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Nemet A, Ben Ephraim Noyman D, Nasser W, Sela T, Munzer G, Sapir S, Mimouni M, Kaiserman I. Factors associated with changes in posterior corneal surface following laser-assisted in situ keratomileusis. Graefes Arch Clin Exp Ophthalmol 2024; 262:1215-1220. [PMID: 37947823 DOI: 10.1007/s00417-023-06295-8] [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: 07/10/2023] [Revised: 09/14/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE To identify factors associated with changes in the posterior corneal curvature following laser-assisted in situ keratomileusis (LASIK). METHODS This retrospective study included myopic astigmatic eyes that underwent LASIK between January and December 2013 at Care-Vision Laser Center, Tel-Aviv, Israel. The average posterior keratometry was measured with the Sirius device at a radius of 3 mm from the center. The correlations between the surgically induced change in average posterior keratometry and preoperative parameters such as preoperative sphere, cylinder, spherical equivalent, central corneal thickness (CCT), refraction, Baiocchi Calossi Versaci (BCV) index, ablation depth, percent of tissue altered (PTA), and residual stromal bed (RSB) are reported. RESULTS A total of 115 eyes with a mean age of 32.5 ± 8.3 years (range 22-56 years) were included. Central corneal thickness (p < 0.005), preoperative sphere (p < 0.001), spherical equivalent (p < 0.005), and preoperative posterior inferior/superior ratio (p < 0.05) were all significantly correlated with the percentage of change in the mean posterior K. According to ranked stepwise multiple regression analysis, 22% of the variance of change in posterior K could be explained by the examined factors. The factors that remained significant were the percentage of change in posterior inferior/superior ratio, preoperative subjective sphere, and preoperative mean posterior K (for all, p < 0.001). CONCLUSIONS The percentage of change in posterior inferior/superior ratio, subjective sphere, and preoperative mean posterior K are all correlated with change in the mean posterior K after LASIK. Understanding of the variables that can influence posterior corneal changes following refractive surgery may play a role in the prevention of iatrogenic keratectasia.
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Affiliation(s)
- Achia Nemet
- Department of Ophthalmology, Assuta Ashdod Medical Center, Ashdod, Israel.
- Ben-Gurion University of the Negev, Be'er Sheva, Israel.
| | - Dror Ben Ephraim Noyman
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Waseem Nasser
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Tzahi Sela
- Care-Vision Laser Centers, Tel-Aviv, Israel
| | - Gur Munzer
- Care-Vision Laser Centers, Tel-Aviv, Israel
| | - Shawn Sapir
- Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Igor Kaiserman
- Care-Vision Laser Centers, Tel-Aviv, Israel
- Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
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Ichikawa K, Ichikawa K, Yamamoto N, Horai R. Flexural and Cell Adhesion Characteristic of Phakic Implantable Lenses. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1282. [PMID: 37512093 PMCID: PMC10385999 DOI: 10.3390/medicina59071282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: In this study, we aimed to compare the physical properties of hole-implantable collamer lenses (H-ICLs) and implantable phakic contact lenses (IPCLs) and investigate their flexural and cell adhesion characteristics. Materials and Methods: Transverse compression load to achieve lens flexion and static Young's modulus were measured in H-ICLs and IPCLs using designated equipment. Load was measured both with and without restraining the optic section of the lenses. Adhesion of iHLEC-NY2 cells to the lens surfaces was examined using phase-contrast microscopy, and cell proliferation activity was evaluated using WST-8 assay. Results: The H-ICL showed a greater tendency for transverse compression load compared to IPCL, while the IPCL showed a higher Young's modulus with respect to the force exerted on the center of the anterior surface of the optic section. The joint between the optic section and haptic support in the IPCL was found to mitigate the effects of transverse compression load. Both lens types showed minimal cell adhesion. Conclusions: Our findings indicate that H-ICLs and IPCLs exhibit distinct physical properties and adhesive characteristics. The IPCL demonstrated higher Young's modulus and unique structural features, while the H-ICL required greater transverse compression load to achieve the flexion required to tuck the haptic supports into place behind the iris to fix the lens. The observed cell non-adhesive properties for both lens types are promising in terms of reducing complications related to cell adhesion. However, further investigation and long-term observation of IPCL are warranted to assess its stability and potential impact on the iris. These findings contribute to a better understanding of the performance and potential applications of H-ICLs and IPCLs in ophthalmology.
