Mean Uncorrected Distance Research Articles

Rotational stability of plate-haptic toric intraocular lenses in Asian eyes: risk period for intraocular lens rotation and its influencing factors.

To investigate the rotational stability of plate-haptic toric intraocular lenses (IOLs) during 3-month follow-up. Eye and ENT Hospital of Fudan University, Shanghai, China. Prospective observational study. Patients with cataracts implanted with AT TORBI 709M toric IOLs were enrolled and followed at 1 hour, 1 day, 3 days, 1 week, 2 weeks, 1 month, and 3 months postoperatively. A linear mixed model of repeated measures was applied to investigate the time course of absolute IOL rotation change. The 2-week overall IOL rotation was analyzed in the age, sex, axial length (AL), lens thickness (LT), preexisting astigmatism, and white-to-white subgroups. A total of 328 eyes of 258 patients were included. The rotation from the end of surgery to 1 hour and 1 day to 3 days was significantly smaller compared with the rotation from 1 hour to 1 day but more than that at other time intervals in the overall group. 2 weeks postoperatively, the mean uncorrected distance visual acuity and remaining positive cylinder were 0.19 ± 0.22 logMAR and 0.60 ± 0.44 diopters, respectively. Significant between-group differences in 2-week overall rotation were found in the age, AL, and LT subgroups. Maximum rotation occurred within 1 hour to 1 day postoperatively, and the first 3 days postoperatively was a high-risk period for the plate-haptic toric IOL rotation. Surgeons should make the patients aware of this.

Clinical Profile and Corneal Complications of Staphylococcal Blepharitis at the Philippine General Hospital

Objectives. Staphylococcal blepharitis is a common ocular condition that can cause significant visual morbidities due to corneal complications. This study described the clinical profile of patients with staphylococcal blepharitis seen in a tertiary referral eye center, and determined the frequency and the type of corneal complications, the possible reasons for the delay in diagnosis, and the management prior to the consult.Methods. This study was a single-center, five-year retrospective case series design. The charts of all patients from January 2016 to December 2021 with the diagnosis of staphylococcal blepharitis seen at the External Disease and Cornea Clinic of the Philippine General Hospital that have fulfilled the inclusion and exclusion criteria were included. The data extracted were age, sex, chief complaint, laterality, time of onset of symptoms to consult, previous consults, lid and lid margin findings, conjunctival and corneal findings, pre- and post-treatment uncorrected distance visual acuity, duration of follow-up, and treatments received.Results. Fifty-five (55) charts out of 107 charts with a diagnosis of staphylococcal blepharitis were included. Eighty percent (80%) or 44 patients had bilateral disease. Ninety-nine (99) eyes of 55 patients were analyzed. The median age of the study population was 19 years. Sixty-seven percent (67%) were female, and 33% were male. The mean duration of follow-up at the External Disease and Cornea Clinic was 10.8 ± 14.61 months. Corneal opacity, eye redness, and blurring of vision comprised 70% of the reasons for consult. The mean time from the onset of symptoms to consult was 18.36 ± 25.69 months. Sixty-seven percent (67%) had prior consults elsewhere and 45% came in with a different diagnosis. Seventy-eight (78) eyes had fibrin or crust on the lashes. Fifty percent (50%) of the eyes had concomitant conjunctivitis, while 30% had meibomitis. Fifty-eight percent (58%) of patients had corneal complications. Seventy-two percent (72%) of eyes had bilateral involvement. The median age of patients with corneal complications subgroup was 13 years. The most common corneal complications noted were neovascularization, phlyctenulosis, pannus formation, and marginal infiltrates or ulcers. Twenty-two percent (22%) of all study eyes had visually disabling corneal complications like corneal ulcer, descemetocele, corneal perforation, and corneal scar. Ninety percent (90%) of the patients received standard medical treatment and three patients underwent penetrating keratoplasty. The mean uncorrected distance visual acuity at initial consult of eyes with corneal complication was 20/55 (LogMAR 0.43 ± 0.51) and 20/35 (LogMAR 0.25 ± 0.40) after treatment (p = 0.032).Conclusion. Staphylococcal blepharitis was most prevalent among young female patients, and it affected both eyes. Almost all patients manifested the typical lid margin lesions. Nearly 60% of the patients presented with corneal complications and 22% had corneal lesions that were potentially blinding. Close to 50% had delay in treatment due to misdiagnosis.

