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Ding X, Zhang F, Li S. Modified femtosecond laser-assisted arcuate keratotomy for managing low corneal astigmatism using trifocal intraocular lens implantation in Chinese cataract patients. Lasers Med Sci 2024; 39:178. [PMID: 38990392 DOI: 10.1007/s10103-024-04131-x] [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: 02/14/2024] [Accepted: 07/02/2024] [Indexed: 07/12/2024]
Abstract
To evaluate the visual outcome and astigmatic correction following trifocal intraocular lens (IOL) implantation using the modified femtosecond laser-assisted arcuate keratotomy (FSAK) in Chinese cataract patients with low astigmatism. This retrospective study included consecutive cataract patients with regular corneal astigmatism ranging from 0.75 to 1.5 D who underwent FSAK combined with the trifocal IOL implantation between November 2020 and September 2022. Monocular uncorrected distance visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity, and refractive data were collected at the 3-month follow-up. The pre- and post-operative high-order aberrations (HOAs) were recorded. The variation in astigmatism was analyzed using Alpins vector analysis. A total of 27 eyes from 23 patients were analyzed. The monocular uncorrected distance visual acuity (UDVA) (5 m) at the 3-month follow-up was 0.04 ± 0.09 logarithm of the minimum angle of resolution (logMAR), which was significantly improved compared with the preoperative value of 0.95 ± 0.51 logMAR (P <.001). The corneal astigmatism was significantly reduced from 1.24 ± 0.42 D to 0.49 ± 0.34 D (P <.001). The target-induced astigmatism (TIA) was 1.25 ± 0.43 D, the surgically induced astigmatism (SIA) was 1.16 ± 0.52 D, and the difference vector (DV) was 0.5 ± 0.34 D. The magnitude of error (ME) (difference between SIA and TIA) was -0.1 ± 0.41 D, and the correction index (CI) (ratio of SIA to TIA) was 0.93 ± 0.36. The angle of error was 3.92° ± 16.90°. Total HOA was reduced from 0.89 ± 1.11 to 0.41 ± 0.55 (P = 0.184), and the corneal HOA was lowered from 0.17 ± 0.18 to 0.10 ± 0.10 (P = 0.129). Implantation of trifocal IOL following the modified FSAK in Chinese cataract patients exhibited excellent visual efficacy and effectively reduced corneal astigmatism.
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Affiliation(s)
- Xue Ding
- Beijing Aier-Intech Eye Hospital, Beijing, 100021, China
| | - Fan Zhang
- Aier Academy of Ophthalmology, Central South University, Changsha, 410004, China
| | - Shaowei Li
- Beijing Aier-Intech Eye Hospital, Beijing, 100021, China.
- Aier Academy of Ophthalmology, Central South University, Changsha, 410004, China.
- Institute of Corneatology in Aier Eye Hospital, Beijing, 100021, China.
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Brar S, Ganesh S, Karegowda M. Clinical outcomes and rotational stability after implantation of a monofocal toric intraocular lens with textured haptics in normal vs high axial lengths. J Cataract Refract Surg 2024; 50:718-723. [PMID: 38377183 DOI: 10.1097/j.jcrs.0000000000001429] [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: 12/08/2023] [Accepted: 02/11/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE To compare the clinical outcomes and rotational stability after implantation of a toric intraocular lens (IOL) with textured haptics in eyes with normal vs high axial lengths (ALs). SETTING Nethradhama Superspeciality Eye Hospital, Bangalore, India. DESIGN 2-arm, retrospective comparative study. METHODS This retrospective study included 114 eyes of 114 patients who underwent femtolaser cataract surgery followed by implantation of the HOYA Vivinex Toric monofocal IOL (Model XY1A-SP), of which 62 and 52 eyes belonged to normal (≤23.9 mm) and high (≥24 mm) AL groups, respectively. 1 week and 3 months postoperatively, clinical outcomes and rotational stability of the toric IOL was evaluated. RESULTS 3 months postoperatively, % eyes achieving refractive astigmatism accuracy within ≤0.50 diopter, was 100% (n = 62) in the normal vs 94% (n = 49) in the high AL group. All eyes that is, 100% (n = 62) in the normal and 96.15% (n = 50) eyes in the high myopia group were <5 degrees of the intended axis. The mean change in postoperative rotation from 1 week to 3 months was 0.28 ± 0.09 degrees in the normal, and 0.30 ± 1.11 degrees in the high AL group ( P = .80). No significant correlation was observed between AL and white-to-white diameter with 1-week postoperative rotation values. No eye required repositioning of toric IOL for significant misalignment. CONCLUSIONS No significant differences were observed for clinical outcomes and postoperative rotational stability between eyes with normal and high ALs, suggesting excellent rotational stability of the Vivinex Toric IOL with textured haptics in all eyes, irrespective of the preoperative AL measurements.
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Affiliation(s)
- Sheetal Brar
- From the Department of Phaco and Refractive Services, Nethradhama Super Speciality Eye Hospital, Bangalore, India
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Nagpal R, Shakkarwal C, Ahsan S, Maharana PK, Goel M, Sharma N. Outcomes of preloaded toric intraocular lens implantation in eyes undergoing phacoemulsification. Indian J Ophthalmol 2023; 71:2480-2486. [PMID: 37322666 PMCID: PMC10417997 DOI: 10.4103/ijo.ijo_3068_21] [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: 01/07/2022] [Revised: 03/01/2022] [Accepted: 02/02/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose To evaluate the clinical outcomes of preloaded toric intraocular lens (IOLs) implantation in eyes undergoing phacoemulsification. Methods This prospective study included 51 eyes of 51 patients with visually significant cataracts and corneal astigmatism ranging between 0.75 and 5.50 D. All patients underwent phacoemulsification with SupraPhob toric intraocular lens implantation under topical anesthesia. The main outcome measures were uncorrected distance visual acuity (UDVA), residual refractive cylinder, spherical equivalent, and IOL stability at 3 months follow-up. Results At 3 months, 49% (25/51) of patients had UDVA equal to or better than 20/25 with 100% of eyes achieving better than 20/40. Mean logMAR UDVA improved from 1.02 ± 0.39, preoperatively to 0.11 ± 0.10 at 3 months follow-up (P < 0.001, Wilcoxon signed-rank test). The mean refractive cylinder improved from - 1.56 ± 1.25 D preoperatively to - 0.12 ± 0.31 D at 3 months follow-up (P < 0.001) while the mean spherical equivalent value changed from - 1.93 ± 3.71D preoperatively to - 0.16 ± 0.27D (P = 0.0013). The mean root mean square value for higher order aberrations was 0.30 ± 0.18 μm while the average contrast sensitivity value (Pelli-Robson chart) was 1.56 ± 0.10 log unit, at the final follow-up. The mean IOL rotation at 3 weeks was 1.7 ± 1.61 degrees, which did not change significantly at 3 months (P = 0.988) follow-up. There were no intraoperative or postoperative complications. Conclusion SupraPhob toric IOL implantation is an effective method for addressing preexisting corneal astigmatism in eyes undergoing phacoemulsification with good rotational stability.
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Affiliation(s)
- Ritu Nagpal
- Department of Ophthalmology, Cataract, Cornea and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Chetan Shakkarwal
- Department of Ophthalmology, Cataract, Cornea and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Saima Ahsan
- Department of Ophthalmology, Cataract, Cornea and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prafulla Kumar Maharana
- Department of Ophthalmology, Cataract, Cornea and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Madhav Goel
- Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India
| | - Namrata Sharma
- Department of Ophthalmology, Cataract, Cornea and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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O'Neill BP, Diakonis VF, Tsaousis KT, Weinstock RJ. Outcomes of toric IOL implantation guided by iris-registered femtosecond laser capsulotomy markings. Int Ophthalmol 2021; 41:4009-4015. [PMID: 34313930 DOI: 10.1007/s10792-021-01973-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the accuracy and stability of iris-registered femtosecond laser-assisted anterior capsule axis markings (compensating cyclotorsion) along with refractive and visual outcomes after toric IOL implantation. METHODS This prospective case series included eyes with visually significant cataracts and regular corneal astigmatism ranging from 1.25D to 4.0D, which received FLACS and toric IOL implantation, at The Eye Institute of West Florida, Largo, Florida, USA. Preoperative iris registration was used in conjunction with a femtosecond laser platform to create cyclotorsion corrected axis marks at the capsulotomy edge to facilitate toric IOL axial alignment. Patients were examined one, seven and thirty days after surgery to assess capsulotomy marks axis, toric IOL axis along with visual and refractive outcomes. RESULTS Eighteen eyes of 13 patients aged 74.35 ± 8.65 years were included. Mean pre-op CDVA was 0.24 ± 0.16 LogMAR, while mean post-op UDVA was 0.09 ± 0.09 LogMAR. Mean pre-op corneal astigmatism was 1.85 ± 0.41 D, decreasing to 0.24 ± 0.41 D of refractive astigmatism postoperatively (p < 0.001). The capsular toric axis markings were visible in 100% of eyes throughout the follow-up; the mean difference between intended capsulotomy mark axis and measured capsulotomy mark axis was 1.6°, 1.7° and 1.3 o at the 1, 7 and 30 day intervals (p > 0.05), respectively. No capsule-related or any other type of complications was noted. CONCLUSIONS Iris-registered femtosecond laser-assisted anterior capsule axis markings are safe and may be considered as an alternative option to the known axis marking techniques for toric IOL axial alignment at the time of cataract surgery.
