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Borkenstein AF, Packard R, Dhubhghaill SN, Lockington D, Donnenfeld ED, Borkenstein EM. Clear corneal incision, an important step in modern cataract surgery: a review. Eye (Lond) 2023; 37:2864-2876. [PMID: 36788364 PMCID: PMC10516977 DOI: 10.1038/s41433-023-02440-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/29/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
A clear corneal incision (CCI) is the most commonly used entrance site in modern phacoemulsification cataract surgery. Despite some initial concerns about increased endophthalmitis rates through a self-sealing CCI, recent literature suggests that the risk of infection with proper wound construction and all other necessary precautions is minimal. The technique of creating a clear corneal incision has, with recent developments in corneal imaging, undergone critical appraisal leading to a better understanding of incision architecture. Many surgeons operate through smaller incisions, and they have a wide choice of surgical instruments to create their corneal incisions. The aim of this review is to discuss the history and the current status of clear corneal incision creation, the design and materials of surgical blades, and the current trends in manufacturing and sustainability. Although disposable instruments have some advantages and are very popular, recycling, if possible, and avoiding unnecessary plastic waste are important considerations. In any case, the step of CCI is a small one for the surgeon, but a big one for the eye. That is why it has to be done with the utmost precision and in-depth knowledge is important.
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Affiliation(s)
- Andreas F Borkenstein
- Borkenstein and Borkenstein, Private Practice at Privatklinik Kreuzschwestern, Graz, Austria.
| | | | | | - David Lockington
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | | | - Eva-Maria Borkenstein
- Borkenstein and Borkenstein, Private Practice at Privatklinik Kreuzschwestern, Graz, Austria
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Yan Q, Han B, Ma ZC. Femtosecond Laser-Assisted Ophthalmic Surgery: From Laser Fundamentals to Clinical Applications. MICROMACHINES 2022; 13:1653. [PMID: 36296006 PMCID: PMC9611681 DOI: 10.3390/mi13101653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/19/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Femtosecond laser (FSL) technology has created an evolution in ophthalmic surgery in the last few decades. With the advantage of high precision, accuracy, and safety, FSLs have helped surgeons overcome surgical limits in refractive surgery, corneal surgery, and cataract surgery. They also open new avenues in ophthalmic areas that are not yet explored. This review focuses on the fundamentals of FSLs, the advantages in interaction between FSLs and tissues, and typical clinical applications of FSLs in ophthalmology. With the rapid progress that has been made in the state of the art research on FSL technologies, their applications in ophthalmic surgery may soon undergo a booming development.
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Affiliation(s)
- Quan Yan
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
- National Clinical Research Center for Eye Diseases, Shanghai 200080, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai 200080, China
| | - Bing Han
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Zhuo-Chen Ma
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai 200240, China
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Teuma EV, Bucci FA, Bedi R, Gray G, Packer M. Accuracy and safety of partial thickness femtosecond laser radial and arcuate keratotomy incisions in porcine eyes. EYE AND VISION 2021; 8:41. [PMID: 34847968 PMCID: PMC8638553 DOI: 10.1186/s40662-021-00268-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022]
Abstract
Background To evaluate the accuracy and safety of micro radial and arcuate keratotomy incisions constructed by a femtosecond laser system with a curved contact patient interface in porcine eyes.
Methods Partial thickness micro radial and arcuate keratotomy incisions were constructed in porcine eyes with a femtosecond laser system and evaluated for precision of depth, quality, and consistency. Optical coherence tomography was used to determine the accuracy and precision of incision depth. Corneal endothelial safety was assessed by a fluorescent live/dead cell viability assay to demonstrate laser-induced endothelial cell loss. Quality was evaluated by ease of opening and examination of interfaces. Results In two micro radial incision groups, intended incision depths of 50% and 80% resulted in mean achieved depths of 50.01% and 77.69%, respectively. In three arcuate incision groups, intended incision depths of 80%, 600 μm or 100 μm residual uncut bed thickness resulted in mean achieved depths of 80.16%, 603.03 μm and residual bed of 115 μm, respectively. No loss of endothelial cell density occurred when the residual corneal bed was maintained at a minimum of 85–116 µm. The incisions were easy to open, and interfaces were smooth. Conclusions A femtosecond laser system with curved contact interface created precise and reproducible micro radial and arcuate keratotomy incisions. Accuracy and precision of the incision depth and preservation of endothelial cell density demonstrated the effectiveness and safety of the system.
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Wendelstein JA, Hoffmann PC, Mariacher S, Wingert T, Hirnschall N, Findl O, Bolz M. Precision and refractive predictability of a new nomogram for femtosecond laser-assisted corneal arcuate incisions. Acta Ophthalmol 2021; 99:e1297-e1306. [PMID: 33629542 PMCID: PMC9540120 DOI: 10.1111/aos.14837] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/12/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Validating a new nomogram for low to moderate astigmatism (0.75 D to 2.5 D) correction with epithelium- and Bowman-penetrating femtosecond laser-assisted arcuate incisions. METHODOLOGY Prospective, interventional case series at the Augen- und Laserklinik, Castrop-Rauxel, Germany. Cataract patients with low to moderate corneal astigmatism were treated with femtosecond laser-assisted arcuate incisions. Patients with previous refractive corneal treatment were excluded. Outcome assessment was based on manifest refraction, astigmatic vector analysis and visual acuity. RESULTS The study analysed 43 eyes of 33 patients after three months and 35 eyes of 27 patients after 12 months. After 12 months, 100% of all eyes treated had ≤1.0 D and 97% ≤0.5 D of subjective residual astigmatism. Mean residual astigmatism was 0.27 D. 90% of all eyes were within one line of difference between UDVA and CDVA. SEQ Mean Absolute Error was 0.26 D and SEQ. Mean error was -0.08 ± 0.32 D. CI was 0.98 ± 0.2 D, and Index of Success, 0.20 ± 0.18 D. CONCLUSION The Castrop nomogram showed results that are comparable to or better than results presented in the literature for existing nomograms. Our results for astigmatic reduction are comparable to published results for TIOL implantation. It seems to be a predictable and safe measure to reduce manifest astigmatism.