Long-term results of laser in situ keratomileusis for myopia

Laser in situ keratomileusis (LASIK) is still the most popular refractive surgery in the world. The aim of the study is to assess the long term clinical outcomes of LASIK in treating patients with different types of myopia. Pre- and postoperative distance visual acuity, refractive spherical equivalent (SE) and clinical examinations of dry eye disease were recorded. Values obtained at baseline and controls were compared with each other. While preoperative mean uncorrected distance visual acuity (UDVA) of low and moderate myopic patients was 0.1±0.07 on Snellen eye chart, and it was 0.86 ±0.11 at the 6th month and 0.92 ±0.05 at the 3rd year. At the last control examination, the percertages of manifest refractive SE in the range of ±0.50D and ±1.00D were 78.3%, 88.3%, respectively. The mean UDVA of high myopic patients was 0.03 ±0.02 preoperatively, and it was 0.84 ±0.16 at the 6th month and 0.69 ±0.21 at the 3rd year. UDVA at 3 years was significantly decreased compared with 6 month postoperatively.(p=0.01) At the last control examination of this group, the percentages of manifest refractive SE in the range of ±0.50D and ±1.00D were 48.3%, 66.1 %, respectively. These also decreased from 6 month to 3 years postoperatively.The mean tear break-up time and schirmer-1 values, which decreased in the postoperative first year visits of the patients, were close to the preoperative values at the last control. There were no statistically significant difference between the preoperative and 3rd year comparisons.(all p>0.05) In conclusion, LASIK is an effective and safe procedure in patient with myopia, preoperative higher SE is a predictor of low postoperative efficacy.

Vogt striae: Demystified

BackgroundTo study the correlation of different variables of Vogt striae to other attributes of keratoconus and to suggest a new grading system for Vogt striae to exactly represent the configuration and extent in each individual keratoconic cornea. MethodsThe study was an observational and data review study. A total of 386 eyes of 207 keratoconus patients were screened from February 2016 to August 2018. Patients with prior history of collagen cross linking were excluded from the study as measurement of corneal thickness is less reliable for many months after collagen cross linking, and patients may have superficial corneal striae and scarring after collagen cross linking. Patients with history or clinical features suggestive of corneal hydrops or who had undergone lamellar or full thickness corneal transplants and intracorneal ring segments were also excluded from the study. ResultsOf total 52 eyes with Vogt striae, 31 eyes (59.6%) had vertical orientation, 3 (5.8%) had horizontal, 11 (21.2%) had oblique while 7 eyes (13.5%) had mixed orientation of Vogt striae. Mean uncorrected distance visual acuity (UCVA) in the vertical group was 0.76 logMAR, horizontal group was 0.80 logMAR, oblique group was 0.65 logMAR, and mixed group was 1.17 logMAR units. Corneal scarring was present in 15 eyes (28.8%) and absent in 37 (71.2%) eyes with Vogt striae. In the mixed Vogt striae group, 85.7% eyes (6 eyes of 7) had corneal scarring, while 16.1% in vertical group (5 eyes of 31), and 27.3% in oblique group (3 of 11) had corneal scarring. Based on three attributes of Vogt striae, that is orientation, number, and corneal scarring, a new grading for Vogt striae was also suggested. ConclusionThis is the first study to report the presence of mixed Vogt striae (combination of horizontal and/or vertical and/or oblique Vogt striae in a single cornea) in cases of keratoconus. For the first time, oblique Vogt striae have been described, and clear limits have been set to call it horizontal, oblique, or vertical striae. A new grading for Vogt striae is also suggested.

Preliminary results obtained by a new intraocular lens based on accommodative technology for the treatment of cataract and presbyopia