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Affiliation(s)
| | | | - Konstantinos T Tsaousis
- Department of Ophthalmology, Volos General Hospital, Polymeri 134, 38222, Volos, Thessaly, Greece.
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Diakonis VF, Kounis GA, Yesilirmak N, Warren D, Tsaousis KT, Davis Z, Yoo SH, Donaldson KE. Outcomes of toric intraocular lens implantation after femtosecond laser and traditional cataract surgery. Clin Exp Optom 2020; 104:69-73. [PMID: 32519369 DOI: 10.1111/cxo.13099] [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: 10/24/2022] Open
Abstract
CLINICAL RELEVANCE Having an understanding of the refractive outcomes of different forms of cataract surgery will assist optometrists in explaining the implication of such procedures to patients being referred for such procedures. BACKGROUND The purpose of this study was to compare the refractive outcomes after toric intraocular lens implantation between femtosecond laser-assisted cataract surgery and traditional phacoemulsification. METHODS This retrospective non-randomised case series included 114 eyes of 92 consecutive patients (59 male and 55 female) aged 71.65 ± 10.46-years (range 57 to 92-years), who underwent either femtosecond laser-assisted cataract surgery (using two laser platforms) (group 1) or traditional phacoemulsification (group 2) between August 2013 and September 2015. Pre-operative keratometric values, the attempted refraction from the biometry platform and the toric intraocular lens web-based calculator, and the one month post-operative manifest refraction were assessed to evaluate the refractive outcomes of the two groups. RESULTS Mean pre-operative topographic corneal astigmatism was -1.94 ± 0.73 D (range 0.91 to 4.61 D) and -1.98 ± 0.60 D (range 1.07 to 3.43 D) for groups 1 and 2, respectively (p > 0.05). Mean axial length was 24.22 ± 0.73-mm (range 21.78 to 29.30-mm) and 24.60 ± 1.09-mm (range 21.82 to 25.95-mm) for groups 1 and 2, respectively (p > 0.05). Multivariate vector analysis of the remaining refractive error between the two groups (desired refraction minus achieved refraction) revealed no statistically significant difference (p > 0.05). Analysis within each group demonstrated a higher accuracy of refractive outcomes for the femtosecond laser-assisted cataract surgery eyes (p < 0.05) when compared to the traditional phacoemulsification (p > 0.05). CONCLUSION Femtosecond laser-assisted cataract surgery and traditional phacoemulsification demonstrate similar refractive outcomes after toric intraocular lens implantation, while femtosecond laser-assisted cataract surgery seems to provide a slightly higher accuracy.
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Affiliation(s)
- Vasilios F Diakonis
- Department of Cornea and External Diseases, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine , Miami, Florida, USA
| | - George A Kounis
- Department of Cornea and External Diseases, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine , Miami, Florida, USA
| | - Nilufer Yesilirmak
- Department of Cornea and External Diseases, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine , Miami, Florida, USA
| | - Daniel Warren
- Department of Cornea and External Diseases, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine , Miami, Florida, USA
| | - Konstantinos T Tsaousis
- Department of Cornea and External Diseases, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine , Miami, Florida, USA
| | - Zachary Davis
- Department of Cornea and External Diseases, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine , Miami, Florida, USA
| | - Sonia H Yoo
- Department of Cornea and External Diseases, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine , Miami, Florida, USA
| | - Kendall E Donaldson
- Department of Cornea and External Diseases, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine , Miami, Florida, USA
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Rementería-Capelo LA, Contreras I, García-Pérez JL, Blázquez V, Ruiz-Alcocer J. Visual quality and patient satisfaction with a trifocal intraocular lens and its new toric version. J Cataract Refract Surg 2019; 45:1584-1590. [PMID: 31587937 DOI: 10.1016/j.jcrs.2019.06.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess and compare the visual quality and subjective outcomes of a trifocal spherical intraocular lens (IOL) and its new toric version. SETTING Clínica Rementería, Madrid, Spain. DESIGN Prospective case series. METHODS Patients had bilateral implantation of the AcrySof IQ PanOptix spherical or toric IOL. Three months postoperatively, monocular and the binocular uncorrected and corrected distance, intermediate, and near visual acuities; binocular defocus curves; and binocular contrast sensitivity function (CSF) were assessed. Patient satisfaction was evaluated with the Catquest 9SF questionnaire. RESULTS The study comprised 250 eyes (166 with spherical IOL; 84 with toric IOL) of 125 patients. Both groups had good monocular visual acuity at all distances with no statistically significant differences between groups. The mean monocular uncorrected acuity in the spherical group was 0.06 logarithm of the minimum angle of resolution (logMAR) ± 0.07 (SD), 0.20 ± 0.10 logMAR, and 0.05 ± 0.07 logMAR for far, intermediate, and near, respectively, and in the toric group, 0.07 ± 0.10 logMAR, 0.23 ± 0.20 logMAR, and 0.07 ± 0.12 logMAR, respectively. Defocus curves showed a visual acuity of 0.1 logMAR or better between -2.5 diopters (D) and +0.5 D with no differences between groups. The CSF values were within normal ranges with both IOLs. The questionnaire showed high rates of patient satisfaction with no differences between groups. CONCLUSIONS The visual outcomes with the 2 IOLs were similar. With optimum implantation and alignment, the trifocal toric IOL seems to provide visual quality and patient satisfaction that is equivalent to that with the nontoric version with the same platform.
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Affiliation(s)
| | - Inés Contreras
- Clínica Rementería, Spain; Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias, Spain
| | | | - Vanesa Blázquez
- Clínica Rementería, Spain; Optics and Optometry Department, Universidad Complutense de Madrid, Spain
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Lüdeke I, Gonnermann J, Jφrgensen J, Neuhann T, McKay K, Fleischer M, Galambos P, Lerche RC. Refractive outcomes of femtosecond laser–assisted secondary arcuate incisions in patients with residual refractive astigmatism after trifocal intraocular lens implantations. J Cataract Refract Surg 2019; 45:28-34. [DOI: 10.1016/j.jcrs.2018.08.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 08/06/2018] [Accepted: 08/09/2018] [Indexed: 11/24/2022]
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Khodzhaev NS, Sobolev NP, Mushkova IA, Izmaylova SB, Karimova AN. [Visual rehabilitation of patients with large post-traumatic defects of the anterior eye segment through iris-lens diaphragm implantation]. Vestn Oftalmol 2018; 133:23-29. [PMID: 29319666 DOI: 10.17116/oftalma2017133623-29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The diversity of methodological approaches and lack of pathogenetically reasonable tactics for patients with combined ocular injuries became the basis for the development and systematization of surgical rehabilitation stages of patients, in whom post-traumatic cataract is combined with post-traumatic aniridia and corneal scarring. AIM to construct a visual rehabilitation approach to patients with post-traumatic defects of the anterior eye segment following optical-reconstructive surgery that involved implantation of an iris-lens diaphragm (ILD). MATERIAL AND METHODS We have analyzed 80 reconstructive cases with ILD implantation in patients with post-traumatic aniridia and corneal damage. These patients constituted the first study group (Group 1). We have also investigated 58 eyes with residual ametropy and stable visual function 1 year after ILD implantation before and after conducting a laser keratorefractive surgery. These patients were assigned to the second study group (Group 2). RESULTS Rehabilitation approach to patients after anterior segment injuries that has been proposed allows to achieve high clinical and functional results and reduce the risk of intra- and postoperative complications. CONCLUSION The proposed approach to patients after optical-reconstructive surgery with iris-lens diaphragm implantation followed by keratorefractive surgery is an effective method of visual rehabilitation of anterior eye segment post-traumatic defects.
