Decimal Corrected Distance Visual Acuity Research Articles

Sequential Custom Therapeutic Keratectomy for the Treatment of Granular Corneal Dystrophy Type 1: A Long-term Study.

To evaluate the effectiveness of sequential custom phototherapeutic keratectomy (SCTK) for granular corneal dystrophy type 1 (GCD1). Thirty-seven eyes of 21 patients with GCD1 were treated with SCTK to remove superficial opacifications, regularize the corneal surface, and decrease optical aberrations. SCTK is a sequence of custom therapeutic excimer laser keratectomies with step-by-step intraoperative corneal topography monitoring of results. Six eyes of 5 patients previously treated with penetrating keratoplasty received SCTK for disease recurrence. Pre-operative and postoperative corrected distance visual acuity (CDVA), refractive values, mean pupillary keratometry, and pachymetry were retrospectively analyzed. The mean follow-up period was 41.3 months. SCTK provided significant decimal CDVA improvement, from 0.33 ± 0.22 to 0.63 ± 0.24 (P < .0001) at the last available follow-up visit. One eye, initially treated with penetrating keratoplasty, showed visually significant disease 8 years after the first SCTK and was re-treated. Mean corneal pachymetry difference between preoperative and final follow-up values was 78.42 ± 62.26 µm. Mean corneal curvature and the spherical component did not show a statistically significant change or hyperopic shift. Astigmatism and higher order aberration reduction were statistically significant. SCTK is a powerful tool for the treatment of anterior corneal pathologies hindering vision and quality of life, such as GCD1. SCTK is less invasive and fosters more rapid visual recovery than penetrating keratoplasty or deep anterior lamellar keratoplasty. Providing significant visual improvement, SCTK can be the preferred initial treatment in eyes with GCD1. [J Refract Surg. 2023;39(6):422-429.].

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.].

Visual And Refractive Outcomes In Hyperopic Pseudophakic Patients Implanted With A Trifocal Intraocular Lens.

PurposeTo assess visual and refractive results after bilateral implantation of a trifocal intraocular lens (IOL) in patients with hyperopia.MethodsIn a retrospective nonrandomized study, 196 eyes of 98 patients had bilateral implantation of a trifocal IOL. The Barrett Universal II formula was used for IOL power calculation. Eyes were divided into two groups for their analysis: low-moderate, with IOL power ranging from 22 to 26 D, and high, with IOL power ranging from 25 to 34 D. Refractive error was used to assess predictability, and corrected distance visual acuity (CDVA) and uncorrected distance visual acuity values were used to assess efficacy and safety of the surgery.ResultsSix months postoperatively, our results revealed a Snellen decimal CDVA of 0.97±0.05 and 0.94±0.09, for the low-moderate and high groups, respectively. The low-moderate hyperopia group showed a 75.23% of eyes with 20/20 of CDVA and 100% of eyes with 20/25 of CDVA, and the high hyperopia group showed 60.95% and 94.29% for these values of visual acuity, respectively. The mean postoperative spherical equivalent was −0.25±0.36D and −0.24±0.42D for low-moderate and high hyperopia groups, respectively. In the case of low-moderate hyperopia group, 81% of eyes were within ±0.50D and 99% within ±1.00D. These values were 78% and 95%, respectively, for the high hyperopic eyes.ConclusionBilateral implantation of a trifocal IOL in hyperopic eyes provided good visual and refractive outcomes. The Barrett Universal II formula was accurate in predicting the IOL power in hyperopic eyes.

