Mean Manifest Refraction Spherical Equivalent Research Articles

Three-year outcomes of a novel toric intraocular lens implantation for moderate-high myopic astigmatism in phakic eyes

PurposeTo investigate the three-year visual, refractive outcomes and adverse events of the Eyecryl toric phakic IOL (pIOL) for moderate-to-high myopic astigmatism.MethodsThis retrospective study included eligible patients who underwent refractive surgery in one or both eyes with Eyecryl toric pIOL for myopic astigmatism. The efficacy, safety, predictability, rotational stability, vector analysis, and adverse events were evaluated in patients with spherical refraction from − 4.50 to -17.00 diopters (D) and cylindrical refraction from − 0.75 to -5.50 D.ResultsFifty-two eyes of 28 patients were included in the study. The mean efficacy and safety index were 1.12 ± 0.35 and 1.38 ± 0.42, respectively. The mean manifest refraction spherical equivalent was − 10.06 ± 2.69 D and − 0.64 ± 0.61 D preoperatively and postoperatively at 36 months, respectively. The mean manifest astigmatism was − 2.06 ± 1.16 D and − 0.44 ± 0.48 D preoperatively and 36 months postoperative, respectively. During the final examination, 70% of the eyes showed an increase in CDVA of one or more lines compared to their preoperative state. There was a cumulative endothelial cell loss of 3.1% at 36 months postoperatively. One eye developed visually significant anterior subcapsular opacity, whereas another eye experienced pIOL opacification.ConclusionThe Eyecryl toric pIOL demonstrated satisfactory visual acuity and refractive outcomes, as assessed by efficacy, safety and stability over a three-year period.

Ten-Year Clinical Outcomes of V4c Implantable Collamer Lens Implantation: Longitudinal Analysis of Visual Acuity, Endothelial Cell Density, and Vault Dynamics

This study aimed to evaluate the long-term clinical outcomes of V4c Implantable Collamer Lens (ICL) implantation for myopia correction over a 10-year period. Retrospective interventional case series METHODS: This retrospective interventional study involved 103 myopic eyes from 54 patients. Visual outcomes, including visual acuity and manifest refraction were assessed. Annual measurements of endothelial cell density (ECD), vault, anterior chamber depth, and intraocular pressure were analyzed using mixed-effects models. At the 10-year follow-up, the mean Logarithm of the Minimum Angle of Resolution (logMAR) uncorrected distance visual acuity and corrected distance visual acuity (CDVA) were -0.037 ± 0.052 and -0.041 ± 0.046, respectively. The mean efficacy and safety indices were 1.11 ± 0.13 and 1.12 ± 0.12. A loss of one line of CDVA occurred in 2% of cases, while 59% gained one or more lines. Postoperative manifest refraction spherical equivalent (MRSE) was within ±0.5 diopters (D) and ±1.0 D in 74% and 99% of cases, respectively, with a mean MRSE of -0.19 ± 0.41 D. Data for ECD and vault fit an exponential decay model, demonstrating a continuous yet gradually slowing decrease over time. Decay rates were 0.012 ± 0.001 per year for ECD and 0.056 ± 0.003 per year for the vault. Notably, ECD lower outliers had significantly lower preoperative ECD values. There were no instances of cataract formation, angle closure, glaucoma, or ICL removal throughout the study. The 10-year outcomes of V4c ICL implantation demonstrate effective and safe visual results. Both ECD and vault exhibit exponential decay patterns over the decade. Patients with lower preoperative ECD values require careful post-implantation monitoring.

Comparison of Outcomes after Wavefront-optimized and Topography-guided Transepithelial Photorefractive Keratectomy.

To evaluate the outcomes of wavefront-optimized (WFO) and topography-guided (TG) transepithelial photorefractive keratectomy (transPRK) in the treatment of myopia and myopic astigmatism. Patients who underwent transPRK using the WaveLight EX500 excimer laser for the correction of myopia and myopic astigmatism between January 2022 and March 2023 were divided into groups of WFO transPRK (77 eyes of 36 patients) or TG transPRK (63 eyes of 31 patients) in this retrospective, observational cohort study. The preoperative and postoperative 3-month refractive and visual outcomes of the two groups were analyzed. In both groups, the uncorrected distance visual acuity was 0.0 logarithm of the minimum angle of resolution or better in 95% of eyes 3 months postoperatively, and the mean manifest refraction spherical equivalent was within ±1.0 diopter in 90% of eyes. No significant differences were observed between the groups in terms of the uncorrected distance visual acuity or astigmatism. A significant induction of higher order aberrations (HOAs) was observed in both groups. However, the induction of total corneal HOAs (p = 0.014) and spherical aberrations (p < 0.001) was significantly lower in the TG group than that in the WFO group. WFO and TG transPRK effectively improved the visual and refractive outcomes; however, the induction of total corneal HOAs and spherical aberration was lesser following the TG ablation.

