Mean Uncorrected Visual Acuity Research Articles

The effect of Belin-Ambrósio Deviation (BAD-D) Index on two-year refractive outcomes of Photorefractive Keratectomy (PRK).

To assess the effect of preoperative BAD-D index on two-year visual, refractive, and tomographic outcomes, as well as the efficacy and safety of PRK surgery. Eye clinic, Mashhad, Iran. Prospective cohort study. This study included 66 patients (66 eyes) who underwent PRK surgery, with a minimum follow-up period of 2 years. Participants were divided into two groups: preoperative BAD-D≥1.60 (high BAD-D) and preoperative BAD-D<1.60 (low BAD-D). Pre- and postoperative visual, refractive, and tomographic parameters were evaluated, and the efficacy and safety of the procedure were compared between groups. Sixty-six patients with a mean age of 35.50 years±8.21 (range 22 to 55 years) were included. Post-operatively, the mean spherical equivalent (SE) of refractive error was +0.32±0.65D in the high BAD-D group and +0.18±0.66D in the low BAD-D group (p=0.40). Also, at two years of follow-up, the mean uncorrected visual acuity was 0.98±0.07 in high BAD-D group and 0.97±0.08 in low BAD-D group (p=0.905). Among the postoperative tomographic parameters, front elevation thickness (F.EIe.Th), maximum Ambrósio relational thickness (ARTmax), astigmatism, and central corneal thickness were significantly different between the two groups (all, p< 0.05). At the two-year follow-up, the mean safety Index was 1.02±0.04, and 1.01±0.04 in high and low BAD-D groups respectively (p=0.37) and the mean efficacy Index was 0.99±0.07 and 0.98±0.06 in high and low BAD-D groups respectively (p=0.40). The preoperative BAD-D index does not predict postoperative visual, refractive, and tomographic outcomes in patients with low-to-moderate myopia. However, in patients with normal preoperative BAD-D values, higher agreement was expected between the attempted and achieved SE.

Corrélation entre la réfraction et la longueur axiale du sujet Albinos

To investigate the relationship between refraction and ocular axial length in albinos. A cross-sectional, analytical study was carried out from June to November 2021 at the Central Hospital of Yaounde (Cameroon), which included consenting albino subjects aged over 15years. All subjects underwent visual acuity testing, axial length measurements and objective refraction under cycloplegia. We included 51 albino subjects. The mean age was 26.06±9.47years, and the sex ratio was 0.5. Type 2 oculocutaneous albinism (OCA2) was predominant, representing 82.4% of cases. The mean uncorrected visual acuity was 0.93±0.25 logMAR, and the most common ametropia was myopic astigmatism (52.9%). The mean axial length was 24.65±2.54mm with extremes of 21.54 and 30.33mm. Eyes with myopia and myopic astigmatism had significantly longer axial lengths than those with hyperopic and mixed astigmatism. A strong, significant negative correlation (r=-0.93; P˂0.001) between the spherical component of the refraction and axial length was found. The spherical component of the refraction decreases significantly with increasing axial length in albinos.

Clinical Outcomes of A New Hydrophobic Trifocal Intraocular Lens with Hydroxyethyl Methacrylate in Cataract Surgery: A Prospective Multicenter Study.

To investigate the clinical outcomes of new hydrophobic trifocal intraocular lens (IOL) with hydroxyethyl methacrylate (HEMA) in the Korean population. This prospective, multicenter, and observational study evaluated the clinical outcomes of eighty eyes of 40 patients with age-related cataract underwent cataract surgery using CNWT (Clareon PanOptix). Assessment included monocular and binocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA at 60cm), near visual acuity (UNVA at 40cm and 33cm), uncorrected defocus curves, questionnaires evaluating photic phenomena, spectacle independence and spectacle free satisfaction. At 3-month postoperatively, mean uncorrected binocular visual acuities were 0.04, 0.04, 0.03 logMAR at far, intermediate, and near distances respectively. All patients achieved uncorrected binocular VAs of 0.2 logMAR or better. Monocular and binocular defocus curve indicated a mean VA of 0.2 logMAR or better at the defocus range of +1.0 D to - 3.0D (100 cm to 33 cm) and +1.0 D to - 3.5 D (100 cm to 28 cm). High spectacle independence was observed at all distances, with 37.5% patients reporting photic phenomena. The Clareon PanOptix IOL has shown positive clinical outcomes, providing a viable option for cataract surgery. These lenses effectively address patients' visual needs, especially in intermediate and near distance tasks, reducing dependence on glasses.