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Affiliation(s)
- N S Khodzhaev
- S. Fyodorov Eye Microsurgery Federal State Institution, 59a Beskudnikovskiy blvd, Moscow, Russian Federation, 127486
| | - N P Sobolev
- S. Fyodorov Eye Microsurgery Federal State Institution, 59a Beskudnikovskiy blvd, Moscow, Russian Federation, 127486
| | - I A Mushkova
- S. Fyodorov Eye Microsurgery Federal State Institution, 59a Beskudnikovskiy blvd, Moscow, Russian Federation, 127486
| | - S B Izmaylova
- S. Fyodorov Eye Microsurgery Federal State Institution, 59a Beskudnikovskiy blvd, Moscow, Russian Federation, 127486
| | - A N Karimova
- S. Fyodorov Eye Microsurgery Federal State Institution, 59a Beskudnikovskiy blvd, Moscow, Russian Federation, 127486
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Multifocal intraocular lenses: An overview. Surv Ophthalmol 2017; 62:611-634. [DOI: 10.1016/j.survophthal.2017.03.005] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 02/28/2017] [Accepted: 03/03/2017] [Indexed: 01/18/2023]
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Yu JG, Zhong J, Mei ZM, Zhao F, Tao N, Xiang Y. Evaluation of biometry and corneal astigmatism in cataract surgery patients from Central China. BMC Ophthalmol 2017; 17:56. [PMID: 28446167 PMCID: PMC5405481 DOI: 10.1186/s12886-017-0450-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 04/22/2017] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate the distribution of biometric parameters and corneal astigmatism using the IOLMaster device before phacoemulsification in cataract patients in Central China. Methods Consecutive cataract patients were recruited at the Central Hospital of Wuhan between January 2015 and June 2016. Ocular axial length (AL), keratometry values, anterior chamber depth (ACD) and horizontal corneal diameter (white to white [WTW]) of each cataract-affected eye were measured with the IOLMaster device. Results The study evaluated 3209 eyes of 2821 cataract patients. The mean AL, ACD, and WTW were 24.38 ± 2.47 mm, 3.15 ± 0.48 mm, and 11.63 ± 0.43 mm, respectively. Corneal astigmatism of 0.51–1.00 diopters (D) was the most common range of values (34.96%). A total of 10.56% patients exhibited a corneal astigmatism greater than 2.0 D. The flat and steep keratometry values gradually increased with age. The mean ACD and WTW showed increasing trends as the AL increased (P < 0.001). When the AL was shorter than 26.0 mm, the keratometry decreased as AL increased. The against-the-rule (ATR) astigmatism proportion increased with age and the with-the-rule (WTR) astigmatism proportion decreased with age. Conclusions The profile of ocular biometric data and corneal astigmatism may help ophthalmologists improve their surgical procedures and make an appropriate IOL choice to gain a high quality of postoperative vision.
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Affiliation(s)
- Ji-Guo Yu
- Department of Ophthalmology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No, 26 Shengli Street, Wuhan, Hubei Province, 430014, China
| | - Jie Zhong
- Department of Ophthalmology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No, 26 Shengli Street, Wuhan, Hubei Province, 430014, China
| | - Zhong-Ming Mei
- Department of Ophthalmology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No, 26 Shengli Street, Wuhan, Hubei Province, 430014, China
| | - Fang Zhao
- Department of Ophthalmology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No, 26 Shengli Street, Wuhan, Hubei Province, 430014, China
| | - Na Tao
- Department of Ophthalmology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No, 26 Shengli Street, Wuhan, Hubei Province, 430014, China
| | - Yi Xiang
- Department of Ophthalmology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No, 26 Shengli Street, Wuhan, Hubei Province, 430014, China.
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Moulick PS, Kalra D, Sati A, Gupta S, Khan MA, Singh A. Prevalence of corneal astigmatism before cataract surgery in Western Indian Population. Med J Armed Forces India 2017; 74:18-21. [PMID: 29386726 DOI: 10.1016/j.mjafi.2017.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 02/03/2017] [Indexed: 11/30/2022] Open
Abstract
Background The prevalence and nature of corneal astigmatism among cataract surgery candidates has not been well-documented in Indian population. The purpose of the study is to analyse prevalence and presentation patterns of corneal astigmatism (CA) in cataract surgery candidates. Methods Keratometric values were measured in patients before cataract extraction. Descriptive statistics of CA were analysed including the assessment with age ranges. Results Mean CA of 223 eyes of 223 patients [mean age 61 ± 10 years (range, 29-90 years)] was 0.88 ± 0.61 (95% CI, 0.80-0.96) with 27.8%, 51.1% and 21.1% having with the rule (WTR), against the rule (ATR) and oblique astigmatism (OBL) respectively. Between 40 and 50 years, ATR exceeds WTR and reaches 100% by 80 years. A trend of less negative CA was seen up to 60 years and then increases up to 90 years. CA was below 0.25 dioptre (D) in 17.5% of eyes, between 0.25 and 1.25 D in 63.7% and ≥1.50 D in 18.8% of eyes. Conclusions Considering CA < 1.25 D in majority of cataract surgery candidates, it is preferable to perform inexpensive keratorefractive procedures rather expensive toric IOLs, especially in developing world.
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Affiliation(s)
- P S Moulick
- Professor & Head, Dept of Ophthalmology, Armed Forces Medical College, Pune 40, India
| | - Deepak Kalra
- MG (Med), Medical Branch, HQ (Southern Command), C/o 56 APO, India
| | - Alok Sati
- Assistant Professor, Dept of Ophthalmology, Armed Forces Medical College, Pune 40, India
| | - Sandeep Gupta
- Associate Professor, Dept of Ophthalmology, Armed Forces Medical College, Pune 40, India
| | - M A Khan
- Associate Professor, Dept of Ophthalmology, Armed Forces Medical College, Pune 40, India
| | - Archana Singh
- Resident, Dept of Ophthalmology, Armed Forces Medical College, Pune 40, India
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Visual Performance after Bilateral Implantation of a Four-Haptic Diffractive Toric Multifocal Intraocular Lens in High Myopes. J Ophthalmol 2016; 2016:5320105. [PMID: 27563460 PMCID: PMC4985582 DOI: 10.1155/2016/5320105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/21/2016] [Accepted: 06/27/2016] [Indexed: 11/23/2022] Open
Abstract
Background. The vision with diffractive toric multifocal intraocular lenses after cataract surgery in long eyes has not been studied previously. Objectives. To report visual performance after bilateral implantation of a diffractive toric multifocal intraocular lens in high myopes. Methods. Prospective, observational case series to include patients with axial length of ≥26 mm and corneal astigmatism of >1 dioptre who underwent bilateral AT LISA 909M implantation. Postoperative examinations included photopic and mesopic distance, intermediate, and near visual acuity; photopic contrast sensitivity; visual symptoms (0–5); satisfaction (1–5); and spectacle independence rate. Results. Twenty-eight eyes (14 patients) were included. Postoperatively, mean photopic monocular uncorrected distance, intermediate, and near visual acuities (logMAR) were 0.12 ± 0.20 (standard deviation), 0.24 ± 0.16, and 0.29 ± 0.21, respectively. Corresponding binocular values were −0.01 ± 0.14, 0.13 ± 0.12, and 0.20 ± 0.19, respectively. One eye (4%) had one-line loss in vision. Under mesopic condition, intermediate vision and near vision decreased significantly (all P ≤ 0.001). Contrast sensitivity at all spatial frequencies did not improve significantly under binocular condition (all P > 0.05). Median scores for halos, night glare, starbursts, and satisfaction were 0.50, 0.00, 0.00, and 4.25, respectively. Ten patients (71%) reported complete spectacle independence. Conclusions. Bilateral implantation of the intraocular lens in high myopes appeared to be safe and achieved good visual performance and high satisfaction.