AbstractPurpose: The aim of this study was to report the clinical results obtained by a new accommodative intraocular lens (AIOL) in terms of visual acuity, refraction, defocus curve, contrast sensitivity and complications incidence for multiple follow‐up phases.Methods: This is a prospective and experimental study composed by patients interested in an AIOL implantation (Lumina, Akkolens) to improve their visual performance. An exhaustive postoperative follow‐up (1 week, 1 month, 3 months, 6 months, 1 year) was performed including the measurements of visual acuity for multiple distances in decimal notation, subjective refraction, accommodative evaluation by defocus curve, contrast sensitivity and a slit lamp and fundus exploration.Results: The study included 42 eyes of 21 patients (mean age of 61.4 ± 10.9 years; 52% females, 48% males). The mean uncorrected distance visual acuity at week was 0.71 ± 0.28, but it improved to 0.85 ± 0.27 a year after the surgery. Similarly, the mean uncorrected near visual acuity improved for 0.48 ± 0.23 at 1 week to 0.60 ± 0.17 at 1 year. The mean equivalent sphere was −0.39 ± 0.60 diopters and the mean corrected distance visual acuity was 1.04 ± 0.16 at 1 year. For a defocus range comprised between 0.00 and −2.00 diopters the mean visual acuity was better than 0.50. The contrast sensitivity assessment showed values higher than 1.10 log units for all frequencies. Capsule opacification with YAG laser requirement was present in 21% of cases (N = 9). At the end of the follow‐up all minimal complications were resolved.Conclusions: The AIOL Lumina Akkolens provided suitable distance vision and functional near vision improving its performance over time. Contrast sensitivity was good being comparable with a monofocal design, but the Lumina IOL shows better near visual performance as revealed in the defocus curve. Significant persistent complications were not observed. These results will be updated with more patients and will be compared with a control group.

Three-Year Results of Simultaneous Transepithelial Phototherapeutic Keratectomy and Conventional Photorefractive Keratectomy (Cretan Protocol Plus) Followed by Corneal Crosslinking for Keratoconus.

The aim of this study was to present the 3-year outcomes after simultaneous transepithelial phototherapeutic keratectomy (t-PTK) and conventional photorefractive keratectomy (PRK) followed by corneal crosslinking (CXL) for keratoconus. In this prospective, interventional case series, patients with progressive keratoconus underwent simultaneous t-PTK and conventional PRK followed by CXL (Cretan protocol plus). Visual, refractive, and topographic outcomes were evaluated along with endothelial cell density (ECD) preoperatively and at 1, 2, and 3 years postoperatively. Twenty-two patients (31 eyes) were enrolled. No intraoperative or postoperative complications were observed in any of the patients. Logarithm of the minimum angle of resolution (logMAR) mean uncorrected and mean corrected distance visual acuity improved from 0.81 ± 0.40 and 0.18 ± 0.21 preoperatively to 0.38 ± 0.33 ( P < 0.001) and 0.06 ± 0.12 ( P < 0.001) at 3-year follow-up. Mean spherical equivalent improved from -5.39 ± 3.89 diopters (D) preoperatively to -2.29 ± 2.65 D ( P < 0.001) at 3 years postoperatively. Mean corneal astigmatism reduced from -4.70 ± 2.86 D preoperatively to -3.55 ± 2.45 D ( P = 0.001) at 3 years postoperatively. No ECD alterations were observed throughout the 3-year follow-up ( P > 0.05). Simultaneous t-PTK and conventional PRK followed by CXL seems to be an effective and safe treatment for progressive keratoconus over 3-year follow-up.

Clinical outcomes of the immediate reapplication of small-incision lenticule extraction without adjusting the surgical parameters after suction loss

This study was to analyze the clinical outcomes of immediate reapplication of small-incision lenticule extraction (SMILE) without adjusting the surgical parameters after suction loss and to compare the outcomes with contralateral eyes that underwent uneventful SMILE. A total of 74 patients who underwent uneventful SMILE in one eye (Uneventful group) and immediate reapplication of SMILE without adjusting the surgical parameters after suction loss in the contralateral eye (Suction loss group) were included. Suction loss occurred during the posterior lenticule surface cut in 39 eyes (53%) and the cap cut in 35 eyes (47%). Surgical outcomes, including visual acuity, manifest refraction, keratometry, and corneal wavefront aberrations, were evaluated at 6 months postoperatively. The mean uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and spherical equivalent were − 0.02 ± 0.07, − 0.04 ± 0.04, and − 0.10 ± 0.46 diopters (D), respectively, in the Suction loss group and − 0.02 ± 0.07, − 0.04 ± 0.05, and − 0.19 ± 0.53 D, respectively (P = 0.965, 0.519, and 0.265, respectively), in the Uneventful group. Changes between the preoperative and 6-month postoperative total corneal aberrations, spherical aberrations, and horizontal and vertical coma did not significantly differ between the Suction loss and Uneventful groups. Immediate reapplication of SMILE without adjusting the surgical parameters after suction loss resulted in good surgical outcomes that were comparable with those of uneventful SMILE.

Refractive Corneal Lenticule Extraction With the CLEAR Femtosecond Laser Application.