Conventional Epithelial-Off Corneal Crosslinking in Patients With Progressive Keratoconus: 10-Year Outcomes.

Corneal crosslinking (CXL) is the standard treatment of progressive keratoconus (KC). We evaluated the safety and 10-year outcomes of conventional "epithelial-off" CXL for progressive KC for the first time in a cohort in France. We conducted a retrospective review of patients undergoing conventional CXL (Dresden protocol) in our tertiary ophthalmology department from 2006 to 2011 with 10-year follow-up. The primary outcome was change in preoperative versus postoperative keratometry measured by maximum keratometry (Kmax), steep keratometry (K2), flat keratometry (K1), mean keratometry (Km), and topographic cylinder. Secondary outcomes were changes in visual and refractive outcomes. We report postoperative complications and adverse events. Eighty-nine eyes from 76 patients (67% male patients, mean age 22.7 ± 7.6 years) were included. Mean Kmax (-2.31 ± 2.98 diopters (D); P < 0.00001), K2 (-2.07 ± 3.15 D; P < 0.00001), K1 (-1.00 ± 2.29 D; P = 0.00008), Km (-1.53 ± 2.47 D; P < 0.00001), and topographic cylinder (-1.15 ± 2.53 D; P = 0.00004) significantly decreased 10 years after CXL compared with preoperative baseline. Significant decreases were still observed between 5 and 10 years after for mean Kmax, mean K2, mean K1, and mean Km. Mean distance best spectacle-corrected visual acuity and mean manifest refraction spherical equivalent were significantly improved after 10 years versus before CXL. The 10-year rate of repeat CXL was n = 3/76 patients (4%) (all younger than 18 years at first CXL) and of loss of >3 lines in best spectacle-corrected visual acuity was n = 1/76 patients (1%). Progressive KC was effectively stabilized with a prolonged flattening and maintenance of functional vision improvements after 10 years. Repeat CXL was rare and only required among younger patients.

Safety and Effectiveness of Smooth Incision Lenticular Keratomileusis (SILKTM) Using the ELITA(TM) Femtosecond Laser System for Correction of Myopic and Astigmatic Refractive Errors.

To evaluate visual outcomes following the Smooth Incision Lenticular Keratomileusis (SILKTM) procedure for correction of myopic refractive errors with and without astigmatism, using the ELITATM Femtosecond Laser System. A prospective, multicenter, single-arm, open-label clinical study was conducted. Eighty-five myopic subjects (n = 170 eyes), aged 18 years or older, with manifest refractive spherical equivalent (MRSE) up to -12.00 D and astigmatism up to -6.00 D, were treated binocularly using the ELITA femtosecond laser and followed up for 6 months. Intended correction was emmetropia for all eyes. The primary outcome measures included post-operative uncorrected and corrected distance visual acuity (UDVA and CDVA). Secondary outcome measures included surgeon's rating for ease of lenticule extraction, predictability, safety, and stability. A total of 170 eyes of 85 patients underwent SILK. Preoperative mean MRSE was -4.14D ± 1.32 D (range -1.38 D to -8.88D) and the mean cylinder was -0.77 D ± 0.62D. Intraoperative surgeon ease of lenticule dissection was rated as grade 0 or 1 in 85.3% of eyes (no/only mild dissection needed). UDVA at 1 day, 1 week, 1 month, and 6 months was 20/20 or better in 65.9%, 85.4%, 91.5%, and 96% of eyes, respectively. No eyes lost any lines of CDVA at 6 months compared to the preoperative. The postoperative MRSE was stable over time, ranging from -0.34 D ± 0.24 D at 1 month to -0.33 D ± 0.23 D at 6 months. MRSE predictability (± 0.50 D) was 93.5% (129/138) at 3 months and 91.1% (113/124) at 6 months. No serious adverse events were noted. The SILK procedure with the ELITA Femtosecond Laser System is safe and effective for the treatment of myopic refractive errors with and without astigmatism. Fast visual recovery was demonstrated, with stability achieved by 3 months.

