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Sella R, Sorkin N, Safir M, Beylin Y, Sela T, Munzer G, Kaiserman I, Mimouni M. Hyperopic LASIK and postoperative corneal steepness: revisiting the 49-diopter limit. J Cataract Refract Surg 2024; 50:550-557. [PMID: 38305328 PMCID: PMC11146188 DOI: 10.1097/j.jcrs.0000000000001411] [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: 06/15/2023] [Revised: 01/10/2024] [Accepted: 01/28/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE To compare corrected distance visual acuity (CDVA) outcomes of hyperopic laser in situ keratomileusis (LASIK) with a postoperative corneal steepness above vs below 49 diopters (D). SETTING Care-Vision Laser Centers, Tel-Aviv, Israel. DESIGN Retrospective study. METHODS This study included consecutive patients who underwent hyperopic LASIK between January 2013 and December 2019. Hyperopic patients were divided into 2 groups based on postoperative corneal steepness with steep corneas defined >49.0 D and the control group ≤49.0 D. Adjustments were performed to account for differences in baseline and intraoperative parameters. RESULTS Overall, 1703 eyes of 1703 patients were included. Mean age was 48.3 ± 10.0 years, and 45.3% were male. Preoperatively, the steep group (2.4%, n = 41/1703) had steeper mean (44.6 D vs 43.1 D, P < .001) and steep (45.1 D vs 43.5 D, P < .001) keratometry, worse logMAR CDVA (0.07 vs 0.04, P = .02), and higher sphere (4.9 D vs 2.9 D, P < .001). Intraoperatively, they had a higher spherical treatment (4.6 D vs 2.8 D, P < .001). After hyperopic LASIK, the steep group had worse logMAR CDVA (0.10 vs 0.06, P = .01). However, after accounting for differences in baseline and spherical treatment, no significant differences were found in postoperative logMAR CDVA (0.06 vs 0.06, P = .99). The factors that remained associated with worse postoperative CDVA were higher spherical treatment (0.01 logMAR per 1 D, P < .001) and preoperative CDVA (0.60 logMAR per 1.00 logMAR, P < .001). CONCLUSIONS Postoperative corneal steepness greater than 49 D is not associated with worse visual outcomes after hyperopic LASIK. However, lower preoperative visual potential and higher spherical treatment applied are associated with worse outcomes. The 49 D cutoff should be revisited.
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Affiliation(s)
- Ruti Sella
- From the Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel (Sella); Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Sella, Sorkin); Care Vision Laser Centers, Tel-Aviv, Israel (Sella, Sela, Munzer, Kaiserman, Mimouni); Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv, Israel (Sorkin); Department of Ophthalmology, Itzhak Shamir Medical Center, Beer Yaakov, Israel (Safir); Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Beylin, Mimouni); Department of Ophthalmology, Barzilai Medical Center, Ashkelon and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel (Kaiserman); Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel (Mimouni)
| | - Nir Sorkin
- From the Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel (Sella); Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Sella, Sorkin); Care Vision Laser Centers, Tel-Aviv, Israel (Sella, Sela, Munzer, Kaiserman, Mimouni); Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv, Israel (Sorkin); Department of Ophthalmology, Itzhak Shamir Medical Center, Beer Yaakov, Israel (Safir); Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Beylin, Mimouni); Department of Ophthalmology, Barzilai Medical Center, Ashkelon and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel (Kaiserman); Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel (Mimouni)
| | - Margarita Safir
- From the Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel (Sella); Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Sella, Sorkin); Care Vision Laser Centers, Tel-Aviv, Israel (Sella, Sela, Munzer, Kaiserman, Mimouni); Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv, Israel (Sorkin); Department of Ophthalmology, Itzhak Shamir Medical Center, Beer Yaakov, Israel (Safir); Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Beylin, Mimouni); Department of Ophthalmology, Barzilai Medical Center, Ashkelon and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel (Kaiserman); Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel (Mimouni)
| | - Yonatan Beylin
- From the Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel (Sella); Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Sella, Sorkin); Care Vision Laser Centers, Tel-Aviv, Israel (Sella, Sela, Munzer, Kaiserman, Mimouni); Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv, Israel (Sorkin); Department of Ophthalmology, Itzhak Shamir Medical Center, Beer Yaakov, Israel (Safir); Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Beylin, Mimouni); Department of Ophthalmology, Barzilai Medical Center, Ashkelon and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel (Kaiserman); Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel (Mimouni)
| | - Tzahi Sela
