Corrected Distance Visual Acuity Values Research Articles

Comparison of three techniques for simultaneous intraocular lens implantation in subluxated cataract surgery: Transconjunctival intrascleral, Z-suture knotless transscleral, and Cionni capsular tension ring assisted.

To evaluate and compare the clinical outcomes of three different methods of intraocular lens (IOL) implantation in the surgery of subluxated cataracts. In this retrospective, comparative, clinical interventional study, the medical records of patients who underwent IOL implantation with sutureless 27-gauge needle-assisted transconjunctival intrascleral (Group 1), Z-suture knotless transscleral (Group 2), and Cionni capsular tension ring (Cionni-CTR) assisted (Group 3) simultaneously with subluxated cataract extraction between June 2010 and June 2022 were evaluated. Demographic characteristics, follow-up times, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical and cylindrical refractive values, and spherical equivalent (SE) values of three groups were compared. Intraoperative and postoperative complications were recorded. There were 20 eyes in Group 1, 35 eyes in Group 2, and 40 eyes in Group 3. In all groups, statistically significant improvement was observed in postoperative UDVA and CDVA compared to preoperative values (each p < 0.05). There was no statistical difference between the groups in postoperative UDVA and CDVA values. (p = 0.130, p = 0.167 respectively). No significant difference was observed between the groups in terms of postoperative spherical, cylindrical, and SE values (each p > 0.05). The study suggests that three different IOL implantation techniques for simultaneous IOL implantation in subluxated cataract surgery have similar effects on visual and refractive outcomes.

Clinical Results of a Monofocal Aspheric Bitoric Intraocular Lens with Plate Haptics in Hyperopic Eyes.

To assess the refractive and visual outcomes of hyperopic and astigmatic eyes implanted with a monofocal, aspheric, bitoric intraocular lens (IOL) with plate haptics following cataract surgery. The study evaluated 51 eyes implanted with the AT TORBI 709M IOL (Carl Zeiss Meditec AG, Jena, Germany) during a follow-up of 12-months. Refractive error, rotational stability, monocular uncorrected distance visual acuity (UDVA), monocular corrected distance visual acuity (CDVA), and contrast sensitivity were analyzed at 1-, 6-, and 12-months post-surgery. At 12 months, the cumulative CDVA was 20/25 in 94.12% of eyes and 20/32 or better in 98.04%. The UDVA was the same as, or better than, the CDVA in 88.24% of eyes. The mean logMAR UDVA and CDVA values were 0.06 ± 0.11 and 0.00 ± 0.08, respectively. In addition, 92.16% of eyes were within ±0.50D and 98.04% were within ±1.00D of a spherical equivalent, and 86.27% of eyes had refractive astigmatism ≤0.50D and 100% were ≤1.00D. The mean spherical equivalent was 0.21 ± 0.31D and the mean refractive cylinder 0.34 ± 0.27D. The IOL rotation was 1.18 ± 1.35 degrees and all eyes had a rotation ≤5 degrees. The log contrast sensitivity functions were good and similar for all spatial frequencies during follow-up. Our results demonstrate that implantation of the AT TORBI 709M IOL in hyperopic and astigmatic eyes is effective and safe. The visual and refractive outcomes were good, showing excellent rotational stability.

Circular RNA expression profile identifies potential circulating biomarkers for keratoconus