The aim of this study was to evaluate a new femtosecond laser application for refractive corneal lenticule extraction with suction control and computerized regulation of centration and alignment (Ziemer CLEAR). This was a retrospective, consecutive, noncomparative case series study. Patients undergoing CLEAR for spherical equivalent (SE) between -3 and -10 D, evaluating SE, defocus equivalent, refractive astigmatism, visual acuity, and centration at 10 months were evaluated in the study. Fifty-three eyes of 42 patients (mean age 40.4 ± 8.6 years) were included, with preoperative SE -5.99 ± 1.49 D and mean corrected distance visual acuity (CDVA) of 0.05 ± 0.07 logMAR. With no suction losses, an intact lenticule was extracted in all eyes. In 6 eyes, peripheral adhesion was resolved by lenticulerrhexis, and in 1 eye, the incision was opened by a crescent blade. Moderate interface inflammation occurred in 3 eyes. At day 1, in the 42 eyes with uneventful surgery, the mean CDVA was 20/27, whereas in the 11 eyes with extra surgical manipulations, it was 20/36 ( P = 0.04). At 10 months, for the 53 eyes, the mean uncorrected distance visual acuity was 0.05 ± 0.09 logMAR; in 37 eyes (70%), it was 20/25 or better; and the mean CDVA was 0.04 ± 0.06 logMAR. Eight eyes (15%) lost 1 logMAR line. The mean SE was -0.13 ± 0.15 D. The mean defocus equivalent was 0.33 ± 0.32 D, with 46 eyes (87%) ≤0.50 D and 52 eyes (98%) ≤1 D. Refractive astigmatism was ≤0.50 D in 48 eyes (90%). The efficacy index was 1.00, and the safety index was 0.98. The mean decentration from the corneal vertex was 0.28 ± 0.07 mm. The application yielded good predictability, efficacy, and safety. Slower visual recovery was observed after extra surgical manipulations.

Description of three new species previously identified as Stolephorusbengalensis (Dutt & Babu Rao, 1959) or Stolephorusinsularis Hardenberg, 1933 and a re-description of S.bengalensis (Chordata, Osteichthyes, Clupeiformes, Engraulidae).

Examination of numerous specimens characterised by predorsal scute, long maxilla, indented preopercle and pelvic scute lacking a spine and previously identified as Stolephorusbengalensis (Dutt & Babu Rao, 1959) or Stolephorusinsularis Hardenberg, 1933, revealed four distinct species, true S.bengalensis (distributed from the Bay of Bengal to Pakistan) and three new species, viz., Stolephoruseldorado sp. nov. (Taiwan to Java, Indonesia), Stolephorusdiabolus sp. nov. (Strait of Malacca, from Penang , Malaysia, to Singapore) and Stolephoruseclipsis sp. nov. (Bintan Island, Riau Archipelago, Indonesia). Characters separating the four species include numbers of gill rakers on each gill arch and vertebrae and pelvic fin and dorsal-fin ray lengths. Two molecular markers (mitochondrial cytochrome b and cytochrome oxidase I genes) demonstrated the distinction of three of the species examined morphologically and enabled a reconstruction of their phylogenetic relationships. Each species was genetically divergent from the others by 3.5%-7.7% mean uncorrected distance in the mitochondrial cytochrome oxidase I gene.

Anterior Chamber Iris-Fixated Phakic Intraocular Lens Implantation for Treatment of High Anisometropia in Children: Long-term Results.

To evaluate the long-term efficacy of anterior chamber iris-fixated phakic intraocular lens (PIOL) implantation in the treatment of high myopic (> -9.00 diopters [D]) or hyperopic (> +6.00 D) anisometropia in children with intolerance to spectacles or contact lenses. A total of 58 children with anisometropic myopia (range: -9.25 to -18.50 diopters [D]) and 13 children with anisometropic hyperopia (range: +6.00 to +8.50 D) underwent unilateral iris-claw PIOL implantation from 2008 to 2018. The mean age was 6.7 years. The mean follow-up was 38.5 months. Target refraction was emmetropia. The cycloplegic refraction (mean spherical equivalent) improved from -12.47 D (range: -9.25 to -18.50 D) to -0.73 D (range: +0.75 to -1.50 D) in myopic eyes and reduced from +7.15 D (range: +6.00 to +8.50 D) to +0.94 D (range: -0.50 to + 1.75 D) in hyperopic eyes. Eighty-four percent of eyes were corrected to within ±1.00 D of emmetropia. The mean uncorrected distance visual acuity (UDVA) improved from 1.74 ± 0.36 to 0.45 ± 0.28 logarithm of the minimum angle of resolution (logMAR) (P = .0014). The mean corrected distance visual acuity (CDVA) changed from 0.68 ± 0.32 to 0.27 ± 0.15 logMAR (P = .02179). The safety index was 2.18 and the efficacy index was 1.51. The mean preoperative endothelial cell count of 2,874.7 cells/mm2 changed to 2,685.3 cells/mm2 at 2 to 6 years postoperatively. Binocular vision quality was improved in 55 patients. No patient had serious complications or lost any Snellen lines of CDVA. Iris-fixated PIOL implantation is an effective and safe method in the treatment of high anisome-tropic myopia and hyperopia and amblyopia in pediatric patients who are noncompliant with spectacles or contact lenses. [J Pediatr Ophthalmol Strabismus. 2023;60(3):203-209.].

