Mean Postoperative Uncorrected Visual Acuity Research Articles

A new technique to implant intracorneal ring-segments from the perilimbal region: one-year prospective pilot study report

BackgroundRecently a new surgical technique for intracorneal ring-segments (ICRS) assisted by femtosecond laser (FSL) called ByLimB was developed, involving the creation of the incision from a paralimbic region. This study aims to evaluate the safety and efficacy of the ByLimb technique following one year of follow-up.MethodsA prospective, single-center study was conducted at the Zaldivar Institute in Buenos Aires, Argentina. Keratoconus patients with indication for ICRS-FSL assisted procedure, operated with the ByLimb technique were included. By using the ByLimb technique, the ICRS are placed without affecting the tunnel’s roof, and the end of the ICRS is always away from the incision area. Visual acuity, topographic astigmatism, and the occurrence of complications were evaluated. Safety index was the main outcome and efficacy indes was a complimentary outcome.ResultsA total of 17 eyes completed the 12-month follow-up period. The safety index was 1.10 (mean postoperative corrected distance visual acuity (CDVA) in decimal: 0.76/preoperative CDVA: 0.69), while the efficacy index was 0.89 (mean postoperative uncorrected distance visual acuity UDVA in decimal: 0.62/preoperative CDVA: 0.69). Mean preoperative astigmatism was 5.3 ± 2.3, decreasing twelve months after surgery at 2.1 ± 1.2 (p < 0.001). No eye loss lines of vision and no intraoperative complications were observed. During the first month after surgery, an improper positioning of the ICRS based on topographic assessment was detected in five cases. A second procedure was performed, which consisted of opening the incision and introducing a Sinsky hook, through which the ICRS was mobilized and placed in its correct position. No incisional alterations, signs of infection, anterior segment anomalies, or fundus alterations were observed.ConclusionFSL-assisted ICRS implantation through the perilimbal region has demonstrated an adequate safety index one year post-surgery. Additionally, this technique has facilitated accurate realignment of ICRS during secondary surgical interventions within one-month post-surgery. While the current findings are promising, continued follow-up of these cases is warranted.

VISUAL AND REFRACTIVE OUTCOME OF NEW GENERATION SMALL INCISION LENTICULE EXTRACTION (SMILE) IN MYOPIA AND MYOPIC ASTIGMATISM

Introduction: Two main options for the surgical correction of high myopia and myopic astigmatism are corneal refractive surgery and implantation of phakic intraocular lens (IOL). Small Incision Lenticule Extraction (SMILE) is becoming more popular technique which includes a minimally invasive flap-free procedure. The aim of this study is to evaluate the visual and refractive outcome of New Generation SMILE in myopia and myopic astigmatism. Methods: This is an observational retrospective study in patients who underwent SMILE using Visumax 800 Femtosecond laser procedure at Undaan Eye Hospital in period December 2022 to February 2023. Pre and post operative uncorrected visual acuity (UCVA), spherical equivalent (SE), astigmatism value, keratometry and intra ocular pressure (IOP) were evaluated at 1 day, 1 week and 1 month follow-up. Results: The study comprised 30 eyes of 15 patients age from 18 to 32 years old. The mean post operative UCVA was significantly improved to 0.03 ± 0.06 logMAR at 1-day, 0.02 ± 0.04 logMAR at 1-week and -0.01 ± 0.02 logMAR at 1-month follow-up compared to preoperative UCVA 1.35 ± 0.23 logMAR (p&lt;0.001). The mean refractive spherical equivalent was significantly changed from -4.60 ± 1.47 D preoperatively to -0.57 ± 0.38 D at 1-month follow up (p &lt; 0.001). The mean refractive astigmatism decreased from -1.02 ± 0.66 D preoperatively to -0.34 ± 0.25 D at 1- month follow up (p&lt;0.001). Conclusion: New Generation of SMILE has shown good visual and refractive outcome for the correction of myopia and myopic astigmatic eyes since the early phase after surgery.

Evaluation of Visual Outcomes and 3-Month Refractive Stability of a New Hydrophobic Acrylic Intraocular Lens.