Rethinking presbyopia: results of bilateral refractive lens exchange with trifocal intraocular lenses in 17 603 patients

PurposeTo evaluate the safety and effectiveness of bilateral refractive lens exchange (RLE) with trifocal intraocular lens (IOL) as the surgical treatment of presbyopia.SettingsMemira AS. Norway, Sweden and Denmark.DesignMulticentric retrospective interventional...

Comparison of the Clinical Outcomes between Combined Femtosecond Laser-Assisted In Situ Keratomileusis and Corneal Cross Linking versus Combined Small-Incision Lenticule Extraction and Corneal Cross Linking.

Purpose The purpose of this study was to compare femtosecond laser-assisted in situ keratomileusis with prophylactic cross linking (FS-LASIK Xtra) and small-incision lenticule extraction with prophylactic cross linking (SMILE Xtra) in terms of their postoperative clinical outcomes. Methods In this retrospective study, 24 patients (48 eyes) with myopia and myopia astigmatism were recruited from 2017 to 2018. All patients underwent comprehensive ophthalmic examinations preoperatively and follow-up visits at one and three months. Four patients (eight eyes) in each group were followed up for 12 months. The following were assessed at each visit: uncorrected distance visual acuity (UDVA), manifest refractive spherical equivalent (MRSE), keratometry values, biomechanical properties, anterior and posterior curvature, and corneal pachymetry. Results The FS-LASIK Xtra and SMILE Xtra groups both included 24 eyes of 12 patients. At 1, 3, and 12 months after surgery, a UDVA of 20/20 or better was achieved for 91.7%, 91.7%, and 87.5% of individuals, respectively, in the FS-LASIK group and 95.8%, 100%, and 100% in the SMILE group, respectively. For 75% of eyes in the FS-LASIK Xtra group and 100% of eyes in the SMILE Xtra group, the achieved MRSE was within ±1.00D of attempted correction. The LASIK Xtra group had a significantly higher mean MRSE than the SMILE Xtra group at 3 and 12 months after surgery (P=0.006, 0.01), and the SMILE Xtra group had significantly higher K1 and K2 values than the FS-LASIK group at one month after surgery (P=0.024, 0.023). Corneal thickness decreased significantly at one month postoperatively and started to increase over the next 12 months in both groups (P=0.001). The biomechanical properties showed no significant intergroup differences at the 12-month follow-up. Conclusions FS-LASIK Xtra and SMILE Xtra are safe and effective in the correction of myopia and myopia astigmatism, and both procedures have the same effect on postoperative corneal morphology and biomechanics.

Comparison between Small Incision Lenticule Extraction and Wavefront-Guided Femtosecond Laser-Assisted In Situ Keratomileusis in Correction of Myopic Astigmatism