Visual Function after Implantation of a Presbyopia-Correcting Trifocal Intraocular Lens

Purpose: To evaluate distance, intermediate, and near visual performance in patients implanted with a trifocal aspheric presbyopia-correcting intraocular lens (IOL). Methods: Forty patients were bilaterally implanted with the AcrySofIQ PanOptix IOL after femtosecond laser-assisted lens surgery. Binocular best corrected distance visual acuity (CDVA) (4 m), best distance-corrected near visual acuity (DCNVA) (40 and 30 cm), best corrected distance intermediate visual acuity (DCIVA) (70, 60, and 50 cm), binocular distance contrast sensitivity under photopic conditions (85 cd/m²), and defocus curves were evaluated at 6-months. Results: Six months postoperatively, the mean binocular Snellen decimal CDVA and DCNVA were 0.94 ± 0.10 (ranging from 0.70 to 1.25) and 0.85 ± 0.13 (ranging from 0.63 to 1.00), respectively. At a distance, all patients showed a cumulative binocular distance-corrected visual acuity of 0.8 or better, and about 80% (n = 31) of the patients had a value of 1.0 (20/20). At near and intermediate distances, all patients showed a cumulative distance-corrected visual acuity of 0.5 (20/40) or better at 30, 40, 50, 60, and 70 cm. Specifically, 50 cm showed the highest percentage of patients with larger values of visual acuity (60% [n = 26] with 20/20). Defocus curve showed a wide range of useful vision with two peaks of best visual acuity at distance and at 50 cm, and the binocular distance contrast sensitivity was within normal limits. Conclusions: The outcomes of the present study show that the visual performance obtained with bilateral implantation of the trifocal aspheric AcrySofIQ PanOptix IOL is good at far, intermediate, and near distances.

Small-incision lenticule extraction for the correction of myopic astigmatism

To report the outcomes of small-incision lenticule extraction (SMILE) in myopic eyes with astigmatism of 1.0 to 3.0 diopters (D). Center for Refractive Surgery, Eye Department, St. Francis Hospital, Muenster, Germany. Retrospective case series. Inclusion criteria were myopia of -0.5 D or more, astigmatism between -1.0 D and 3.0 D, and decimal corrected distance visual acuity (CDVA) of 1.0 or better. The study comprised 206 eyes. Preoperatively, the mean attempted spherical equivalent (SE) correction was -5.45±2.37 D (range -1.25 to -11.38 D) and the mean cylinder was -1.52±0.57 D (range -1.0 to -3.0 D). Three months postoperatively, the mean SE refraction was -0.07±0.38 D (range -1.25 to +1.00 D) and the mean cylinder was -0.32±0.29 D (range 0.0 to -1.5 D). The mean decimal uncorrected distance visual acuity (UDVA) was 1.13, the mean efficacy index was 0.87, and the mean safety index was 1.00. The UDVA was the same as or better than the CDVA in 67% of cases. The angle of error was ±5 degrees in 67% and ±15 degrees in 94% of cases, and the residual astigmatism was 0.5 D or less in 88% and 1.0 D or less in all patients. Small-incision lenticule extraction for the correction of myopic astigmatism was safe and effective, with outcomes comparable to those reported for laser insitu keratomileusis using modern eye-tracking systems.

Risk factors for loss of epithelial flap integrity in laser-assisted subepithelial keratectomy surgery

To evaluate risk factors leading to loss of epithelial flap integrity in laser-assisted subepithelial keratectomy (LASEK). Boston Eye Group, Brookline, Massachusetts, USA. Retrospective case study. This retrospective chart review was performed for LASEK surgeries that occurred between January 2009 and October 2013. Logistic regression was performed to determine whether epithelium preservation was correlated with age, sex, sphere, cylinder, spherical equivalent (SE), keratometry, and central corneal thickness (CCT). The study reviewed 1009 eyes of 509 patients with a mean age of 29.1years±12.2 (SD). The mean preoperative spherical refraction was -4.7±2.5 diopters (D), and the mean preoperative cylinder was -1.1±0.8 D. The mean preoperative decimal corrected distance visual acuity was 1.01±0.07. Single-sheet mobilization of the loosened epithelium flap was found in 72.3% of cases. Fragmented preservation events occurred in 17.6% of cases; the flap was discarded in 10.0% of cases. Epithelium preservation was significantly correlated with age (P=.048) but not with other parameters (P>.05 for sex, sphere, cylinder, SE, keratometry, CCT, and surgeon experience). Epithelial flap dissection was less likely to lead to a single epithelial sheet in patients older than 50years than in younger patients (56.3% versus 74.9%). The mean postoperative decimal uncorrected distance visual acuity (UDVA) at 3months was 0.98±0.08. There was no statistical difference in postoperative UDVA between the undiscarded flap group and discarded flap group (P=.128). Successful dissection of single-sheet epithelial flap diminished with age. No author has a financial or proprietary interest in any material or method mentioned.

