Difference In Visual Outcome Research Articles

Central retinal vein occlusion: modifying current treatment protocols.

Central retinal vein occlusion (CRVO) is a common retinal vascular disorder that can result in severe visual acuity loss. The randomized control study, CRUISE, helped establish anti-VEGFs as the standard of care in cases with CRVO. The extension studies for CRUISE; HORIZON and RETAIN showed that not all visual gains are maintained beyond the first year. In addition, patients showed different behavior patterns; with some patients showing complete response with few recurrences, whereas others showed partial or even no response with multiple recurrences. Long-term follow-up demonstrated that patients responding poorly to anti-VEGFs tended to do so early in the course of treatment. It also demonstrated the effectiveness of a pro re nata (PRN) protocol for improving vision and maintaining these gains over long-term follow-ups. The SHORE study further illustrated this point by demonstrating that there were minimal differences in visual outcomes between patients receiving monthly injections and patients being treated PRN. In this review we analyzed the data from the major randomized clinical trials (RCT) that looked at anti-VEGFs as the primary treatment modality in patients with CRVO (CRUISE and the extension studies HORIZON and RETAIN for ranibizumab as well as GALILEO and COPERNICUS for aflibercept). In addition, we looked at SCORE and GENEVA to help determine whether there is a place for steroids as a first line therapy in current treatment practice. We then explored alternative treatment regimens such as laser therapy and switching between anti-VEGF agents and/or steroids for non or partially responding patients. Finally, we propose a simplified modified treatment algorithm for patients with CRVO for better long-term outcomes in all types of responders.

Comparison of Corneal Biological Healing After Femtosecond LASIK and Small Incision Lenticule Extraction Procedure

ABSTRACTPurpose: To assess and compare the dry-eye-associated parameters and corneal biomechanical status after small-incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK).Methods: Sixty-five patients’ (128 eyes) were collected between November 2012 and April 2013. Thirty-five (69 eyes) underwent SMILE and thirty (59 eyes) underwent FS-LASIK. Visual acuity, manifest refraction, tear break-up time (TBUT), Schirmer’s test (ST), corneal sensitivity, Ocular Surface Disease Index (OSDI), corneal hysteresis (CH) and corneal resistance factor (CRF) were evaluated preoperatively and 1 day, 1 week, 1 month, 3 and 6 months postoperatively.Results: There was no significant difference in visual outcomes of SMILE and FS-LASIK (p = 0.208). TBUT, ST, CH and CRF decreased significantly after surgery in both groups (all p < 0.05); however, the decrease of TBUT, ST and CRF in the SMILE group was not as significant as that in the FS-LASIK group (all p < 0.05) and the change of CH value was comparable in both groups (p = 0.052).Corneal sensitivity was significantly decreased in the FS-LASIK group postoperatively (p < 0.05), but not significantly changed in the SMILE group (p > 0.05). OSDI scores were significantly increased after surgery for the two groups (all p < 0.05), and the scores were much higher in the FS-LASIK group than in the SMILE group (p = 0.000).Conclusion: The corneal biological healing of SMILE surgery was superior to FS-LASIK in the early period.

23‐Gauge versus 25‐Gauge vitrectomy for proliferative diabetic retinopathy: A comparison of surgical outcomes

PurposeThis study compared clinical outcomes and complications between 23‐gauge (23 g) and 25‐gauge (25 g) transconjunctival sutureless vitrectomy in patients with proliferative diabetic retinopathy.MethodsIt was a retrospective study using data prospectively defined and collected. 80 eyes underwent 23 g transconjunctival sutureless vitrectomy, and 80 eyes underwent 25 g surgery using the same vitrectomy system by one surgeon. Primary outcome measures were best‐corrected visual acuity, intraocular pressure (IOP), and incidence of intraoperative and postoperative complications.ResultsVision was significantly improved after intervention in both groups (p ≥ 0.0001). There was no significant difference in visual outcomes between the groups (p = 0.43) or in the type and frequency of retinal breaks occurring during surgery (p = 0.63). The 23 g group had significantly more patients with a day 1 IOP of &lt;6 mm Hg (p = 0.034) and significantly more patients requiring a sclerostomy suture postoperatively (p = 0.014).ConclusionsBoth gauges are equally effective for the treatment of proliferative diabetic retinopathy.

Postmarketing analysis of aflibercept-related sterile intraocular inflammation.