To determine the refractive stability of a new hydrophobic acrylic intraocular lens (IOL) when implanted bilaterally. This was a prospective, evaluator masked, single surgeon study of 58 eyes of 29 patients. Patients were bilaterally implanted with the Clareon monofocal IOL (CNA0T0, Alcon Vision LLC). Refractive stability was evaluated between 1 and 3 months postoperatively. At 3 months postoperatively, data were also collected for binocular uncorrected and distance corrected visual acuities at distance (4 m) and intermediate (80 cm and 66 cm) and binocular defocus curve. Postoperative refraction was statistically equivalent between 1 and 3 months postoperatively (p < 0.001). Mean postoperative uncorrected distance visual acuity was -0.01 ± 0.10 logMAR, and mean corrected distance visual acuity was -0.04 ± 0.06 logMAR. Mean postoperative uncorrected intermediate visual acuity was 0.16 ± 0.13 logMAR and 0.24 ± 0.14 logMAR at 80 cm and 66 cm, respectively. With distance correction in place, mean visual acuity at 80cm and 60cm was 0.16 ± 0.13 logMAR and 0.23 ± 0.14 logMAR, respectively. The Clareon monofocal IOL can provide stable refraction, excellent distance vision, and functional intermediate vision postoperatively.

Four-Point Flange Intrascleral Fixation With Double Suture Through the Dislocated Plate-Haptic Trifocal Intraocular Lens

To describe a technique for the replacement of dislocation of plate-haptic trifocal intraocular lens (IOL) through double-suture four-point flange intrascleral fixation. Retrospective, interventional, noncomparative, case series METHODS: A total of 7 eyes of 7 patients with a dislocated plate-haptic trifocal IOL were enrolled for four-point flange intrascleral fixation with double 7-0 polypropylene suture. Preoperative and postoperative visual acuity, operating time, refractive results, postoperative IOL tilt and decentration, intra-operative and postoperative complications were recorded. The mean postoperative uncorrected distance visual acuity (UDVA) was 0.05 ± 0.06 logMAR. The mean postoperative uncorrected intermediate visual acuity (UIVA) at 80 cm was 0.09 ± 0.06 logMAR and the mean postoperative uncorrected near visual acuity (UNVA) at 40 cm was 0.06 ± 0.07 logMAR. The mean postoperative residual spherical equivalent values were - 0.27 ± 0.39 D. VF-14 questionnaire showed that no difficulty was found in >80% of subjects for all of the tasks. The mean surgical time was 16.23 ± 5.64 minutes. The mean tilt of IOL was 3.74 ± 1.31° and the mean decentration of the IOL was 0.18 ± 0.09 mm. No important complications appeared. The authors have described the technique of four-point flange intrascleral fixation for plate-haptic trifocal IOL.

Clinical Outcomes of Toric Intraocular Lenses in Patients with Fuchs Endothelial Corneal Dystrophy.

Implantation of toric intraocular lenses (IOLs) in patients with Fuchs endothelial corneal dystrophy (FECD) is still considered relatively contraindicated, without sufficient clinical evidence. Therefore, this study was designed to evaluate the results of toric IOL implantation in patients with FECD. A retrospective case-control study of 28 eyes of FECD patients and 84 eyes of healthy control patients who received toric IOLs during routine cataract surgery was performed. The outcome measures were uncorrected and corrected distance visual acuity, spherical equivalent, and refractive residual astigmatism. The mean postoperative uncorrected and corrected distance visual acuity in the FECD eyes compared to the control eyes were 0.15 ± 0.14 vs. 0.13 ± 0.17, respectively (P = 0.32), and 0.05 ± 0.08 vs. 0.06 ± 0.10, respectively (P = 0.95). The spherical equivalent in the FECD eyes compared to the control eyes was -0.29 ± 0.43 vs. -0.21 ± 0.50, respectively (P = 0.19). The preoperative corneal centroid astigmatism in the FECD eyes compared to the control eyes was 0.85D@93° ± 2.42° vs. 0.23D@68° ± 2.50°, respectively (P = 0.43), and the mean preoperative corneal astigmatism magnitude was 2.26 ± 1.1D vs. 2.28 ± 1.03D, respectively (P = 0.82). A trend toward higher postoperative refractive centroid astigmatism was found in the FECD eyes compared with the control eyes: 0.24D@28° ± 0.57° vs. 0.03D@127° ± 0.53°, respectively (P = 0.09). However, the mean refractive astigmatism magnitude was similar in FECD eyes and the healthy control eyes: 0.52 ± 0.31D vs. 0.42 ± 0.31D, respectively (P = 0.44) (D diopters). The postoperative refractive astigmatism (both centroid astigmatism and mean magnitude astigmatism) was no higher than 0.52D in both groups. Therefore, FECD patients without corneal edema can be considered for toric IOLs.

