Postoperative Spherical Equivalent Refraction Research Articles

Aphakic retropupillary iris-claw intraocular lens (IOL) pseudophakic accommodation

Dear Editor, We read with great interest the article by Schopfer et al. showing the changes of the objective refraction related to the patients’ position [1]. In the “Abstract” the authors indicated: “...the phenomenon of pseudophakic accommodation is explained by pseudomyopia and pseudo-hyperopia...”. Actually, the pseudophakic accommodation phenomenon refers to myopia induced by the displacement of the IOL in response to contraction of the ciliary muscle, as the authors correctly stated later, in the “Discussion” section of their article [2, 3]. Thus, in these eyes with a retropupillary iris-claw IOL, where themovement of the IOL is not related to the ciliary muscle contraction, but to gravity, there is no such true pseudophakic accommodation. Moreover, the terms “pseudomyopia” and “pseudo-hyperopia” have no place in this definition. In “Results”, data indicating the percentage of eyes achieving a postoperative spherical equivalent refraction within 0.5 D (diopter) (8 %) and 1.0 D (12 %) of plano are confusing. According to the information provided, it seems that correct data are 26 % and 58 %. These percentages are significantly lower than benchmark standard of 55 % and 85 % that has been suggested for cataract surgery [4]. It would be important to know what A-constant the authors used in their biometric calculations. Authors indicated that the “mean amplitude of accommodation” was 4.96 D in backward position, 5.70 D in primary position and 5.18 D in forward head position. Those data of “pseudophakic accommodation” of this non-accommodative IOL are significantly higher than published for other IOLs. Tsorbatzoglou, Nemeth et al., using the defocusing technique, reported mean results of pseudophakic accommodation between 0.82 and 1.00 D [2]. Later, the same authors measured accommodation amplitudes in pseudophakic eyes using three different methods, and all mean values were lower than 1 D [5]. Uthoff et al., using the same device than Schopfer and coauthors (accommodometer), reported significantly more distant near points even for an accommodative IOL (0.6 m) as opposed to between 0.18 and 0.20 m measured by Schopfer et al. [3]. Kuchle et al., also using the accommodometer and an accommodative IOL, reported a postoperative mean of accommodative range of 2.02 D at 12 months [6]. Thus, data and the technique used to obtain them by Schopfer et al. [1] must be verified. Our experience using the iris-claw IOL (Artisan®) fixated in the posterior surface of the iris has also been positive. In the last 5 years we have implanted 22 lenses in combination with penetrating keratoplasty or DSAEK, and 54 lenses as a procedure to correct aphakia (41 as planned secondary implantation and 13 as contingency procedure in case of posterior capsule rupture). We used the A constant of 117.5 (SRK/T formula). A BCVA of 20/40 or better 6months after surgerywasmeasured in 36.6%of the eyes that underwent keratoplasty and 74.1 % of eyes that underwent only iris-claw IOL implantation, with a mean spherical equivalent of 0.05±2.6 D (range from −3.50 to +3.50 D) for the former group, and −0.62±1.06 D (range from −2.75 to + 1.25 D) for the latter group. BCVAworse than 20/40 was related with concurrent macular disease or ocular surface problems. We have abandoned suturing IOLs to sclera or to iris, since we feel that in these challenging cases, with absence of This work did not have public or private financial support.

One-Year Experience in Presbyopia Correction With Biaspheric Multifocal Central Presbyopia Laser In Situ Keratomileusis

To analyze simultaneous vision (distance and near) 1-year after biaspheric multifocal central presbyLASIK treatments for hyperopia and myopia with or without astigmatism. Patients were treated to correct distance ametropias and alleviating presbyopic symptoms simultaneously. All patients have been treated in Presby aberration-free mode using FemtoLASIK for Sphere from -7.00 to +3.25 diopters (D), astigmatism up to 3.00 D, and addition up to +2.75 D. No eye had previous corneal refractive surgery. Preoperative corneal curvature ranged between 40 and 48 D, with pachymetry thicker than 500 μm. Preoperative corrected distance visual acuity was 0.1 logarithm of the minimum angle of resolution (logMAR) or better, with near vision of 0.2 logRAD or better with addition up to +2.50 D. Sixty-six eyes treated bilaterally using PresbyMAX software were reviewed. For 31 patients (94%), 1-year follow-up was completed. At 1 year, 70% of patients achieved uncorrected distance visual acuity 0.1 logMAR or better, 84% patients obtained uncorrected near visual acuity 0.1 logRAD or better, and 83% of eyes were within 0.75 D of defocus. Postoperative mean spherical equivalent refraction was -0.47 ± 0.44 D. Stability was achieved from the 6-week follow-up. Eighty-five percent of patients achieved simultaneously uncorrected distance visual acuity 0.2 logMAR or better and uncorrected near visual acuity 0.2 logRAD or better. Patient selection and expectation management is essential to achieve patient satisfaction. Even though optically the results are predictable and good, some patients find it difficult to adapt to the compromise and others are dissatisfied by the minor loss of distance visual acuity. Certain individuals are best suited for PresbyMAX. A test with multifocal contact lenses or trial frames that creates slightly defocused images can be used to simulate postoperative visual impressions and verify patient acceptance.