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Chen X, Zhao M, Shi Y, Yang L, Lu Y, Huang Z. Visual outcomes and optical quality after implantation of a diffractive multifocal toric intraocular lens. Indian J Ophthalmol 2016; 64:285-91. [PMID: 27221680 PMCID: PMC4901846 DOI: 10.4103/0301-4738.182939] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: This study evaluated the visual function after implantation of a multifocal toric intraocular lenses (IOLs). Materials and Methods: This study involved 10 eyes from eight cataract patients with corneal astigmatism of 1.0 diopter (D) or higher who had received phacoemulsification with implantation of an AcrySof IQ ReSTOR Toric IOL. Six-month evaluations included visual acuity, spherical equivalent (SE), defocus curve, residual astigmatism, IOL rotation, contrast sensitivity (CS), wavefront aberrations, modulation transfer function (MTF), and patient satisfaction assessments. Results: At 6 months postoperatively, uncorrected distance visual acuity (logarithm of the minimum angle of resolution) was 0.09 ± 0.04, corrected distance visual acuity was 0.02 ± 0.11, and uncorrected near visual acuity was 0.12 ± 0.07. The mean SE was −0.095 ± 0.394 D (±0.50 D in 90%). Refractive astigmatism at the 6-month follow-up visit was significantly reduced to 0.35 ± 0.32 D from 1.50 ± 0.41 D presurgery (P < 0.05). The mean IOL axis rotation was 3.20 ± 1.55°. Postoperative CS levels were high. Postoperative total order aberrations (TOAs), lower-order aberrations (LOAs), higher-order aberrations (HOAs), and spherical aberrations were decreased compared with preoperative values (P < 0.05). At 3 months postoperatively, TOAs, LOAs, and HOAs with a 3 mm pupil diameter as well as TOAs, LOAs, and astigmatism aberrations with a 5 mm pupil diameter were statistically lower than those at 1-month post surgery, but without subsequent significant changes (P > 0.05). There was an increase in MTF results between preoperative and postoperative evaluations at all spatial frequencies. Conclusions: The diffractive multifocal toric IOL is able to provide a predictable astigmatic correction with apparently outstanding levels of optical quality after implantation.
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Affiliation(s)
- Xiangfei Chen
- Department of Endocrinology, Geriatric Research Center, Nanjing 210002; Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China
| | - Ming Zhao
- Department of Endocrinology, Geriatric Research Center, Nanjing 210002, China
| | - Yuhua Shi
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China
| | - Liping Yang
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China
| | - Yan Lu
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China
| | - Zhenping Huang
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China
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Mohammadi M, Naderan M, Pahlevani R, Jahanrad A. Prevalence of corneal astigmatism before cataract surgery. Int Ophthalmol 2016; 36:807-817. [DOI: 10.1007/s10792-016-0201-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 02/13/2016] [Indexed: 12/13/2022]
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Emesz M, Dexl AK, Krall EM, Bachernegg A, Moussa S, Jell G, Grabner G, Arlt EM. Randomized controlled clinical trial to evaluate different intraocular lenses for the surgical compensation of low to moderate-to-high regular corneal astigmatism during cataract surgery. J Cataract Refract Surg 2015; 41:2683-94. [DOI: 10.1016/j.jcrs.2015.07.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/01/2015] [Accepted: 07/13/2015] [Indexed: 10/22/2022]
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Microincision versus Standard Corneal Incision Phacoemulsification: Visual Outcome. Optom Vis Sci 2015; 92:796-803. [PMID: 26002004 DOI: 10.1097/opx.0000000000000626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To compare the visual outcome of microincision (2.2 mm) with standard (2.75 mm) corneal incision phacoemulsification. METHODS In this prospective, randomized comparative study, patients with senile cataract and less than 1 diopter (D) of astigmatism were divided into two groups. Group 1 included patients undergoing phacoemulsification with 2.2 mm clear corneal incision and group 2 included those undergoing phacoemulsification with 2.75 mm incision. The steep axis measured on keratometry was marked preoperatively. Phacoemulsification was performed through clear corneal incision on this steep axis. Assessment of visual acuity (distance and near), keratometry, keratometric cylinder, contrast sensitivity by Functional Acuity Contrast Test, and surgically induced astigmatism (SIA) was performed at 1 day, 1 week, and 1, 3, and 6 months. RESULTS Fifty eyes of 50 patients were included in the study (29 were male). There were 25 patients in each group. The mean (±SD) SIA calculated by vector analysis method (Holladay-Cravy-Koch) using keratometry value, at the end of 6 months, was 0.54 (±0.18) D and 0.58 (±0.14) D in groups 1 and 2, respectively (p = 0.27). No significant differences were found in the distance and near uncorrected visual acuity, mean keratometry, keratometric cylinder, contrast sensitivity, and SIA at any follow-up visit between two groups. CONCLUSIONS In patients with less than 1 D astigmatism undergoing phacoemulsification, both 2.2-mm and 2.75-mm clear corneal incisions result in similar postoperative visual outcome in terms of SIA, keratometry, and contrast sensitivity.
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Krall EM, Arlt EM, Hohensinn M, Moussa S, Jell G, Alió JL, Plaza-Puche AB, Bascaran L, Mendicute J, Grabner G, Dexl AK. Vector analysis of astigmatism correction after toric intraocular lens implantation. J Cataract Refract Surg 2015; 41:790-9. [PMID: 25840303 DOI: 10.1016/j.jcrs.2014.07.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/05/2014] [Accepted: 07/15/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine astigmatic changes by vector analysis and postoperative refractive and visual outcomes after implantation of the monofocal aspheric bitoric AT Torbi 709M toric intraocular lens (IOL). SETTING Three centers in Salzburg, Austria, and Alicante and San Sebastián, Spain. DESIGN Prospective interventional case series. METHODS Preoperative and postoperative visual acuity, subjective and objective refractions, and corneal radii using a topographer were examined in all patients. All patients had postoperative examinations within the first week and at 6 to 12 weeks. Astigmatic changes were evaluated using the Alpins vector method based on 3 fundamental vectors as follows: target induced astigmatism (TIA), surgically induced astigmatism (SIA), and difference vector. The various relationships between these 3 vectors were calculated, providing an extensive description of the astigmatic correction achieved. RESULTS Eighty-eight eyes (71 patients) were included. Postoperatively, refractive cylinder was reduced significantly (P < .001), concurrent with visual improvement. The mean magnitude of the SIA vector (2.54 diopters [D] ± 1.21 [SD]) was slightly higher than the mean magnitude of the TIA vector (2.37 ± 1.15 D) at the last follow-up. The mean difference vector was 0.46 ± 0.46 D, the mean magnitude of error was 0.16 ± 0.46 D, and the mean correction index was 1.09 ± 0.21, all indicating minimal overcorrection at 3 months that remained stable during the follow-up. CONCLUSION Implantation of the toric IOL was safe and effective for the treatment of eyes with cataract in combination with preexisting regular corneal astigmatism over a short-term follow-up. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Eva M Krall
- From the Department of Ophthalmology (Krall, Arlt, Hohensinn, Moussa, Jell, Grabner, Dexl), Paracelsus Medical University, Salzburg, Austria; the Division of Ophthalmology (Alió, Plaza-Puche), Vissum Corporation, Universidad Miguel Hernández, Alicante, and the Ophthalmology Service (Bascaran, Mendicute), Donostia Hospital, San Sebastián, Spain
| | - Eva M Arlt
- From the Department of Ophthalmology (Krall, Arlt, Hohensinn, Moussa, Jell, Grabner, Dexl), Paracelsus Medical University, Salzburg, Austria; the Division of Ophthalmology (Alió, Plaza-Puche), Vissum Corporation, Universidad Miguel Hernández, Alicante, and the Ophthalmology Service (Bascaran, Mendicute), Donostia Hospital, San Sebastián, Spain
| | - Melchior Hohensinn
- From the Department of Ophthalmology (Krall, Arlt, Hohensinn, Moussa, Jell, Grabner, Dexl), Paracelsus Medical University, Salzburg, Austria; the Division of Ophthalmology (Alió, Plaza-Puche), Vissum Corporation, Universidad Miguel Hernández, Alicante, and the Ophthalmology Service (Bascaran, Mendicute), Donostia Hospital, San Sebastián, Spain
| | - Sarah Moussa
- From the Department of Ophthalmology (Krall, Arlt, Hohensinn, Moussa, Jell, Grabner, Dexl), Paracelsus Medical University, Salzburg, Austria; the Division of Ophthalmology (Alió, Plaza-Puche), Vissum Corporation, Universidad Miguel Hernández, Alicante, and the Ophthalmology Service (Bascaran, Mendicute), Donostia Hospital, San Sebastián, Spain
| | - Gerlinde Jell
- From the Department of Ophthalmology (Krall, Arlt, Hohensinn, Moussa, Jell, Grabner, Dexl), Paracelsus Medical University, Salzburg, Austria; the Division of Ophthalmology (Alió, Plaza-Puche), Vissum Corporation, Universidad Miguel Hernández, Alicante, and the Ophthalmology Service (Bascaran, Mendicute), Donostia Hospital, San Sebastián, Spain
| | - Jorge L Alió
- From the Department of Ophthalmology (Krall, Arlt, Hohensinn, Moussa, Jell, Grabner, Dexl), Paracelsus Medical University, Salzburg, Austria; the Division of Ophthalmology (Alió, Plaza-Puche), Vissum Corporation, Universidad Miguel Hernández, Alicante, and the Ophthalmology Service (Bascaran, Mendicute), Donostia Hospital, San Sebastián, Spain
| | - Ana B Plaza-Puche
- From the Department of Ophthalmology (Krall, Arlt, Hohensinn, Moussa, Jell, Grabner, Dexl), Paracelsus Medical University, Salzburg, Austria; the Division of Ophthalmology (Alió, Plaza-Puche), Vissum Corporation, Universidad Miguel Hernández, Alicante, and the Ophthalmology Service (Bascaran, Mendicute), Donostia Hospital, San Sebastián, Spain
| | - Lucia Bascaran
- From the Department of Ophthalmology (Krall, Arlt, Hohensinn, Moussa, Jell, Grabner, Dexl), Paracelsus Medical University, Salzburg, Austria; the Division of Ophthalmology (Alió, Plaza-Puche), Vissum Corporation, Universidad Miguel Hernández, Alicante, and the Ophthalmology Service (Bascaran, Mendicute), Donostia Hospital, San Sebastián, Spain
| | - Javier Mendicute
- From the Department of Ophthalmology (Krall, Arlt, Hohensinn, Moussa, Jell, Grabner, Dexl), Paracelsus Medical University, Salzburg, Austria; the Division of Ophthalmology (Alió, Plaza-Puche), Vissum Corporation, Universidad Miguel Hernández, Alicante, and the Ophthalmology Service (Bascaran, Mendicute), Donostia Hospital, San Sebastián, Spain
| | - Günther Grabner
- From the Department of Ophthalmology (Krall, Arlt, Hohensinn, Moussa, Jell, Grabner, Dexl), Paracelsus Medical University, Salzburg, Austria; the Division of Ophthalmology (Alió, Plaza-Puche), Vissum Corporation, Universidad Miguel Hernández, Alicante, and the Ophthalmology Service (Bascaran, Mendicute), Donostia Hospital, San Sebastián, Spain
| | - Alois K Dexl
- From the Department of Ophthalmology (Krall, Arlt, Hohensinn, Moussa, Jell, Grabner, Dexl), Paracelsus Medical University, Salzburg, Austria; the Division of Ophthalmology (Alió, Plaza-Puche), Vissum Corporation, Universidad Miguel Hernández, Alicante, and the Ophthalmology Service (Bascaran, Mendicute), Donostia Hospital, San Sebastián, Spain.