Aflibercept-related sterile inflammation, an event that is poorly understood, has been the subject of ongoing postmarketing reports. To analyze cases of aflibercept-related sterile inflammation reported to the American Society of Retina Specialists (ASRS) Therapeutic Surveillance Committee (TSC), an independent task force formed to monitor drug- and device-related safety events. A retrospective review of 56 cases in 55 patients was performed of all cases of sterile inflammation after aflibercept injection that were voluntarily reported by 12 practices throughout the United States to the ASRS TSC from December 1, 2011, through February 12, 2014. Cases of aflibercept-related sterile inflammation were analyzed for baseline and demographic information, presenting symptoms and findings, visual acuity changes, injection technique, and management details. Among 56 reported cases of sterile inflammation, mean time to onset was 3.5 days (median, 2 days; range, 0-30 days). Most cases consisted of initial loss of vision and intraocular inflammation without prominent redness, severe pain, or hypopyon. Thirty-seven cases (66%) were treated with topical corticosteroids and/or observation alone. Mean time to resolution was 28.6 days (median, 28 days; range, 4-84 days). Although final vision was overall unchanged, some patients developed permanent vision loss, which may have resulted from inflammation and/or progression of the underlying disease. Age older than 80 years was associated with worse visual outcomes. No difference in visual outcome was detected in patients with sterile inflammation undergoing topical therapy alone vs invasive procedures (vitreous biopsy and/or intravitreal antibiotic administration and/or vitrectomy). With the largest number of reported cases of aflibercept-related sterile inflammation to our knowledge, this analysis suggests typical findings and an often favorable prognosis of this event. Analysis of real-world, postmarketing data has limitations, and these findings should be considered as hypothesis-generating assessments rather than a definitive reflection of this event or its typical course. Distinguishing sterile inflammation and infectious endophthalmitis at the time of presentation may often be difficult, and cautious evaluation and management of these patients are warranted. The ASRS TSC encourages active postmarketing surveillance by all physicians.

A comparative fellow-eye prospective study evaluating the efficacy of wavefront-guided VSS VISX CustomVue STAR S4 IR versus the wavefront-optimized WaveLight Allegretto in correction of compound myopic astigmatism

Aim The aim of the present study was to compare the differences in visual outcomes, higher-order aberrations and corneal asphericity, as measured by Q values, in patients undergoing laser in-situ keratomileusis using wavefront-guided variable-spot size VISX CustomVue and wavefront-optimized small-spot size WaveLight Allegretto platforms. Type of study This study was designed as a randomized, prospective, single-blinded, double-armed, fellow-eye comparative study. Patients and methods A total of 100 eyes of 50 patients undergoing customized laser in-situ keratomileusis for compound myopic astigmatism were enrolled and randomly divided into two groups. Each patient underwent full ophthalmological examination; aberrometry was performed on either eye by using VISX CustomVue aberrometer and Allegretto WaveLight aberrometer. Each patient had one eye examined using the Allegretto Wave eye Q system (small-spot scanning), and the fellow eye by using VISX Star CustomVue S4 system (variable-spot scanning). All patients were given postoperative steroids, antibiotic drops and artificial tears. First day postoperative visit was scheduled to check for flap stability, and to exclude complications. Clinical examination and best corrected visual acuity, corneal imaging and aberrometry were scheduled at 1 month and 1 year later. Results Final best corrected visual acuity showed insignificant difference between the two groups ( P = 0.712). The final differences between the groups were insignificant in all other parameters. Conclusion The two ablation profiles are highly comparable in treating compound myopic astigmatism.

Visual Outcomes and Complications of Piggyback Intraocular Lens Implantation Compared to Aphakia for Infantile Cataract.