Abstract Aim of the Work To compare visual acuity, refractive and topographic outcome between small incision lenticule extraction (SMILE) and wavefront-guided femtosecond laser-assisted in situ keratomileusis (WFG FS-LASIK) in patients with myopic astigmatism. Patients and methods This prospective, non-randomized, comparative clinical study included 60 eyes of 30 patients with simple or compound myopic astigmatism presenting for refractive error correction. Femtosecond assisted LASIK group included 30 eyes and SMILE group included 30 eyes. The following tests were done for all patients preoperatively and at 3 months postoperatively: full ophthalmological examination, manifest refraction, UDVA, CDVA, corneal topography using combined schimflug and placcido disc imaging namely Pentacam. (Oculus Inc.) and wavefront analysis using ATLAS 9000 (Carl Zeiss Meditec) Main Outcome Measures: Uncorrected distance visual acuity (UDVA), corrected disctance visual acuity (CDVA), manifest refraction, Efficacy, safety, predictability, corneal higher order aberrations. Results At 3 months, the mean manifest refractive spherical equivalent (MRSE) in SMILE group was -0.33 ± 0.34 D and the mean MRSE in FS- LASIK group was 0.23 ± 0.35 D and there was a statistically significant difference between both groups (P &amp;lt; 0.05). mean postoperative cylinder was -0.56 ± 0.28 D in SMILE group and -0.53 ± 0.38D in FS-LASIK with statistically significant difference ( P = 0.254 ) 93% and 93% of eyes in the SMILE and FS-LASIK groups were within ± 0.5 D; 96.67% and 100% of eyes in the SMILE and FS-LASIK groups, respectively, were within ± 1 D. There were 86.66% of treated eyes in the SMILE group, and 93.33% treated eyes in the FS-LASIK group that had 20/25 or better UDVA. Regarding safety, the CDVA in the SMILE group, 20 eyes (66.67%) showed no change, 8 eyes (27%) gained 1 line, 2 eyes (7%) lost 1 line, and no eyes lost more than 1 line. whereas in the FS-LASIK group, 27 eyes (90%) exhibited no change, 2 eyes (6.66%) gained 1 line, 1 eye (3.33%) lost 1 line, and no eyes lost more than 1 line and There was no statistically significant difference between both groups (P = 0. 554 ). Regarding corneal asphericity, both procedures increased Q-value with no statistically significant difference between both groups (P = 0. 052). Regarding corneal higher order aberrations, both procedures significantly increased total corneal aberrations but there was no statistically significant difference in the change in RMS of total corneal higher order aberration (P = 0.434) .but SMILE increased RMS of coma aberration significantly more than FS-LASIK (P = 0. 029). Conclusion both SMILE and FS-LASIK procedures have shown excellent efficacy, safety, and predictability for the correction of myopia and myopic astigmatism. SMILE was closer to emmetropia regarding sphere and spherical equivalent, However, astigmatic undercorrection was noted after both surgeries with increased astigmatism. Both procedures increased the total corneal higher order aberrations with no statistically significant difference between both groups. A higher vertical coma was found in SMILE than WFG FS-LASIK.

Comparative study of small-incision lenticule extraction with and without prophylactic corneal crosslinking: 1-year outcomes.

To compare myopia and astigmatic correction after small-incision lenticule extraction (SMILE) with or without prophylactic crosslinking (SMILE Xtra). Shenyang Aier Eye Hospital, Central South University, China. Retrospective study. Patients with comparable manifest sphere and cylinder undergoing SMILE Xtra or SMILE were enrolled. The crosslinking (CXL) energy was 2.7 J/cm2. Only right eyes were selected. Visual and refractive changes were evaluated for 1 year. Astigmatic correction was analyzed using Alpins method. Thirty-six eyes undergoing SMILE Xtra and 40 eyes undergoing SMILE were enrolled. The uncorrected distance visual acuity at 1-day visit was lower after SMILE Xtra than that after SMILE (P = .01). At 12 months, the mean manifest refraction spherical equivalent (MRSE) and manifest cylinder were 0.08 ± 0.32 diopters (D) and -0.29 ± 0.23 D in SMILE Xtra group, whereas -0.25 ± 0.29 D and -0.22 ± 0.19 D in SMILE group (P < .01 and P = .135), respectively. Thirty-four eyes (94%) and 32 eyes (89%) in SMILE Xtra group and 36 eyes (91%) and 39 eyes (98%) in SMILE group exhibited target MRSE and manifest cylinder within ±0.50 D (P = .771 and P = .294), respectively. Compared with SMILE group, spherical correction index (SCI), correction index (CI), and difference vector were higher in SMILE Xtra group since 1-week follow-up (all P < .05). SCI and CI were slightly more than 1.0 after SMILE Xtra even at postoperative 12-month follow-up. With CXL protocol of 30 mW/cm2 for 90 seconds, SMILE Xtra exhibited comparable astigmatic correction with SMILE up to 1-year follow-up, although slight spherical equivalent and astigmatic overcorrection were evident after SMILE Xtra.

Toric Implantable Collamer Lens for the Treatment of Myopic Astigmatism.