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Affiliation(s)
| | - Kei Ichikawa
- Chukyo Eye Clinic, Nagoya 456-0032, Aichi, Japan
- General Aoyama Hospital, Toyokawa 441-0103, Aichi, Japan
| | - Naoki Yamamoto
- Support Office for Bioresource Research, Translational Research Headquarters, Fujita Health University, Toyoake 470-1192, Aichi, Japan
| | - Rie Horai
- Chukyo Eye Clinic, Nagoya 456-0032, Aichi, Japan
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Factors associated with changes in posterior corneal surface following photorefractive keratectomy. Graefes Arch Clin Exp Ophthalmol 2021; 259:3477-3483. [PMID: 34097113 DOI: 10.1007/s00417-021-05237-6] [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: 03/30/2020] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To identify factors associated with changes in the posterior cornea curvature following laser refractive surgery. MATERIALS AND METHODS This retrospective study included myopic astigmatic eyes that underwent PRK between January 2013 and December 2013 at Care-Vision Laser Centers, Tel-Aviv, Israel. The average posterior K was measured with the Sirius device at a radius of 3 mm from the center. The correlations between the surgical induced change in average posterior k and preoperative parameters such as central corneal thickness (CCT), refraction, Baiocchi Calossi Versaci index (BCV), ablation depth, percent tissue altered (PTA), and residual stroma bed (RSB) were analyzed. RESULTS A total of 280 eyes with a mean age of 24.9 ± 6.1 years (range, 18-47 years were included in this study. The mean PTA was 14.8 ± 6.0%. A greater change in posterior K was found in females (p = 0.01), smaller treatment zones of 6.0 mm (p = 0.02) and PTA > 20% (p < 0.001). A lower CCT (r = - 0.24, p < 0.001), higher myopia (r = - 0.34, p < 0.001), higher astigmatism (r = - 0.17, p < 0.001), higher total BCV (r = 0.13, p = 0.03), lower back BCV (r = - 0.12, p = 0.05), higher front BCV (r = 0.16, p = 0.01), higher posterior I-S ratio (r = 0.16, p = 0.01), and a lower RSB (r = - 0.42, p < 0.001) were all significantly correlated with percentage of change in mean posterior K. In ranked stepwise multiple regression analysis, 26.2% of the variance of change in posterior K could be explained by the examined factors. The factors that remained significant were PTA (p < 0.001), CCT (p = 0.001), and posterior I-S ratio (p = 0.001). PTA alone accounted for 15% of the variance in posterior K changes in multivariate analysis. CONCLUSIONS Understanding of factors affecting a change in posterior cornea after refractive surgery may have an important practical value for the prevention of iatrogenic keratectasia. Preoperative CCT, posterior I-S ratio, and PTA were significantly associated with changes in posterior K after PRK. PTA was the strongest predictor of posterior corneal changes (p < 0.001).
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Abstract
PURPOSE To assess the stability, safety, predictability, and efficacy of small incision lenticule extraction (SMILE) in high myopia. METHODS The study was conducted as a retrospective noncomparative analysis of the records of 495 eyes of 270 patients treated by the ReLEx SMILE technique for a mean spherical myopic error of -12.84 ± 2.47 D (range: -10.0 to -14.0 D) combined with a mean astigmatism of -1.17 ± 1.34 D (up to -4.0 D). The mean LogMAR corrected distance visual acuity (CDVA) was 0.2 ± 0.6. In this study, 225 patients had the bilateral SMILE procedure, whereas 45 patients had a single eye treated with SMILE. RESULTS One month after surgery, the mean refractive error was 20.72 ± 0.88 D (range: +1 to 21.5 D), and the mean postoperative astigmatism was -0.83 ± 1.04 D. The mean LogMAR UDVA was 0.2 ± 0.34. In the last follow-up visit, 3 years after surgery, all the before mentioned parameters were the same or within minimal changes with no statistically significant difference from the earlier results. However, the spherical error demonstrated a significant change from -0.72 ± 0.88 D at 1 month to -1.17 ± 1.01 D at the end of the follow-up. However, this change had an insignificant visual impact. At the end of the follow-up period, approximately 94% of patients had unchanged CDVA or gained one or more lines, 6% lost one line of CDVA, and 1% lost 2 lines. CONCLUSIONS SMILE may be effective and safe, with a stable and predictable outcome for correction of very high myopia.