Effect of eye laterality on correction of myopic astigmatism with small incision lenticule extraction (SMILE) using vector analysis.

To compare the vector analysis, visual, and refractive outcomes after myopic astigmatic correction using SMILE between the right and left eyes. This is a retrospective study including 41 right and 40 left eyes that underwent SMILE for correction of myopic astigmatism greater than 0.75 diopters (D) with a follow-up of at least 3months. Vector analysis for astigmatic correction was done. Visual and refractive parameters were compared between both groups by measuring mean postoperative logMAR uncorrected distance visual acuity, mean postoperative spherical equivalent (SE), cylinder, and refractive predictability in terms of SE and cylindrical correction. Efficacy and safety of SMILE were also determined. No significant difference was found between vector outcomes except for angle of error (AE). The right eye group yielded a negative mean AE (- 2.71 ± 5.35), while the left eye group yielded a positive mean AE (0.23 ± 9.60). Correction index, magnitude of error and refractive predictability of cylindrical correction showed undercorrection of astigmatism in both groups. The right eye group showed lower predictability for higher cylindrical correction. Visual outcomes were similar for both eyes. Rotational errors account for vectorial outcome differences between right and left eyes. Despite achieving good visual and refractive outcomes with low cylinder correction, the tendency to undercorrect between eyes due to this error may be more evident when treating higher amounts of astigmatism. More careful preoperative control for cyclotorsion is warranted for right eyes compared to left eyes.

Comparative study of refractive outcomes after photorefractive keratectomy and small-incision lenticule extraction in moderate myopia

ObjectivesTo compare the refractive outcomes after photorefractive keratectomy (PRK) and small-incision lenticule extraction (SMILE) in moderate myopia.BackgroundPRK and SMILE are two flapless procedures for the correction of myopia and astigmatism. In PRK, an excimer laser is used for photoablation, whereas in SMILE, a femtosecond laser is used to create the lenticule.Patients and methodsA retrospective study was conducted on 80 patients (160 eyes) who were classified into two groups: PRK and SMILE. A total of 40 patients (80 eyes) were included in each group. Assessment was between 6 months and 3 years postoperatively comparing the uncorrected distance visual acuity, best-corrected distance visual acuity, and manifest refraction spherical equivalent with the preoperative data in addition to assessing the efficacy, safety, and predictability in each procedure.ResultsThe two groups were matched for age, sex, and preoperative characteristics. The mean postoperative uncorrected distance visual acuity in the PRK group was 0.96 ± 0.06 and in the SMILE group was 0.95 ± 0.08 (P = 0.621). The mean postoperative best-corrected distance visual acuity in the PRK group was 0.96 ± 0.06 and in the SMILE group was 0.97 ± 0.07 (P = 0.735). The mean postoperative manifest refraction spherical equivalent in the PRK group was − 0.24 ± 0.34 and in the SMILE group was − 0.30 ± 0.20 (P = 0.186). The mean efficacy index in the PRK group was 0.99 ± 0.05 and in the SMILE group was 0.99 ± 0.07 (P = 0.456). The mean safety index in the PRK group of all eyes was 1.00 ± 0.03 and in the SMILE group was 1.00 ± 0.04 (P = 0.704). In the PRK group, 90% of all eyes were within ± 0.50 D of intended refraction and 100% were within ± 1.00 D. In the SMILE group, 95% of all eyes are within ± 0.50 D of intended refraction and 100% were within ± 1.00 D.ConclusionPRK and SMILE procedures showed excellent efficacy, safety, and predictability in moderate myopia, whereas SMILE was noticed to be better in predictability than PRK.