Agreement Between Pentacam and IOLMaster in Patients Undergoing Toric IOL Implantation

To investigate inter-device agreement between the Pentacam (Optikgerate GmbH, Wetzlar, Germany) and IOLMaster (Carl Zeiss Meditec, Jena, Germany) in measuring corneal power, cylinder, and axis of astigmatism. Retrospective case series reviewing the status of eyes after toric IOL implantation to evaluate inter-device agreement in measuring corneal power, cylinder, and axis of astigmatism. Forty-nine eyes from 41 patients were evaluated. Agreement for corneal power and cylinder were deemed good and moderate, with 95% limits of agreement of -1.02 to +1.13 and -1.37 to +1.09 diopters (D), respectively. Agreement for axis of astigmatism was only fair, with a mean absolute difference of 8.9 degrees (range: 0.3 to 37.7 degrees, standard deviation: 8.79 degrees). Thirty percent of eyes had a 10-degree or greater difference in axis measurements, and 13% of eyes had a 20-degree or greater difference in measurements. Analysis by multivariate logistic regression showed higher cylinder powers associated with discrepant corneal power measurements (odds ratio: 3.46, P = .02), and increasing age was associated with discrepant axis measurements (odds ratio: 1.09, P = .03). Overall, there was no significant difference in accuracy predicting postoperative spherical equivalent refraction. Pentacam and IOLMaster agree well for corneal power but less so for cylinder and axis of astigmatism and thus cannot be used interchangeably.

Outcomes of Femtosecond Laser Cataract Surgery With a Diffractive Multifocal Intraocular Lens

To report the visual and refractive outcomes in an initial series of eyes undergoing femtosecond laser cataract surgery with implantation of a diffractive multi-focal intraocular lens (IOL). The first 61 consecutive eyes undergoing femtosecond laser cataract surgery and ReSTOR (Alcon Laboratories Inc) +3.00-diopter (D) add IOL implantation between May and July 2011 were enrolled in the study (LCS group). The control group consisted of a retrospective consecutive cohort of 29 eyes that underwent manual phacoemulsification cataract surgery and ReSTOR +3.00-D add IOL implantation (MCS group) between December 2010 and April 2011. Visual and refractive parameters were collected pre- and postoperatively at 1 and 3 months. Mean postoperative spherical equivalent refraction was -0.01±0.35 D and -0.06±0.30 D in the LCS and MCS groups, respectively (P=.492). Mean absolute refractive prediction error (PE) was 0.26±0.25 D for the LCS group and 0.23±0.16 D for the MCS group (P=.489). Mean arithmetic refractive PE was 0.06±0.44 D and -0.02±0.30 D for the LCS and MCS groups, respectively (P=.388). No significant difference was noted in mean postoperative uncorrected distance visual acuity or uncorrected near visual acuity between groups. No eyes in either group had surgical complications or loss of corrected distance visual acuity in the follow-up period. Mean spherical equivalent refraction and visual acuity of our initial group of patients undergoing laser cataract surgery are comparable to the manual phacoemulsification cohort for the AcrySof ReSTOR +3.00-D add IOL.

Correction of Undesirable Pseudophakic Refractive Error With the Sulcoflex Intraocular Lens

To evaluate the visual outcomes, efficacy, predictability, and short-term safety of implanting the Sulcoflex (Rayner Intraocular Lenses Ltd) intraocular lens (IOL) to correct residual pseudophakic errors. Retrospective study of patients undergoing implantation of the Sulcoflex IOL. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity and refractive outcomes were evaluated. Postoperative follow-up was at 1 week and 1, 3, 6, and 12 months. Fifteen eyes (13 patients) were evaluated. Mean follow-up was 20 months (range: 14 to 30 months). The Sulcoflex aspheric (653L) and toric (653T) IOLs were implanted in 3 and 12 eyes, respectively. Preoperatively, mean logMAR (Snellen) UDVA and CDVA were 0.44 (20/55) and 0.05 (20/22), respectively. At 3 months, all eyes achieved logMAR UDVA of 0.20 (20/32) or better, with 10 (67%) eyes achieving UDVA of 0 (20/20) or better. Preoperative mean spherical and astigmatic errors were 1.07±0.83 diopters (D) and -1.45±0.98 D, respectively. Preoperative mean spherical equivalent refraction was -0.54±1.11 (D). Postoperative mean sphere and astigmatism at 3 months were -0.25±0.38 D and -0.50±0.57 D, respectively. Postoperative mean spherical equivalent refraction at 3 months was -0.15±0.28 D. All patients were within 1.00 D of attempted correction, with 93% within 0.50 D. Linear regression analysis showed good correlation (R²=0.72) between attempted versus achieved spherical equivalent refractions. No significant intra- or postoperative complications occurred. Implantation of the Sulcoflex IOL was found to be an effective and predictable option for enhancing postoperative refractive results and reducing spectacle dependence for distance after surgery. The IOL was well tolerated in all eyes.