Five-year functional outcomes and vault of −20 diopter myopic phakic intraocular lens implantation

To evaluate refractive and visual outcomes and complications associated with phakic intraocular lens (pIOL) implantation to correct high myopia. Fernández-Vega Ophthalmological Institute, Oviedo, Spain. Retrospective observational case series. Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), refraction, vault, and adverse effects were evaluated after 5 years with Visian ICMV4 pIOL. Mean spherical equivalent (SE) dropped from -18.32 ± 2.37 diopters (D) preoperatively to -0.88 ± 0.52D 5 years postoperatively; 61% of eyes were within ±0.75 D of the target. The mean Snellen decimal CDVA and UDVA were 0.73 ± 0.23 and 0.55 ± 0.26, respectively. More than 50% of eyes achieved 20/25 or better CDVA postoperatively. Four eyes had lost 2 or 1 lines of CDVA, 10 eyes had not lost any lines from preoperatively, and 46 eyes had gained 1 or more lines of CDVA 5 years postoperatively. The safety index was 1.26 ± 0.32. Forty eyes had UDVA of 20/40 or better postoperatively. The efficacy index was 0.99 ± 0.42. At 5-year follow-up, the mean central vault was 475.28 ± 216.38 μm. No eyes showed central contact between the pIOL and crystalline lens. Nevertheless, 10 eyes showed peripheral contact with a central vault between 150 and 260 μm. Two eyes developed anterior subcapsular cataract, although only 1 eye required cataract surgery. Predictability, safety and effective outcomes of posterior pIOL of (- were good, as well as postoperative complications over the long term. A central vault of 260 μm was enough to prevent the peripheral contact between the pIOL and crystalline lens in eyes with high myopia. The authors have no proprietary interest in any of the materials mentioned in this article.

Injectable intraocular telescope: Pilot study

To assess the feasibility of a new injectable telescopic intraocular lens (IOL). London Eye Hospital, London, United Kingdom. Prospective interventional pilot study. Eyes with bilateral, intermediate, or advanced dry age-related macular degeneration (AMD); preoperative decimal corrected distance visual acuity (CDVA) of 0.25 or less; and improvement with extraocular simulation of the intervention had implantation of 2 IOLs designed for use together in a Galilean telescope configuration (iolAMD). Patients were followed for 4 months. Safety was assessed by monitoring visual acuity, intraocular pressure, specular microscopy, and anterior segment and macular optical coherence tomographies. Fixation stability and macular sensitivity were determined using microperimetry in some eyes. There were no significant intraoperative or postoperative complications. In 1 eye, an anterior sulcus IOL was replaced; there were no sequelae. The mean endothelial cell density was reduced by 18%. The mean decimal CDVA improved from 0.12 preoperatively to 0.20 at 4 months, a 67% gain. The mean change in spherical equivalent after implantation was -1.5 diopters (D) with 0.5 D of induced astigmatism. Microperimetric testing indicated a magnification effect and a deviation of the retinal image by up to 5 degrees, with improved fixation stability. This injectable intraocular miniature telescope appears safe in the short to medium term and capable of improving visual function. No significant issues were encountered regarding candidate eye selection or patient retention and cooperation. Further work is needed to evaluate the safety and efficacy of the device, particularly with respect to daily-living activities and the range of indications. Dr. Qureshi has a financial interest in London Eye Hospital Pharma. No other author has a financial or proprietary interest in any material or method mentioned.