Early diagnosis is important for improving the outcomes of keratoconus (KC). Stable expression and a closed-loop structure of circular RNAs (circRNAs) make them ideal for the diagnosis and treatment of diseases. However, the expression pattern and potential function of circRNAs in KC is not studied yet. Hence, this study explored the circRNA expression profile of KC corneas through transcriptome sequencing and circRNA expression profile analysis. The diagnostic potential of blood circRNAs for KC was explored by analysing the circRNAs' expression levels of fifty paired blood samples from patients with KC and normal controls. The results showed that 107 significantly upregulated and 145 significantly downregulated circRNAs (|fold change| ≥ 2.0, p-value <0.05) were identified in KC tissues. Eight top differently expressed circRNAs were further validated in more cornea samples. Among them, five circRNAs expressed in peripheral blood, and four circRNAs (circ_0006156, circ_0006117, circ_0000284 and circ_0001801) showed significant downregulation in KC patients’ peripheral blood too. The blood circ_0000284 expression levels of early, moderate, and advanced KC patients both were significantly lower than the controls. The blood circ_0006117 expression levels present a positive correlation with corrected distance visual acuity values, and a negative correlation with back elevation values of KC eyes. Notably, the expression levels of these circRNAs distinguished KC patients from their healthy counterparts, with the area under the curve (AUC) of circ_0000284, circ_0001801, and circ_0006117 being 0.7306, 0.6871 and 0.6701, respectively. Further, the AUC value for five circRNAs under the logistic regression model was 0.8203, indicating that they can function as effective biomarkers for the KC diagnostics. In conclusion, the expression of circRNAs showed a relationship with KC, with four significantly differentially expressed circRNAs demonstrating potential as biomarkers for the disease.

Visual and Refractive Outcomes of a Trifocal Toric Intraocular Lens Implanted in Eyes With High Corneal Astigmatism.

To analyze the refractive and visual outcomes following cataract surgery and implantation of a trifocal toric intraocular lens (IOL) in eyes with high degrees of corneal astigmatism. A total of 29 eyes from 21 patients who underwent implantation of a trifocal toric IOL (FineVision PODFT; PhysIOL) were evaluated in this study. Phacoemulsification with femto-second laser and intraoperative aberrometry were performed in all cases. All IOLs used exhibited a cylinder power of 3.75 diopters (D) or greater. The main outcome measures were refractive error and corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA) values. Eyes were evaluated during a follow-up period of 5 years. A total of 96.30%, 100%, 95.83%, and 89.47% of eyes were within ±1.00 D at 1, 2, 3, and 5 years postoperatively, respectively. Furthermore, 92.31%, 86.36%, 82.61%, and 84.21% of eyes showed a refractive cylinder value of ±1.00 D at 1, 2, 3, and 5 years postoperatively, respectively. During the entire follow-up period, between 81.48% and 91.30% of eyes showed a CDVA of 20/25 or better. The mean monocular Snellen decimal CDVA values were 0.90 ± 0.12, 0.90 ± 0.11, 0.91 ± 0.11, and 0.90 ± 0.12 at 1, 2, 3, and 5 years postoperatively, respectively. No significant rotation was reported in any eye during follow-up. The current study suggests that use of this trifocal toric IOL in eyes with high amounts of corneal astigmatism provides accurate refractive outcomes with good distance visual acuity. [J Refract Surg. 2023;39(4):229-234.].

Comparison of Vision Correction and Corneal Thickness at 180-Day Follow-Up After Femtosecond Laser-Assisted In-Situ Keratomileusis (FS-LASIK), Photorefractive Keratectomy (PRK), and Small Incision Lenticule Extraction (SMILE): A Study from a Single Center in Poland of 120 Patients with Myopia.

BACKGROUND This study from a single center in Poland included 120 patients with myopia, and the aim was to compare vision correction and corneal thickness at the 180-day follow-up after femtosecond laser-assisted in-situ keratomileusis (FS-LASIK), photorefractive keratectomy (PRK), or small incision lenticule extraction (SMILE). MATERIAL AND METHODS The effectiveness and safety of laser vision correction (LVC) procedures were evaluated by determining pre- and post-procedure uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) values on the Snell chart. Twenty patients with diagnosed mild myopia (sphere maximum -3.0 diopters D; cylinder maximum 0.5 D) were qualified for PRK surgery. Fifty patients with diagnosed intolerance (sphere maximum -6.0 D; cylinder maximum 5.0 D) were eligible for the FS-LASIK procedure. Fifty patients with diagnosed myopia (sphere maximum -6.0 D cylinder 3.5 D) were qualified for the SMILE procedure. RESULTS Regardless of which procedure was performed, both UDVA and CDVA improved significantly postoperatively (P<0.05). In addition, the UDVA and CDVA values were similar in the postoperative period (P>0.05). For each procedure, the EI was no less than 0.94. Regardless of which type of LVC procedure was performed, CET at the center and 1.5 mm from the center in 4 meridians thickened, and this change was not statistically significant over the observation period (P>0.05). CONCLUSIONS Our analysis demonstrated similar effectiveness of the 3 methods - PRK, FS-LASIK, and SMILE - in patients with mild and moderate myopia.