PurposeTo report visual outcomes following surgical correction of myopic astigmatism with Visian Toric implantable collamer lens (ICL) (STAAR Surgical, Monrovia, CA, USA) at a single tertiary refractive center in the United States.Patients and MethodsToric ICL was implanted in 96 eyes (55 patients) with mean preoperative sphere of −8.98 ± 3.04 diopters (D) and cylinder of −2.67 ± 1.02 D from December 2018 to February 2021. Primary visual outcomes of efficacy, safety, stability, predictability of refractive correction, and astigmatic analysis were reported at three and twelve months postoperatively. Secondary subjective outcomes included patient-reported dry eye symptoms and glare/halos at postoperative visits. Other secondary outcomes were biometric data and postoperative vault over time.ResultsAt three and twelve months, 75 and 46 eyes were evaluated, respectively. At twelve months, the mean manifest refraction spherical equivalent (MRSE) was −0.23 ± 0.47 D with 93% achieving within ±1.00 D of target refraction. The manifest refractive cylinder (MRC) at twelve months was −0.73 ± 0.51 D, with 86% within ±1.00 D of target. Uncorrected distance visual acuity (UDVA) was 20/20 or better in 74% of eyes at twelve months. No patients lost ≥2 lines of corrected distance visual acuity (CDVA) at twelve months. The mean angle of error was −0.9 ± 10.2° at three months and −1.6 ± 12.8° at twelve months. One patient required bilateral lens rotation, four patients underwent secondary enhancement with LASIK/PRK, and seven patients underwent postoperative limbal relaxing incisions.ConclusionThis initial single-site experience finds Toric ICL implantation for myopic astigmatism to be safe and effective. Patients can achieve markedly improved UDVA in a single surgery with stable vision over time and minimal adverse subjective symptoms.

One-year follow-up of a new posterior chamber toric phakic intraocular lens implantation for moderate-to-high myopic astigmatism.

To investigate refractive and visual outcomes as well as rotational stability following implantation of Eyecryl phakic toric intraocular lens (pIOL) for moderate-to-high myopic astigmatism. The efficacy, safety, predictability, stability, and adverse events of Eyecryl toric pIOL were evaluated in patients with spherical refraction from - 4.50 to - 18.50diopters (D) and cylindrical refraction from - 0.50 to - 5.50D. This study included 60 eyes of 31 patients. The mean manifest refraction spherical equivalent (MRSE) dropped from - 10.45 ± 2.74D preoperatively to - 0.34 ± 0.51D and - 0.40 ± 0.56D at 6 and 12months postoperatively, respectively. There was an 81% decrease in astigmatism after surgery. The safety and efficacy of indices were 1.36 ± 0.43 and 1.20 ± 0 .32. At the final follow-up, the rate of eyes within ± 1.00D and ± 0.50D of the desired MRSE were 85% and 68.33%, respectively. Vision-threatening complications were not observed during the follow-up. The implantation of pIOL was effective, safe, and predictable in patients with moderate-to-high myopic astigmatism during 1-year follow-up.

Efficacy of progressive thickness intrastromal corneal ring segments in the treatment of duck phenotype keratoconus.

To evaluate clinical outcomes in patients with asymmetric duck phenotype keratoconus implanted with asymmetric progressive thickness intrastromal corneal ring segments (PT-ICRS, Keraring AS, Mediphacos, Belo Horizonte, Brazil), and to demonstrate improved visual acuity and symmetry in corneal flattening. This single-center, retrospective, observational study evaluated the clinical outcomes at 1, 3, and 6 months after implantation of PT-ICRS in patients with duck phenotype keratoconus. After creating the intrastromal tunnel with a femtosecond laser, one 160-degree arc length PT-ICRS, either 150/250 µm or 200/300 µm, was implanted. Changes in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction (MR), manifest refraction spherical equivalent (MRSE), mean keratometry (Kmean), maximum keratometry (Kmax), Coma@5mm, and manifest and topographical astigmatism were documented. The study cohort included 23 eyes of 17 patients with a mean age of 24.6 years. From baseline to 6 months following implantation, mean UDVA improved from 0.70 logarithm of the minimum angle of resolution (logMAR) (20/100 Snellen) to 0.22 logMAR (20/33 Snellen), CDVA improved from 0.33 logMAR (20/42 Snellen) to 0.14 logMAR (20/27 Snellen), the mean sphere and MRSE decreased from -1.05 diopters (D) and -2.70 D to -0.25 D and -0.80 D, respectively, and the Kmean and Kmax improved from 46.5 D and 53.7 D to 44.6 D and 48.7 D, respectively. The Keraring AS ICRS offers a safe, effective means of improving visual acuity while reducing refractive error, mean and max keratometry, and aberrations in patients with duck phenotype keratoconus.