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Affiliation(s)
- Jascha A. Wendelstein
- Department of Ophthalmology and OptometryKepler University Hospital GmbHJohannes Kepler University LinzLinzAustria
| | | | - Siegfried Mariacher
- Department of Ophthalmology and OptometryKepler University Hospital GmbHJohannes Kepler University LinzLinzAustria
| | - Tina Wingert
- Department of Ophthalmology and OptometryKepler University Hospital GmbHJohannes Kepler University LinzLinzAustria
| | - Nino Hirnschall
- VIROS – Vienna Institute for Research in Ocular SurgeryKarl Landsteiner InstituteHanusch HospitalViennaAustria
| | - Oliver Findl
- VIROS – Vienna Institute for Research in Ocular SurgeryKarl Landsteiner InstituteHanusch HospitalViennaAustria
| | - Matthias Bolz
- Department of Ophthalmology and OptometryKepler University Hospital GmbHJohannes Kepler University LinzLinzAustria
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Rani K, Grover AK, Singh AK, Grover T, Garg SP. Correction of preexisting astigmatism by penetrating arcuate keratotomy in femtosecond laser-assisted cataract surgery. Indian J Ophthalmol 2021; 68:1569-1572. [PMID: 32709778 PMCID: PMC7640873 DOI: 10.4103/ijo.ijo_2060_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Purpose: To evaluate the astigmatism correcting effect of penetrating arcuate keratotomy (AK) done during femtosecond laser-assisted cataract surgery (FLACS). Methods: In this nonrandomized prospective study, 80 eyes of 70 patients were studied. The study included patients who underwent combined FLACS and AK, with corneal astigmatism ranging from 0.4 to 1.5 diopters (D). Femtosecond laser-assisted penetrating arcuate keratotomies were created at 8 mm optical zone at 80% depth and were centered at the limbus. Keratometric astigmatism was measured prior to and 3 months post-surgery. Vector analysis was performed using Power vector analysis method. Results: The mean preoperative keratometric astigmatism without accounting for axis was 0.85 ± 0.27 D, which reduced significantly to 0.47 ± 0.27 D at 3-month follow-up. The mean astigmatism correction attained without accounting for axis was 0.38 ± 0.32 D. The vector corrected mean preoperative astigmatism was 0.85 ± 0.27 D which reduced significantly to 0.50 ± 0.31 D postoperatively (P < 0.001, 95% CI). Vector corrected mean astigmatism correction attained was 0.35 ± 0.38 D. There were no significant intraoperative or postoperative complications. Conclusion: Preexisting astigmatism can be tackled effectively with penetrating AK during FLACS although under correction is observed with present nomograms. Further refinements may achieve better correction.
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Affiliation(s)
| | | | | | | | - S P Garg
- Vision Eye Centre, New Delhi, India
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Five-Year Changes in Corneal Astigmatism After Combined Femtosecond-Assisted Phacoemulsification and Arcuate Keratotomy. Am J Ophthalmol 2020; 217:232-239. [PMID: 32437671 DOI: 10.1016/j.ajo.2020.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/26/2020] [Accepted: 05/01/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the long-term stability of corneal astigmatism after combined femtosecond (fs)-assisted phacoemulsification and arcuate keratotomy. DESIGN Retrospective, interventional case series. METHODS Surgery was performed using a Victus (Bausch & Lomb) platform. A single, 450-μm-deep arcuate keratotomy was paired at the 8-mm zone with the main phacoemulsification incision in the opposite meridian. The keratotomy incisions were not opened. Corneal astigmatism measurements obtained preoperatively and at 2 and 5 years postoperatively were analyzed using vector analysis. RESULTS A total of 44 eyes of 44 patients (mean age 66.0 ± 10.1 years) were included. The mean preoperative corneal astigmatism was 1.40 ± 0.66 diopters (D). This was reduced to 0.74 ± 0.54 D at 2 years and 0.70 ± 0.50 at 5 years postoperatively (P < .001). There were no statistically significant differences between postoperative corneal astigmatism at 2 years and at 5 years (P = .609). Both magnitude of error and absolute angle of error were comparable between the 2 postoperative time points (P > .805). At the end of 5 years, 65% of the eyes were within 15 degrees of the preoperative astigmatic meridian. Comparative analysis showed significantly higher surgically induced astigmatism, lower differences in vector and absolute angles of error for the eyes with preoperative with-the-rule (WTR) astigmatism than eyes with against-the-rule (ATR) astigmatism at 5 years (P < .004). CONCLUSIONS Our study showed the stability of femtosecond (fs)-assisted arcuate keratotomy was well-maintained over 5 years. There was a tendency of increasing overcorrection of preoperative WTR astigmatism and undercorrection of ATR astigmatism over time.