ICL Postimplantation Decentration and Tilt in Myopic Patients with Primary Iridociliary Cysts.

To observe the decentration and tilt of implantable collamer lens (ICL) as well as possible visual effects postimplantation in primary iridociliary cysts. The present investigation was a retrospective cohort study. All 48 patients (91 eyes) who underwent ICL surgery at the Center of Refraction Surgery of Tianjin Medical University Eye Hospital between July 2018 and May 2020 were split into two groups based on the absence or presence of primary iridociliary cysts established by ultrasonic biological microscopy (UBM) examination. Intraocular pressure (IOP), corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), anterior chamber angle (ACA), anterior chamber volume (ACV), and anterior chamber depth (ACD) were recorded preoperatively and postoperatively at 1, 6, and 12 months. Additionally, we performed an analysis of the ICL vault, decentration, and tilt using a rotating Scheimpflug Oculus Pentacam camera system at 1, 6, and 12 months after surgery. No serious complications were observed. Significant postoperative improvement (P < 0.05) of UDVA was established in the two studied groups; however, we did not observe statistically significant intergroup differences (P > 0.05) throughout the entire research period. In each group, the preoperative ACA, ACV, and ACD were statistically significantly reduced (P < 0.05), but no such decrease was established between their postoperative values (P > 0.05). We observed no statistical differences between both groups with regard to their values of IOP, ACA, ACV, ACD, ICL vault, ICL decentration, and tilt at 1, 6, and 12 months after surgery. Similarly, no statistically significant within-group correlation (P > 0.05) of the decentration of ICL and the tilt and the CDVA values was established. No postimplantation effect of ICL with a central hole on vision was established in myopia patients with primary iridociliary cysts, within certain limits of ICL decentration and tilt values.

Accelerated versus Standard Corneal Cross-linking for Progressive Keratoconus in Syria.

PurposeTo compare the outcomes of accelerated versus standard corneal cross-linking for the treatment of progressive keratoconus.Methods In this retrospective comparative study, 63 eyes of 40 patients with progressive keratoconus were divided into two groups; 27 eyes in group one were treated with an accelerated protocol (10 mW/cm, 9 min) and 36 eyes in group two were treated with the standard method (3 mW/cm, 30 min). Visual acuity, refraction, corneal topography, corneal tomography, and anterior and posterior corneal higher-order aberrations (HOAs) were assessed preoperatively and 18–30 months postoperatively.ResultsThe LogMAR uncorrected and corrected distance visual acuity values were improved in both groups postoperatively. However, the improvement was significantly higher in group one (P 0.05, all). The flattening in the anterior keratometry readings, flat K, steep K, and average K were significantly higher in group two (P 0.001, all). The maximum anterior keratometry (AKf) values significantly decreased in both groups, whereas the maximum posterior keratometry (AKb) values increased. The reduction in the minimum corneal thickness (ThKmin) was significantly greater (36.49um) in group two, compared to 10.85um in group one. There was a significant increase in the posterior average keratometry, and a significant decrease in the posterior astigmatism, along 3 mm meridian in S-CXL (P = 0.03, P = 0.008, respectively), while the corresponding values showed no statistical significance in group one (P 0.05). The anterior corneal trefoil was significantly reduced in group one (P = 0.002), whereas anterior total HOAs and coma were significantly improved in group two (P 0.0014, all). The posterior corneal spherical aberration decreased significantly in group one (P = 0.02), while group two revealed significant reduction in the posterior trefoil values (P = 0.011). The change in the anterior maximum keratometry was significantly and positively correlated to the preoperative maximum keratometry in group two (P = 0.53, P = 0.003).ConclusionAn accelerated cross-linking protocol using 10 mW/cm for 9 min showed more visual improvement and less pachymetric reduction when compared to the standard protocol, however, anterior corneal flattening, posterior corneal steepening, and the change in the posterior astigmatism were significantly higher in the standard protocol; while corneal HOAs were improved in both protocols.