Implantation of Hydrophobic Acrylic Toric Intraocular Lens with High-Water Contents Using Swept-Source Optical Coherence Tomography Biometer Integrated with a Surgical Guiding System.

To evaluate postoperative outcomes after implantation of toric intraocular lenses (IOLs) made of high-water-content hydrophobic acrylic material in Japanese patients using a swept-source optical coherence tomography (SS-OCT) biometer integrated with a surgical guiding system. In this prospective observational study, toric IOL models CNW0T3 to CNW0T9 (Alcon) were implanted in 33 eyes of 33 patients and followed-up for one month. Powers and toric models were determined using an SS-OCT biometer ARGOS® Ver 1.5 (Alcon), and the IOLs were aligned using surgical guidance. Differences between planned and actual axis positions at the end of the surgery (misalignment) and rotations from the end of surgery to one month postoperatively were measured. Additionally, postoperative uncorrected visual acuity, refraction, and residual astigmatism were evaluated. Mean and median misalignments were 2.3° (standard deviation [SD]: 1.6, 95% confidence interval [CI]: 1.7-2.9) and 2°, and those of postoperative rotation were 2.4° (SD: 2.6, 95% CI: 1.5-3.4) and 2°, respectively. Mean postoperative refraction was 0.06 D (SD: 0.62). Prediction errors within ±0.5 and ±1.0 D were 69.7% and 93.9%, respectively. Mean residual astigmatisms were 0.19 D (SD: 0.41), and mean uncorrected visual acuity was 0.00 logMAR (SD: 0.11), and 64% of the eyes scored 20/20 or better. Implantation of high-water-content hydrophobic acrylic toric IOLs using SS-OCT biometry integrated with a surgical guiding system effectively corrected corneal astigmatism with accurate IOL alignment in Japanese patients.

Real-World Clinical Results with the Hoya Vivinex Impress Intraocular Lens with Enhanced Depth of Focus.

In cataract surgery, intraocular lenses (IOLs) with enhanced depth of focus are an option to correct presbyopia. The purpose of this quality assurance analysis was to evaluate visual acuity and patient satisfaction after implantation of the Hoya Vivinex Impress IOL. The Hoya Vivinex Impress IOL was implanted in patients undergoing cataract surgery at the Pallas Klinik, Olten, Switzerland. Five weeks postoperatively, a clinical examination and a survey on patient satisfaction were conducted. A total of 17 eyes (9 patients; mean age 64 years) underwent cataract surgery with implantation of a Hoya Vivinex Impress IOL. Five weeks postoperatively, mean uncorrected distance visual acuity (UDVA) was 0.2 logMAR, uncorrected intermediate visual acuity (UIVA) was 0.0 logMAR, and uncorrected near visual acuity (UNVA) was 0.2 logMAR. The mean distance-corrected visual acuity results were 0.0 logMAR, 0.1 logMAR, and 0.3 logMAR, respectively. Reading the newspaper without glasses was possible for 33.4% of patients. Visual disturbances such as halos and glares were not reported. Cataract surgery with Hoya Vivinex Impress IOL implantation revealed good distance and intermediate vision and, in some patients, functional near vision as well as a high patient satisfaction.

Visual And Refractive Outcomes of Myopia Astigmatism After Small Incision Lenticule Extraction (ReLEx SMILE) Procedures; Retrospective Study

Abstract&#x0D; Introduction &amp; Objectives : Small Incision Lenticule Extraction (ReLEx SMILE) is becoming more popular as a flapless and minimally invasive form of laser vision correction for the treatment of myopia and myopia astigmatism. This study aimed to assess postoperative visual and refractive outcomes of SMILE- based correction of myopia astigmatism, to evaluate the efficacy, predictability, safety, and stabilityof this procedure over a one-month postoperative period&#x0D; Methods : This retrospective study evaluated 200 eyes of 100 patients who underwent ReLEX SMILE technique, using the Zeiss VisuMax Laser between July 2020 and October 2022. Before surgery, 1 day and 1 month after surgery, the efficacy, predictability, safety, and stability of the procedure were assessed.&#x0D; Results : The preoperative Mean Uncorrected Distance Visual Acuity (UCVA) was 1.55 ± 0.53. Corrected Distance Visual Acuity (BCVA) was 20/20 or better in 74.50% and 90% of eyes in 1 day and 1 month after surgery, respectively. MRSE reduced from -5.22 ± 2.44 to -0.22 ± 0.54 at 1 day post-operative, and -0.19 ± 0.51 at 1 month. 75% of eyes had an unchanged BCVA between 1 day and 1 month after surgery. 72% of eyes achieved spherical equivalent within ±0.5 D and 94% of eyes were within ±1.0 1 month after surgery. The intraoperative complication was suction loss in two patients.&#x0D; Conclusion : SMILE can be considered an effective and safe refractive surgery for the treatment of myopia astigmatism.