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Lim CW, Somani S, Chiu HH, Maini R, Tam ES. Astigmatic Outcomes of Single, Non-Paired Intrastromal Limbal Relaxing Incisions During Femtosecond Laser-Assisted Cataract Surgery Based on a Custom Nomogram. Clin Ophthalmol 2020; 14:1059-1070. [PMID: 32368004 PMCID: PMC7183774 DOI: 10.2147/opth.s238016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 03/25/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose To determine astigmatic changes of intrastromal limbal-relaxing incisions (LRIs) performed during femtosecond laser-assisted cataract surgery (FLACS). Design Retrospective case series. Patients and Methods Patients undergoing FLACS with adjunctive astigmatism management with intrastromal LRIs were included. All eyes had preoperative corneal cylinder (Kcyl) ≥0.20 D on ocular biometry. An intrastromal LRI nomogram of single, non-paired LRIs placed at the 9 mm optical zone was used. Keratometry was measured preoperatively, and postoperatively at 1 week, 1 month, and 3 months (POM3). Alpins astigmatism analysis was used to calculate target-induced astigmatism (TIA, equivalent to preoperative Kcyl), surgically induced astigmatism (SIA), difference vectors (DV), and correction indices (CI). Secondary analysis included multivariable binary logistic regression to determine clinical factors associated with corrections >125% (CI > 1.25). Results A total of 154 eyes (125 patients) were studied. Mean preoperative Kcyl was 0.87±0.42 D (SD), which did not significantly differ from POM3 Kcyl (0.87±0.51 D, p=0.470). Only the against-the-rule (ATR) subgroup demonstrated a small but significant reduction in Kcyl from preoperative (0.96±0.51D) to POM3 (0.89±0.55D, p=0.032). Sixteen eyes (10.4%) had Kcyl ≤0.5 D preoperatively, compared to 46 eyes (29.9%) at POM3 (p<0.0001). Mean SIA was 0.80±0.52 D. Mean DV was 0.85±0.47. Mean CI was 0.79. Fifty-one eyes (33%) had astigmatism correction >125%. On multivariable regression analysis, ATR astigmatism class (p=0.026) and lower arc lengths (30º) (p=0.005) were associated with correction >125%. Lower preoperative corneal astigmatism was inversely correlated with CI (p<0.001). Conclusion Although intrastromal LRIs can be conveniently performed during FLACS and appear safe, only patients with ATR astigmatism demonstrated a significant reduction in corneal astigmatism 3-months postoperatively under the current nomogram. Areas for future refinements to the nomogram were identified.
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Affiliation(s)
- Carter W Lim
- Faculty of Medicine, University of Ottawa, Ottawa K1H 8M5, Canada.,Eye Foundation of Canada, Toronto M3N 2V6, Canada.,William Osler Health System, Brampton L6R 3J7, Canada
| | - Sohel Somani
- William Osler Health System, Brampton L6R 3J7, Canada.,Uptown Eye Specialists, Brampton L6Y 0P6, Canada.,Faculty of Medicine, University of Toronto, Toronto M5S 1A8, Canada
| | - Hannah H Chiu
- William Osler Health System, Brampton L6R 3J7, Canada.,Uptown Eye Specialists, Brampton L6Y 0P6, Canada.,Faculty of Medicine, University of Toronto, Toronto M5S 1A8, Canada
| | - Raj Maini
- William Osler Health System, Brampton L6R 3J7, Canada.,Uptown Eye Specialists, Brampton L6Y 0P6, Canada.,Faculty of Medicine, University of Toronto, Toronto M5S 1A8, Canada
| | - Eric S Tam
- William Osler Health System, Brampton L6R 3J7, Canada.,Uptown Eye Specialists, Brampton L6Y 0P6, Canada.,Faculty of Medicine, University of Toronto, Toronto M5S 1A8, Canada
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Comparison of astigmatism correction between anterior penetrating and intrastromal arcuate incisions in eyes undergoing femtosecond laser–assisted cataract surgery. J Cataract Refract Surg 2020; 46:394-402. [DOI: 10.1097/j.jcrs.0000000000000069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Byun YS, Kim S, Lazo MZ, Choi MH, Kang MJ, Lee JH, Yoo YS, Whang WJ, Joo CK. Astigmatic correction by intrastromal astigmatic keratotomy during femtosecond laser-assisted cataract surgery: Factors in outcomes. J Cataract Refract Surg 2019; 44:202-208. [PMID: 29587975 DOI: 10.1016/j.jcrs.2017.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/09/2017] [Accepted: 11/30/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the 6-month outcomes of femtosecond laser astigmatic keratotomy (AK) combined with femtosecond laser-assisted cataract surgery and identify factors affecting the efficacy of astigmatic correction. SETTING Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea. DESIGN Retrospective case series. METHODS Femtosecond laser AK was performed during femtosecond laser-assisted cataract surgery. The keratometric astigmatism, refractive cylinder, corneal hysteresis (CH), and corneal resistance factor (CRF) were measured preoperatively and postoperatively at 1 week, 2 months, and 6 months. Vector analysis to evaluate the 6-month outcomes of femtosecond laser AK and univariable regression analysis to determine the factors influencing the correction index were performed. RESULTS The study enrolled 89 eyes of 89 patients. The stigmatism type, CH, CRF, and absolute angle of error showed significant correlations with the correction index (P = .041, P = .029, P = .044, and P < .001, respectively). There was a significant difference in the correction index and no difference in keratometric astigmatism between with-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism (P = .044). The keratometric astigmatism with ATR and oblique astigmatism (0.66 diopter [D] ± 0.42 [SD] and 0.46 ± 0.27 D, respectively) was significantly lower than the refractive cylinder (0.92 ± 0.56 D and 0.78 ± 0.43 D, respectively) (P < .05); this was not the case for WTR astigmatism. CONCLUSIONS The efficacy of femtosecond laser AK was affected by the biomechanical properties of the cornea and astigmatism type. Further studies incorporating the individual biomechanical properties of the cornea and total corneal astigmatism in a nomogram are recommended.
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Affiliation(s)
- Yong-Soo Byun
- From the Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, and the Catholic Institute of Visual Science, Catholic University of Korea, Seoul, South Korea
| | - Seonjoo Kim
- From the Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, and the Catholic Institute of Visual Science, Catholic University of Korea, Seoul, South Korea
| | - Marjorie Z Lazo
- From the Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, and the Catholic Institute of Visual Science, Catholic University of Korea, Seoul, South Korea
| | - Mi-Hyun Choi
- From the Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, and the Catholic Institute of Visual Science, Catholic University of Korea, Seoul, South Korea
| | - Min-Ji Kang
- From the Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, and the Catholic Institute of Visual Science, Catholic University of Korea, Seoul, South Korea
| | - Jee-Hye Lee
- From the Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, and the Catholic Institute of Visual Science, Catholic University of Korea, Seoul, South Korea
| | - Young-Sik Yoo
- From the Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, and the Catholic Institute of Visual Science, Catholic University of Korea, Seoul, South Korea
| | - Woong-Joo Whang
- From the Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, and the Catholic Institute of Visual Science, Catholic University of Korea, Seoul, South Korea
| | - Choun-Ki Joo
- From the Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, and the Catholic Institute of Visual Science, Catholic University of Korea, Seoul, South Korea.