Purpose:To evaluate the long-term visual outcomes and complications of the piggyback intraocular lens (IOL) implantation compared to aphakia for infantile cataract.Patients and Methods:In a comparative study from 1998 to 2007, piggyback IOL implantation (piggyback IOL group) was performed for 14 infants (23 eyes) with infantile cataract and 20 infants (32 eyes) who were aphakic (aphakia group) after infantile cataract surgery. Data were collected on logMAR visual acuity, and postoperative complications over a mean follow-up time of 6.2 ± 1.7 years and 5.8 ± 1.7 years.Results:The mean age at surgery was 7.5 ± 0.6 months and 6.0 ± 3.3 months for the piggyback and the aphakic group respectively (P > 0.05). At the last follow-up visit, visual acuity was 0.85 ± 0.73 (median = 0.70, interquartile range = 0.3–1.32) in the piggyback IOL group and 0.89 ± 0.56 (median = 0.86, interquartile range = 0.50–1.24) in the aphakic group (P > 0.05). There was a positive relationship between age and visual outcomes in the aphakic group (r = 0.4, P = 0.04) but not in the piggyback IOL group (P = 0.48). There was no significant difference between the mean myopic shift in the piggyback IOL group (∑5.28 ± 1.06 D) and the aphakic group (∑5.10 ± 1.02 D) (P > 0.05). The incidence of reoperation due to complications in piggyback IOL group was higher than aphakic group (%48 vs. %16, respectively, P ≤ 0.01). However, in patients older than 6 months, this risk was not significantly different compared to the aphakic group.Conclusions:Although piggyback IOL implantation for infantile cataract is optically acceptable as a treatment option, there is no significant difference in visual outcomes compared to aphakia. The incidence in reoperation due to complications in patients aged 6 months or younger is higher than those treated with aphakia.

COMPARISON BETWEEN PHOTOREFRACTIVE KERATECTOMY (PRK) AND LASER IN SITU KERATOMILEUSIS (LASIK) OUTCOME AFTER SIX MONTHS IN TREATMENT OF MYOPIC ASTIGMATISM

Astigmatism is corrected by either by toric lenses or surgical intervention including laser refractive surgery. Photorefractive keratectomy (PRK) is performed with the excimer laser which can accurately ablate corneal tissue to an exact depth with minimal disruption of surrounding tissue, it is done by removing the epithelial layer up to Bowman layer which then ablate with anterior stroma. Laser in situ keratomileusis (LASIK) is also performed with the excimer laser, but with creation a flap involving the stroma. This study aimed to compare the differences in visual outcome after 6 months between PRK and LASIK in treatment of astigmatism. It is a retrospective study in which 222 eyes of 115 patients (some of them had only astigmatism in one eye) who underwent laser refractive correction in Al-Hakeem General Hospital in Annajaf city to correct their astigmatismic refractive error were included in the study, 152 of astigmtismic eyes were corrected by LASIK (82 of female eyes and 70 of male eyes), 67 of astigmatismic eyes were corrected by PRK ( 35 of female eyes and 32 of male eyes). Patients were grouped into six groups according to their refractive error: G1: less than 1.0 dioptre, G2: 1.0-1.9 dioptres, G3: 2.0-2.9dioptres, G4: 3.0-3.9 dioptres, G5: 4.0-4.9dioptres and G6: 5.0-14.0 dioptres. The outcome of visual acuity was followed-up by autorefraction six months postoperatively and were grouped into five groups according to their visual outcome: a:emmetropia, b:no correction, c:undercorrection, d: increase the refractive error, e: overcorrection. The results shows that in those with astigmatism between 0.25-0.9 dioptre, no statistically significant association was found between outcome and type of operation (P=0.66). In those with astigmatism between 1.0-1.9 dioptres, statistically significant association was found between outcome and type of operation (p=0.023). In those with astigmatism between 2.0-2.9 dioptres, statistically significant association was found between outcome and type of operation (P=0.0009). In those with astigmatism between 3.0-3.9 dioptres, statistically significant association was found between outcome and type of operation (P=0.001). In those with astigmatism between 4.0-4.9 dioptres, no statistically significant association was found between outcome and type of operation (P=0.113). In those with astigmatism between 5.0-14.0 dioptres, no statistically significant association was found between outcome and type of operation (P=0.92). In conclusion, there is no statistical significant difference after 6 months of correction of astigmatism wither by LASIK or PRK at different levels of refractive error.

23-Gauge versus 25-Gauge Vitrectomy for Proliferative Diabetic Retinopathy: A Comparison of Surgical Outcomes

Purpose: This study compared clinical outcomes and complications between 23-gauge (23g) and 25-gauge (25g) transconjunctival sutureless vitrectomy in patients with proliferative diabetic retinopathy. Study Design: It was a retrospective study using data prospectively defined and collected. 80 eyes underwent 23g transconjunctival sutureless vitrectomy, and 80 eyes underwent 25g surgery using the same vitrectomy system by one surgeon. Primary outcome measures were best-corrected visual acuity, intraocular pressure (IOP), and incidence of intraoperative and postoperative complications. Results: Vision was significantly improved after intervention in both groups (p ≥ 0.0001). There was no significant difference in visual outcomes between the groups (p = 0.43) or in the type and frequency of retinal breaks occurring during surgery (p = 0.63). The 23g group had significantly more patients with a day 1 IOP of <6 mm Hg (p = 0.034) and significantly more patients requiring a sclerostomy suture postoperatively (p = 0.014). Conclusion and Message: Both gauges are equally effective for the treatment of proliferative diabetic retinopathy.