Refractive Errors Among Members of the Armed Forces of the Czech Republic.

Objective: To evaluate the prevalence of refractive errors among members of the Armed Forces of the Czech Republic, to recommend a safe way of correcting refractive errors with regard to the specific needs of military personnel (especially members of combat units and flying personnel), and to propose a system for solving these errors in order to increase combat effectivity. Methodology: Questionnaire to determine previous refractive surgery and spectacle correction wear. Measurement of refraction with a hand-held autorefractometer and evaluation of current visual acuity on ETDRS optotypes (Landolt rings). Results: 259 servicemen (518 eyes) were investigated. The return rate of the questionnaires was 100%. The incidence of myopia greater than -0.75D was 22% (113 eyes), myopia greater than -0.5D 32% (166 eyes). The mean value of myopia was -0.78 D (SD ±0.6). Hypermetropia values ranged from +0.25 to +5.0 D. The mean value of hypermetropia was 0.63 D (SD ±0.7). Astigmatism values ranged from -0.25 to -3.75. The mean value of astigmatism was -0.55 Dcyl (SD ±0.49). The average visual acuity was 84.1 letters ETDRS SD (±6.1), visual acuity worse than 80 letters was manifested by 23% of the members of the monitored group. 25 people (10%) had undergone laser refractive surgery. Visual acuity after laser refractive surgery was measured in 19 people (38 eyes). Mean uncorrected post-laser visual acuity was 83.87 (SD ±6.1) ETDRS letters. The mean follow-up period after laser refractive surgery was 6.78 (SD ±4.8) years. Conclusion: Despite the initial selection of military personnel and entry limitations, the prevalence of refractive errors is comparable to the general population. However, in contrast with the general population, refractive errors larger than -3.0 D were not represented in the group. Due to the finding of insufficient correction of refractive errors, increased emphasis should be placed on identifying and regularly observing military personnel with refractive errors

Outcomes of 320-degree intrastromal corneal ring segment implantation for advanced keratoconus.

The purpose of this study is to investigate visual and tomographic outcomes and complications of long-arc length intrastromal corneal ring segment (ICRS) implantation for the treatment of advanced keratoconus. This retrospective study enrolled 10 eyes of 9 subjects. All patients received 320-degree ICRS (320-ICRS) implantation with femtosecond laser-assisted technique based on their advanced grading with preoperative high keratometry (K) value, asphericity (Q), and astigmatism. Medical records and corneal tomography changes of consecutive patients were reviewed at baseline, 1, and 3 months after treatment. There are 6 female and 3 male patients with a mean age of 29.6 ± 7.8 years in this study. Mean K (Km) reduced from 59.01 ± 5.81 D preoperatively to 50.7 ± 5.3 and 50.2 ± 3.66 postoperatively (after 1 month and 3 months respectively, P < 0.001). The changes in mean K, K1, K2, and maximum K (Kmax) reading were all statistically significant (all P < 0.001). Mean uncorrected distance visual acuity (UCVA) improved from 20/400 to 20/200. Mean best-corrected distance visual acuity (BCVA) improved from 20/100 to 20/60. Both UCVA and BCVA showed a trend of improvement at postoperative month 3, though insignificant in BCVA (P = 0.114). Mean Q improved from -1.59 ± 0.62 preoperatively to -0.48 ± 1.08 and -0.11 ± 1.04 postoperatively (after 1 month and 3 months respectively, P = 0.016, 0.002). No intraoperative or postoperative complications were observed. The present results suggest that implanting a 320-ICRS is a safe and effective procedure for treating patients with advanced keratoconus. Preoperative corneal measurements and the selection of types and thickness of ICRS are important to prevent unpredictable results.

Outcomes of the Q value-based nomogram in managing pediatric versus adult keratoconus: a prospective interventional study.