Cataract Surgical Problem: May consultation #1

Figure 1. Mydriasis shows a sulcus-fixated IOL with 2-hole PMMA optic and polypropylene loops fixated in the sulcus. The iris exhibits a basal coloboma at 12 o'clock, giving visual access to the anterior capsule rim sealed to the posterior capsule. The IOL optic is decentered inferiorly and slightly tilted but definitely shows a positive distance to the pupillary margin with the pupil undilated. A 79-year-old woman had cataract surgery with intraocular lens (IOL) implantation in the left eye in 1990. A 3-piece IOL with a poly(methyl methacrylate) (PMMA) optic with positioning holes and polypropylene loops was fixated in the ciliary sulcus. In 1993, the right eye also had cataract surgery with implantation of a PMMA diffractive multifocal IOL. In 2013, 23 years after the first surgery, the patient started having repeated attacks of blurred vision and pain in the left eye, mostly after bowing her head. These symptoms subsided within several hours. When immediately consulting with the local ophthalmologist on 2 such occasions, a 3+ erythrocyte Tyndall phenomenon was found in the anterior chamber aqueous and trickle marks (traces) were found in the inferior sector of the cornea; the intraocular pressure (IOP) approached 60 mm Hg. The patient was treated with pressure-lowering eyedrops and acetazolamide tablets; by the following day, the condition of the eye had returned to normal. The attacks, however, recurred with increasing frequency. On 1 such occasion, 1 IOL loop was reported to be visible in the peripheral coloboma at 12 o’clock; however, this was not the case when the patient returned later. When these attacks persisted, the patient was finally referred to an anterior segment specialist. When the patient first presented, the pupil in the left eye was small, the IOL optic was at a distinct distance to the pupillary margin, and no IOL loop was visible in the slit-shaped peripheral coloboma. The refraction was 1.50 +1.25 175 in the right eye and 1.50 +0.50 5 in the left eye. The decimal corrected distance visual acuity (CDVA) was 0.8 and 0.9, respectively. Both central capsules where clear, the retina and macula were normal, and the optic nerve head was vital and centrally excavated with a cup-to-disc ratio of 0.4 in the right eye and 0.3 in the left eye. On full pupil dilation, a 3-piece IOL with a PMMA optic with positioning holes and polypropylene loops was exposed in the left eye (Figure 1). The loops were fixated in the ciliary sulcus, and the slightly tilted optic was decentered inferiorly. The aqueous was clear, and the IOPwas 17mmHg. No change in haptic position or IOL rotation could be induced by gently massaging the limbus with a cotton swab under topical anesthesia. The patient was asked to immediately return if the symptoms recurred. Ten days later, she presented 2 hours after another attack. The biomicroscopic findings in the left eye were as described above, and the

Development of a nomogram to achieve ultrathin donor corneal disks for Descemet-stripping automated endothelial keratoplasty

To report the predictability of a nomogram for ultrathin donor lamella creation for Descemet-stripping automated endothelial keratoplasty (DSAEK) with an automated microkeratome. Instituto de Oftalmología La Arruzafa, Córdoba, Spain. Prospective nonrandomized consecutive case series. This study enrolled eyes of consecutive patients in which DSAEK was performed to treat Fuchs dystrophy or bullous keratopathy. Patients with macular pathology or other vision-limiting pathology were included. The same surgeon performed all surgeries using an automated keratome (Amadeus II) linked to an artificial anterior chamber. The target donor lamella thickness was from 70 to 120 μm based on a nomogram that incorporates advancement speed, blade holder size, and corneal thickness. The decimal corrected distance visual acuity (CDVA) at 3 months postoperatively, graft thickness at 1 month, and complications were recorded. Fifty-one patients (60 eyes) were enrolled. One month postoperatively, the mean donor lamella thickness was 99.33 μm ± 16.97 (SD) (range 67 to 130 μm). The target thickness range was achieved in 96.66% of cases (58 eyes). In 32 patients with a potential visual acuity of 20/20, the mean postoperative CDVA was 0.80 ± 0.16 (range 0.55 to 1.20). There were no complications during flap preparation, intraoperatively, or postoperatively and no events caused donor corneal tissue to be discarded. The use of a nomogram with an automated microkeratome for DSAEK provided good visual outcomes with a thin donor lamella (≤120 μm). The outcomes with the nomogram were similar to those reported for Descemet membrane endothelial keratoplasty. Neither author has a financial or proprietary interest in any material or method mentioned.

