qingdao Eye Hospital (center C). Anterior segment features, including corneal curvature and central corneal thickness (CCT), were obtained from Pentacam HR (Oculus, Wetzlar, Germany). Information gain was calculated to analyze the importance of features affecting postoperative refraction. Results Preoperative and postoperative mean spherical equivalent (SE) refraction were −5.00 (−6.13, −3.88) D and 0.00 (−0.25, 0.13) D, respectively. None of the patients lost more than two lines of corrected distance visual acuity. The safety index was 1.32 ± 0.24, 1.03 ± 0.08, and 1.13 ± 0.16 in centers A, B, and C, respectively. The efficacy index was 1.31 ± 0.25, 1.02 ± 0.08, and 1.13 ± 0.17 in centers A, B, and C, respectively. At least 95% of the eyes were within ±1.00 D of the attempted correction. Postoperative refraction was related to preoperative spherical diopter refraction (r = 0.369, p < 0.001), preoperative SE (r = 0.364, p < 0.001), maximum lenticule thickness (r = −0.311, p < 0.001), preoperative uncorrected distance visual acuity (r = 0.164, p < 0.001), residual stromal thickness (r = 0.139, p < 0.001), preoperative mean anterior corneal curvature (r = −0.127, p < 0.001), preoperative flattest anterior corneal curvature (r = −0.122, p < 0.001), nomogram (r = −0.100, p < 0.001) and preoperative CCT (r = −0.058, p = 0.005). Conclusions SMILE was considered a safe and effective procedure for correcting myopia. Based on information gain, postoperative refraction was influenced by preoperative mean anterior corneal curvature, CCT, refraction, and residual stromal thickness.
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Affiliation(s)
- Shuang Liang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Shufan Ji
- School of Computer Science and Engineering, Beijing University of Aeronautics and Astronautics, Beijing, China
| | - Xiao Liu
- School of Computer Science and Engineering, Beijing University of Aeronautics and Astronautics, Beijing, China
| | - Min Chen
- Qingdao Eye Hospital, Shandong First Medical University, Qingdao, China
| | - Yulin Lei
- Jinan Mingshui Eye Hospital, Jinan, China
| | - Jie Hou
- Jinan Mingshui Eye Hospital, Jinan, China
| | - Mengdi Li
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Haohan Zou
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Yusu Peng
- Qingdao Eye Hospital, Shandong First Medical University, Qingdao, China
| | - Zhixing Ma
- Jinan Mingshui Eye Hospital, Jinan, China
| | - Yuanyuan Liu
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Yan Wang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China.,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Tianjin, China
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Zhao Y, Fu D, Chen Z, Zhou X. Three-Year Follow-Up of Posterior Corneal Elevation in Thin Corneas After Small Incision Lenticule Extraction. Front Med (Lausanne) 2022; 9:758223. [PMID: 35186987 PMCID: PMC8854970 DOI: 10.3389/fmed.2022.758223] [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: 09/06/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To evaluate the changes in posterior corneal elevation in thin corneas after small incision lenticule extraction (SMILE). Methods In this prospective study, 97 eyes of 97 patients undergoing SMILE were recruited. Eyes were categorized into the following groups based on the preoperative minimum central corneal thickness (CCT): group A (37 eyes, 480–499 μm), group B (30 eyes, 500–529 μm), and group C (30 eyes, 530–560 μm). The posterior corneal surface was measured with a Pentacam over a 3-year follow-up period. Changes in the posterior corneal elevation at the central point (PCE), thinnest point (PTE), and predetermined area were measured. Results No iatrogenic keratectasia was observed during the follow-up period. The mean changes in PCE, PTE, and the inferior area in group A were 1.14 ± 3.40 μm, −0.11 ± 3.20 μm, and −0.26 ± 1.23 μm, respectively (P ≥ 0.125). Although statistically significant change in the central-4 mm area was noted, the value was quite small (0.98 ± 1.67 μm) and was not higher than that in the other two groups (P = 0.003). For all three groups, the elevation remained stable or showed a backward change in the central annulus, while there was a small forward displacement in the 6-mm optical zone. In group A, changes in elevation values yielded negative statistical correlations with residual bed thickness and CCT (P ≤ 0.006) (except for the inferior area, the 4-mm and 6-mm optical zone). Conclusions With a strict preoperative assessment, SMILE achieved good safety and efficacy in correcting myopia in thin corneas and enabled a stable posterior corneal surface over a 3-year follow-up period. Synopsis Careful preoperative assessment and suitable surgical design should be taken to ensure posterior corneal stability after SMILE in thin corneas.
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Affiliation(s)
- Yu Zhao
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Dan Fu
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Zhuoyi Chen
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- *Correspondence: Xingtao Zhou
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