Keratoconus (KCN) is an ectatic disorder of the cornea characterized by stromal weakness and apical protrusion of the cornea, and is associated with a gradual and painless reduction in visual acuity. KCN in pediatric patients has certain important characteristics, such as a progressive and aggressive nature. We aimed to analyze the visual, refractive, and topographic outcomes of implanting a single 210° arc-length Keraring segment according to a novel, objective, Q value-based nomogram (Q-N) for the treatment of pediatric versus adult KCN. This prospective, multicenter, non-randomized, open-label trial included 47 eyes of 47 patients who were allocated to one of two groups. The adult group included 33 eyes of patients ≥ 18 years of age, whereas the pediatric group included 14 eyes of patients aged 14 - 17 years. All patients underwent femtosecond laser-assisted implantation of a single 210° arc-length Keraring segment according to the Q-N and were followed up for 6 months. All eyes underwent visual acuity measurement, cycloplegic refraction, and corneal topography at baseline and 6 months after surgery. The study groups were comparable in terms of sex proportions and KCN grades (both P > 0.05). The adult group exhibited significant postoperative improvements in mean uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), sphere, cylinder, spherical equivalent (SE), and Kmax (all P < 0.001) with a mean change of -0.56 logarithm of the minimal angle of resolution (logMAR), - 0.40 logMAR, 3.07 diopters (D), 0.70 D, 3.42 D, and - 5.26 D, respectively. The pediatric group exhibited significant postoperative improvements in mean UDVA, CDVA, sphere, SE, and Kmax (all P < 0.05) with a mean change of - 0.62 logMAR, - 0.34 logMAR, 3.18 D, 3.67 D, and - 5.37 D, respectively. There were no significant differences between the groups in terms of the mean change in visual, refractive, and topographic variables (all P > 0.05). No postoperative complications were observed in either group. Use of the objective Q-N was efficient in the treatment of pediatric KCN, with postoperative improvements in the mean visual, refractive, and topographic parameters, comparable to outcomes in adult keratoconus. Q-N achieved good corneal remodeling with subsequent improvements in visual, refractive, and topographic outcomes in both adult and pediatric patients with keratoconus. To verify our preliminary findings, we recommend further multicenter randomized clinical trials using the Q-N nomogram in a larger sample of pediatric patients with KCN as an adjunct treatment before or after CXL.

Soczewka wewnątrzgałkowa o wydłużonej głębi ostrości AcrySof&lt;sup&gt;®&lt;/sup&gt; IQ Vivity&lt;sup&gt;®&lt;/sup&gt; – doświadczenia własne

PurposeTo present preliminary results of distance, intermediate and near visual acuity, objective and manifest refraction in two groups of patients: targeted on emmetropia and targeted on small myopia after cataract surgery with an implantation of Extended Depth-of-Focus AcrySof&lt;sup&gt;®&lt;/sup&gt; IQ Vivity&lt;sup&gt;®&lt;/sup&gt; DFT015 (Alcon Inc., Fort Worth, TX, USA) intraocular lens in three months follow-up.Material and MethodsA total of 18 eyes of 15 patients underwent 2.4 mm coaxial cataract surgery with an implantation of AcrySof&lt;sup&gt;®&lt;/sup&gt; IQ Vivity&lt;sup&gt;®&lt;/sup&gt; DFT015 intraocular lens (Alcon Inc., Fort Worth, TX, USA). Before surgery best-corrected distance visual acuity, objective and manifest refraction and corneal keratometry were evaluated. Three months after the surgery uncorrected and best-corrected distance visual acuity, uncorrected intermediate visual acuity uncorrected and best-corrected near visual acuity, objective and manifest refraction and corneal keratometry were analyzed in both groups.ResultsThree months after the surgery in the emmetropic group refractive outcomes were: mean uncorrected distance visual acuity 0.04 ± 0.05, mean best-corrected visual acuity 0.01 ± 0.04, mean uncorrected intermediate visual acuity 0,01 ± 0,03, mean uncorrected near visual acuity 0.15 ± 0.09 and mean best-corrected near visual acuity 0.00 ± 0. In the mini monovision group: mean uncorrected distance visual acuity was 0.13 ± 0.11, mean best corrected visual acuity 0.01 ± 0.02, mean uncorrected intermediate visual acuity 0.00 ± 0, mean uncorrected near visual acuity 0.09 ± 0.13 and mean best-corrected near visual acuity 0.00 ± 0. There was no significant change in corneal keratometry in flat and steep meridian (&lt;i&gt;p&lt;/i&gt; = 0.59 and &lt;i&gt;p&lt;/i&gt; = 0.4) in whole group. There were no intra- and post-operative complications in any of the patients.ConclusionsAcrySof&lt;sup&gt;®&lt;/sup&gt; IQ Vivity&lt;sup&gt;®&lt;/sup&gt; DFT015 (Alcon Inc., Fort Worth, TX, USA) provided good distance and intermediate visual acuity with the functional near. It is well tolerated with poor impact of post-operative optical phenomena. Significant gains in binocular near vision can be achieved by leaving the nondominant eye of patients with 0.50 D to 1.00 D of myopia.