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Moussa S, Dietrich M, Lenzhofer M, Ruckhofer J, Reitsamer HA. Femtosecond laser in refractive corneal surgery. Photochem Photobiol Sci 2019; 18:1669-1674. [PMID: 31265052 DOI: 10.1039/c9pp00039a] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The introduction of the femtosecond (fs) laser has revolutionized ophthalmic surgery. With the worldwide application of fs-lasers, clinical outcomes and safety in corneal procedures have improved significantly and they have become an ideal tool for ultra-precise corneal refractive surgery. Flap creation in laser in situ keratomileusis (LASIK) is the most common use of this laser. It can also be used for other corneal refractive procedures including channel creation for the insertion of intrastromal corneal ring segments (ICRS), performing astigmatic keratotomies (AK), femtosecond lenticule extraction including small incision lenticule extraction (SMILE), and the insertion of corneal inlays. This article summarizes recent advanced applications of fs laser technology in corneal refractive surgery.
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Affiliation(s)
- Sarah Moussa
- Paracelsus Medical University Salzburg, Department of Ophthalmology and Optometry, Müllner Hauptstr. 48, 5020 Salzburg, Austria.
| | - Marie Dietrich
- Paracelsus Medical University Salzburg, Department of Ophthalmology and Optometry, Müllner Hauptstr. 48, 5020 Salzburg, Austria.
| | - Markus Lenzhofer
- Paracelsus Medical University Salzburg, Department of Ophthalmology and Optometry, Müllner Hauptstr. 48, 5020 Salzburg, Austria.
| | - Josef Ruckhofer
- Paracelsus Medical University Salzburg, Department of Ophthalmology and Optometry, Müllner Hauptstr. 48, 5020 Salzburg, Austria.
| | - Herbert A Reitsamer
- Paracelsus Medical University Salzburg, Department of Ophthalmology and Optometry, Müllner Hauptstr. 48, 5020 Salzburg, Austria.
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Lin HY, Chuang YJ, Lin PJ, Ho YJ. Novel method for preventing cyclorotation in Ziemer Femto LDV Z8 femtosecond laser-assisted cataract surgery with Verion image-guided system. Clin Ophthalmol 2019; 13:415-419. [PMID: 30858691 PMCID: PMC6387593 DOI: 10.2147/opth.s177219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the feasibility of a new method involving the use of the Verion image-guided system in preventing cyclorotation during femtosecond laser-assisted cataract surgery (FLACS). Patients Our preliminary data included details of 24 consecutive patients. All patients underwent cataract surgery at Universal Eye Center, Zhong-Li, Taiwan, between December 2016 and January 2017. Methods We developed a technique to use the Verion image-guided system in FLACS and evaluated whether this new technique is compatible with Femto LDV Z8. The Verion image-guided system was used to prevent misalignments. The only additional step in this technique is using a marking tool to place ink on the corneal limbus (at 3 and 9 o’clock positions) guided by the Verion digital marker system. Remaining procedures could be performed using the touchscreen of Femto LDV Z8 to calibrate the horizontal reference axis. Results This study included 24 patients who underwent cataract surgery. The technique used could effectively neutralize misalignments at an average of 8.08° and 2.66° in clockwise and counterclockwise directions, respectively. Conclusion This technique combines the advantages of iris fingerprinting technology and mobile features of Femto LDV Z8, has fewer transfer steps, improves centration of the eyes, and, most importantly, can prevent misalignments through cyclotorsion or docking procedures. Furthermore, this method can improve the accuracy of arcuate incisions and toric intraocular lens alignment in astigmatism correction.
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Affiliation(s)
- Hung-Yuan Lin
- Universal Eye Center, Zhong-Li, Taiwan, Republic of China.,Department of Optometry, Central Taiwan University of Science and Technology, Taichung City, Taiwan, Republic of China.,Ophthalmology Department, Shanghai Ruidong Hospital, Shanghai, China
| | - Ya-Jung Chuang
- Universal Eye Center, Long-Tan, Taiwan, Republic of China
| | - Pi-Jung Lin
- Universal Eye Center, Taipei, Taiwan, Republic of China
| | - Yi-Ju Ho
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China,
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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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14
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Chang JSM. Femtosecond laser-assisted astigmatic keratotomy: a review. EYE AND VISION 2018; 5:6. [PMID: 29564359 PMCID: PMC5853056 DOI: 10.1186/s40662-018-0099-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/26/2018] [Indexed: 11/10/2022]
Abstract
Background Astigmatic keratotomy (AK) remains an accessible means to correct surgically induced or naturally occurring astigmatism. The advantages of femtosecond laser-assisted astigmatic keratotomy (FSAK) over conventional methods have been recognized recently. Main text This review evaluates the efficacy, complications, and different methods of FSAK for correction of astigmatism in native eyes and those that underwent previous penetrating keratoplasty (PKP). The penetrating and intrastromal FSAK (IFSAK) techniques can reduce post-keratoplasty astigmatism by 35.4% to 84.77% and 23.53% to 89.42%, respectively. In native eyes, the penetrating and IFSAK techniques reduce astigmatism by 26.8% to 58.62% and 36.3% to 58% respectively, implying that the magnitude of the astigmatic reduction is comparable between the two FSAK procedures. Nonetheless, IFSAK offers the additional advantages of almost no risk of infection, wound gape, and epithelial ingrowth. The use of nomograms, anterior-segment optical coherence tomography, and consideration of posterior cornea and corneal biomechanics are helpful to enhance the efficacy and safety of FSAK. The complications of FSAK in eyes that underwent PKP include overcorrection, visual loss, microperforations, infectious keratitis, allograft rejection, and endophthalmitis. The reported difficulties in native eyes include overcorrection, anterior gas breakthrough, and suction loss. Conclusions In eyes that underwent PKP, FSAK effectively reduces high regular or irregular astigmatism, with rare and manageable complications. Nevertheless, the drawbacks of the procedure include the potential loss of visual acuity and low predictability. For native eyes undergoing femtosecond laser-assisted cataract surgery, IFSAK is a good choice to correct low astigmatism (< 1.5 diopters). The refractive effect of astigmatism from the posterior cornea needs to be considered in the nomograms for native eyes undergoing refractive cataract surgery. To further improve the efficacy of FSAK, more large-scale randomized studies with longer follow-up are needed.