Femtosecond laser-assisted cataract surgery compared with phacoemulsification: the FACT non-inferiority RCT.

Cataract surgery is one of the most common operations. Femtosecond laser-assisted cataract surgery (FLACS) is a technique that automates a number of operative steps. To compare FLACS with phacoemulsification cataract surgery (PCS). Multicentre, outcome-masked, randomised controlled non-inferiority trial. Three collaborating NHS hospitals. A total of 785 patients with age-related cataract in one or both eyes were randomised between May 2015 and September 2017. FLACS (n = 392 participants) or PCS (n = 393 participants). The primary outcome was uncorrected distance visual acuity in the study eye after 3 months, expressed as the logarithm of the minimum angle of resolution (logMAR): 0.00 logMAR (or 6/6 if expressed in Snellen) is normal (good visual acuity). Secondary outcomes included corrected distance visual acuity, refractive outcomes (within 0.5 dioptre and 1.0 dioptre of target), safety and patient-reported outcome measures at 3 and 12 months, and resource use. All trial follow-ups were performed by optometrists who were masked to the trial intervention. A total of 353 (90%) participants allocated to the FLACS arm and 317 (81%) participants allocated to the PCS arm attended follow-up at 3 months. The mean uncorrected distance visual acuity was similar in both treatment arms [0.13 logMAR, standard deviation 0.23 logMAR, for FLACS, vs. 0.14 logMAR, standard deviation 0.27 logMAR, for PCS, with a difference of -0.01 logMAR (95% confidence interval -0.05 to 0.03 logMAR; p = 0.63)]. The mean corrected distance visual acuity values were again similar in both treatment arms (-0.01 logMAR, standard deviation 0.19 logMAR FLACS vs. 0.01 logMAR, standard deviation 0.21 logMAR PCS; p = 0.34). There were two posterior capsule tears in the PCS arm. There were no significant differences between the treatment arms for any secondary outcome at 3 months. At 12 months, the mean uncorrected distance visual acuity was 0.14 logMAR (standard deviation 0.22 logMAR) for FLACS and 0.17 logMAR (standard deviation 0.25 logMAR) for PCS, with a difference between the treatment arms of -0.03 logMAR (95% confidence interval -0.06 to 0.01 logMAR; p = 0.17). The mean corrected distance visual acuity was 0.003 logMAR (standard deviation 0.18 logMAR) for FLACS and 0.03 logMAR (standard deviation 0.23 logMAR) for PCS, with a difference of -0.03 logMAR (95% confidence interval -0.06 to 0.01 logMAR; p = 0.11). There were no significant differences between the arms for any other outcomes, with the exception of the mean binocular corrected distance visual acuity with a difference of -0.02 logMAR (95% confidence interval -0.05 to 0.00 logMAR) (p = 0.036), which favoured FLACS. There were no significant differences between the arms for any health, social care or societal costs. For the economic evaluation, the mean cost difference was £167.62 per patient higher for FLACS (95% of iterations between -£14.12 and £341.67) than for PCS. The mean QALY difference (FLACS minus PCS) was 0.001 (95% of iterations between -0.011 and 0.015), which equates to an incremental cost-effectiveness ratio (cost difference divided by QALY difference) of £167,620. Although the measurement of outcomes was carried out by optometrists who were masked to the treatment arm, the participants were not masked. The evidence suggests that FLACS is not inferior to PCS in terms of vision after 3 months' follow-up, and there were no significant differences in patient-reported health and safety outcomes after 12 months' follow-up. In addition, the statistically significant difference in binocular corrected distance visual acuity was not clinically significant. FLACS is not cost-effective. To explore the possible differences in vision in patients without ocular co-pathology. Current Controlled Trials ISRCTN77602616. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 6. See the NIHR Journals Library website for further project information. Moorfields Eye Charity (grant references GR000233 and GR000449 for the endothelial cell counter and femtosecond laser used).