Comparison of ketorolac 0.4% and nepafenac 0.1% for the prevention of cystoid macular oedema after phacoemulsification: prospective placebo-controlled randomised study

PurposeTo compare the anti-inflammatory efficacy of ketorolac of tromethamine 0.4% and nepafenac 0.1% eye drops for prophylaxis of cystoid macular oedema (CME) after small-incision cataract extraction.MethodsPatients were assigned randomly to...

English

AIMS: Comparative study of manual SICS technique by superior straight incision and oblique (9-12 O’clock) straight incision in terms of surgical duration, surgeon and patient’s comfort, intraoperative and postoperative complications and visual outcome up to 6 weeks. MATERIALS AND METHODS: 200 eyes of cataract were randomly subjected to cataract surgery by manual SICS technique using superior and oblique incision approach in 100 eyes each. Further grouping was done as Group A: RSS-Right superior straight incision, Group B: RSUT-Right superior upper temporal: Group C: LSS-Left superior straight, Group D: LSUN-Left superior upper nasal: 50 case each. Surgeon comfort was accessed in 5 steps namely tunnel making, capsulorrhexis, nucleus delivery, cortical wash and IOL implantation in both groups and graded as comfortable, convenient and difficult. Patient comfort was accessed as pain felt at 1st postoperative day, taken as P1, P2 and P3 according to increasing pain intensity. Surgical duration in both approaches was studied and compared. Visual outcome and complications were accessed at 2, 4 and 6 weeks. STATISTICAL ANALYSIS: Commercial SPSS 17 was used for statistical analysis. Chi square test and independent t test was used for calculating p value. RESULTS: Visual outcome was comparable in both the groups at 2, 4 and 6 weeks (p>0.05).Mean SIA in superior incision was +0.88D and +0.63D in oblique group (p value=0.00).Mean surgical duration in oblique group was 455.88+14.559 seconds and 541.63+31.699 seconds in superior group. Surgeon was comfortable in all 5 steps in both approaches except tunnel making, being difficult in oblique incision. Patient comfort at 1st postoperative day was insignificant between two groups. Postoperative hyphaema was found in 6 % in superior as compared to 14% in oblique incision group. CONCLUSION: Oblique (9-12 O’clock) incision was associated with less surgically induced astigmatism and surgical duration as compared to Superior incisional approach. Difference in visual outcome, Intra and postoperative complications, surgeon and patient comfort was insignificant between two groups.

Multi-country real-life experience of anti-vascular endothelial growth factor therapy for wet age-related macular degeneration

Background/aimsReal-life anti-vascular endothelial growth factor (VEGF) therapy use in patients with wet age-related macular degeneration (wAMD) was assessed in a retrospective, observational study in Canada, France, Germany, Ireland, Italy, the...

Same-Day Versus Next-Day Repair of Fovea-Threatening Primary Rhegmatogenous Retinal Detachments

Purpose: To evaluate the outcomes of same-day versus next-day repair of fovea-threatening rhegmatogenous retinal detachments (FT RRD). Design: Retrospective, multi-surgeon observational case series. Methods: Operative reports and medical records were reviewed to evaluate a number of visual and anatomic outcomes, including presenting features, intraoperative complications, and postoperative results in the repair of primary FT RRD undergoing same-day versus next-day repair with scleral buckling, pars plana vitrectomy, or both procedures. Participants: A total of 96 consecutive patients (43 same-day, 45 next-day, and eight two days later) were compared. Results: There was no statistically significant difference in visual outcomes between same-day and next-day repair at postoperative months 3 and 6 and at last follow-up (month 3 mean BCVA 20/30 same day; 20/32 next day; p = 0.82). Preoperative vision was strongly correlated with postoperative acuity. Effect of differences in length or type of visual symptoms, location of RRD, gender, or lens status on postoperative month 3 best-corrected visual acuity (BCVA) was not statistically significant. Overall, 85% of patients had a BCVA of 20/40 or better at postoperative month 3. Reoperation rate and intraoperative complications were not statistically different between the two groups. Re-attachment was achieved in all but one patient in both groups. Time in the operating room was longer for same-day surgery (2.98 ± 0.46 hours) compared to next-day surgery (2.54 ± 0.38 hours) (p < 0.001), which was statistically significant even when factoring in the type of surgery performed. However, one case did progress to a macula-off detachment in a superior RRD with breaks found in lattice degeneration. Conclusion: Next-day surgery provided equivalent visual outcomes. Emergent, same-day surgery has logistical and resource implications as it may be more expensive, may necessitate rescheduling of previously booked cases, and may limit preoperative examination by the surgeon and perioperative team.