Intrastromal corneal ring segments followed by PRK for postkeratoplasty high astigmatism: prospective study.

To evaluate refractive and topographic results of the association of intrastromal corneal ring segments (ICRS) with photorefractive keratectomy (PRK) for the correction of high (>6.0 diopters [D]) postkeratoplasty astigmatism (PKA). University of São Paulo, São Paulo, Brazil. Prospective interventional study. Postpenetrating keratoplasty patients, intolerant to contact lens fitting, and with corneal astigmatism higher than 6.0 D were treated by the combination of ICRS and PRK from January 2017 to June 2019. First, patients underwent femtosecond laser-assisted ICRS implantation to reduce and regularize corneal astigmatism, and 3 months later, submitted to PRK for the residual astigmatism. Outcomes were obtained 12 months after PRK. The study comprised 30 eyes of 29 patients. Mean uncorrected distance visual acuity (logMAR) changed from 1.16 ± 0.37 in the preoperative to 0.69 ± 0.40 after ICRS ( P < .0001) and to 0.34 ± 0.29 12 months after PRK ( P < .0001). Mean spherical equivalent decreased from -5.19 ± 4.81 D in the preoperative to -3.38 ± 4.51 D after ICRS ( P < .0001) and to -2.30 ± 2.84 D after PRK ( P = .132). Mean topographic astigmatism decreased from 7.88 ± 2.13 D in the preoperative to 5.47 ± 2.29 D after ICRS ( P < .0001) and to 4.12 ± 2.93 D after PRK ( P = .003). Mean refractive astigmatism decreased from 7.10 ± 1.13 D in the preoperative to 4.61 ± 1.61 D after ICRS ( P < .0001) and to 2.58 ± 1.49 D after PRK ( P < .0001). After PRK, the mean correction index (CI) for corneal astigmatism was 0.77 ± 0.36. The ICRS/PRK combination resulted in a higher CI than ICRS only, both for corneal and refractive astigmatism. 2 eyes (8%) presented clinically significant opacification. Other complications were endothelial rejection (n = 1, 4%), infectious keratitis (n = 1, 4%), and ICRS extrusion after corneal melting (n = 1, 4%). The association of ICRS and PRK was effective for treating high PKA. This strategy improved visual acuity, spherical equivalent, topographic and refractive astigmatism and resulted in a high CI. Safety questions remain open and must be balanced against benefits.

Transepithelial photorefractive keratectomy: a prospective randomized comparative study between the two-step and the single-step techniques

ObjectivesTo assess and compare the six-month outcome of the two-step transepithelial phototherapeutic keratectomy- photorefractive keratectomy (PTK-PRK) and the single-step transepithelial PRK for myopia and myopic astigmatism.MethodsA prospective randomized study. The study enrolled 100 eyes of 50 patients with mild to moderate myopia or myopic astigmatism stratified into two groups, PTK-PRK (n = 50 eyes) and single step PRK (n = 50 eyes). Primary outcome measures were visual acuity and manifest refraction. Secondary outcome measures were epithelial healing duration, post-PRK pain scores and 3-month postoperative haze grading.ResultsPreoperative characteristics were similar in both groups (p value > 0.05). The mean uncorrected distance visual acuity (UDVA) at 1 week, 1 month, 3 and 6 months was significantly better in the single-step PRK group than in the two-step PTK-PRK group (p < 0.001). The mean manifest sphere, cylinder and spherical equivalent showed a significant difference at all follow up visits in favour of the single-step PRK (p value < 0.001). Epithelial healing duration was faster in single-step PRK (p value < 0.001). Pain scores were significantly lower following single-step PRK at 8 h, 1 day, 3 days (p value < 0.001) but were similar at the 7th day. Haze scores showed no statistical difference between the two groups at 3-month follow-up.ConclusionThe two transepithelial PRK techniques were effective in correcting mild to moderate myopia and myopic astigmatism. However, Single-step transepithelial PRK achieved faster visual recovery, better refractive outcome and shorter epithelial healing time with less post-PRK pain.Clinical trials registry(Clinical Trials.gov Identifier): NCT04710082.