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Nagpal R, Sharma N, Vasavada V, Maharana PK, Titiyal JS, Sinha R, Upadhyay AD, Vajpayee RB. Toric intraocular lens versus monofocal intraocular lens implantation and photorefractive keratectomy: a randomized controlled trial. Am J Ophthalmol 2015; 160:479-486.e2. [PMID: 26095261 DOI: 10.1016/j.ajo.2015.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 06/10/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the outcomes of phacoemulsification with toric intraocular lens implantation vs phacoemulsification with monofocal intraocular lens implantation followed by photorefractive keratectomy (PRK) for correction of pre-existing astigmatism. DESIGN Randomized controlled trial, 6-month study. METHODS setting: Institutional. STUDY POPULATION Sixty eyes of 52 patients with age-related senile cataract and regular corneal astigmatism ranging from 1.50 to 3.00 diopters, enrolled and randomly allocated in 2 groups based on computer-generated random number table. INTERVENTION Group 1 patients underwent phacoemulsification with toric intraocular lens (IOL) implantation and Group 2 patients underwent phacoemulsification with monofocal IOL implantation followed by PRK 3 months later. MAIN OUTCOME MEASURES The main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), residual cylinder, contrast sensitivity, glare acuity, pain score, and higher-order aberrations. RESULTS At 6 months 53.3% of eyes in the toric IOL and 60% eyes in the monofocal IOL with PRK group attained UDVA of 20/20. Median residual refractive cylinder value was higher in the toric IOL group (toric IOL = -0.5, monofocal IOL with PRK = 0; P = .02). Mean root mean square value of total aberrations (5 mm pupil) was higher in monofocal IOL with PRK eyes (toric IOL= 1.02 ± 0.44, monofocal IOL with PRK = 1.28 ± 0.5; P = .04). Mean contrast sensitivity values were comparable. Mean toric IOL rotation was 1.3 ± 2.1 degrees. Mean glare acuity was better in toric IOL eyes (toric IOL = 0.46 ± 0.16, monofocal IOL with PRK = 0.73 ± 0.12; P < .001). Median postoperative pain scores were higher in monofocal IOL with PRK eyes. CONCLUSION PRK yields lesser residual cylinder compared to toric IOL. However, it causes greater postoperative pain and corneal aberrations, and poor glare acuity.
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Sáles CS, Manche EE. Managing residual refractive error after cataract surgery. J Cataract Refract Surg 2015; 41:1289-99. [DOI: 10.1016/j.jcrs.2015.05.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/07/2014] [Accepted: 10/13/2014] [Indexed: 11/26/2022]
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Hayashi K, Masumoto M, Takimoto M. Comparison of visual and refractive outcomes after bilateral implantation of toric intraocular lenses with or without a multifocal component. J Cataract Refract Surg 2014; 41:73-83. [PMID: 25466485 DOI: 10.1016/j.jcrs.2014.04.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/27/2014] [Accepted: 04/02/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare visual outcomes between patients with a multifocal toric intraocular lens (IOL) and those with a monofocal toric IOL. SETTING Hayashi Eye Hospital, Fukuoka, Japan. DESIGN Prospective case-control series. METHODS Eyes with preoperative corneal astigmatism between 0.75 diopter (D) and 2.82 D scheduled for implantation of a diffractive multifocal toric IOL (Restor SND1T) or monofocal toric IOL (Acrysof SN6AT) were recruited. Three months postoperatively, visual acuity at various distances, contrast visual acuity, and refractive outcomes were examined. RESULTS Each group comprised 66 eyes (33 patients). Postoperatively, the mean refractive astigmatism decreased to 0.71 D in the multifocal group and 0.74 D in the monofocal group. The mean monocular and binocular uncorrected and corrected near visual acuity at 0.3 m and intermediate visual acuity at 0.5 m were significantly better in the multifocal group than in the monofocal group (P≤.0011). The uncorrected and corrected visual acuities at other distances were similar between groups except at 1.0 m. Binocular photopic and mesopic contrast visual acuities at high to moderate contrasts did not differ significantly between groups; however, acuities at low contrasts were worse in the multifocal group (P≤.0429). CONCLUSION Diffractive multifocal toric IOL implantation decreased refractive astigmatism to an acceptable range in eyes with moderate corneal astigmatism and provided useful visual acuity (≥20/40) at any distance and significantly better near and intermediate visual acuity than a monofocal toric IOL. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Moshirfar M, McCaughey MV, Santiago-Caban L. Corrective Techniques and Future Directions for Treatment of Residual Refractive Error Following Cataract Surgery. EXPERT REVIEW OF OPHTHALMOLOGY 2014; 9:529-537. [PMID: 25663845 DOI: 10.1586/17469899.2014.966817] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Postoperative residual refractive error following cataract surgery is not an uncommon occurrence for a large proportion of modern-day patients. Residual refractive errors can be broadly classified into 3 main categories: myopic, hyperopic, and astigmatic. The degree to which a residual refractive error adversely affects a patient is dependent on the magnitude of the error, as well as the specific type of intraocular lens the patient possesses. There are a variety of strategies for resolving residual refractive errors that must be individualized for each specific patient scenario. In this review, the authors discuss contemporary methods for rectification of residual refractive error, along with their respective indications/contraindications, and efficacies.
