Visian® ICLV4c™ and Artiflex®: Comparative Analysis with the HD AnalyserTM and Integration with Subjective Performance and Anatomical Parameters

A comparative study of two phakic posterior chamber implantable lenses

This study aimed to compare the postimplantation clinical outcomes of 2 types of posterior chamber phakic intraocular lenses (IOLs): Visian™ implantable collamer lenses (ICL; EVO+ V5; Staar Surgical, Monrovia, CA) and an implantable phakic contact lens (IPCL) (IPCL V2.0, Care Group Sight Solution, India) to correct high myopia and myopic astigmatism. This retrospective study included patients who had undergone phakic IOL implantation performed by a single surgeon between March 2021 and March 2022. Preoperative assessments included slit-lamp examination, fundus examination, spherical equivalent, uncorrected distant visual acuity (UDVA), corrected distant visual acuity (CDVA), specular microscope parameters, and optical quality analysis system parameters. Postoperative assessments after 1 year included slit-lamp examination to detect adverse effects and spherical equivalent, UDVA, CDVA, specular microscope, optical quality analysis system, and anterior-segment optical coherence tomography. Eighty eyes from 42 patients (47 eyes from 24 patients in the ICL group and 33 eyes from 18 patients in the IPCL group) were included. No statistically significant differences were observed between the 2 groups regarding preoperative parameters. At 1-year postoperatively, the mean UDVA in the ICL and IPCL groups was 0.019 ± 0.040 logMAR and 0.019 ± 0.041 logMAR, respectively. The mean CDVA was 0.001 ± 0.008 logMAR and 0.001 ± 0.007 logMAR in the ICL and IPCL groups, respectively, showing no statistically significant differences. The postoperative parameters did not differ significantly between the 2 groups. The visual acuity and refractive results of both groups were excellent, and both groups exhibited similar efficacy and safety profiles.

New Terminology and Methodology for the Assessment of the Vitreous, Its Floaters and Opacities, and Their Effect on Vision: Standardized and Kinetic Anatomical and Functional Testing of Vitreous Floaters and Opacities (SK VFO Test)

OBJECTIVE

To introduce VFO and SK VFO Test: new, more representative terminology for symptoms of vitreous floaters/opacities (VFO) and new standardized kinetic (SK) anatomical-functional assessment.

MATERIALS AND METHODS

Eight eyes underwent before-after limited vitrectomy (LV): best-corrected visual acuity, low-luminance visual acuity, Minnesota Low Vision Reading Chart near visual acuity in logMAR, contrast sensitivity function (CV1000E), and straylight measurements (SM) (HDA/LDA/C-Quant). SK infrared confocal scanning laser ophthalmoscopy (SK IRcSLO) and swept-source widefield optical coherence tomography (SS-WF-OCT) identified VFO and posterior vitreous detachment (PVD). SK IRcSLO was performed with gaze directed towards the extreme superior, inferior, and lateral directions.

RESULTS

Anatomical-functional results after LV improved in 7 eyes (87.5%): objective scatter index (27.34%), disturbance index (47.97%) and C-Quant Log units (2.26%). Pre-LV SK IRcSLO and SS-WFOCT imaging identified dynamic well-defined VFO and PVD status (100%). A residual asymptomatic anterior cortical vitreous-induced shadowing ripple effect was detected post-LV.

CONCLUSIONS

This is the first objective-standardized test accounting for VFO kinesis and intermittent effect. There is potential for personalizing treatment and establishing best candidates for laser or surgery. [Ophthalmic Surg Lasers Imaging Retina 2023;54:306-315.].

Early outcomes of anterior segment parameters after implantable collamer lens V4c implantation

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.

Quality of Vision After LASIK, PRK and FemtoLASIK: An Analysis Using the Double Pass Imaging System HD AnalyzerTM®

Purpose

Analyze and compare the quality of vision of Photorefractive keratectomy (PRK), LASER in situ keratomileusis with mechanical microkeratome (LASIK) and femtosecond-assisted LASIK (FS-LASIK) using the double-pass imaging system HD AnalyzerTM^®.

Setting

Ophthalmology department of Centro Hospitalar Universitário do Porto (CHUPorto).

Design

Retrospective, non-randomized, single center study.