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Affiliation(s)
- John S M Chang
- Department of Ophthalmology, Hong Kong Sanatorium & Hospital, 8/F, Li Shu Pui Block, Phase II, 2 Village Road, Happy Valley, Hong Kong
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Ho Wang Yin G, Hoffart L. Post-keratoplasty astigmatism management by relaxing incisions: a systematic review. EYE AND VISION 2017; 4:29. [PMID: 29238735 PMCID: PMC5725940 DOI: 10.1186/s40662-017-0093-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 11/26/2017] [Indexed: 12/02/2022]
Abstract
Postoperative visual acuity can be limited by post-keratoplasty astigmatism, even with a clear corneal graft. Astigmatism management can be performed by selective suture removal, adjustment of sutures, optical correction, photorefractive procedures, wedge resection, intra-ocular lens implantation, intracorneal ring segments, relaxing incisions with or without compression sutures and repeated keratoplasty. Relaxing incisions can be made in the graft, graft-host interface or host cornea. Despite the unpredictability of the method because the flat and steep meridians are usually not orthogonal after penetrating keratoplasty, with asymmetric power distribution, all the studies showed an overall reduction of refractive, keratometric or topographic astigmatism, ranging from 30% to 72% with manual or femtosecond-assisted techniques. Most patients with astigmatism higher than 6 diopters had residual cylinder less than or equal to 3 diopters, which can be treated by laser excimer ablation or secondary intraocular lens implantation.
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Affiliation(s)
- Gaëlle Ho Wang Yin
- Ophthalmology Department, Aix-Marseille University - APHM, Hôpital de la Timone, 264 rue Saint Pierre, 13 385 Marseille Cedex 5, France.,Institut Fresnel UMR 7249, Aix Marseille Université, CNRS, Centrale Marseille, Domaine universitaire de Saint-Jérôme Avenue Escadrille Normandie Niemen, 13397 Marseille cedex 20, France.,CERIMED, Aix-Marseille University, 27 Boulevard Jean-Moulin, 13385 Marseille cedex 05, France
| | - Louis Hoffart
- Ophthalmology Department, Aix-Marseille University - APHM, Hôpital de la Timone, 264 rue Saint Pierre, 13 385 Marseille Cedex 5, France.,Ramsay Générale de Santé, Clinique Monticelli-Velodrome, Marseille, France
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Moshirfar M, Jehangir N, Fenzl CR, McCaughey M. LASIK Enhancement: Clinical and Surgical Management. J Refract Surg 2017; 33:116-127. [DOI: 10.3928/1081597x-20161202-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 04/26/2016] [Indexed: 11/20/2022]
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Chan TC, Ng AL, Cheng GP, Wang Z, Woo VC, Jhanji V. Corneal Astigmatism and Aberrations After Combined Femtosecond-Assisted Phacoemulsification and Arcuate Keratotomy: Two-Year Results. Am J Ophthalmol 2016; 170:83-90. [PMID: 27496784 DOI: 10.1016/j.ajo.2016.07.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/24/2016] [Accepted: 07/26/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the stability of corneal astigmatism and higher-order aberrations after combined femtosecond-assisted phacoemulsification and arcuate keratotomy. DESIGN Retrospective, interventional case series. METHODS Surgery was performed using a VICTUS (Bausch & Lomb Inc, Dornach, Germany) platform. A single, 450-μm deep, arcuate keratotomy was paired at the 8-mm zone with the main phacoemulsification incision in the opposite meridian. The keratotomy incisions were not opened. Corneal astigmatism and higher-order aberration measurements obtained preoperatively and at 2 months and 2 years postoperatively were analyzed. RESULTS Fifty eyes of 50 patients (mean age 66.2 ± 10.5 years) were included. The mean preoperative corneal astigmatism was 1.35 ± 0.48 diopters (D). This was reduced to 0.67 ± 0.54 D at 2 months and 0.74 ± 0.53 D at 2 years postoperatively (P < .001). There was no statistically significant difference between postoperative corneal astigmatism over 2 years (P = .392). Both magnitude of error and absolute angle of error were comparable between the 2 postoperative time points (P > .283). At postoperative 2 months and 2 years, 72% and 70% of eyes were within 15 degrees of preoperative meridian of astigmatism, respectively. All wavefront measurements increased significantly at 2 months and 2 years (P < .007), except spherical aberration (P > .150). There was no significant difference in higher-order aberrations between 2 months and 2 years postoperatively (P > .486). CONCLUSIONS Our study showed the stability of femtosecond-assisted arcuate keratotomy. Further studies using other platforms and nomograms are needed to corroborate the findings of this study.
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Abstract
PURPOSE OF REVIEW This article reviews current concepts in intraocular lens alignment strategies to maximize intraocular lens (IOL) positioning. RECENT FINDINGS A variety of strategies has been developed to maximize toric IOL position, including preoperative calculators to determine the appropriate IOL power and orientation, intraoperative alignment devices, and postoperative software to determine if IOL rotation would be beneficial for refractive outcomes. SUMMARY The combination of using multiple toric IOL calculators and intraoperative alignment devices has improved toric IOL outcomes. The relationship of the posterior corneal power and its effect on outcomes remains to be fully elucidated. Postoperative IOL rotation may be necessary even when the IOL is aligned as planned because of surgically induced astigmatism.