Can toric IOL rotation be minimized? Toric IOL-Capsular Tension Ring suturing technique and its clinical outcomes

ABSTRACT Purpose: In this study, we aimed to evaluate the outcomes of the toric intraocular lens (IOL) and capsular tension ring (CTR) suturing technique in patients with cataract and astigmatism. Methods: Group 1 comprised 37 eyes of 36 patients to whom the CTR-toric IOL complex was co-implanted after the CTR was sutured to the toric IOL haptic. Group 2 comprised 35 eyes of 33 patients in whom the toric IOL and CTR were implanted without suturing. Both groups were compared in terms of preoperative and postoperative astigmatism, best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), and IOL rotation. Results: The mean rotation degree was 0.54° ± 2.29° in group 1 and 4.28° ± 8.84° in group 2 (p = .01). While there was no significant difference between the postoperative residual astigmatism and the estimated residual astigmatism in group 1, the postoperative residual astigmatism was statistically higher than the estimated residual astigmatism in group 2 (p = .47 and 0.000, respectively). The mean postoperative UCVA was 0.02 ± 0.04 (logMAR) in group 1 and 0.08 ± 0.13 (logMAR) in group 2 (p = .01). Conclusion: The toric IOL and CTR suturing technique provides excellent rotational stability and astigmatism correction.

Sutureless Scleral-Fixated Intraocular Lens Implantation in the Treatment of Congenital Lens Subluxation Related to Marfan Syndrome.

To evaluate the efficacy and safety of bimanual capsulorhexis combined with sutureless scleral-fixated intraocular lens (IOL) implantation in children diagnosed as having Marfan syndrome. The study included 14 eyes with subluxated lenses of 7 children who were diagnosed as having Marfan syndrome and underwent bimanual capsulorhexis combined with sutureless scleral-fixated IOL implantation by the same surgeon between 2015 and 2019 at the University of Health Sciences, Kartal Dr. Lütfi Kirdar City Hospital's Eye Department. The mean preoperative and postoperative uncorrected visual acuity was 1.47 ± 0.41 and 0.42 ± 0.15 logarithm of the minimum angle of resolution (logMAR), respectively (P = .001). The preoperative best corrected visual acuity (BCVA) ranged from 1.30 to 0.40 logMAR with a mean value of 0.81 ± 0.30 logMAR. Postoperatively, all patients had an increase in the BCVA with a mean value of 0.20 ± 0.11 logMAR, which was statistically significant (P = .001). The mean preoperative and postoperative spherical equivalent was -9.69 ± 4.59 and -0.27 ± 1.21 diopters, respectively. Despite the small number of patients in this study, good visual results and a low complication rate were obtained in patients with ectopic lens. The long-term IOL status in patients who have undergone sutureless scleral-fixated IOL implantation will make it possible to better evaluate the safety and applicability of the technique. [J Pediatr Ophthalmol Strabismus. 2021;58(6):401-406.].

Toric phakic IOLs in keratoconus\u2014evaluation of preoperative parameters on the outcome of phakic anterior chamber lens implantation in patients with keratoconus

PurposeTo evaluate the influence of the type of the keratectasia and preoperative keratometry readings on the efficacy of implantation of iris-fixated phakic anterior chamber intraocular lenses (pIOL) in patients with keratoconus.MethodsIn this retrospective study, iris-fixated pIOLs (Artisan/Artiflex (Ophtec®), Verisyse/Veriflex (AMO®)) were implanted in 38 eyes of 22 patients with stable keratoconus. Thirty-six eyes underwent corneal crosslinking (CXL) prior to the lens implantation. The refractive outcome was evaluated 6 weeks postoperatively and the influence of preoperative refraction and topo- and tomographical factors were analyzed.ResultsThe mean postoperative uncorrected distance visual acuity (UDVApost) was 0.25 ± 0.15 logMAR and was not statistically different from the mean preoperative corrected distance visual acuity (CDVApre), which was 0.24 ± 0.13 logMAR. Twenty-seven eyes (71%) reached UDVApost/CDVApre ≥ 1 (efficacy index), whereas patients with PMD-like ectasia (n = 14) showed significantly (p = 0.003) higher efficacy index (100%) than patients diagnosed with keratoconus (n = 24) (54%). Higher eccentricity of the maximum posterior elevation showed a significant beneficial influence on the efficacy index (p = 0.021). Furthermore, a higher Amsler-Krumeich stage and preoperative MAE were correlated with a worse UDVApost. The mean absolute spherical equivalent was significantly decreased from 5.71 ± 4.96 D to 1.25 ± 1.20 D (p < 0.001). No significant difference was found in endothelial cell count.ConclusionThe results indicate that the implantation of phakic iris-fixated anterior chamber IOLs is a reasonable refractive option for patients with keratoconus. Keratoconus patients with a pellucidal marginal degeneration (PMD)-like appearance ectasia seem to benefit most from such procedures.