Evaluation of Corneal Aberration Alterations After Accelerated Transepithelial Corneal Crosslinking

Objective: This study aimed to report the corneal aberration alterations after accelerated transepithelial corneal crosslinking (A-TE CXL) and to investigate the relationship between corrected distance visual acuity (CDVA) and corneal aberrations.&#x0D; Methods: Fifty-six eyes of 45 progressive keratoconus (KCN) patients who underwent A-TE CXL were retrospectively evaluated. Total ocular aberrations (TOA), high-order aberrations (HOA), low order aberrations (LOA), and spectacle-CDVA values were recorded preoperatively, 6, and 12 months after the procedure. The alterations of the parameters were compared and correlation analysis was performed between corneal aberrations and CDVA.&#x0D; Results: The mean age of the patients was 22.23±3.14 years. The preoperative, postoperative 6 and 12 months median CDVAs were 0.50 (0.20-0.90), 0.60 (0.20-1.0) and 0.60 (0.10-0.90), respectively. The preoperative root means square (RMS)-TOA, RMS-HOA, and RMS-LOA values were 2.4±0.88μm, 1.50±0.59μm, and 1.78±0.88μm, respectively. The CDVA values increased significantly at postoperative-6 month examinations. After the A-TE CXL procedure, the aberrations were detected as 2.58±0.94μm, 1.62±0.57μm, 1.90±0.99μm and 2.38±0.81μm, 1.46±0.57μm, 1.77±0.85μm at 6th and 12th months, respectively. The TOA and HOA values significantly decreased 6 and 12 months after A-TE CXL. The LOA alterations were not statistically significant. The correlation analysis between corneal aberrations and CDVA revealed no significance at any time point.&#x0D; Conclusion: Although the TOA and HOA values significantly decreased and CDVA significantly increased in the early postoperative period, a relationship between the CDVA and corneal aberration alterations was not detected. Even the corneal aberration improvement had contributed to the increase in CDVA, evaluation of epithelial structural alterations can be suggested to better understand the clinical outcomes.

Changes in straylight and densitometry values after corneal collagen crosslinking

To evaluate the change in backward-directed and forward-directed corneal straylight in eyes after corneal collagen crosslinking (CXL) and its correlation with corrected distance visual acuity (CDVA) and changes in corneal topography. Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Retrospective cohort study. Following the Dresden protocol, corneal CXL was performed in eyes with progressive keratoconus. Corneal light scattering was evaluated using densitometry measurements from different corneal layers and zones obtained using Scheimpflug tomography (Pentacam HR). Retinal straylight values were measured using the C-Quant device. The CDVA was recorded during each follow-up examination. Changes in corneal topography were measured using Scheimpflug tomography. The study evaluated 31 eyes of 31 patients. The mean densitometry of different corneal layers and in 3 different zones increased 3 months postoperatively and decreased thereafter. The mean densitometry in the 0.0 to 2.0 mm zone remained statistically significantly elevated after 12 months (P < .05). The mean preoperative retinal straylight was 1.14 log(s) ± 0.28 (SD). The mean straylight peaked after 1 month and then decreased continuously but remained elevated after 1 year at 1.26 ± 0.21 log(s). There was an increase in CDVA and flattening of the steepest keratometry (K) value (maximum K). Eyes with the greatest maximum K reduction also had the highest densitometry values. Crosslinking-induced stromal changes resulted in an increase in densitometry, especially in the anterior stroma of the central (0.0 to 2.0 mm) zone. These changes correlated with an increase in retinal straylight but not with the postoperative CDVA values.