Refractive change and optical biometry dynamics after 25-gauge vitrectomy in pseudophakic eyes

ObjectiveTo investigate the refractive change and optical biometry dynamics after 25-gauge vitrectomy without gas tamponade for macular pathology in pseudophakic eyes. DesignA prospective observational case series. ParticipantsPatients with pseudophakic eyes who were scheduled for vitrectomy owing to macular pathology by an experienced surgeon (T.S.) at the Hayashi Eye Hospital between March 2019 and February 2020. MethodsThe primary endpoint was the change in manifest refraction spherical equivalent (MRSE) between baseline (preoperatively) and 3 months postoperatively. The secondary endpoint was the change in optical biometry parameters obtained by swept-source optical coherence tomography–based biometers between baseline and 3 months postoperatively. Optical biometry parameters included corneal curvature and axial length, evaluated by the IOLMaster 700, and intraocular lens position—that is, lens decentration, lens tilt, and aqueous depth (AQD)—evaluated by the CASIA2. ResultsThirty-four eyes of 34 patients were enrolled. The mean MRSE values at baseline and 3 months postoperatively were −0.70 ± 1.21 diopter (D) and −0.82 ± 1.27 D, respectively, showing a significant myopic shift of −0.12 ± 0.41 D postoperatively (p = 0.043). There was no significant difference between the pre- and postoperative values of the optical biometry parameters, except for the AQD (4.28 ± 0.34 mm vs 4.27 ± 0.34 mm; p = 0.019). ConclusionsThe results suggest that replacing the vitreous by the aqueous during vitrectomy induces an average myopic shift of −0.12 D.

Visual Performance of a Polynomial Extended Depth of Focus Intraocular Lens

Purpose: To clinically evaluate a new extended depth of focus intraocular lens (ISOPURE, PhysIOL) with optic design modification based on a unique polynomial concept to improve intermediate vision while keeping the quality of distance vision equal to a monofocal lens. Methods: 18 patients (11 female, 7 male, mean age of 69.4 years) with bilateral cataract and regular corneal astigmatism ≤ 1.0 D underwent bilateral cataract surgery with ISOPURE implantation. Patients were followed for up to 6 months. Measured parameters were uncorrected (UDVA) and corrected distance visual acuity (CDVA), uncorrected (UIVA) and distance-corrected intermediate visual acuity at 80 cm and 66 cm (DCI80VA, DCI66VA) subjective refraction, defocus curve, tolerance of cylinder induction, and contrast sensitivity. The data from all implanted eyes (all-eyes) and a subset only including the first eye implanted for each patient were analysed. Results: The mean manifest refraction spherical equivalent (MRSE) decreased from 1.05 D pre-operatively to ?0.15 D at the 4 - 6 month assessment, with 80.6% of eyes within ±0.50 D of emmetropia. At the final follow-up, mean (SD) monocular CDVA was ?0.06 (0.04) logMAR, DCI80VA was 0.18 (0.08) logMAR and DCI66VA was 0.27 (0.13) logMAR. Despite a cylinder induction of ?0.50 D, uncorrected distance visual acuity of 0.02 logMAR was still achieved. Conclusion: The ISOPURE intraocular lens provides excellent distance corrected visual acuity for far and intermediate distances along with high contrast sensitivity and good tolerance of residual refractive cylinder.

Clinical Effect and Rotational Stability of TICL in the Treatment of Myopic Astigmatism.

Purpose To investigate the clinical outcomes and possible risk factors associated with rotational stability after the implantation of a V4c toric implantable Collamer lens (TICL) for the correction of moderate to high myopic astigmatism. Methods A total of 112 eyes of 66 patients with moderate to high myopic astigmatism underwent TICL implantation. All patients were followed up for more than 1 year. The uncorrected and best-corrected visual acuity (UCVA and BCVA), astigmatism and spherical equivalent, intraocular pressure, vault, endothelial cell morphometry, and rotation of the TICL axis were assessed at l day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively. Postoperative rotation was defined as the angle between the intended axis and the achieved axis. Regression analysis was used to investigate the possible risk factors for TICL rotation postoperatively. Results The mean efficacy index and safety index 12 months postoperatively were 1.03 ± 0.09 and 1.05 ± 0.10, respectively. All patients had the same or better visual acuity than preoperatively. The mean astigmatism value decreased from −1.86 ± 0.79 D preoperatively to −0.37 ± 0.35 D. The mean absolute axis deviation of the TICL at the last follow-up was 2.75 ± 2.04° (range, 0°∼11°). The mean manifest refraction spherical equivalent (MRSE) changed from -9.04 ± 2.67 D preoperatively to −0.67 ± 0.51 D postoperatively. The logistic regression demonstrated that the absolute degree of TICL rotation had a significant association with the fixation angle of the TICL and the size of the lens (P=0.003, P=0.026, resp.). Conclusion The results of our study support that TICL implantation is safe, effective, and predictable in the treatment of moderate to high myopic astigmatism, with relatively good postoperative rotational stability.