Effect of astigmatism on visual outcomes after multifocal intraocular lens implantation: a systematic review and meta-analysis

PurposeTo investigate the effects of postoperative astigmatism on the visual outcomes following presbyopia-correcting surgery with multifocal intraocular lens implantation.MethodsA comprehensive literature search was conducted using PubMed, Embase, and Web of Science for articles published until January 2023. Additionally, we included retrospective case series and prospective comparative studies. The combined mean difference (MD) with 95% confidence intervals (CI) and odds ratio (OR) with 95% CI were used to express continuous and categorical outcomes, respectively. All statistical analyses were performed using Review Manager (version 5.4.1).ResultsWe included nine eligible studies that analyzed 3,088 eyes. The proportion of eyes with useful postoperative visual acuity (logMAR ≤ 0.20) and residual astigmatism significantly differed with respect to the magnitude of astigmatism and presence/absence of blurred vision (p &amp;lt; 0.001 for both). Additionally, the mean uncorrected distance visual acuity (MD, 0.14; 95% CI, 0.06 to 0.21; p = 0.0003) and uncorrected intermediate visual acuity (MD, 0.07; 95% CI, 0.00 to 0.13; p = 0.04), but not the uncorrected near visual acuity (MD, 0.02; 95%CI-0.01 to 0.05; p = 0.17), significantly differed according to the magnitude of astigmatism.ConclusionAstigmatism, even at low levels (≥ 0.5D), has a significant effect on visual outcomes, especially on UDVA and UIVA, following multifocal intraocular lens implantation. Accurate preoperative and postoperative evaluation of astigmatism is important.

Customized corneal allogenic intrastromal ring segments (CAIRS) for keratoconus with decentered asymmetric cone.

Corneal allogenic intrastromal ring segments (CAIRS) refer to the intracorneal placement of fresh, unprocessed, processed, preserved, or packaged allogenic rings/segments of any type/length. We described uniform-thickness CAIRS previously. We now describe a new technique of customized CAIRS to personalize the flattening effect as per individual topography. A prospective interventional case series of patients with pericentral/ paracentral decentered cones and gradation of keratometry with one side steeper than the other was conducted. Individually customized tapered CAIRS with variable volume, arc length, taper length, and gradient of taper were implanted. In total, 32 eyes of 29 patients with at least 1-year follow-up were included. Special double-bladed trephines and a CAIRS customizer template allowed the creation of individually customized CAIRS. Mean uncorrected distance visual acuity (UDVA) and spectacle-corrected distance visual acuity improved from 0.22 to 0.47 (P = 0.000) and from 0.76 to 0.89 (P = 0.001), respectively. Significant improvement was seen in K1, K2, Km, Kmax, topographic astigmatism, Q-value, sphere, cylinder, spherical equivalent, Root Mean Square (RMS), Higher Order Aberrations (HOA), and vertical coma (P < 0.01, 0.05). There was no significant change in the width or height of CAIRS between 1 month and last visit on anterior-segment optical coherence tomography. Five eyes continued to remain at the same UDVA, 27 eyes had at least 2 lines, and 13 eyes had at least 3 or more lines improvement in UDVA. The maximum improvement in UDVA was 7 lines. A significant difference in flattening was obtained at different zones across the tapered CAIRS. Thus, differential flattening was achieved across the cone based on the customization plan. Personalized customization was possible for each cornea, unlike limited models of progressive-thickness synthetic segments. Allogenic nature, greater customizability, efficacy, and absent need for large inventories are advantages compared to synthetic segments.

Quality of life and vision assessment with scleral lenses in keratoconus.