A prospective study of treatment patterns and 1-year outcome of Asian age-related macular degeneration and polypoidal choroidal vasculopathy.

ObjectiveTo study the treatment patterns and visual outcome over one year in Asian patients with choroidal neovascular membrane secondary to age-related macular degeneration (AMD-CNV) and polypoidal choroidal vasculopathy (PCV).DesignProspective cohort, non-interventional study.Methods132 treatment-naïve patients who received treatment for AMD-CNV and PCV were included. All patients underwent standardized examination procedures including retinal imaging at baseline and follow-up. AMD-CNV and PCV were defined on fundus fluorescein angiography and indocyanine green angiography at baseline. Patients were treated according to standard of care.We report the visual acuity (VA) and optical coherence tomography (OCT) measurements at baseline, month 3 and month 12 The factors influencing month 12 outcomes were analyzed.Main Outcome MeasureType of treatment, number of Anti-vascular endothelial growth factor (VEGF) treatments, visual outcome over one year.ResultsAnti-VEGF monotherapy was the initial treatment in 89.1% of AMD-CNV, but only 15.1% of PCV. The mean number of anti-VEGF injections up to month 12 was 3.97 (4.51 AMD-CNV, 3.43 PCV, p = 0.021). Baseline OCT, month 3 OCT and month 3 VA were significant in determining continuation of treatment after month 3. At month12, mean VA improved from 0.82 (∼20/132) at baseline to 0.68 (∼20/96) at month 12 (mean gain 6.5 ETDRS letters, p = 0.002). 34.2% of eyes (38/113 eyes) gained ≥15 ETDRS letters and 14.4% (16/113 eyes) lost ≥15 ETDRS letters. There were no significant differences in visual outcome between AMD-CNV and PCV (p = 0.51). Factors predictive of month 12 visual outcome were baseline VA, baseline OCT central macular thickness, month 3 VA and age.ConclusionsThere is significant variation in treatment patterns in Asian eyes with exudative maculopathy. There is significant visual improvement in all treatment groups at one year. These data highlight the need for high quality clinical trial data to provide evidence-based management of Asian AMD.

Early initial clinical experience with intravitreal aflibercept for wet age-related macular degeneration

BackgroundAge-related macular degeneration (AMD) is a degenerative process that leads to severe vision loss. Wet AMD is defined by choroidal neovascularisation, leading to the accumulation of subretinal fluid (SRF), macular...

Effect of intraoperative 5-fluorouracil and low molecular weight heparin on the outcome of high-risk proliferative vitreoretinopathy

PurposeTo evaluate the efficacy of a combination of 5-fluorouracil (5-FU) and low molecular weight heparin (LMWH) during vitrectomy, as adjuvants in preventing proliferative vitreoretinopathy (PVR). DesignDouble-blind, prospective, randomized placebo-controlled trial. MethodsForty consecutive patients diagnosed with rhegmatogenous retinal detachment with high-risk PVR, were randomized to study and control groups (n=20 each). Study group (group 1) patients underwent vitrectomy with the use of both intraoperative 5-FU (0.2mg/ml) and LMWH (5IU/ml). In the control group (group 2), a similar surgery was performed without the use of adjuvants. Patients were evaluated at 1month, 3months and 6months after surgery. Postoperative retinal reattachment, recurrence of PVR, best-corrected visual acuity and complications at the end of 6months were compared between the two groups. A Chi-square statistical analysis was used on all of the outcome measures. ResultsAt 6months post-surgery, 62.5% of patients had reattached retina. There was no significant difference (Chi-square test showed x2=0.106, P=0.7447, P>0.05) in retinal reattachment in both of the groups. The rate of postoperative PVR in the control group was 55%; in the study group, the rate was 45% (the Chi-square test showed x2=0.4, P=0.5271, P>0.05), which proves statistically insignificant. In addition, there was no statistically significant difference in visual outcomes between the two groups (Chi-square test showed x2=0.1002, P>0.05), no significant difference in the complication rate and drug toxicity was noted between two groups. ConclusionsThis study fails to prove the efficacy of the intraoperative use of 5-FU and LMWH in combination as an antiproliferative regiment for the prevention of postoperative PVR or improvement in final visual acuity. At the same time, no significant complications could be attributed to the treatment.