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Affiliation(s)
- Majid Moshirfar
- Department of Ophthalmology, Co-Director Cornea and Refractive Surgery Division, Francis I. Proctor Foundation, University of California San Francisco, 10 Koret Way, K101, San Francisco, CA 94143, USA
| | | | - Luis Santiago-Caban
- Ophthalmology Department, University of Puerto Rico School of Medicine, San Juan, PR 00936
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Prevalence of Corneal Astigmatism in Patients before Cataract Surgery in Northern China. J Ophthalmol 2014; 2014:536412. [PMID: 24991429 PMCID: PMC4060487 DOI: 10.1155/2014/536412] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 04/26/2014] [Accepted: 05/19/2014] [Indexed: 11/17/2022] Open
Abstract
Purpose. To analyze the prevalence and presentation patterns of corneal astigmatism in cataract surgery candidates in a teaching hospital in northern China. Methods. From May 1, 2012, to April 30, 2013, partial coherence interferometry (IOLMaster) measurements of all qualified cataract surgery candidates were retrospectively collected and analyzed. Results. The study evaluated 12,449 eyes from 6,908 patients with a mean age of 69.80 ± 11.15 (SD) years. The corneal astigmatism was 0.5 diopters (D) or less in 20.76% of eyes, 1.0 D or more in 47.27% of eyes, 2.0 D or more in 13.16% of eyes, and 3.0 D or more in 3.75% of eyes. With-the-rule astigmatism was found in 30.36% of eyes, while against-the-rule was found in 52.41% of eyes. The percentage of against-the-rule astigmatism increased with age. Conclusion. Our study showed that almost one-half of preoperative eyes (47.27%) in northern China have a corneal astigmatism of 1.0 D or more, indicating that more surgical techniques or toric IOLs are needed to achieve better visual rehabilitation.
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Huseynova T, Kanamori T, Waring GO, Tomita M. Outcomes of small aperture corneal inlay implantation in patients with pseudophakia. J Refract Surg 2014; 30:110-6. [PMID: 24763476 DOI: 10.3928/1081597x-20140120-06] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 11/11/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the improvement in near visual acuity after KAMRA corneal inlay (AcuFocus, Inc., Irvine, CA) implantation in patients with pseudophakia. METHODS A retrospective study analysis of patients with pseudophakia undergoing monocular corneal inlay implantation in the non-dominant eye was performed. The inlay was implanted monocularly in the non-dominant eye of patients. Manifest refractive spherical equivalent, uncorrected distance visual acuity, corrected distance visual acuity, uncorrected near visual acuity, and corrected near visual acuity were evaluated. The follow-up period was 3 months. RESULTS Thirteen eyes from 13 patients were evaluated. Four patients underwent LASIK for improved distance acuity at the time of inlay implantation. Mean uncorrected near visual acuity improved five lines (from J10 to J4) postoperatively. Mean uncorrected distance visual acuity, corrected distance visual acuity, and corrected near visual acuity remained stable and were 20/20, 20/16, and J1, respectively, before and after KAMRA implantation. Three eyes lost two lines and 1 eye lost one line of uncorrected distance visual acuity. Two eyes lost two lines and 1 eye lost 1 line of corrected distance visual acuity. Mean manifest refractive spherical equivalent changed before and after KAMRA implantation from -0.01 ± 1.07 diopters (D) (range: 2.25 to -1.88 D) to -1.12 ± 0.87 D (range: 0.25 to -2.75 D), respectively. CONCLUSIONS Implantation of a small aperture corneal inlay improved uncorrected near visual acuity while maintaining uncorrected and corrected distance visual acuity in monofocal patients with pseudophakia.
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Abstract
PURPOSE To assess the horizontal meridian misalignment of limbal marking under a slit lamp microscope by means of anterior segmental image assessment. METHODS A consecutive series of the 32 eyes of 16 subjects (7 males and 9 females) aged 29 ± 6 years (range, 23-44 years), who had refractive errors but were otherwise healthy, were used in this study. With each subject seated at the slit lamp and a coaxial slit turned to the horizontal meridian, we aligned the subject's head vertically and placed two reference marks aligned with the 3- and 9-o'clock positions on the limbal conjunctiva, using a marker pen or a toric marker. We quantitatively evaluated the accuracy of axis aliment by determining deviation from the horizontal reference line using a corneal topographer with an anterior segment image. RESULTS The amount of the axis misalignment was 3.4° ± 2.2° (range, 0°-8°) when the marker pen was used, and 6.9° ± 5.0° (range, 0-24°) when the toric marker was used. Location identification using the toric marker showed a significantly larger deviation in axis alignment than that using the marker pen (Wilcoxon sign rank test, p < 0.001). CONCLUSIONS Horizontal limbal marking using a slit lamp microscope showed the axis misalignment by an average of 3.4° to 6.9°. These alignment errors led to a reduction of the effectiveness of astigmatism correction by an average of 10% to 20%, which was not necessarily negligible when we aim to correct astigmatism completely, if possible. For successful astigmatic surgical procedures, increased accuracy of preoperative limbal marking by decreased misalignment of the astigmatism axis is essential.
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Fernández-Buenaga R, Alió JL, Pérez Ardoy AL, Quesada AL, Cortés LP, Barraquer RI. Resolving Refractive Error After Cataract Surgery: IOL Exchange, Piggyback Lens, or LASIK. J Refract Surg 2013; 29:676-83. [DOI: 10.3928/1081597x-20130826-01] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 06/12/2013] [Indexed: 11/20/2022]
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Bachernegg A, Rückl T, Riha W, Grabner G, Dexl AK. Rotational stability and visual outcome after implantation of a new toric intraocular lens for the correction of corneal astigmatism during cataract surgery. J Cataract Refract Surg 2013; 39:1390-8. [DOI: 10.1016/j.jcrs.2013.03.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 03/14/2013] [Accepted: 03/14/2013] [Indexed: 10/26/2022]
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Effects of the toric intraocular lens on correction of preexisting corneal astigmatism. Jpn J Ophthalmol 2012; 56:445-52. [DOI: 10.1007/s10384-012-0168-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 05/29/2012] [Indexed: 10/28/2022]
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Ferreira TB, Almeida A. Comparison of the Visual Outcomes and OPD-Scan Results of AMO Tecnis Toric and Alcon Acrysof IQ Toric Intraocular Lenses. J Refract Surg 2012; 28:551-5. [DOI: 10.3928/1081597x-20120703-03] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 06/20/2012] [Indexed: 11/20/2022]
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Piñero DR, Ayala Espinosa MJ, Alió JL. LASIK outcomes following multifocal and monofocal intraocular lens implantation. J Refract Surg 2011; 26:569-77. [PMID: 19894668 DOI: 10.3928/1081597x-20091030-02] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 10/06/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the efficacy, predictability, and safety of LASIK to correct residual refractive error following cataract surgery using multifocal and monofocal intraocular lenses (IOL). METHODS Included in this retrospective, comparative study were 100 consecutive eyes with residual refractive error that had undergone cataract surgery with monofocal or multifocal IOL implantation. Two groups were studied according to the implanted IOL--multifocal group (50 eyes, mean age 57.8 +/- 9.9 years) and monofocal group (50 eyes, mean age 51.0 +/- 10.0 years). In all cases, LASLK was performed using the SCHWIND ESIRIS excimer laser. RESULTS A statistically significant improvement was observed in uncorrected distance (P < .01) and corrected distance (P < .01) visual acuity at 6 months postoperatively in both groups. A statistically significant reduction was also observed in defocus equivalent and cylinder (P < .01) postoperatively. No statistically significant differences in the percentage of eyes losing lines of corrected distance visual acuity were found between groups (14% multifocal vs 4% monofocal, P = .40). When comparing eyes undergoing hyperopic LASIK in each group, a difference in the limit of statistical significance was found in the percentage of eyes with a spherical equivalent refraction within +/- 0.50 diopters (70% multifocal vs 84% monofocal, P = .06). No significant differences in predictability were found between multifocal and monofocal myopic subgroups (P = .25). CONCLUSIONS Laser in situ keratomileusis refinement after cataract surgery with monofocal IOL implantation provides a more accurate refractive outcome than after multifocal IOL implantation. Predictability of LASIK correction is limited in hyperopic eyes implanted with multifocal IOLs.
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Affiliation(s)
- David R Piñero
- Instituto Oftalmológico de Alicante, Vissum Corporación, Alicante, Spain
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Kamiya K, Umeda K, Ando W, Igarashi A, Shimizu K. Clinical outcomes of photoastigmatic refractive keratectomy for the correction of residual refractive errors following cataract surgery. J Refract Surg 2011; 27:826-31. [PMID: 21710952 DOI: 10.3928/1081597x-20110623-02] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 05/27/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the clinical outcomes of photoastigmatic refractive keratectomy (PARK) for the correction of residual refractive errors after cataract surgery. METHODS This study evaluated 88 eyes of 66 consecutive patients with mean spherical equivalent refraction of -3.16±1.71 diopters (D) who underwent PARK to correct refractive errors after phacoemulsification with intraocular lens (IOL) implantation. Patient age at the time of surgery was 65.2±12.7 years. Safety, efficacy, predictability, stability, and adverse events of the surgery were assessed 1, 3, 6, and 12 months postoperatively. RESULTS At 1 year postoperatively, uncorrected distance visual acuity and corrected distance visual acuity were 0.08±0.16 logMAR (Snellen 20/25) and -0.08±0.11 logMAR (Snellen 20/16), respectively. Safety and efficacy indices were 1.08±0.25 and 0.76±0.28, respectively. At 1 year, 68% of eyes were within ±0.50 D and 88% were within ±1.00 D of targeted correction. Manifest refraction changes of -0.06±1.06 D occurred from 1 week to 1 year. No vision-threatening complications occurred during the observation period. CONCLUSIONS Photoastigmatic refractive keratectomy is safe and moderately effective in the correction of residual refractive errors in pseudophakic eyes, suggesting its viability as a surgical option for the treatment of such eyes.