Evaluation of a Toric Implantable Collamer Lens After Corneal Collagen Crosslinking in Treatment of Early-Stage Keratoconus

The aim of this study was to assess the predictability, efficacy, safety, and stability in patients who received a toric implantable collamer lens (TICL) after collagen crosslinking in early-stage keratoconus. This prospective interventional case series study was conducted at the Alexandria Main University hospitals, University of Alexandria, Egypt. Sixteen eyes underwent implantation of a TICL (STAAR Surgical Inc) after crosslinking. The mean spherical refraction was -5.98 ± 4.39 diopters (D) (range, -0.50 to -14.50 D), and the mean cylinder was -4.91 ± 1.51 D (range, -2.50 to -7.75 D). Uncorrected distance visual acuity (UDVA), manifest and cycloplegic refraction, corrected distance visual acuity (CDVA), vault, intraocular pressure, and endothelial cell count (using specular microscopy) were evaluated during a 3-year follow-up. The mean Snellen decimal CDVA improved from 0.56 ± 0.13 (range, 0.40-0.80) preoperatively to 0.89 ± 0.17 (range, 0.60-1.20) at 3 years of the follow-up (P < 0.0001). The mean UDVA also improved significantly from 0.63 ± 0.14 before ICL implantation to 0.88 ± 0.18 after 3 years of the follow-up (P < 0.001). At 3 years, the mean spherical and cylindrical manifest refractions were 0.00 ± 0.18 D and -0.05 ± 0.14 D, respectively. At the end of the follow-up, the vault was 509.75 ± 141.47 μm (range, 320-900) and the intraocular pressure was 11.94 ± 1.12 mm Hg. No complications occurred during the surgical procedures. No eye needed explantation or repositioning of the TICL. The endothelial cell count loss after 3 years was -8.98%. Correction of spherical and cylindrical refractive errors in keratoconic eyes by TICL implantation 12 months after crosslinking gave significantly promising outcomes, particularly in the astigmatic component of refraction.

Collagen copolymer toric phakic intraocular lens for residual myopic astigmatism after intrastromal corneal ring segment implantation and corneal collagen crosslinking in a 3-stage procedure for keratoconus

To evaluate staged combined treatment for keratoconus with intrastromal corneal ring segment (ICRS) implantation followed by corneal collagen crosslinking (CXL) with riboflavin-ultraviolet-A (UVA) and then toric implantable collagen copolymer phakic intraocular lens (pIOL) implantation. Large private ophthalmic hospital system. Case series. Eyes with progressive keratoconus had ICRS implantation, then CXL, and then pIOL implantation (minimum 6 months between procedures). The study enrolled 14 eyes (9 patients). After the combined treatments, the mean decimal uncorrected distance visual acuity (UDVA) and mean decimal corrected distance visual acuity (CDVA) were significantly improved from 0.01 and 0.14, respectively, preoperatively to 0.44 and 0.57, respectively (P<.0001). The mean manifest refraction spherical equivalent decreased from -16.40 diopters (D) ± 3.56 (SD) (range -11.50 to -22.50 D) to -0.80 ± 1.02 D (range -2.00 to +2.00 D) after the combined treatments (P<.0001). The mean refractive astigmatism decreased from -4.73 ± 1.32 D (range -3.00 to -7.00 D) to -0.96 ± 0.35 D (range -0.50 to -1.50 D) (P<.0001). The mean steep and mean flat keratometry values reduced from 60.57 D and 56.16 D, respectively, to 54.48 D and 53.57 D (P<.0001), respectively. No intraoperative or postoperative complications occurred. A combined 3-stage-approach keratoconus treatment comprising ICRS implantation followed by CXL and then toric pIOL implantation was effective in improving functional vision and reducing disease progression. Longer term studies are required for further evaluation and comparison with other methods.