Irisnahtfixierte Hinterkammerlinse

Intraocular approaches to correct aphakia in cases of inadequate capsular support include an anterior chamber intraocular lens, fixation of a posterior chamber lens to the sclera or iris by suturing or iris claw, respectively. This article reviews the indications and contraindications for iris fixation with sutures and gives an overview of surgical techniques, potential complications and outcomes. Based on a selective search of pertinent literature in PubMed the information from original articles and reviews are analyzed, summarized and discussed. New surgical techniques have imparted an impetus to iris suture fixation with encouraging functional and morphological results offering a new promising alternative to the established options. Improved aspects arise for repositioning of a decentered intraocular lens and for a minimally invasive method for repair of late in-the-bag lens dislocation as seen more frequently by cataract surgeons. A final evaluation of the proposed techniques is not possible because none has clearly emerged as the optimal method. Precise determination of small differences in visual outcome or complication rates requires a large prospective, randomized clinical trial.

Efficacy and Safety of Intra-Arterial Thrombolysis in Central Retinal Artery Occlusion

To investigate the efficacy and safety of intra-arterial thrombolysis (IAT) for acute central retinal artery occlusion (CRAO). Records from 101 CRAO patients treated with either IAT (n = 57) or standard treatment (ST; n = 44) were retrospectively reviewed. ST consisted of ocular massage and intraocular pressure-lowering agents. We used fundoscopic and angiographic findings to categorize CRAO as incomplete (diminished visual acuity [VA] with slight retinal edema, slight cherry-red spot), subtotal (severe VA reduction, cherry-red spot, distinct retinal edema), or total (massive edema, occluded perimacular arterioles, additional choroidal blood flow interruption). One-month and final best-corrected VA (BCVA) of the IAT group were compared with those of the ST group. Early (≤3-day) and final (1-month) reperfusion (improvement of retinal perfusion) rates were compared between groups. Subgroup analyses were performed according to CRAO stage. Overall, VA did not significantly differ between groups, but early reperfusion was greater in the IAT group (74.1% vs. 42.9%, P = 0.005). In incomplete CRAO, the IAT group exhibited greater visual improvement after 1 month (1.08 ± 0.21 vs. 0.23 ± 0.26 logarithmic values of the minimum angle of resolution [logMAR], P < 0.001) and at the final visit (1.08 ± 0.53 vs. 0.08 ± 0.57 logMAR, P < 0.001). However, in subtotal and total CRAO, no significant differences in visual outcomes were observed between groups. IAT resulted in clinically insignificant cerebral infarcts, detectable on brain imaging, in 8% of patients. Hemorrhagic transformation was not noted. The IAT treatment may provide early restoration of retinal perfusion and offer functional benefits in the management of incomplete CRAO.

Combined Silicone Oil Removal with Secondary Implantation of Anterior Chamber or Sclera-fixed Posterior Chamber Intraocular Lenses