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Affiliation(s)
- Kazutaka Kamiya
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan.
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Hayashi K, Manabe SI, Yoshida M, Hayashi H. Effect of astigmatism on visual acuity in eyes with a diffractive multifocal intraocular lens. J Cataract Refract Surg 2010; 36:1323-9. [DOI: 10.1016/j.jcrs.2010.02.016] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2009] [Revised: 01/29/2010] [Accepted: 02/11/2010] [Indexed: 11/16/2022]
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Neuhann IM, Lege BAM, Bauer M, Hassel JM, Hilger A, Neuhann TF. Static and dynamic rotational eye tracking during LASIK treatment of myopic astigmatism with the Zyoptix laser platform and Advanced Control Eye Tracker. J Refract Surg 2010; 26:17-27. [PMID: 20199008 DOI: 10.3928/1081597x-20101215-03] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2008] [Accepted: 01/13/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the amount of cyclotorsion and the effect of static and dynamic rotational eye tracking with the Advanced Control Eye Tracker (Bausch & Lomb) based on iris recognition in the treatment of myopic astigmatism with LASIK. METHODS All patients with myopic LASIK and attempted cylinder correction >0.75 diopters (D) on the Zyoptix 217z100 excimer laser platform between May 2005 and May 2007 were identified retrospectively through the existing databank. Pre- and postoperative refraction and the amount of cyclotorsion during treatment were extracted and analyzed in 828 eyes with >3-month follow-up. RESULTS Preoperative mean manifest refraction spherical equivalent (MRSE) was -4.31+/-1.84 D (range: -0.37 to -9.50 D), and mean cylinder was -1.27+/-0.87 D (range: -0.75 to -6.75 D). Mean static rotation was 3.96+/-2.96 degrees (maximum 14.8 degrees ). Median dynamic rotation was 1.32+/-1.85 degrees (maximum 24 degrees). At 3 months postoperatively, MRSE was -0.10+/-0.36 D (range: -2.25 to +1.25 D), and mean cylinder was -0.33+/-0.35 D (range: -2.00 to 0 D). Predictability was 90.2% within +/-0.50 D and 98.2% within +/-1.00 D (MRSE), and 82.5% within +/-0.50 D and 96.9% within +/-1.00 D (cylinder). The efficacy ratio was 0.99. Safety was 99.4% (5 dry eyes), reaching 100% at 12 months. Stability from 3 to 12 months (n=275) was 98.2% for sphere, 95.3% for cylinder, and 96.0% for MRSE. CONCLUSIONS Our study demonstrates that significant cyclotorsion occurs before and during treatment. By using the dynamic rotational eye tracker presented, the efficacy of cylinder correction can be improved compared to those studies not performing cyclotorsional correction.
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Terzi E, Wang L, Kohnen T. Accuracy of modern intraocular lens power calculation formulas in refractive lens exchange for high myopia and high hyperopia. J Cataract Refract Surg 2009; 35:1181-9. [DOI: 10.1016/j.jcrs.2009.02.026] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Revised: 02/24/2009] [Accepted: 02/24/2009] [Indexed: 11/25/2022]
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Mendicute J, Irigoyen C, Ruiz M, Illarramendi I, Ferrer-Blasco T, Montés-Micó R. Toric intraocular lens versus opposite clear corneal incisions to correct astigmatism in eyes having cataract surgery. J Cataract Refract Surg 2009; 35:451-8. [PMID: 19251137 DOI: 10.1016/j.jcrs.2008.11.043] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 11/05/2008] [Accepted: 11/12/2008] [Indexed: 11/28/2022]
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Jin GJ, Merkley KH, Crandall AS, Jones YJ. Laser in situ keratomileusis versus lens-based surgery for correcting residual refractive error after cataract surgery. J Cataract Refract Surg 2008; 34:562-9. [DOI: 10.1016/j.jcrs.2007.11.040] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Accepted: 11/03/2007] [Indexed: 11/30/2022]
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Refractive enhancement following presbyopia-correcting intraocular lens implantation. Curr Opin Ophthalmol 2008; 19:18-21. [PMID: 18090892 DOI: 10.1097/icu.0b013e3282f14d9f] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Presbyopia-correcting intraocular lenses are widely available. Residual ametropia is one of the most common issues that can result in patient dissatisfaction. Options for correcting refractive surprises include piggyback intraocular lens implantation, corneal incisional surgery and laser correction. Excimer laser surgery is a safe and predictable method to correct residual amounts of ametropia in pseudophakic patients with monofocal intraocular lenses; however, there is scant published literature regarding this technique. RECENT FINDINGS Presbyopia-correcting intraocular lenses require emmetropia for the best visual outcome, as small amounts of astigmatism or residual refractive errors can limit their visual performance. Laser-assisted in-situ keratomileusis and photorefractive keratectomy are safe and effective results in pseudophakic patients. Surgeons can refine the refractive outcome after intraocular lens implantation with the excimer laser to achieve better results and higher patient satisfaction. SUMMARY Excimer laser corneal surgery for fine-tuning residual ametropia after presbyopia-correcting intraocular lenses is a safe adjunct treatment to increase patient satisfaction. Which technique (photorefractive keratectomy or laser-assisted in-situ keratomileusis) to use depends on surgeon preference and patient characteristics, as both demonstrate similar results in published literature. Knowledge of all available refractive methods and technologies are crucial for improving outcomes in these patients.
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Lee KM, Kim EC, Kim MS. Excimer Laser Refractive Surgery to Correct Anisometropia due to Residual Astigmatism After Cataract Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.10.1589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kyung Min Lee
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University, Seoul, Korea
| | - Eun Chul Kim
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University, Seoul, Korea
| | - Man Soo Kim
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University, Seoul, Korea
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Claramonte PJ, Alió JL, Ramzy MI. Conductive keratoplasty to correct residual hyperopia after cataract surgery. J Cataract Refract Surg 2006; 32:1445-51. [PMID: 16931254 DOI: 10.1016/j.jcrs.2006.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Accepted: 04/11/2006] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the efficacy, predictability, safety, and stability of conductive keratoplasty (CK) for correcting residual hyperopia after cataract surgery with intraocular lens implantation. SETTING Vissum-Instituto Oftalmologico de Alicante, Alicante, and Vissum-Instituto de Albacete, Albacete, Spain. METHODS Sixteen eyes of 16 patients had CK for the correction of residual hyperopia after cataract surgery. The CK was performed with the CK View Point Refractec (RCS-200, Refractec, Inc.). The follow-up was 12 months. RESULTS One year after CK, 10 eyes (62.5%) achieved an uncorrected visual acuity (UCVA) of 0.50 or better. The mean UCVA was 0.50 +/- 0.21 (SD), and the mean best spectacle-corrected visual acuity (BSCVA) was 0.68 +/- 0.24. One eye lost 1 line of BSCVA, and none lost 2 or more lines. The mean spherical equivalent refraction was +0.39 +/- 0.84 D 1 year after CK. No vision-threatening complications occurred. CONCLUSIONS One-year data show that CK for the correction of low to moderate hyperopia after cataract surgery was safe, stable, relatively predictable, and efficient. No complications occurred when CK was performed after phacoemulsification.