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Bianchi GR. PRESBYOPIA MANAGEMENT WITH DIFFRACTIVE PHAKIC POSTERIOR CHAMBER IOL. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2021; 76:211-219. [PMID: 33499642 DOI: 10.31348/2020/30] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate safety and refractive efficiency after posterior chamber diffractive implantable phakic contact lens (IPCL) surgery. MATERIAL AND METHODS A prospective non-randomized case-series study was performed on 54 myopic eyes of 27 patients who had undergone diffractive IPCL surgery. Corneal endothelial cell density (ECD), central corneal thickness (CCT), intra-ocular pressure (IOP), vault, uncorrected distance (UDVA), spherical equivalent (SE) and defocus curve, were all evaluated twelve months after surgery. The presence of cataracts was evaluated by slit-lamp during a postoperative follow-up. RESULTS Mean age was 47 ± 2.62 years-old. Mean SE decreased, from -5.95 ± 2.56 D in a pre-operative stage, to -0.25 ± 0.25 D twelve months after surgery. Achieved UDVA was 20/20 in 24.1% of all cases, 20/25 in 74.1% of them, and 20/32 in all remaining cases. No eyes suffered lost lines of vision. The binocular defocus curve was 0.06 ± 0.05 logMAR for a -3.0 D of defocus; 0.11 ± 0.04 logMAR for a -1.5 D of defocus, and 0.08 ± 0.03 logMAR for a 0 D of defocus. Twelve months after surgery, mean ECD had decreased by 1.43 %, whereas mean CCT had increased by 0.06 %, without any significant statistical difference (p = 0.28 and p = 0.93 respectively). No difference (p: 0.86) in the vault was observed at 6 months vs.12 months, as well as between IOP measurements (p = 0.22). There were no non-intra or postoperative complications, and, specifically, no cataracts developed either. CONCLUSIONS Diffractive IPCL was implanted safely. Corneal endothelial CD, CCT, vault, and IOP remained stable twelve months after surgery. Visual acuity for distance, intermediate and near sight were achieved without spectacles.
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Wu J, Xiong L, Wang Z, Reinstein DZ, Vida RS, Archer TJ. Correction of Moderate to High Hyperopia With Implantation of an Allogeneic Refractive Lenticule. J Refract Surg 2020; 36:772-779. [DOI: 10.3928/1081597x-20200826-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/19/2020] [Indexed: 11/20/2022]
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Biscevic A, Bohac M, Ahmedbegovic-Pjano M, Pidro A, Bejdic N, Patel S. The relationship between patient age and residual refractive error after uneventful laser in situ keratomileusis for moderate-to-high hyperopia. Eur J Ophthalmol 2020; 31:1725-1732. [PMID: 32597207 DOI: 10.1177/1120672120937658] [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: 11/15/2022]
Abstract
PURPOSE To determine if the manifest sphero-cylindrical residual refractive error, at various time points over a 12-month postop period after laser in situ keratomileusis (LASIK) was associated with patient age at time of surgery. METHODS Patients with moderate to high hyperopia (3.00-7.00 DS) and astigmatism ⩽2 DC underwent LASIK using Wavelight Allegretto Eye Q (400 Hz). Treatments were centered on corneal vertex, flaps were made with Moria M2 mechanical microkeratome. Pre-and postoperative uncorrected and corrected distant visual acuity, best corrected spherical equivalent (SEQ) were measured. Measurements were taken at 1 week, 1, 3, 6, and 12 months after the surgery. Target refraction was emmetropia. Total of 161 patients were treated. In binocular cases, data from the right eyes were included for analysis. In this article, we report on refraction data only. Raw data