Refractive and visual outcomes of two different aspheric monofocal intraocular lenses with differing tinting and spherical aberration values

Purpose: To compare refractive and visual outcomes of two diffractive monofocal intraocular lenses (IOLs) with different tinting and spherical aberration values. Study design: Retrospective case series. Methods: The right eye of consecutive patients who had undergone bilateral implantation of SZ-1 (NIDEK Co. Ltd., Gamagori, Japan) or ZCB00 (Johnson and Johnson Inc. New Brunswick, NJ, USA) IOLs was evaluated. Refractive outcomes, changes in visual acuity, ocular spherical aberration, and changes in photopic and mesopic contrast sensitivity were analyzed. Results: Thirty-three eyes received the SZ-1 IOL (SZ-1 group, while 29 eyes received the ZCB00 IOL (ZCB00 group). The mean preoperative manifest refraction spherical equivalent (MRSE) was −1.48 ± 4.74 D and −0.34 ± 1.50 in the SZ-1 group and ZCB00 group, respectively. At 3 months, the mean MRSE was −0.87 ± 1.08 D and −0.65 ± 0.76, respectively (p=0.25). At 3 months postoperatively, the mean best spectacle-corrected visual acuity was 0.14 ± 0.20 LogMAR and 0.11 ± 0.17 LogMAR, respectively (p=0.67). At the same time point, ocular spherical aberration was statistically significantly different (0.01 ± 0.23 μm vs. −0.51 ± 0.51 μm, respectively; p<0.0001). Postoperatively, the mean photopic and scotopic contrast sensitivity did not differ between the groups (p=0.57). Conclusion: Postoperative refractive outcomes and visual acuity following the implantation of these aspheric IOLs were similar. The different asphericity and yellow tinting of the SZ-1 IOL did not affect postoperative visual performance.

Outcomes of implantable collamer lenses (ICL), femtosecond-assisted laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) for correction of hyperopia

Abstract Purpose To evaluate the outcomes of implantable collamer lenses (ICL), femtosecond-assisted laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) for treatment of hyperopia. Settings Tertiary eye center. Design Case series. Methods All patients with hyperopia managed by ICL (Gr 1), LASIK (Gr 2) and PRK (Gr 3) in 2014 to 2019 were reviewed for safety and efficiency, predictability and spherical equivalent (SE) pre-operatively then at one and 12 months after surgery. Results Total of 99 hyperopic eyes, management Gr 1, Gr 2 and Gr 3 included 26, 57 and 16 eyes respectively. The mean pre-operative manifest refraction spherical equivalent (MRSE) was +5.13D, +3.15D D, +2.39D for Gr 1, Gr 2 and Gr 3 respectively. One year after surgery, the mean MRSE was −0.23D, +0.34D and +0.08D respectively (p = 0.065). The safety index was 1.0 and efficacy index was 0.89 in all groups. The predictability for achieving ±1.0 D SE was 95.8%, 92%, and 93.3% in Gr 1, Gr 2 and Gr 3 respectively. Peripheral faint corneal haze was noticed in PRK group (P = 0.05). Conclusions All three procedures had excellent visual gain and stable refraction at one year after surgeries with low complication rates. They seem to be safe, efficient and predictable procedures.

Femtosecond Laser-Assisted LASIK in Children With Hyperopia and Anisometropic Amblyopia: 7 Years of Follow-up.