Femtosecond LASIK Retreatments After Primary Myopic Photorefractive Keratectomy.

The purpose of the study was to evaluate the results and complications of laser-assisted in situ keratomileusis (LASIK) using a femtosecond laser as a retreatment modality of myopia and myopic astigmatism after previous myopic photorefractive keratectomy (PRK). In this retrospective, consecutive, noncomparative case series study, 69 eyes of 41 patients receiving femtosecond LASIK after previous myopic PRK were evaluated. The mean age was 43.0 ± 8.9 years. The preoperative mean SE was -1.82 ± 1.01 diopter (D), range -0.62 to -6.25. The mean central epithelial thickness was 65 ± 5 μm. A flap was created using a low-energy femtosecond laser (Ziemer LDV Z8), with a programmed thickness calculated by adding 40 μm to the epithelial thickness. Refractive ablation was performed using a Technolas Teneo 317 laser (Bausch and Lomb). Twelve months after LASIK, the mean SE was -0.03 ± 0.17 D, with all eyes ≤0.50 D of SE. The mean DE was 0.30 ± 0.25, with 62 eyes (89.9%) ≤0.50 D and all eyes ≤1 D. The mean corrected distance visual acuity (CDVA) was 0.04 ± 0.10 logMAR; no eye lost more than 1 line of CDVA. The mean uncorrected distance visual acuity was 0.07 ± 0.13 logMAR, being 20/25 or better in all eyes. The safety index (postoperative CDVA/preoperative CDVA) was 1.05. The efficacy index (postoperative uncorrected distance visual acuity/preoperative CDVA) was 0.98. No significant complications occurred. Myopic retreatments by femtosecond LASIK after primary PRK yielded excellent refractive results without relevant complications. The flap thickness must be tailored to the epithelial thickening after PRK.

Femtosecond Laser-Assisted Cataract Surgery: A Report by the American Academy of Ophthalmology

To evaluate refractive outcomes, safety, and cost-effectiveness of femtosecond laser-assisted cataract surgery (FLACS) compared with phacoemulsification cataract surgery (PCS). A PubMed search of FLACS was conducted in August 2020. A total of 727 abstracts were reviewed and 33 were selected for full-text review. Twelve articles met inclusion criteria and were included in this assessment. The panel methodologist assigned a level of evidence rating of I to all 12 studies. No significant differences were found in mean uncorrected distance visual acuity, best-corrected distance visual acuity, or the percentage of eyes within ± 0.5 and ± 1 diopter of intended refractive target between FLACS and PCS. Intraoperative and postoperative complication rates were similar between the 2 groups, and most studies showed no difference in endothelial cell loss between FLACS and PCS at various time points between 1 and 6 months. In large randomized controlled studies in the United Kingdom and France, FLACS was less cost-effective than PCS. Both FLACS and PCS have similar excellent safety and refractive outcomes. At this time, one technique is not superior to the other, but economic analyses performed in some populations have shown that FLACS is less cost-effective.

Changes in visual outcomes and ocular morphometrics after foldable myopic and toric intraocular lens implantation: 5-year results.

To evaluate the refractive, visual, and morphometric changes after implantation with a foldable iris-fixated phakic intraocular lens (pIOL) to correct myopia or astigmatism. University Eye Clinic Maastricht, the Netherlands. Prospective case series. We evaluated patients implanted with the Artiflex Myopia Toric (Ophtec B.V.) iris-fixated pIOL as of January 2004. Measurements were performed annually and reported after 1 and 5 years. The study included 481 eyes (277 patients; age 39.8 ± 10.9 years [SD]). 5 years postoperatively, 91% of eyes were within ±1.0 diopter (D) of target, and the mean myopization over a 5-year period was 0.22 D (P < .001). The logMAR corrected distance visual acuity (CDVA) increased by a mean 0.015 (P = .015) over 5 years; 88% of eyes had a CDVA of 20/20 or better, and 5.5% lost 2 or more lines of CDVA. Mean uncorrected distance visual acuity (UDVA) increased by 0.045 logMAR over 5 years (P < .001); 96% reached an UDVA of 20/40 or more. Anterior chamber depth (ACD) decreased by 0.04 mm (P < .001), and axial length (AL) increased by 0.23 mm (P < .001) over 5 years. Chronic endothelial cell loss showed a 5-year decline of 320 cells/mm2 in the myopic and 310 cells/mm2 in the toric subgroups (P < .001). Cataract resulted in pIOL explantation in 4.0% of eyes (mean survival 59.0 ± 40.0 months); higher preoperative age (hazard ratio [HR], 1.13; P < .001) and smaller ACD (HR, 6.80; P = .035) were risk factors for shorter survival due to cataract formation. Over 5 years, logMAR CDVA and UDVA decreased significantly due to myopization caused by lenticular changes and AL elongation.