The purpose of the study is to evaluate the visual outcomes and improvement in quality of life (QOL) of patients with keratoconus with scleral lenses. In this prospective study, 14 patients (28 eyes) with bilateral keratoconus were fitted with scleral lenses (McAsfeer 16.00 mm) in Pune city, Maharashtra, India. Uncorrected visual acuity (VA), best spectacle-corrected VA, and VA with scleral lenses were evaluated. The patients were given the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) for judging the QOL, before and after using scleral lenses for 3 months. The mean uncorrected VA of the 14 patients with a mean age of 28.64 ± 6.57 years was 1.18 ± 0.19 logMAR. Best spectacle-corrected high-contrast VA improved from 0.47 ± 0.25 logMAR to 0.03 ± 0.07 logMAR with scleral lenses (P < 0.001). Best spectacle-corrected low-contrast VA improved from 0.68 ± 0.22 logMAR to 00.47 ± 0.10 logMAR with scleral lenses (P < 0.001). Along with the increase in overall median scores on the NEI VFQ-25 from 1735 to 2930 points (P < 0.001), the distance and near activities (P < 0.001), vision-specific mental health (P < 0.002), social functioning (P < 0.004), and driving (P < 0.005) improved after using scleral lenses for 3 months. Scleral lenses can be an effective and safe management option for patients with keratoconus leading to an improved vision and QOL.

Therapeutic effect of a new implantation method of rotationally asymmetric multifocal intraocular lenses on visual quality.

To assess the visual quality after implantation of a rotationally asymmetric multifocal intraocular lens (IOL) using a new method according to the angle kappa. Qingdao Eye Hospital, Qingdao, China. Prospective case series. Patients with the implantation of SBL-3 IOLs for age-related cataract from September to December 2019 had the distance-horizontal zone of the IOL placed at the center of the optic axis using the Callisto Eye System. Postoperative visual acuities and defocus curves were recorded. Modulation transfer function cutoff frequency, Strehl ratio, and objective scatter index were measured using the Optical Quality Analysis System. The decentration and tilt of IOLs were analyzed by iTrace aberrometry and anterior segment optical coherence tomography. A questionnaire of patient satisfaction was also collected. Thirty patients (60 eyes) were involved, with a balanced sex ratio. Their average age was 56.04 ± 10.83 years. The average angle kappa distance was 0.23 ± 0.121 mm. At 3 months after surgery, the mean uncorrected and corrected distance visual acuities were 0.01 ± 0.07 logMAR and 0.01 ± 0.06 logMAR. The uncorrected intermediate and near visual acuities were 0.09 ± 0.11 logMAR and 0.09 ± 0.11 logMAR. The mean horizontal and vertical tilts of IOLs were 0.67 ± 0.52 degrees and 0.47 ± 0.32 degrees. The mean decentration of IOLs was 0.17 ± 0.08 mm. Most patients were satisfied with their distance, intermediate, and near vision. There was mild glare in 58.3% of the eyes. Locating the center of the optic axis in the distance-horizontal zone during the implantation of SBL-3 IOLs could provide satisfactory visual acuity and quality.

Medium-term visual and refractive outcomes in patients with pseudoexfoliation implanted with a toric or multifocal intraocular lens.

To report medium-term visual acuity and refractive outcomes of patients with pseudoexfoliation implanted with toric or multifocal intraocular lenses (IOLs). We retrospectively reviewed patients with pseudoexfoliation who had undergone phacoemulsification between 2016 and 2020 with at least 24 months follow-up. Mean follow-up was 44.17 ± 14.95 months. Toric IOLs were implanted in 48 eyes: mean uncorrected LogMAR visual acuity one month after surgery was 0.03 ± 0.09, decreasing to 0.08 ± 0.11 at the last visit (p = .01). Mean refractive cylinder was -0.12 ± 0.36 diopters one month after surgery and -0.25 ± 0.44 diopters at the last follow-up visit, p = .012. Multifocal IOLs were implanted in 42 patients: binocular uncorrected distance visual acuity was -0.02 ± 0.04 one month after surgery and 0.01 ± 0.05 at the last visit (p = .004); near acuity was 0.01 ± 0.03 and 0.04 ± 0.06 respectively (p = .001). In eyes with pseudoexfoliation, absolute spherical equivalent prediction error was 0.22 ± 0.20 diopters for toric and 0.21 ± 0.19 diopters for multifocal IOLs. One month after surgery 68.6% of eyes with toric IOLs and 74.2% of eyes with multifocal IOLs were within ±0.25 diopters of target spherical equivalent and 91.6% and 90.5% were within ±0.5 diopters, respectively. Spherical equivalent did not change significantly during follow-up for either group. Prediction error in eyes with pseudoexfoliation implanted with toric or multifocal IOLs was low and similar to values reported for normal eyes. Postoperative refractive cylinder with toric IOLs was low, with little change during follow-up. Visual function in patients receiving multifocal IOLs was excellent. Therefore, the implantation of these IOLs in eyes with pseudoexfoliation does not seem to cause medium-term problems.