Methods

Analysis of three equivalent groups of patients submitted to PRK, LASIK and FS-LASIK at our department. The objective quality of vision assessment included the objective scatter index (OSI), the modular transfer function cutoff frequency (MTF) and the predicted visual acuity within the 100% (PVA), 20% (PVA20) and 9% contrast levels (PVA9) that were evaluated at baseline, 1st week, 1 and 6 months after surgery.

Results

118 eyes were included: 40 underwent LASIK, 43 FS-LASIK and 35 PRK. The mean age was 30.6±4.6 years old and 56% were female. There was a significant impact concerning the type of procedure in the objective quality of vision analysis (Repeated measures ANOVA): the FS-LASIK group showed lower OSI values overtime [F(1,2)=4.566, p=0.012, OSI 0.83±0.53 (FS-LASIK) vs 0.87±0.47 (PRK) and 1.21±1.44 (LASIK)], higher MTF values [F(1,2)=6.569, p=0.002, MTF 40.17±8.33 vs 32.37±11.4 (PRK) and 30.26±10.28 (LASIK)], higher PVA 100% [F(1,2)=10.871, p<0.001], PVA 20% [F(1,2)=9.737, p<0.001] and PVA 9% [F(1,2)=6.335), p=0.003].

Conclusion

In our study, FS-LASIK showed an excellent optical performance through the HD AnalyzerTM technology, with significantly lower OSI and higher MTF, PVA100, PVA20 and PVA9 values. According to our results, this procedure seems to be superior to PRK and LASIK regarding visual quality objective parameters.

Phakic intraocular lens explantation: a series of 175 surgeries

PURPOSE

The ideal timing for phakic intraocular lens (pIOL) explantation remains unknown. Our study aims to evaluate the indications for pIOL explantation, pIOL survival time, visual outcomes, and access endothelial cell loss (ECL) after explantation.

SETTING

Ophthalmology Department, Centro Hospitalar Universitário do Porto, Portugal. Design: Retrospective longitudinal study.

METHODS

Chart review was performed for all consecutive patients that underwent pIOL explantation from January 2010 to December 2019 in a single center.

RESULTS

This study included 175 eyes of 112 patients, 77% of which were female. Phakic IOL survival was 12.9 ± 4.8 [3.7 - 28.6] years and the follow-up period after explantation was 4.1 ± 3.0 [0.3 - 9.9] years. The most frequent causes for explantation were cataract formation (44.0%, n=77) and ECL (50.3%, n=88). During the follow-up period after explantation, mean ECL rate was 2.27 ± 9.32 %/year in the cataract group and -2.14 ± 10.24 %/year in the ECL group, reflecting a positive change in cell density in the latter. Eight eyes (4.6%) required a corneal transplant during the follow-up. Mean corrected distance visual acuity was 0.17 ± 0.24 logMAR at the last visit.

CONCLUSION

Our study demonstrates that pIOL explantation, after an average survival time of 13 years, is a safe procedure. The main causes for explantation were cataract formation and ECL. Most patients show a sustained improvement in visual acuity and endothelial cell density after pIOL explantation, and yet its timing should be ideal to avoid irreversible complications.

In vivo optical quality of posterior-chamber phakic implantable collamer lenses with a central port

BACKGROUND

The aim of this review is to summarize the optical quality results in patients following the implantation of the V4c implantable collamer lens with a central port (ICL, STAAR Surgical Inc.).

MAIN TEXT

A literature search in several databases was carried out to identify those publications, both prospective, retrospective and/or comparative with other refractive surgery procedures, reporting optical outcomes of patients who were implanted with the V4c ICL model. A total of 17 clinical studies published between 2012 and 2021 were included in this review. A detailed analysis of the available data was performed including number of eyes, follow-up and preoperative spherical equivalent. Specifically, the review focused on several optical parameters including higher-order aberrations (HOAs), modulation transfer function (MTF) cut-off frequency and Strehl ratio. This review encompassed a total of 817 eyes measured using different optical devices based on Hartmann-Shack, retinal image quality measurement and ray-tracing technologies at different follow-ups.

CONCLUSIONS

The outcomes found in this review lead us to conclude that the ICL V4c model provides good optical quality, by means of different metrics, when implanted.