LASIK Cerrahisi Sonrası Ağrıyı Azaltmak İçin Kullanılan Farklı Bir Yaklaşım

Objective: To evaluate the effectiveness of topical 0.4% ketorolac tromethamine usage with contact lenses following laser-assisted in situ keratomileusis (LASIK) surgery, for post-operative pain reduction. Material and Methods: Two hundred and ninety two eyes of 146 patients who underwent LASIK surgery under topical anesthesia were included in the study. Contact lenses soaked in a 0.4% solution of ketorolac tromethamine were applied to 148 eyes of 74 patients who had undergone LASIK surgery for refractive errors (Group 1). Contact lenses with no medication were applied to 144 eyes of 72 patients who had undergone LASIK surgery for refractive errors (Group 2). Pain scores were recorded in both groups every hour from hour 1 to hour 5, postoperatively. Results: There were no significant differences between the two groups with regard to age or sex (p>0.05). No significant difference was found between the two groups in respect of either preoperative or postoperative mean uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and intraocular pressure values (p>0.05). The mean postoperative UCVA was significantly better than the mean preoperative UCVA in both groups (p<0.05). Pain scores for Group 1 patients at postoperative hours 2, 3, and 4 were significantly lower than for patients in Group 2 (p<0.001, p<0.001 and p=0.023, respectively). Topical ketorolac tromethamine did not negatively affect wound healing, corneal flap, or ocular surface in any patient. Conclusion: Topical ketorolac tromethamine application with contact lenses following LASIK surgery decreases pain and discomfort effectively.

The evaluation of postoperative objective and subjective refraction for premium intraocular lenses

Abstract Purpose: To evaluate six different premium IOLs retrospectively in respect to both subjective and objective refraction after cataract operation. Methods: Five hundreds and seventy eyes of 285 patients with bilateral cataract who had undergone phacoemulsification and IOL implantation operation between February 2017 and September 2018 were enrolled in this study. The mean age of the patients was 57.78 ± 7.49 (41-71) years. Out of 285 patients 137 were male (48.07%) and 148 were female (51.93%). TheIOLsusedare: RayOne Trifocal (Rayner, Worthing, UK), Lucidis (Swiss Advanced Vision, Neuchâtel, Switzerland), PanOptix (Alcon, Fort Worth, USA), LentisMplus (Oculentis, Berlin, Germany), TecnisSymfony (Abbott, Illinois, USA) and Acriva Trinova (VSY Biotechnology, Istanbul, Turkey). Results: There were no significant differences among the groups regarding age, sex, axial length, the mean preoperative and postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), the mean preoperative spherical equivalent (SE) and the mean postoperative SE (subjective measurement) (P> .05). The postoperative refractions measured with autorefractometer were more myopic than subjective refractions in all patients except the patients who had PanOptix IOL. In postoperative twelfth month, the mean UCVA arrived 0.00 logMAR in 405 eyes (78.48%) , however, the mean autorefractometric measurement was -1.28 ± 1.02 (0.00_-2.75) D. Conclusion: The autorefractometer measurements of all patients who had premium IOLs except PanOptix IOL were not coherent with their visual acuities postoperatively. The ophthalmologists and/or optometrists should be careful while examining these types of patients.

Refractive and visual outcomes of small incision lenticule extraction (SMILE) in eyes with thin corneas.