Evaluation of long-term clinical outcomes after Toric Implantable Collamer Lens implantation.

To evaluate the long-term (8-10 years) outcomes of Toric Implantable Collamer Lens (TICL) surgery. Nagoya Eye Clinic, Nagoya, Aichi, Japan. Retrospective observational study. We enrolled patients who underwent TICL surgery from 2005-2009 to correct myopia and myopic astigmatism. The safety, efficacy, predictability, astigmatism correction efficacy, and complications were evaluated using preoperative, 1-year postoperative, and final examination data. We included 133 eyes of 77 patients. At the final visit, the mean uncorrected and corrected visual acuity were -0.01±0.2 and -0.17±0.05, respectively. The mean safety and efficacy indices were 0.91±0.26 and 0.68±0.21, respectively. The manifest astigmatism was -0.45±0.43 D. The mean corneal astigmatism change from 1 year post-surgery to the final visit was 0.40±0.26 D. Of the 38 eyes with a change in corneal astigmatism ≥0.5 D, 30 eyes (78.9%) changed to against-the-rule (ATR) astigmatism, one (2.6%) changed to oblique astigmatism, and seven changed (18.4%) to with-the-rule (WTR) astigmatism. The mean manifest astigmatism change from 1 year post-surgery to the final visit was 0.43±0.52 D. Of the 60 eyes with a change in manifest astigmatism ≥0.5 D, 25 (41.7%) changed to ATR astigmatism, 18 (30.0%) changed to oblique astigmatism, and 17 (28.3%) changed to WTR astigmatism. During follow-up, eight of 133 eyes (6.0%) developed anterior subcapsular cataracts, among which four (3.0%) underwent TICL removal and phacoemulsification and aspiration. No vision-threatening complications occurred. TICL surgery showed good long-term astigmatism-correcting effects, although the long-term uncorrected visual acuity decreased. The procedure was effective in correcting myopia and astigmatism.

Outcomes of peripheral corneal relaxing incisions for residual astigmatism in patients after cataract surgery.

To evaluate the outcomes of peripheral corneal relaxing incisions (PCRIs) for correcting residual astigmatism in eyes after cataract surgery. Cullen Eye Institute, Baylor College of Medicine, Houston, Texas. Retrospective case series. Retrospectively, we reviewed all consecutive cases that had previous cataract surgery and subsequent PCRIs by 1 surgeon. The PCRI length was determined according to a nomogram based on age and manifest refractive astigmatism. Visual acuity and manifest refractive astigmatism before and after the PCRIs were compared. Vector analysis was performed, and net refractive changes along the incision meridian were calculated. Criteria were met by 111 eyes. After the PCRIs, mean uncorrected visual acuity was significantly improved, and the percentage of eyes with uncorrected distance visual acuity of ≥20/20 increased significantly by 36%; the mean refractive astigmatism magnitude decreased significantly, and the percentages of eyes with refractive cylinder of ≤0.25 diopters (D) and ≤0.50 D increased significantly by 63% and 75%, respectively (all P < .05). The vector magnitude difference between pre- and post-operative refractive astigmatism was 0.88 ± 0.38 D. The postoperative refractive astigmatism had significantly smaller centroid and variance values than the preoperative refractive astigmatism ( P < .05). PCRIs are an effective approach for correcting low amounts of residual astigmatism in patients after cataract surgery.

Baseline Characteristics of 1976 Patients With Ectatic Corneal Disorders at a Single Center From 2010 to 2021: A Cross-Sectional Study of the Homburg Keratoconus Center.