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Affiliation(s)
- Pascual J Claramonte
- Instituto Oftalmológico de Alicante & Albacete-Vissum, Refractive Surgery and Cornea Department, Miguel Hernández University, Medical School, Alicante, Spain
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Khokhar S, Lohiya P, Murugiesan V, Panda A. Corneal astigmatism correction with opposite clear corneal incisions or single clear corneal incision: Comparative analysis. J Cataract Refract Surg 2006; 32:1432-7. [PMID: 16931252 DOI: 10.1016/j.jcrs.2006.04.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2005] [Accepted: 04/07/2006] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the astigmatic correcting effect of paired opposite clear corneal incisions (OCCIs) on the steep axis with that of single clear corneal incisions (CCIs) in cataract patients having phacoemulsification. SETTING Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India. METHODS This randomized prospective clinical study comprised 40 eyes of 40 patients with topographic astigmatism of more than 1.50 diopters (D). Paired 3.2 mm OCCIs were made in the steep axis in Group 1 and single CCIs in Group 2. Preoperative evaluation included uncorrected visual acuity, refraction, applanation tonometry, dilated fundoscopy, biomicroscopic examination, keratometry, and topography. The steep axis was marked before sub-Tenon's anesthesia was given and routine phacoemulsification was performed through a 3.2 mm CCI on the steep axis. An additional opposite 3-step self-sealing CCI was made in Group 1. Patients were examined 1, 4, and 12 weeks postoperatively. Visual acuity, refraction, keratometry, and topography were evaluated. RESULTS The mean preoperative and postoperative topographic corneal astigmatism was 2.51 D +/- 0.92 (SD) and 0.91 +/- 0.54 D, respectively, in Group 1 and 2.16 +/- 0.80 D and 1.57 +/- 0.70 D, respectively, in Group 2. Mean astigmatic correction was 1.66 +/- 0.5 D and 0.85 +/- 0.75 D in Group 1 and Group 2, respectively. Mean surgically induced astigmatism, measured by a vector-corrected method, was 1.66 +/- 0.50 D and 0.85 +/- 0.75 D in Group 1 and Group 2, respectively (P = .00). The coupling ratio was -0.96 in Group 1 and -0.87 in Group 2. The spherical equivalent was +0.23 +/- 0.41 D in Group 1 and +0.11 +/- 0.17 D in Group 2 at 12 weeks. Uncorrected visual acuity was better in Group 1 than in Group 2 (P = .032). There was no difference in best corrected visual acuity between the groups. There were no incision-related complications. CONCLUSION Paired OCCIs were predictable and effective in providing an enhanced effect for correcting preexisting corneal astigmatism in cataract surgery.
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Affiliation(s)
- Sudarshan Khokhar
- Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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Abstract
PURPOSE OF REVIEW Bioptics treats complex refractive errors by combining refractive techniques with different mechanisms of action, usually using an intraocular implant (a phakic or pseudophakic intraocular lens) followed by a corneal procedure (laser ablation, intrastromal implant). RECENT FINDINGS In myopia and hyperopia, bioptics with phakic intraocular lenses or refractive lens exchange and subsequent excimer laser yields improved predictability and unchanged safety, compared with sole intraocular lens surgery. Complications are related mainly to intraocular lenses. In keratoconus and pellucid marginal degeneration, intracorneal rings have been successfully combined with phacoemulsification or with phakic intraocular lenses in a limited number of eyes. In the author's series, angle-supported phakic intraocular lenses were implanted in 12 eyes to correct a mean regression of -8 D after excimer laser (reverse bioptics), achieving a mean spherical equivalent of -0.3 D, mean best spectacle-corrected visual acuity of 0.7, and mean uncorrected visual acuity of 0.5, with 83% of eyes within 0.5 D of spherical equivalent. SUMMARY Bioptics improves vision and halos and adds no particular risks to phakic or pseudophakic intraocular lens implantation in either myopia or hyperopia. Reverse bioptics, with phakic intraocular lenses or refractive lens exchange, can be used to correct regressed corneal surgery.
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Abstract
Several laser and non-laser refractive surgical procedures have been used to modify the shape of the cornea and correct myopia, hyperopia, astigmatism, and presbyopia. Introduction of the excimer laser to reshape the cornea has resulted in remarkable developments in the correction of these refractive errors. Combined with other advanced ophthalmological instruments, laser refractive eye surgery has resulted in a substantial rise in the safety, efficacy, and predictability of surgical outcomes. Despite these advances, certain limitations and complications persist. In this review, we describe the history, preoperative assessment, surgical techniques, outcomes, and complications of laser refractive surgery.
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Affiliation(s)
- Tohru Sakimoto
- Massachusetts Eye and Ear Infirmary, the Schepens Eye Research Institute, Harvard Medical School, Boston, MA 02114, USA
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Kuo IC, O'Brien TP, Broman AT, Ghajarnia M, Jabbur NS. Excimer laser surgery for correction of ametropia after cataract surgery. J Cataract Refract Surg 2006; 31:2104-10. [PMID: 16412923 DOI: 10.1016/j.jcrs.2005.08.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2005] [Accepted: 01/14/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE To review the cases of patients who had excimer laser refractive surgery to correct unintentional or undesired ametropia after cataract extraction with intraocular lens (IOL) implantation. SETTING Wilmer Laser Vision Correction Center, Wilmer Eye Institute, Baltimore, Maryland, USA. METHODS In this retrospective noncomparative review of consecutive cases, the Wilmer Laser Vision Correction Center's database was searched for patients who had laser in situ keratomileusis or photorefractive keratectomy to correct ametropia after cataract extraction with IOL implantation. RESULTS Using the Visx Star excimer laser system (Visx, Inc.), 11 procedures were performed in 11 eyes of 10 patients a mean of 47 months (range 2 to 216 months) after cataract extraction with IOL implantation. Except for 1 patient with a silicone plate lens, all patients received 3-piece poly(methyl methacrylate) lenses. The mean age at time of excimer treatment was 75 years (range 70 to 81 years). Before laser surgery, the mean spherical equivalent of patient eyes was -3.76 diopters (D) +/- 2.50 (SD) (range -6.50 to +0.75 D), spherical refraction ranged from -9.00 D to plano, and the highest cylindrical refraction was +5.50 D. At last follow-up (mean 12.2 months; range 1 to 38 months), the mean manifest spherical equivalent was -0.88 +/- 1.43 D (range -2.75 to +2.13 D). Changes in mean manifest spherical equivalent were highly significant (P = .03, Wilcoxon signed rank test for paired values). There was no difference between targeted and achieved postoperative refraction (P = .34, Wilcoxon test). Increasing age was correlated with a hyperopic shift (r = 0.525, P = .05). All patients were satisfied with their final uncorrected visual acuity (UCVA), which improved in every case. Except for 1 patient in whom an epiretinal membrane developed, best spectacle-corrected visual acuity remained unchanged or improved. CONCLUSIONS In this series of patients, who were a few decades older than the typical excimer laser candidate, laser refractive surgery was a safe, effective, and predictable method to correct ametropia after cataract extraction with IOL implantation. It may be a viable, noninvasive alternative to intraocular surgery, which has potential complications. Although satisfactory for all patients, final UCVA was not as high as that reported in laser refractive surgery patients in general, and this result may be because of prior cataract extraction with IOL implantation or increased age.
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Affiliation(s)
- Irene C Kuo
- Wilmer Eye Institute, Baltimore, Maryland 21236, USA.
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Hardten DR. The importance of the refractive aspects of cataract surgery. Am J Ophthalmol 2005; 139:906-7. [PMID: 15860298 DOI: 10.1016/j.ajo.2005.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2005] [Indexed: 11/30/2022]
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Sanchis-Gimeno JA, Lleó-Pérez A, Alonso L, Rahhal MS, Martínez-Soriano F. Reduced Corneal Thickness Values in Postmenopausal Women With Dry Eye. Cornea 2005; 24:39-44. [PMID: 15604865 DOI: 10.1097/01.ico.0000138836.45070.0f] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To study and compare the corneal thickness values of postmenopausal women with dry eye and postmenopausal women without dry eye. METHODS The corneal thickness value of 30 postmenopausal women with dry eye (dry eye group; aged 52 to 55 years) and 32 postmenopausal women without dry eye (normal group; aged 51 to 55 years) was analyzed with the Orbscan Topography System II. Each woman underwent a tear breakup test, the Schirmer test, fluorescein staining of the cornea, and an analysis of the meibomian gland by slit lamp before corneal thickness measurement. The statistical analysis was performed by means of the unpaired Student t test. RESULTS The mean corneal thickness value was significantly decreased in postmenopausal women with dry eye (P < 0.001 at each corneal location). The central cornea had the thinnest mean values in dry eyes and normal eyes (533.10 +/- 4.74 microm and 547.63 +/- 15.11 microm, respectively), whereas superonasal cornea had thicker mean values in both groups (632.43 +/- 6.11 microm and 648.78 +/- 14.98 microm in dry eye and normal eyes, respectively). CONCLUSIONS Postmenopausal women with dry eye have lower corneal thickness values than postmenopausal women without dry eye. Special care must be taken with these reduced corneal thickness values when selecting postmenopausal women for surgery involving corneal photoablation.
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Affiliation(s)
- Juan A Sanchis-Gimeno
- Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, Valencia, Spain.
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