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Day AC, Stevens JD. Stability of Keratometric Astigmatism After Non-penetrating Femtosecond Laser Intrastromal Astigmatic Keratotomy Performed During Laser Cataract Surgery. J Refract Surg 2016; 32:152-5. [DOI: 10.3928/1081597x-20160204-01] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/09/2015] [Indexed: 11/20/2022]
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Day AC, Stevens JD. Predictors of femtosecond laser intrastromal astigmatic keratotomy efficacy for astigmatism management in cataract surgery. J Cataract Refract Surg 2016; 42:251-7. [DOI: 10.1016/j.jcrs.2015.09.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/28/2015] [Accepted: 09/03/2015] [Indexed: 11/27/2022]
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KILAVUZOĞLU AE, GÖNEN T, ÇELEBİ ARC, COŞAR YURTERİ CB, ŞENER AB. Treatment of mixed astigmatism: early clinical outcomes withWaveLight and Technolas excimer lasers. Turk J Med Sci 2016; 46:664-72. [DOI: 10.3906/sag-1504-35] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 07/08/2015] [Indexed: 11/03/2022] Open
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Nonpenetrating femtosecond laser intrastromal astigmatic keratotomy in eyes having cataract surgery. J Cataract Refract Surg 2016; 42:102-9. [DOI: 10.1016/j.jcrs.2015.07.045] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 07/13/2015] [Accepted: 07/31/2015] [Indexed: 11/17/2022]
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Chou TY, Abazari A, Barash A, Shah S, Kaplowitz K. Early-onset methicillin-resistant Staphylococcus aureus keratitis and late-onset infectious keratitis in astigmatic keratotomy incision following femtosecond laser-assisted cataract surgery. J Cataract Refract Surg 2015; 41:1772-7. [PMID: 26432137 DOI: 10.1016/j.jcrs.2015.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 11/18/2022]
Abstract
UNLABELLED A 79-year-old woman had uneventful femtosecond laser-assisted cataract surgery including paired laser astigmatic keratotomies (AKs) in the right eye. Three weeks postoperatively, a corneal infiltrate developed in the superotemporal AK incision. Cultures grew methicillin-resistant Staphylococcus aureus. The infection was treated with topical fortified vancomycin and tobramycin; full resolution required several months of therapy. Five months after cataract surgery, the patient presented with a second stromal infiltrate, also in the superotemporal AK incision. Despite negative cultures, the infiltrate resolved quickly on a short course of broad-spectrum fortified antibiotics. At 6 months, the corrected distance visual acuity was 20/30. This case demonstrates that infectious keratitis can occur following uneventful femtosecond laser-assisted AK performed concurrently with cataract surgery. We reviewed the literature on infectious keratitis following refractive keratotomy and femtosecond laser-assisted procedures. Several recommendations to prevent these infections are proposed. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Timothy Y Chou
- From the Department of Ophthalmology (Chou, Abazari, Barash, Kaplowitz), Stony Brook University, Stony Brook, and the Long Island Eye Surgical Care PC (Shah), Brentwood, New York, USA.
| | - Azin Abazari
- From the Department of Ophthalmology (Chou, Abazari, Barash, Kaplowitz), Stony Brook University, Stony Brook, and the Long Island Eye Surgical Care PC (Shah), Brentwood, New York, USA
| | - Alexander Barash
- From the Department of Ophthalmology (Chou, Abazari, Barash, Kaplowitz), Stony Brook University, Stony Brook, and the Long Island Eye Surgical Care PC (Shah), Brentwood, New York, USA
| | - Shetal Shah
- From the Department of Ophthalmology (Chou, Abazari, Barash, Kaplowitz), Stony Brook University, Stony Brook, and the Long Island Eye Surgical Care PC (Shah), Brentwood, New York, USA
| | - Kevin Kaplowitz
- From the Department of Ophthalmology (Chou, Abazari, Barash, Kaplowitz), Stony Brook University, Stony Brook, and the Long Island Eye Surgical Care PC (Shah), Brentwood, New York, USA
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Monaco G, Scialdone A. Long-term outcomes of limbal relaxing incisions during cataract surgery: aberrometric analysis. Clin Ophthalmol 2015; 9:1581-7. [PMID: 26357459 PMCID: PMC4560521 DOI: 10.2147/opth.s89024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To compare the final changes in corneal wavefront aberration by limbal relaxing incisions (LRIs) after cataract surgery. METHODS This prospective cumulative interventional nonrandomized case study included cataract and astigmatic patients undergoing LRIs and phaco with intraocular lens implantation. LRIs were planned using Donnenfeld nomogram. The root mean square of corneal wave aberration for total Z(n,i)(1≤n≤8), astigmatism Z(2,±1), coma Z(3-5-7,±1), trefoil Z(3-5-7,±2), spherical Z(4-6-8,0), and higher-order aberration (HOA) Z(3≤n≤8) was examined before and 3 years after surgery (optical path difference-Scan II [OPD-Scan II)]. Uncorrected distance visual acuity and best-corrected distance visual acuity (CDVA) for distance, keratometric cylinder, and variations in average corneal power were also analyzed. RESULTS Sixty-four eyes of 48 patients were included in the study. Age ranged from 42 to 92 years (70.6±8.4 years). After LRIs, uncorrected distance visual acuity and best-corrected distance visual acuity improved statistically (P<0.01). The keratometric cylinder value decreased by 40.1%, but analysis of KP90 and KP135 polar values did not show any decrease that could be statistically confirmed (P=0.22 and P=0.24). No significant changes were detected in root mean square of total (P=0.61) and HOAs (P=0.13) aberrations. LRIs did not induce alteration in central corneal power confirming a 1:1 coupling ratio. CONCLUSION LRIs determined a nonsignificant alteration of corneal HOA. Therefore, LRIs can be still considered a qualitatively viable mean in those cases where toric intraocular lenses are contraindicated or not available. Yet, the authors raise the question of nonpersonalized nomograms, as in the present study, LRIs did not reach the preset target cylinder.