The study objective was to analyze the baseline characteristics of keratoconus (KC) patients at the Homburg Keratoconus Center from 2010 to 2021. This cross-sectional study included 3,674 eyes, with analysis of demographics, clinical findings, visual function, endothelial measurements, and topographic, tomographic, and corneal biomechanical data from the first visit. Mean patient age was 36.3±13.8 years. The mean uncorrected distance visual acuity in log of minimal angle of resolution was 0.60 (20/80, Snellen equivalent), and the corrected mean was 0.3 (20/40). Of 1976 patients, 48.9% reported eye rubbing. Mean values (ranges) were 49.4±6.3 (36.3-78.0) D for steep keratometry, 462.4±66.0 (48.0-659.0) μm for thinnest corneal thickness, 9.7±8.7 (-0.5 to 88.8) for Belin/Ambrósio enhanced ectasia total deviation, 0.8±0.4 (0.0-1.0) for the Corvis biomechanical index, 0.9±0.2 (0.0-1.0) for the tomographic biomechanical index, 0.1±0.5 (-0.9 to 2.0) for the KC match index, 8.3±1.8 (2.2-17.7) mm Hg for corneal hysteresis, 7.1±2.2 (0.0-17.0) mm Hg for corneal resistance factor, and 2,562.9±326.3 (1,011-3,937) cells/mm2 for endothelial cell density. The average ABCDE KC stage was A2B3C1D1E2. Distance-corrected visual acuity correlated strongly with topometric, tomographic, and biomechanical data ( P <0.001). This comprehensive description of baseline features of KC patients at a tertiary center provides a reference for further longitudinal and international multicentric studies.

Short-Term Impact of Different Corneal Incision Positions on Postoperative Astigmatism and Visual Quality After SMILE Surgery.

This study aimed to evaluate the short-term impact of different incision positions on astigmatism and visual quality after small incision lenticule extraction (SMILE) surgery. This prospective study enrolled patients who decided to have SMILE to correct myopia. Patients were randomly allocated into three groups of different incision positions (groupA, B, and C with incision position at 90°, 120°, and 150° respectively). Preoperative and postoperative visual acuity, spherical equivalent, and high-order aberrations (HOAs) were measured and compared among groups. Astigmatism was analyzed with the ASSORT Group Analysis Calculator based on the Alpins method. A total of 148 eyes were included for analysis (48 eyes in groupA, 50 eyes in groupB, and 50 eyes in groupC). At 1month postoperatively, the mean uncorrected distance visual acuity (UDVA) logMAR in groupA, B, and C was - 0.03, - 0.03, and - 0.04, respectively. The mean corrected distance visual acuity (CDVA) logMAR in groupA, B, and C was - 0.03, - 0.04, and - 0.04, respectively (P > 0.05). The mean postoperative spherical equivalent (SE) values were - 0.01 ± 0.38, - 0.07 ± 0.39, and - 0.16 ± 0.49 (D) in groupA, B, and C, respectively (P > 0.05). There was no statistically significant difference in preoperative and postoperative magnitude of astigmatism among different groups (P > 0.05). Significant differences were found in the distribution of astigmatism axis among the three groups at 1day (P = 0.02) and 1week (P = 0.02) postoperatively. However, such differences were no longer significant at 1month after surgery (P > 0.05). No significant differences were found in HOAs among different groups 1month after surgery (P > 0.05). Different incision positions have no effect on postoperative astigmatism and visual quality 1month after SMILE surgery, though differences were found in the distribution of the astigmatism axis within 1week after the surgery.

Efficacy and safety of intracorneal allogenic ring segment implantation in keratoconus: 1-year results.

To evaluate the safety and efficacy of corneal allogenic intrastromal ring segments in the management of keratoconus patients. The retrospective, nonrandomized, interventional case series consisted of 65 keratoconic eyes of 49 consecutive patients who had ring segment-shaped corneal allografts (KeraNatural®) implanted in intrastromal tunnels created using a femtosecond laser. The main outcome measures were uncorrected visual acuity (UCVA), corrected distant visual acuity (CDVA), refraction, keratometry, and pachymetry. Computed tomography scans of the corneal surfaces were also performed preoperatively as well as 3, 6 and 12 months postoperatively. Mean age was 29.5 ± 7.3 years (median 29, range: 20-52 years). The mean UCVA improved from 0.91 ± 0.50 logMAR preoperatively to 0.40 ± 0.24 logMAR postoperatively at 6 month follow-up (p < 0.01) and the mean CDVA improved from 0.87 ± 0.20 logMAR preoperatively to 0.27 ± 0.06 logMAR postoperatively (p < 0.01). The mean spherical equivalent improved from -8.82 ± 4.57 to -3.45 ± 4.81D (p < 0.01). Average Keratometry decreased from 49.23 ± 5.22 preoperatively to 45.63 ± 4.89 D postoperatively (p < 0.01). Mean anterior and posterior maximum elevation were also decreased significantly (p < 0.01). In one patient, dislocation of the graft towards the tunnel incision site and dehiscense at the tunnel entrance were observed in the first week of the operation. Yellow-white deposits were observed in the segment tunnels in five cases after 6 months. This study demonstrated that implantation of corneal allograft ring segments is a viable alternative treatment for keratoconus with safety and good visual results.