Ocular wavefront aberrations in acute central serous chorioretinopathy

Background: Central serous chorioretinopathy (CSCR) is a condition of choroidal and retinal pathologies that may affect vision, so we assessed vision by the ocular wavefront in the acute form of CSCR. Methods: This cross-sectional study included 21 cases (16-male, 5-female) of acute onset CSCR was referred to the retina clinic of Nikookari Eye Hospital. Visual acuity and ocular examination with and without pupillary dilation record. Central macular thickness and sub-foveal fluid height of all patients measured by spectral-domain optical coherence tomography (SD-OCT). All of them fulfilled binocular visual function analyzer by Tracy Technology after complete pupillary dilation. The items such as spherical equivalent, total root mean square, total lower-order aberration, total higher-order aberration, defocus, astigmatism, secondary astigmatism, coma, spherical aberration, trefoil, Strehl ratio in point spread function, the average height in the modulation transfer function, and root mean square error registered. Generalized Estimation Equations (GEE) were used to compare two groups of affected CSCR and normal contralateral eyes. Results: The mean uncorrected distance visual acuity in the CSCR eyes is (Decimal Notation) 0.82±0.17 and in the contralateral eyes is 0.95±0.09 (P=0.002). Analysis of macular OCT data CSCR group represents: central foveal thickness 485.9±165.12 μm and mean fluid height 284.3±165.42 μm. The mentioned optical parameters of ocular wavefront aberrations do not have significantly different results in the two groups. Conclusion: Our study showed CSCR reduced uncorrected visual acuity but it did not detect significant ocular wavefront changes in acute CSCR

Long-term Clinical Outcomes of Implantable Collamer Lens

Purpose: To evaluate the long-term clinical outcomes of implantable collamer lens (ICL) implantation in myopic patients.Methods: This retrospective study included 129 eyes of 68 patients who underwent ICL implantation for correction of myopia with a 10-year follow-up.Results: Ten years after ICL implantation, the mean uncorrected and corrected distance visual acuities (LogMAR) were 0.03 ± 0.13 and -0.07 ± 0.06, respectively. Ten years postoperatively, 52.7% and 84.5% of the eyes were within ± 0.5 and ± 1.0 diopters, respectively. The mean efficacy and safety indices were 0.91 ± 0.22 and 1.07 ± 0.19, respectively. There was no significant difference between mean preoperative (13.52 ± 2.88 mmHg) and postoperative (13.59 ± 3.55 mmHg) intraocular pressures. The endothelial cell density decreased from before surgery to 10 years after surgery (3,074 ± 365 cells/mm2, 2,812 ± 406 cells/mm2, respectively; mean decrease: 8.5 ± 10.8%; p = 0.011). Eight eyes (6.2%) developed cataract during follow-up, which was symptomatic in three eyes (2.3%) and treated with ICL explantation and phacoemulsification. Rhegmatogenous retinal detachment occurred in one eye (0.8%) and was treated with vitrectomy.Conclusions: ICL implantation for the correction of myopia had good efficacy and safety outcomes during long-term follow-up of 10 years. However, patients should be closely monitored for complications such as cataract formation, endothelial cell loss, and retinal detachment.

Plasma Rich in Growth Factors (PRGF) in Transepithelial Photorefractive Keratectomy (TPRK).