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Affiliation(s)
- Gaspare Monaco
- Department of Ophthalmology, Ospedale Fatebenefratelli e Oftalmico, Milan, Italy
| | - Antonio Scialdone
- Department of Ophthalmology, Ospedale Fatebenefratelli e Oftalmico, Milan, Italy
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Chan TCY, Cheng GPM, Wang Z, Tham CCY, Woo VCP, Jhanji V. Vector Analysis of Corneal Astigmatism After Combined Femtosecond-Assisted Phacoemulsification and Arcuate Keratotomy. Am J Ophthalmol 2015; 160:250-255.e2. [PMID: 25982969 DOI: 10.1016/j.ajo.2015.05.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/07/2015] [Accepted: 05/08/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the outcomes of femtosecond-assisted arcuate keratotomy combined with cataract surgery in eyes with low to moderate corneal astigmatism. DESIGN Retrospective, interventional case series. METHODS This study included patients who underwent combined femtosecond-assisted phacoemulsification and arcuate keratotomy between March 2013 and August 2013. Keratometric astigmatism was evaluated before and 2 months after the surgery. Vector analysis of the astigmatic changes was performed using the Alpins method. RESULTS Overall, 54 eyes of 54 patients (18 male and 36 female; mean age, 68.8 ± 11.4 years) were included. The mean preoperative (target-induced astigmatism) and postoperative astigmatism was 1.33 ± 0.57 diopters (D) and 0.87 ± 0.56 D, respectively (P < .001). The magnitude of error (difference between surgically induced and target-induced astigmatism) (-0.13 ± 0.68 D), as well as the correction index (ratio of surgically induced and target-induced astigmatism) (0.86 ± 0.52), demonstrated slight undercorrection. The angle of error was very close to 0, indicating no significant systematic error of misaligned treatment. However, the absolute angle of error showed a less favorable range (17.5 ± 19.2 degrees), suggesting variable factors such as healing or alignment at an individual level. There were no intraoperative or postoperative complications. CONCLUSIONS Combined phacoemulsification with arcuate keratotomy using femtosecond laser appears to be a relatively easy and safe means for management of low to moderate corneal astigmatism in cataract surgery candidates. Misalignment at an individual level can reduce its effectiveness. This issue remains to be elucidated in future studies.
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Affiliation(s)
- Tommy C Y Chan
- Hong Kong Eye Hospital, Kowloon, Hong Kong; Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | | | - Zheng Wang
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Clement C Y Tham
- Hong Kong Eye Hospital, Kowloon, Hong Kong; Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | | | - Vishal Jhanji
- Hong Kong Eye Hospital, Kowloon, Hong Kong; Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.
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Nejima R, Terada Y, Mori Y, Ogata M, Minami K, Miyata K. Clinical utility of femtosecond laser-assisted astigmatic keratotomy after cataract surgery. Jpn J Ophthalmol 2015; 59:209-15. [PMID: 25990805 DOI: 10.1007/s10384-015-0383-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 04/10/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To examine the clinical utility of femtosecond laser-assisted astigmatic keratotomy (FSL-AK) for eyes after cataract surgery. METHODS Eight eyes of 6 patients with an intraocular lens and corneal astigmatism of 2.0 diopters (D) or more underwent FSL-AK. The mean preoperative manifest cylindrical refraction was 2.88 ± 0.64 D and the mean corneal astigmatism was 2.84 ± 0.83 D. Paired symmetrical arcuate incisions were created with the same settings, except for the incision depth. Uncorrected distance visual acuity (UDVA), manifest cylindrical power, and surgically induced astigmatism (SIA) were measured at 1 day, 1 week, and 1 month postoperatively. Fourier analysis of corneal topography and incision depths measured with anterior-segment optical coherence tomography were evaluated 1 month postoperatively. RESULTS In all eyes, the UDVA improved at 1 week and 1 month postoperatively, and the manifest cylinder also decreased postoperatively, while the SIA showed overcorrections in 6 eyes. Fourier analysis showed decreases in spherical and regular astigmatic components and increases in higher-order irregularity. The mean incision depth was measured as 60 µm deeper than the intended depth. CONCLUSION The FSL-AK effectively reduced corneal astigmatism and improved the UDVA, although it was demonstrated that the deeper incisions led to overcorrection.
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Affiliation(s)
- Ryohei Nejima
- Miyata Eye Hospital, 6-3 Kurahara-cho, Miyakonojo, Miyazaki, 885-0051, Japan,
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Alpins N, Ong JKY, Stamatelatos G. Corneal coupling of astigmatism applied to incisional and ablative surgery. J Cataract Refract Surg 2014; 40:1813-27. [PMID: 25442882 DOI: 10.1016/j.jcrs.2014.02.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 02/12/2014] [Accepted: 02/15/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To redefine measures of corneal coupling for use with incisional and ablation procedures for astigmatism. SETTING Private clinics, Melbourne, Victoria, Australia. DESIGN Retrospective nonrandomized study. METHODS The measures known as the coupling ratio (CR) and coupling constant (CC) were redefined to ensure validity in most cases of incisional procedures and laser vision correction procedures. In addition, a new measure--the coupling adjustment (CAdj)--was developed to quantify the amount of spherical adjustment that must be applied to compensate for coupling that occurs as a result of astigmatism treatment. These quantitative measures of coupling were applied to retrospective data to show their applicability. RESULTS Pure myopic, compound myopic, and compound hyperopic astigmatism excimer laser treatments showed a CR close to zero, a CC close to 0.5, and a CAdj close to zero. Incision LRIs showed a CR close to 1.0 and a CC close to zero. In all cases, the coupling measures were consistent for treatments with a larger astigmatic component (>1.0 diopter) but variable when the astigmatic component of the treatment was smaller. CONCLUSIONS The revised definitions of CR and CC can be used with incisional and ablative surgery. Incorporating the CAdj into the planning of spherocylindrical treatments allows one to factor in the effect of the astigmatic treatment on the spherical component and thus to more accurately target the desired spherical equivalent. FINANCIAL DISCLOSURE Dr. Alpins and Mr. Stamatelatos have a financial interest in the Assort software program. Dr. Ong is an employee of Assort.