To report the refractive and visual outcomes of small incision lenticule extraction (SMILE) with the thinnest corneal thickness (CCT) of less than 500 µm and evaluate it in terms of safety and efficacy. Refractive Surgery Clinic of University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey. Retrospective case series. The pre-and-postoperative examinations of all patients with thin corneas (preoperative CCT <500 µm) who underwent the SMILE procedure and had a minimum of 24 months of follow-up records were reviewed from medical files. The main outcome measures of the refractive and visual outcomes and the effect on corneal high order aberrations (HOAs) were evaluated. The study included 55 eyes of 39 patients. The mean preoperative uncorrected visual acuity (UDVA) was 1.3 ± 1.5 logMAR, and the mean postoperative UDVA was significantly improved to 0.05 ± 0.80 logMAR at the last visit (p < 0.001). At the last follow-up, 84% of the eyes were within ± 0.50D, and 96% of the eyes were within ±1.00D of attempted SE refraction. The HOAs of coma (p < 0.001), secondary astigmatism (p = 0.015), spherical aberration (p < 0.001), and RMS (p < 0.001) aberrations increased significantly from the baseline to the postoperative last visit. The increase in trefoil was not significant (p = 0.32). No sight threatening complications or ectasia were observed during the follow-up time. SMILE is a safe and effective technique with long-term stability for treatment of myopia in eyes with a thin cornea, and satisfactory results can be obtained if candidates for surgery are selected carefully with particular emphasis on normal preoperative corneal topography.

Correction of pseudophakic presbyopia using Lasik with aspheric ablation profiles and a micro-monovision protocol

To evaluate the outcomes of Lasik with aspheric ablation profiles and a micro-monovision protocol for correction of presbyopia in pseudophakic patients. This study included 50 pseudophakic eyes of 25 patients. Full ophthalmic examination, dominant eye tests and tests for tolerance of anisometropia (1 or 2diopters) were done preoperatively. All cases were treated by Lasik with laser-blended vision technique. The dominant eye corrected to plano, and the nondominant eye corrected with near add in the range from 1.50 to 2.00diopters. Excimer laser ablation was done using the MEL90 with a 250-Hz pulse rate (Carl Zeiss Meditec, Jena, Germany, Triple-A profile, Lasik mode). The follow-up period was 6months with visits at 1, 3 and 6months postoperatively. The mean postoperative uncorrected distant visual acuity at 1month (0.74 ± 0.11) was significantly lower than the preoperative level (0.84 ± 0.14) (p < 0.001). But it improved at the 3rd (0.80 ± 0.09) and 6th months (0.82 ± 0.10) with no significant difference with the preoperative level (p = 0.344). The mean uncorrected near visual acuity was significantly higher at the 1st (2.94 ± 1.63J), 3rd (2.95 ± 1.82J) and 6th (2.92 ± 1.83J) postoperative months than the preoperative level (2.26 ± 1.48J) (p < 0.001). Insignificant change in stereopsis was found after surgery (p = 0.849). The micro-monovision was well tolerated (95.8%). Lasik with aspheric ablation profiles and a micro-monovision protocol is an effective option for presbyopia correction in pseudophakic patients.

Evaluation of axis alignment and refractive results of toric phakic IOL using image-guided system.

To evaluate accuracy of axis alignment and refractive results of toric phakic intraocular lens (IOL) implantation using a digital imaging system. This retrospective study investigated toric implantable collamer lens (ICL) implantation in 30 eyes of 21 patients with myopic astigmatism more than 2.0 D guided with digital imaging system. Data were collected during the first week after phakic IOL implantation. Thirty eyes of 21 patients were included in our study. Patients includes 9 males and 12 females. The mean age of the patients was 26.5±7.1 (range 21-44)y. The mean preoperative manifest astigmatism was 3.2±1.7 (range from 2.25 to 4.75) D. The mean postoperative uncorrected distance visual acuity (UCDVA) were 0.07±0.07 (range from 0.1 to 0.0) logMAR. The mean postoperative residual refractive cylinder was 0.25±0.29 (range 0-0.75) D. Eyes with postoperative residual refractive cylinder of 0.5 D or less represented 80% (24 eyes). The mean postoperative toric IOL misalignment measured by the OPD scan III was 1.9°±1.45° (range from 0 to 5°). Image guided system allows accurate alignment of toric ICL. This is associated with good postoperative visual acuity and low residual refractive astigmatism which correlates with the precision of toric phakic IOL alignment.