To compare the outcomes and complication rates of silicone oil removal (SOR) combined with secondary implantation of modern anterior chamber intraocular lenses (AC IOLs) versus scleral-fixated, posterior chamber IOLs (SF IOLs) in patients who lack capsular support. A prospective, nonrandomized study was performed to compare 2 groups of patients between January 2006 and February 2011. Forty eyes of 40 patients undergoing AC IOL implantation (group 1) and 34 eyes of 34 patients undergoing SF IOL implantation (group 2) were included. The mean follow-up was 22.3 ± 6.3 (range 6-42) months. The mean postoperative corrected distance visual acuity (CDVA) recorded at the last follow-up in groups 1 and 2 was 0.70 ± 0.50 and 0.65 ± 0.55, respectively (p = 0.71). A total of 35 eyes (87.5%) and 29 eyes (85.3%) in groups 1 and 2 had an improved or unchanged CDVA; 5 eyes (12.5%) and 5 eyes (14.7%) had a deteriorated CDVA. The most frequent postoperative complications in the 2 groups were transient corneal edema, elevated intraocular pressure, hypotony, and retinal detachment. The differences in the number of eyes and the total number of complications were not statistically significant for early (p = 0.06) and late (p = 0.13) complications between the 2 groups. Both secondary AC IOL and SF IOL implantation with simultaneous pars plana approach of SOR are suitable for treating silicone oil-filled, aphakic eyes. No significant difference in visual outcome or major complication rates was found between the 2 groups.

Prospective Contralateral Eye Study to Compare 80- and 120- μ m Flap LASIK Using the VisuMax Femtosecond Laser

To compare visual outcomes and flap stability of LASIK with ultrathin 80- and 120-μm flaps created with a VisuMax femtosecond laser (Carl Zeiss Meditec, Jena, Germany) for moderate to high myopia and to evaluate the effect of corneal flap thickness on outcomes. In a prospective contralateral eye study, 36 consecutive patients (72 eyes) underwent bilateral LASIK for myopia ranging from -2.00 to -10.00 diopters using the VisuMax femtosecond laser and MEL-80 excimer laser (Carl Zeiss Meditec). One eye of each patient was randomized to have the 80-μm flap and the other to the 120-μm flap created with 200-kHz VisuMax femtosecond laser. Preoperative and postoperative tests included visual acuity, manifest refraction, contrast sensitivity, and flap thickness measured by anterior segment optical coherence tomography. Main outcomes and complications were checked at postoperative 1 week and 1, 3, and 6 months. There were no differences in visual outcome, residual refractive error, or contrast sensitivity between groups during follow-up, except for better uncorrected visual acuity at postoperative 1 day in the 120-μm group. Mean standard deviations of measured flap thickness during follow-up ranged from 3.16 to 3.80 μm in both groups. Opaque bubble layer, a unique complication in femtosecond LASIK, was more frequent in the 80-μm group (7 of 36: 19%) than in the 120-μm flap group (3 of 36: 8%) without a statistically significant difference (P = .301) and was related to thicker central cornea and steeper keratometric value, although it did not influence clinical results. Comparison of the intended versus achieved correction showed no significant differences between groups. LASIK using the VisuMax femtosecond laser supplied good clinical results and flap reproducibility in both the 80- and 120-μm flap groups. Patients with relatively thin cornea may benefit from 80-μm flap LASIK.

Long-Term Visual and Refractive Outcomes following Surface Ablation Techniques in a Large Population for Myopia Correction

To evaluate the visual and refractive outcome for four wavefront-guided surface ablation (WGSA) techniques (LASEK, LASEK flap-off [LASEK FO], Epi-LASIK, and Epi-LASIK flap-off [Epi-LASIK FO]) in a large myopic population. This retrospective review included 1000 myopic eyes (spherical equivalent [SE] -1.0 to -8.0 diopters [D]) treated with WGSA (VISX STAR S4 with IR) using four different epithelial management techniques. Flaps were either retained (163 Epi-LASIK, 361 LASEK) or discarded (277 Epi-LASIK FO, 199 LASEK FO). Eyes in each group were stratified to either low, mild, moderate, or high myopia based on preoperative SE. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), predictability, lines lost, and haze were compared at 3, 6, and 12 months. At 1 year, UDVA and CDVA of ≥20/20 and 20/15 were comparable across the four procedure groups and within each subgroup of myopia. Predictability was less than or equal to ±0.5 D of intended correction in 96% to 99% of eyes. LASEK FO and Epi-LASIK FO outperformed the EPI-LASIK in achieved MRSE, especially in the high myopia category (-0.012, 0.040, and -0.27 D, respectively, P < 0.05). No eyes lost more than one line of CDVA; and 50% to 60% of eyes in each group gained one or more lines. No significant haze was recorded in any group. There was no statistically significant difference between groups in the preoperative MRSE and efficacy indices except for LASEK FO. At 1 year, there was no statistically significant difference in visual outcomes between techniques for any degree of myopia. However, the MRSE achieved with LASEK FO and Epi-LASIK FO were closer to emmetropia.