Intracorneal Ring Segment Reimplantation in Keratectasia.

The objective of this study was to evaluate the safety and potential for visual improvement of replacing INTACS with Kerarings in patients with keratectasia. Retrospective case series. A review of patients undergoing intracorneal segment exchange was conducted. Ten eyes of 9 patients that underwent INTACS explantation and Keraring re-implantation were included. Visual acuity, manifest refraction, keratometry, and corneal asphericity readings were collected. Data were analyzed preoperatively, immediately before Keraring insertion, and at 3, 6, and 12 months after Keraring implantation. The mean age of subjects was 44.5 ± 11.23 years. The mean time to exchange was 13.9 ± 9.8 months. The initial indications for surgery were post- Laser-Assisted in Situ Keratomileusis ectasia (n = 6) and keratoconus (n = 4). The removal and re-implantation procedure were successfully completed in all eyes without significant complications. No statistical difference was observed with respect to keratometry readings, manifest sphere, and manifest cylinder during follow-up. There was a significant improvement in mean decimal corrected distance visual acuity at 3, 6, and 12 months after Keraring insertion (P>0.05). The Q values were -0.37 ± 0.94 after INTACS implantation and -0.18 ± 0.62, 0.06 ± 0.31, and 0.00 ± 0.38 at 3, 6, and 12 months after insertion of Kerarings. Replacement of INTACS with Kerarings appears to be a safe procedure and may lead to an increase in corrected distance visual acuity in some eyes. This may be related to the change in corneal asphericity as experienced by our cohort.

Clinical outcomes of cataract surgery after bag-in-the-lens intraocular lens implantation following ISO standard 11979-7:2006

To assess the clinical outcomes of bag-in-the-lens intraocular lens (BIL IOL) implantation following the International Organization for Standardization (ISO) 11979-7:2006 in pediatric eyes and eyes with ocular comorbidities. Antwerp University Hospital, Department of Ophthalmology, Antwerp, Belgium. Cohort study. This cohort included the first series of patients having IOL implantation using the bag-in-the-lens technique. Surgeries were performed between December 1999 and September 2006. In addition to IOL implantation, the technique comprised creation of a primary posterior continuous curvilinear capsulorhexis (PCCC) equal in size to the anterior capsulorhexis. The study enrolled 807 eyes of 547 patients; 326 of the eyes (40.40%) had ocular comorbidity. In the 481 eyes without ocular comorbidity, the mean decimal corrected distance visual acuity was 0.52 ± 0.24 (SD) (0.276 ± 0.206 logMAR) preoperatively and 0.94 ± 0.18 (-0.012 ± 0.053 logMAR) postoperatively. The mean postoperative achieved spherical equivalent was 0.48 ± 0.83 diopter (D) and the mean targeted refraction, -0.24 ± 0.71 D. The A-constant was modified from 118.4 to 118.04. Posterior capsule opacification (PCO) did not occur in any adult eye during the follow-up. Retinal detachment after IOL implantation occurred in 10 eyes (1.24%). In 19 eyes, the iris was captured by the IOL haptics postoperatively. Hypopyon occurred in 3 patients and toxic anterior segment syndrome in 1 patient. The BIL IOL met the ISO criteria; that is, primary PCCC was safe in healthy eyes and in eyes with ocular comorbidities and no eye developed PCO over a mean follow-up of 26.1 ± 21.3 months.