To evaluate the usage of plasma rich in growth factor (PRGF) in transepithelial photorefractive keratectomy (TPRK) in low and moderate myopia, patients who underwent myopic and astigmatism TPRK with PRGF were involved in this retrospective, observational study. Subjects underwent a surgical procedure between February 2019 and June 2019. A three-month follow-up was recorded. Pain score was assessed with a visual analogue scale (0–10) and re-epithelialization time recorded. A total of 48 eyes from 24 patients were recruited. Mean uncorrected distance visual acuity (UDVA) was 20/20.31 (0.00 ± 0.02 LogMAR). A total of 98% of eyes did not change corrected distance visual acuity (CDVA) lines. Two percent of eyes lost one line of CDVA. Preoperative spherical equivalent was −2.67 ± 1.37 D and after three months changed to −0.21 ± 0.34 D, and 2% of eyes changed 0.50 D or more between one and three months. Pain score was 3.29 ± 0.61 (3 to 6) score points at day one and 0.08 ± 0.27 score points at day seven. Finally, re-epithelialization time was 2.50 ± 1.20 days. PRGF addition to conventional refractive treatment such as TPRK seems to alleviate immediate postoperative pain and positively contribute to corneal re-epithelization time.

Long-Term Visual, Refractive and Topographic Outcomes of KeraRings Combined with Accelerated Transepithelial Crosslinking for Management of Different Grades of Progressive Keratoconus: A Retrospective Cohort Study

Purpose: To evaluate long-term visual, refractive, and topographic outcomes of KeraRings intrastromal implantation combined with accelerated transepithelial cross-linking for management of different stages of progressive keratoconus. Materials and Methods: This retrospective cohort study included 70 eyes of 70 patients with Amsler-Krumeich grades 1 to 4 keratoconus. They were divided into two groups: group-A included 37 eyes with grades 1-2 keratoconus, and group-B included 33 eyes with grades 3-4 keratoconus. Both groups underwent combined Keraring implantation with TCXL treatment. The main outcome measures included the preoperative and postoperative visual acuity, refraction, keratometry readings, and pachymetry. Results: At postoperative month 60, group-B exhibited significantly higher values of all mean uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), sphere/cylinder/spherical equivalent/defocus equivalent (DEQ), and K1/K2/Kaverages/Kmax parameters compared to that of group A. However, group-A exhibited better stability of postoperative improvements. Keratoconus progression (KCP) was greater in group-B (45.5%) than group-A (10.8%). Two eyes revealed segments' migration while one eye showed tunnel vascularization and opacification with segments' migration. Conclusion: The diagnostic criteria of preoperative-KCP are not adequate for the diagnosis of postoperative-KCP following ICRS implantation. UDVA and K average posterior seemed to be more sensitive parameters than K max in documenting early postoperative-KCP. We suggest that deterioration of UDVA≥0.10 log MAR and/or K average posterior ≥0.25 D are highly suspicious of post-ring implantation keratoconus progression (PR-KCP). The occurrence of two of the following parameters: Kmax≥0.50 D, Kaverageanterior≥0.50 D, K average posterior ≥0.25 D, or pachymetry≥1.5% thinning, is diagnostic of PR-KCP. The occurrence of two or more of the following parameters: Kmax≥0.50 D, Kaverageanterior≥0.50 D, Kaverageposterior ≥0.25 D, pachymetry≥ 1.5% thinning or UDVA≥0.10 logMAR, is diagnostic of PR-KCP. We also suggest that Kmax≥0.75 D alone is diagnostic of PR-KCP.

Objective and subjective evaluation of trifocal diffractive intraocular Lens after cataract extraction with phacoemulsification: a prospective clinical study

BackgroundThis study aimed to assess visual outcomes, quality of vision and patients’ satisfaction of a trifocal diffractive intraocular lens after cataract surgery with phacoemulsification.ResultsThe study included 36 eyes that underwent implantation of trifocal diffractive intraocular lens (IOL). The residual mean postoperative spherical equivalent was − 0.40 ± 0.29 diopters. Mean Uncorrected distance visual acuity was 0.80 ± 0.16 decimal (snellen equivalent 25 ft) while mean Uncorrected intermediate visual acuity was 0.82 ± 0.31 decimal (snellen equivalent 25 ft) and mean Uncorrected near visual acuity (UCNVA) was 0.87 ± 0.20 decimal (snellen equivalent 23 ft). In defocus curve, there was infinitesimal gradual change between the three foci. Contrast sensitivity was just below the inferior limit of normal.ConclusionTrifocal diffractive IOL created a true intermediate focus proved by VA and defocus curve and better quality of vision assessed by contrast sensitivity and high order aberration. Moreover, it was safe and effective for correcting distance and near vision in these patients. Most of the patients were very satisfied and achieved spectacle independence.Trial registrationRegistration number and date: NCT04465279 on July 10, 2020.