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Affiliation(s)
- Noel Alpins
- From NewVision Clinics (Alpins, Stamatelatos) and Assort (Ong), Melbourne, Victoria, Australia.
| | - James K Y Ong
- From NewVision Clinics (Alpins, Stamatelatos) and Assort (Ong), Melbourne, Victoria, Australia
| | - George Stamatelatos
- From NewVision Clinics (Alpins, Stamatelatos) and Assort (Ong), Melbourne, Victoria, Australia
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Abdelghany AA, Alio JL. Surgical options for correction of refractive error following cataract surgery. EYE AND VISION 2014; 1:2. [PMID: 26605349 PMCID: PMC4604120 DOI: 10.1186/s40662-014-0002-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/13/2014] [Indexed: 11/10/2022]
Abstract
Refractive errors are frequently found following cataract surgery and refractive lens exchange. Accurate biometric analysis, selection and calculation of the adequate intraocular lens (IOL) and modern techniques for cataract surgery all contribute to achieving the goal of cataract surgery as a refractive procedure with no refractive error. However, in spite of all these advances, residual refractive error still occasionally occurs after cataract surgery and laser in situ keratomileusis (LASIK) can be considered the most accurate method for its correction. Lens-based procedures, such as IOL exchange or piggyback lens implantation are also possible alternatives especially in cases with extreme ametropia, corneal abnormalities, or in situations where excimer laser is unavailable. In our review, we have found that piggyback IOL is safer and more accurate than IOL exchange. Our aim is to provide a review of the recent literature regarding target refraction and residual refractive error in cataract surgery.
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Affiliation(s)
- Ahmed A Abdelghany
- Clinical research fellow in Vissum Corporación Alicante, Universidad Miguel Hernández, Alicante, Spain ; Minia University, Minia, Egypt
| | - Jorge L Alio
- Vissum Corporación, Alicante, Spain ; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain ; Avda de Denia s/n, Edificio Vissum, Alicante, 03016 Spain
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New combined technique of deep intrastromal arcuate keratotomy overlayed by LASIK flap for treatment of high astigmatism. Cornea 2014; 33:1123-8. [PMID: 25127189 DOI: 10.1097/ico.0000000000000236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to describe a novel technique combining deep intrastromal arcuate keratotomy and superficial lamellar keratotomy followed by excimer photoablation for the management of high naturally occurring or postkeratoplasty astigmatism. METHODS In this retrospective case series, the first step was deep intrastromal arcuate keratotomy and superficial lamellar keratotomy performed at 100-μm depth by femtosecond laser. Manual incisions were made for flap elevation. The second step, after 1 month, consisted of reopening the flap and using an excimer laser to correct residual ametropia. RESULTS Nine eyes series were studied. The mean preoperative refractive cylinder correction was 6.11 ± 2.54 diopters (D). The mean postoperative refractive cylinder correction was 2.85 ± 1.31 D. The mean correction index was 1.07 ± 0.28 D. The mean best-corrected visual acuity improved from 20/40 to 20/22 after the 2 steps. The median follow-up was 11 (range, 9-17) months. No complications were observed and postoperative outcome was satisfactory. CONCLUSIONS Permitting correction of a broader range of high astigmatism with good accuracy, this combined approach minimizes excision of corneal stromal tissue and postoperative complications.
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Viswanathan D, Kumar NL. Bilateral femtosecond laser-enabled intrastromal astigmatic keratotomy to correct high post-penetrating keratoplasty astigmatism. J Cataract Refract Surg 2013; 39:1916-20. [PMID: 24140196 DOI: 10.1016/j.jcrs.2013.08.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 05/23/2013] [Accepted: 05/23/2013] [Indexed: 10/26/2022]
Abstract
A 35-year-old man presented with bilateral high astigmatism following penetrating keratoplasties performed for advanced keratoconus. Femtosecond laser-enabled intrastromal astigmatic keratotomy was performed, resulting in a significant reduction in corneal astigmatism. At 4 months, the corneal astigmatism continued to decrease. The visual acuity, refraction, and serial corneal topographic data are presented.
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Affiliation(s)
- Deepa Viswanathan
- From the Australian School of Advanced Medicine (Viswanathan, Kumar), Macquarie University, and the Sydney Adventist Hospital Clinical School (Kumar), University of Sydney, Sydney, Australia
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Wang L, Moss H, Ventura BV, Padilha H, Hester C, Koch DD. Advances in Refractive Surgery. Asia Pac J Ophthalmol (Phila) 2013; 2:317-27. [PMID: 26107036 DOI: 10.1097/apo.0b013e3182a90647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The objective of this study was to review advances in the field of refractive surgery as reported in the peer-reviewed literature over the previous year. DESIGN This was a literature review. METHODS We conducted a PubMed search for terms related to refractive surgery and reviewed prominent international ophthalmic journals published from May 2012 through April 2013. All pertinent articles were reviewed, and selected articles with the greatest relevance were included. RESULTS Many studies over the previous year have highlighted progress in the field of refractive surgery; topics included keratoconus screening, photorefractive keratectomy and laser in situ keratomileusis, corneal cross-linking, small-incision lenticule extraction, phakic intraocular lenses, corneal inlays, presbyopic corneal treatments, and femtosecond laser-assisted astigmatic keratotomy. CONCLUSIONS The field of refractive surgery continues to provide exciting developments. Improvements in established procedures and promising new surgical options make the current climate an appealing one for refractive surgeons and patients.
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Affiliation(s)
- Li Wang
- From the *Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX; and †Altino Ventura Foundation, Recife; and ‡Hospital de Olhos do Paraná, Curitiba, Brazil
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Krueger RR. What's New and Important in Refractive Surgery? A Year in Review. Asia Pac J Ophthalmol (Phila) 2013; 2:279-81. [PMID: 26107028 DOI: 10.1097/apo.0000000000000005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ronald R Krueger
- From the Cole Eye Institute, Cleveland Clinic 9500 Euclid Avenue, Cleveland, OH 44195
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