To analyze clinical and functional results of femtosecond laser-assisted laser in situ keratomileusis (FSLASIK) in children with hyperopia and unilateral anisome-tropic amblyopia. The study included 24 patients (24 eyes) aged 5 to 15 years. Before the surgery, the mean manifest refractive spherical equivalent (MRSE) of amblyopic eyes was +3.90 ± 1.60 diopters (D) (range: +1.50 to +6.80 D) and the mean refractive anisometropia was 3.06 ± 1.64 D (range: 0.87 to 7.50 D). Every patient had at least 1 year of ineffective traditional amblyopia treatment before surgery. The mean follow-up period was 7 years (range: 6.9 to 7.4 years). At the final follow-up visit, the mean MRSE of operated eyes was +0.41 ± 1.35 D (range: -1.13 to +3.88 D) (P < .001) and anisometropia in MRSE notation was 1.39 ± 1.15 D (range: 0.00 to 4.63 D). Postoperative spherical equivalent was within ±0.50, ±1.00, and ±2.00 D in 31%, 38%, and 92%, respectively. There were no complications. All patients showed a one to seven line gain of corrected distance visual acuity. FS-LASIK was an effective method of hyperopia correction in this cohort of children with amblyopia, resulting in reduction in anisometropia, restoration of refractive balance, and functional improvement in the amblyopic eye when traditional methods failed. [J Refract Surg. 2020;36(6):366-373.].

Comparison of intraoperative vs postoperative optical coherence tomography measurement of implantable collamer lens vaulting.

To compare intraoperative vs postoperative optical coherence tomography (OCT) measurements of implantable collamer lens (ICL) vaulting. American University of Beirut Medical Center, Beirut, Lebanon. Prospective observational cohort study. Patients with myopia or myopic astigmatism undergoing ICL insertion in which intraoperative OCT measurements were obtained were included. Exclusion criteria included coexisting ocular problems and previous ocular surgery. The outcome measures were ICL vaulting as determined by OCT intraoperatively and postoperatively at 1 day, 1 week, 1 month, and 3 months. Forty-five eyes of 26 patients were included. Mean age was 27.23 ± 6.47 years (range 17 to 48 years), and mean manifest refraction spherical equivalent was -10.20 ± 3.92 diopters (D) (range -20.50 to -4.50 D). Mean ICL vaulting measured 731 ± 215 μm intraoperatively, 648 ± 219 μm at 1 day, 640 ± 204 μm at 1 week, 628 ± 212 μm at 1 month, and 632 ± 210 μm at 3 months postoperatively (P = .0009, with all postoperative vaulting measurements statistically similar to each other, but significantly different from the intraoperative measurement). However, intraoperative ICL vaulting had high predictability of postoperative vaulting at 3 months with r = 0.81 (P < .0001), and Bland-Altman analysis demonstrates a relatively constant difference between the 2 measurements as plotted against their mean with a bias of 98.27 μm and tight 95% limits of agreement range. Intraoperative ICL vaulting measured by OCT correlated highly with postoperative OCT vaulting and can be considered a reliable tool to predict the final ICL vault.

High-Resolution Wavefront-Guided Photorefractive Keratectomy and Accelerated Corneal Crosslinking for Stabilization and Visual Rehabilitation of Keratoconus Eyes.

PurposeTo evaluate the visual and refractive outcomes after high-resolution wavefront-guided (HRWG) surface ablation with corneal crosslinking (CXL) in keratoconus eyes.Patients and MethodsIn this prospective, interventional case series, 47 eyes of 28 progressive keratoconus patients older than age 18 were enrolled. All patients underwent HRWG photorefractive keratectomy (PRK) with simultaneous accelerated CXL. The study parameters were manifest refraction spherical equivalent (MRSE), keratometric outcomes, uncorrected (UDVA) and corrected distance visual acuity (CDVA) at postoperative 6 and 12 months.ResultsThere was improvement in mean MRSE from −2.39±1.89 D preoperatively to −0.13 ± 0.68 D at 12 months, with corresponding improvement in UDVA from 0.77 ± 0.35 logMAR to 0.08 ± 0.12 logMAR and CDVA from 0.10 ± 0.11 logMAR to 0.02 ± 0.04 logMAR. Preoperative flat and steep keratometry (K) were 4wct 32.49 ± 1.67 D and 45.94 ± 2.10 D, respectively, and at postoperative 12 months were 41.36 ± 2.08 D and 42.65 ± 2.78 D, respectively. At postoperative 12 months, visual and refractive outcomes were maintained. Comparisons between preoperative and postoperative 12 month timepoints were statistically significant for all parameters.ConclusionSimultaneous wavefront-guided PRK followed by CXL is a promising treatment for the visual rehabilitation of keratoconus patients.