- From the Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel (Sella); Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Sella, Sorkin); Care Vision Laser Centers, Tel-Aviv, Israel (Sella, Sela, Munzer, Kaiserman, Mimouni); Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv, Israel (Sorkin); Department of Ophthalmology, Itzhak Shamir Medical Center, Beer Yaakov, Israel (Safir); Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Beylin, Mimouni); Department of Ophthalmology, Barzilai Medical Center, Ashkelon and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel (Kaiserman); Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel (Mimouni)
| | - Gur Munzer
- From the Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel (Sella); Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Sella, Sorkin); Care Vision Laser Centers, Tel-Aviv, Israel (Sella, Sela, Munzer, Kaiserman, Mimouni); Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv, Israel (Sorkin); Department of Ophthalmology, Itzhak Shamir Medical Center, Beer Yaakov, Israel (Safir); Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Beylin, Mimouni); Department of Ophthalmology, Barzilai Medical Center, Ashkelon and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel (Kaiserman); Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel (Mimouni)
| | - Igor Kaiserman
- From the Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel (Sella); Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Sella, Sorkin); Care Vision Laser Centers, Tel-Aviv, Israel (Sella, Sela, Munzer, Kaiserman, Mimouni); Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv, Israel (Sorkin); Department of Ophthalmology, Itzhak Shamir Medical Center, Beer Yaakov, Israel (Safir); Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Beylin, Mimouni); Department of Ophthalmology, Barzilai Medical Center, Ashkelon and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel (Kaiserman); Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel (Mimouni)
| | - Michael Mimouni
- From the Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel (Sella); Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Sella, Sorkin); Care Vision Laser Centers, Tel-Aviv, Israel (Sella, Sela, Munzer, Kaiserman, Mimouni); Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv, Israel (Sorkin); Department of Ophthalmology, Itzhak Shamir Medical Center, Beer Yaakov, Israel (Safir); Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Beylin, Mimouni); Department of Ophthalmology, Barzilai Medical Center, Ashkelon and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel (Kaiserman); Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel (Mimouni)
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Levinger N, Erdinest N, London N, Levinger E, Goldfeather Ben Zaken S, Barequet D, Barequet I, Achiron A, Levinger S. Femtosecond LASER-Assisted Double Intraocular Lens Exchange in Nanophthalmic Eyes. Case Rep Ophthalmol 2024; 15:143-149. [PMID: 38348443 PMCID: PMC10861217 DOI: 10.1159/000536190] [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: 06/27/2023] [Accepted: 01/01/2024] [Indexed: 02/15/2024] Open
Abstract
Introduction Though patients with nanophthalmos frequently endure decreased quality of vision with contact lenses or spectacles, refractive surgery is generally an inadequate alternative due to the associated high refractive error. A refractive lens exchange (RLE) is an alternative option but is technically challenging, requiring accuracy in biometry measurements and procedures. Case Presentation This case discusses a 27-year-old female with nanophthalmos (axial lengths 17.6 mm and 17.4 mm, right and left eyes, respectively) who underwent a femtosecond laser-assisted (FLA) RLE with simultaneous implantation of a monofocal and a Sulcoflex trifocal (Rayner, Britain) lens in each eye. Preoperative cycloplegic refraction was +11.50/-0.75 × 145 and +12.00/-1.00 × 35 in the RE and LE, respectively. Best-corrected visual acuity (BCVA) at distance and near in the RE and LE was 6/7.5 and J1, 6/8.5 and J2, respectively. Uncorrected visual acuity (UCVA) was >6/120 and >J14 for each eye. FLA RLE was performed in the RE, then in the LE 2 weeks later. In each eye, a monofocal (44.0 D, RE, and LE) and a Sulcoflex trifocal lens (both implants, Rayner, Britain) were implanted in one procedure. Distance and near UCVA measured 6 weeks post-op RE and 1-month post-op LE at 6/8.5 and J1 in the RE, 6/10 and J1 in the LE. The RE and LE refraction and BCVA were +0.50/-1.00 × 115, 6/7.5, and plano/-1.00 × 55, 6/8.5, respectively. The post-op outcomes were uneventful. Conclusion A single procedure concurrently implanting a monofocal and Sulcoflex trifocal intraocular lens in nanophthalmic eyes resulted in an excellent UCVA. This procedure can be considered esthetic and reconstructive as it significantly improves patient appearance and function.
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Affiliation(s)
- Nadav Levinger
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Hadassah Medical Center, Jerusalem, Israel
| | - Nir Erdinest
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
| | | | - Eliya Levinger
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shalhevet Goldfeather Ben Zaken
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
| | - Dana Barequet
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Irit Barequet
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Asaf Achiron
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shmuel Levinger
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
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