Management of cataract in keratoconus: early visual outcomes of different treatment modalities.

A review of 31 eyes with keratoconus who developed cataract and underwent phacoemulsification. Visual acuities were measured 1mo postoperatively. Six eyes with a history of good corrected distance visual acuity (CDVA) and a similar refractive and topographic astigmatic axis were implanted with toric intraocular lenses (IOLs). The mean postoperative uncorrected distance visual acuity (UDVA) was 0.2 logMAR with a spherical equivalent (SE): 0.75D. Eleven eyes with a history of good CDVA and different refractive and topographic axis were implanted with monofocal IOL+/-Toric implantable collamer lenses to treat anisometropia and ametropia; mean UDVA was 0.25 logMAR with a mean SE: -0.51 D postoperatively. Six eyes with poor CDVA were first treated with intra-corneal ring segments, followed by phacoemulsification, the mean postoperative UDVA was 0.82 logMAR with an SE: 0.22 D. Eight eyes had advanced ectesia and received combined phacoemulsification and penetrating keratoplasty. Our approach is efficient in addressing ametropia after cataract surgery in keratoconic eyes.

Outcomes of presbyopia-correcting intraocular lenses after laser in situ keratomileusis.

Laser in situ keratomileusis (LASIK) is the most common refractive surgery in young patients, which aims at providing a clear distance vision without the use of spectacles. With time, these patients develop symptomatic cataract, which affects activities of daily living, and to improve visual acuity, intraocular lens (IOL) implantation can be considered. In post-myopic LASIK patients, to allow continuation of spectacle independence, the implantation of presbyopia-correcting IOLs is a suitable option. The purpose of this retrospective case series is to report the visual outcome and quality in post-myopic LASIK eyes after the implantation of AT LISA tri839MP IOL. Twenty eyes of 13 patients with history of myopic LASIK within 20years underwent phacoemulsification by one single surgeon. All eyes were implanted with AT LISA tri839PMP IOL, and their outcomes were evaluated at 6months postoperation. The mean postoperative uncorrected distance visual acuity (VA) is 0.28 ± 0.29, while the corrected distance VA is 0.06 ± 0.14. The mean postoperative uncorrected near VA is 0.02 ± 0.05, while the corrected near VA is 0.01 ± 0.02. The mean postoperative manifest refraction spherical equivalent (SE) is - 0.92 ± 0.76D. There is a statistically significant difference between the preoperative and postoperative refraction (p = 0.02), which shows a postoperative myopic shift. There is also a statistically significant difference between the mean targeted SE and postoperative manifest refraction SE (p = 0.00). Only one out of 20 eyes (5%) reported halo and glare symptoms. Ten out of 20 eyes (50%) are able to achieve spectacles independence. In conclusion, in post-myopic LASIK eyes, AT LISA tri839MP provides a good visual outcome at both near and distance, but is more predictable at near than at distance. There is a myopic shift in the postoperative SE. Visual quality is satisfactory and has not been exacerbated. Most patients can remain to be spectacles free at all distances.

A clinical study to evaluate the results after toric intraocular lens implantation in cases of corneal astigmatism

BackgroudModern day cataract surgery aims at a spectacle free vision which becomes difficult in cases with pre-operative astigmatism more than 1.5D. Implantation of toric intra-ocular lenses (IOL) after phacoemulsification in such eyes is one of the ways to counteract this problem. MethodsThirty eyes with pre-operative astigmatism between 1.5D and 4.5D were implanted with toric IOLs following uneventful phaco-emulsification. The estimation of the axis of implantation of this toric IOL included calculating the surgically induced astigmatism (SIA) of the surgeon. ResultsPost-operatively, 20 (66.67%) patients had a visual acuity 6/9 or better and 17 (57%) had a visual acuity of 6/6 at 12 weeks. The mean postoperative uncorrected visual acuity (UCVA) was 0.12±0.15 at 12 weeks. The difference between means of preoperative best corrected visual acuity (BCVA) LogMAR and postoperative UCVA at 12wk LogMAR was found to be statistically significant at p=0.001. Mean (SD) scores of pre-op astigmatism of study group was −2.20 (0.67) and residual astigmatism was −0.32 (0.44). ConclusionsThe difference between means of pre-op astigmatism and residual astigmatism in the study group was significant at p=0.001 with 95% CI −2.22 to −1.50. This significant difference was because of the toric IOL implantation.