were subjected to several permutations to elicit any links between refractive outcomes and patient age. RESULTS The key findings were as follows y = postop SEQ (diopters), x = patient age (years), ln(x) = natural logarithm of patient age: At 1 month, y = x[0.049 -0.011.ln(x)] (R = -0.205, p = 0.001, n = 161). At 3 months, y = x[0.077 -0.017.ln(x)] (R = -0.355, p < 0.001, n = 161). At 6 months, y = x[0.088 -0.020.ln(x)] (R = -0.382, p < 0.001, n = 161). At 12 months, y = x[0.093 -0.021.ln(x)] (R = -0.409, p < 0.001, n = 161). There was no significant association between x and y at 1 week (p > 0.05). CONCLUSION Residual postop refractive error after LASIK for hyperopia has a logarithmic association with patient age at time of surgery. In younger patients there is tendency toward undercorrection, the opposite occurs in older patients and this persists 1 year after treatment.
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Affiliation(s)
- Alma Biscevic
- Eye Clinic "Svjetlost," Sarajevo, Bosnia and Herzegovina.,University Eye Hospital "Svjetlost" Zagreb, School of Medicine University of Rijeka, Zagreb, Croatia
| | - Maja Bohac
- Eye Clinic "Svjetlost," Sarajevo, Bosnia and Herzegovina.,University Eye Hospital "Svjetlost" Zagreb, School of Medicine University of Rijeka, Zagreb, Croatia
| | | | - Ajla Pidro
- Eye Clinic "Svjetlost," Sarajevo, Bosnia and Herzegovina
| | - Nita Bejdic
- Eye Clinic "Svjetlost," Sarajevo, Bosnia and Herzegovina
| | - Sudi Patel
- Eye Clinic "Svjetlost," Sarajevo, Bosnia and Herzegovina.,University Eye Hospital "Svjetlost" Zagreb, School of Medicine University of Rijeka, Zagreb, Croatia
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BIANCHI GR. Initial Results From a New Model of Posterior Chamber Implantable Phakic Contact Lens: IPCL V2.0. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2019; 8:57-63. [PMID: 31263713 PMCID: PMC6592306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to evaluate the corneal safety, intraocular pressure (IOP), vault and refractive efficiency of the new implantable phakic contact lens, IPCL V2.0 (Care Group, India). A prospective case series study was performed to evaluate 100 consecutive surgeries with IPCL V2.0 (spherical and toric models). Refractive results, corneal endothelial cell density (CD) and central corneal thickness (CCT) were measured at baseline and 6 months after surgery. Intraocular pressure was measured at baseline, 1 day and 6 months, and vault, 3 and 6 months after surgery. Surgical complications and cataract development were also evaluated. The mean corneal endothelial CD decreased by 2.9% with a statistically significance difference (p: 0.03). The mean CCT decreased by 0.87% at 6 months postoperative, without a statistical significance difference (p: 0.35). The mean ± standard deviation (SD) of IOP at baseline was 13.72 ±1.4 mm Hg, at 1 day postoperative was 13.88 ±1.2 mm Hg, and at 6 months was 13.62 ±1.3 mm Hg. These differences were not statistically significant (p: 0.37). The difference in vault between 3 and 6 months after surgery was not statistically significant (p: 0.97). The coefficient of correlation between the attempted versus achieved spherical equivalent (SE) change was R2: 0.958. Postoperative SE was between -0.50 D to +0.50 D in 52% of cases. The remaining of the eyes had SE values ranging from -1.5 D to +1.35 D. No intra or postoperative complications occurred and specifically cataract was not developed. The corneal endothelial CD, CCT, vault and IOP remained stable 6 months after surgery. Refraction was improved and the IPCL V 2.0 was implanted safely.
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