Inferior Intrastromal Corneal Ring Segments in Paracentral Keratoconus With No Coincident Topographic and Coma Axis

To assess the visual and refractive outcomes of implantation of intrastromal corneal ring segments (ICRS) in keratoconic eyes with no coincident topographic and comatic axes. Forty-one keratoconic eyes of 39 patients with no coincident topographic and comatic axes were implanted inferiorly with a Ferrara-type ICRS (Keraring SI6; Mediphacos Inc., Belo Horizonte, Brazil) of 150° of arc with a thickness of 150, 200, and 250 μm. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), corneal coma-like root mean square, and residual refractive errors analyzed using vector analysis were recorded before and 6 months after the ICRS implantation. Mean UDVA was 0.76 ± 0.41 logMAR before and 0.53 ± 0.46 logMAR after surgery (P = .0006). CDVA was 0.13 ± 0.14 logMAR before and 0.07 ± 0.09 logMAR after surgery (P = .0007). Two eyes (4.9%) lost two lines or more of CDVA, 3 eyes (7.32%) lost one line, 16 eyes (39.02%) had no change in CDVA, 9 eyes (21.95%) gained one line, and 11 eyes (26.83%) gained two lines or more of CDVA. The safety index was 1.10. Spherical equivalent was significantly reduced after ICRS implantation (P < .001). Corneal coma-like root mean square changed from 0.80 ± 0.53 μm before surgery to 0.61 ± 0.59 μm after surgery (P = .02) for 4.5 mm of pupil size. One Ferrara-type ICRS of 150° of arc with a thickness of 150, 200, or 250 μm implanted inferiorly may reduce both astigmatism and corneal coma-like aberrations in keratoconic eyes with no coincident topographic and comatic axes, providing an improvement of UDVA and CDVA values.

Pilot Study of a New Posterior Chamber Phakic Intraocular Lens (Epi.Lens) for High Myopia

To report the first safety and efficacy results of a new posterior chamber phakic intraocular lens (PIOL) (Epi.Lens, Acri.Tec/Carl Zeiss Meditec) implanted in the ciliary sulcus to correct high myopia. The Epi.Lens was implanted for the first time in 48 consecutive eyes of 25 patients in an ongoing two-center clinical study. Pre- and postoperative manifest refraction, uncorrected (UDVA) and corrected distance visual acuity (CDVA), intraocular pressure, slit-lamp and funduscopic examination, and ultrasound biomicroscopy were evaluated. Follow-up examinations were performed at 1, 3, 6, 12, and 24 months postoperatively. For each patient, the latest follow-up data were considered. The study cohort consisted of highly myopic patients with mean preoperative manifest refraction spherical equivalent of -9.90 ± 2.53 D, which was reduced to -0.26 ± 0.84 D postoperatively. Two (4.2%) eyes lost one line of CDVA postoperatively, whereas 19 (40%) met and 27 (56%) eyes exceeded preoperative CDVA values, thus improving mean CDVA from 0.83 ± 0.30 to 1.03 ± 0.26. Mean postoperative UDVA (0.85 ± 0.37) was similar to preoperative CDVA (0.83 ± 0.30). When considering all eyes with good visual potential (preoperative CDVA ≥ 1.00 [20/20] [n=25]), 20 (80%) achieved postoperative UDVA ≥ 1.00 (20/20), and 24 (96%) achieved UDVA ≥ 0.80 (20/25). One lens with a small diameter showed contact of the Epi.Lens and crystalline lens with subsequent slight anterior subcapsular cataract; however, CDVA was 1.00 (20/20) at last follow-up 2 years postoperatively. The results of this Epi.Lens pilot study demonstrate good safety and efficacy. The preliminary data are encouraging, and longer follow-up results are anticipated.