COMPARISON OF POST OPERATIVE CORNEAL ASTIGMATISM BETWEEN SMALL INCISION CATARACT SURGERY (SICS) AND EXTRA CAPSULAR CATARACT EXTRACTION (ECCE)

Background&#x0D; Cataract surgery is the most common type of surgery done by ophthalmologists. There are many methods of performing cataract surgery. Each of them has its own advantages and complications. Here we want to find the outcome of both the manual small incision cataract surgery and the conventional extracapsular cataract extraction surgery. &#x0D; Objectives &#x0D; To find the degree of postoperative corneal astigmatism in both manual small incision cataract surgery and the extracapsular cataract extraction surgery and compare these outcomes in both techniques.&#x0D; Patients and Methods&#x0D; We performed an experimental study conducted from January 2016 to June 2016 in Shahid Dr.Aso hospital ophthalmology department and Best Vision private hospital, Sulemani Province/Kurdistan Region of Iraq. One hundred cases were enrolled in the study, 50 cases underwent manual small incision cataract surgery and the other 50 underwent extracapsular cataract extraction surgery. All patients had their history taken, preoperative evaluation by (Slit-lamp examination, intraocular pressure measurement, indirect ophthalmoscopy for fundus examination, intraocular lens measurement, B-scan). Postoperatively; after 2 months, all cases in both groups were re-evaluated by the same measures of the preoperative examination.&#x0D; Results&#x0D; The mean postoperative uncorrected visual acuity in the manual small incision cataract surgery and extracapsular cataract extraction group was 6/9 and 6/12, respectively. The mean postoperative corneal astigmatism was 1.27+0.94 in manual small incision cataract surgery compared to 2.59+1.65 in the extracapsular cataract extraction surgery.&#x0D; Conclusion&#x0D; Both manual small incision and extracapsular cataract extraction techniques are safe and effective for visual rehabilitation of cataract patients. However, manual small incision cataract surgery gives better uncorrected visual acuity and less induced corneal astigmatism at 8 weeks postoperatively.

Visual and refractive outcomes following implantation of a new trifocal intraocular lens

BackgroundIndependence from all optical aids, and freedom from unwanted symptoms, following cataract and lens surgery remains the ultimate goal of both patient and surgeon. The development of trifocal IOL technology provides an ever-increasing range of options. The purpose of our study is to understand the predictability, safety and efficacy of a new trifocal intraocular lens (IOL) following cataract or refractive lens exchange (RLE) surgery.MethodsThis was a retrospective consecutive case series of patients undergoing cataract extraction or RLE followed by implantation of the Alcon IQ Panoptix IOL. Pre and postoperative refractive and visual parameters were recorded and evaluated. As the cohort followed a normal distribution, standard parametric tests were used. Paired t-test was used to compare the difference between target and postoperative refractive errors. The incidence of intraoperative and postoperative complications was also reported.ResultsThe IOL was implanted in 66 eyes of 33 patients. Mean postoperative spherical equivalent (SE) refraction was -0.08 ± 0.25 dioptres (D). This was not significantly different from the target refraction (p = 0.841). Sixty-five percent of patients were within ± 0.25 D of the target SE refraction with 100% within ± 0.50 D of intended correction. Mean postoperative uncorrected distance visual acuity (UDVA) was 0.01 ± 0.10 LogMAR. All patients achieved an unaided distance acuity of 20/40 or better postoperatively. Binocularly, 100% saw 0.20 LogMAR or better at near without correction and 88.9% achieved this level for uncorrected intermediate visual acuity. No intraoperative complications were noted. Five patients complained of moderate haloes in the early postoperative period.ConclusionThe AcrySof IQ Panoptix IOL provides functional uncorrected visual acuity at distance, intermediate and near positions. Our results remain equivalent with existing trifocal IOL outcomes and provide surgeons with a further IOL alternative for the patient motivated to obtain true spectacle independence. Surgeons should consider individual reading and working requirements when counselling patients preoperatively to optimise postoperative patient satisfaction.