Comparison of IOL Power Calculation and Refractive Outcome After Laser Refractive Cataract Surgery With a Femtosecond Laser Versus Conventional Phacoemulsification

To compare intraocular lens (IOL) power calculation and refractive outcome between patients who underwent laser refractive cataract surgery with a femtosecond laser and those with conventional cataract surgery. In this prospective study, 77 eyes from 77 patients underwent laser refractive cataract surgery (laser group; Alcon LenSx femtosecond laser), and conventional cataract surgery with phacoemulsification was performed in 57 eyes from 57 patients (conventional group). Biometry was done with optical low coherence reflectometry (Lenstar LS900, Haag-Streit AG), and IOL calculation was performed with third-generation IOL formulas (SRK/T, Hoffer Q, and Holladay). The refractive outcome was analyzed using the mean absolute error (MAE; difference between predicted and achieved postoperative spherical equivalent refraction), and multivariable regression analysis was performed to compare the two groups. No significant differences were found between age, axial length, keratometry, and preoperative corrected visual acuity in the laser and conventional groups (P>.05; Mann-Whitney U test). At least 6 weeks after surgery, MAE was significantly lower in the laser group (0.38±0.28 diopters [D]) than in the conventional group (0.50±0.38 D) (P=.04). The difference was the greatest in short (axial length <22.0 mm, 0.43±0.41 vs 0.63±0.48) and long (axial length >26.0 mm, 0.33±0.24 vs 0.63±0.42) eyes. Laser refractive cataract surgery with a femtosecond laser resulted in a significantly better predictability of IOL power calculation than conventional phacoemulsification surgery. This difference is possibly due to a more precise capsulorrhexis, resulting in a more stable IOL position.

Foldable iris‐fixated intraocular lens implantation in children

To describe the results of foldable iris-fixated intraocular lens (IOL) implantation in children. Children with high bilateral or unilateral myopia who were intolerant of spectacle or contact lens correction were implanted with an iris-fixated foldable IOL and prospectively followed. We measured pre- and postoperative visual acuity, refraction, endothelial cell density (ECD) and National Eye Institute Visual Functioning Questionnaire-25. Eleven eyes of six children were implanted. Indications were high bilateral myopia in children with comorbid neurobehavioural disorders, high anisometropia and high myopic astigmatism. Mean preoperative spherical equivalent (SE) refraction was -14.6 dioptres (D)±4.2 SD. Mean follow-up was 15 months. Postoperative SE refraction was -2.40 D±2.40 SD. Corrected distance visual acuity (CDVA) improved from mean logMAR 0.84±0.4 SD to postoperative 0.67±0.34 SD (p=0.005). CDVA was reduced because of coexistent ocular disorders and amblyopia. Vision-related quality of life (QOL) measures improved significantly. There were no intraoperative or postoperative serious complications. Foldable iris-fixated IOL insertion can give a significant improvement in vision and in vision-related QOL in a subset of paediatric patients with special refractive needs who are intolerant to conventional treatment. Long-term follow-up is required for monitoring of ECD.

3-Month experience in presbyopic correction with bi-aspheric multifocal central presbyLASIK treatments for hyperopia and myopia with or without astigmatism

PurposeTo analyze simultaneous vision (distance and near) 3-month after bi-aspheric multifocal central presbyLASIK treatments for hyperopia and myopia with or without astigmatism. MethodsRetrospective study analyzing patients that had been treated for correcting distance ametropiae and alleviating presbyopic symptoms simultaneously. All patients had been treated in Presby Aspheric mode using FemtoLASIK. No eye had previous corneal refractive surgery. Preoperative corneal curvature ranged between 40D and 48D, with pachymetry thicker than 500μm. Preoperative best distance corrected visual acuity (CDVA) was 0.1 LogMAR or better, with best corrected near vision (CNVA) of 0.2 LogRAD or better. Results66 patients treated using PresbyMAX software (SCHWIND eye-tech-solutions GmbH and Co. KG, Kleinostheim, Germany) were reviewed. For 24 patients, 3-month follow-up was completed. At 3 months, 71% of patients achieved UDVA 0.1 LogMAR or better, 79% patients obtained UNVA 0.1 LogRAD or better, and 83% of eyes were within 0.75 diopters (D) of defocus. Postoperative mean spherical equivalent refraction was −0.15±0.50D. Stability was achieved from the 6-week follow-up. 92% of patients achieved UDVA 0.2 LogMAR or better and UNVA 0.2 LogRAD or better. No statistical differences between myopes/hyperopes or between males/females were found. ConclusionsPatient selection and expectation management are essential to achieve patient satisfaction. Even though optically the results are quite predictable, some patients find it difficult to adapt to the compromise between far and near vision, and others are dissatisfied by the minor loss of distance VA.

Refractive Lens Exchange With Toric Intraocular Lenses in Keratoconus

To report the clinical characteristics and surgical outcomes of patients with nonprogressive keratoconus treated with in-the-bag toric intraocular lens (IOL) implantation. A retrospective review was conducted of the medical records of patients diagnosed with keratoconus treated with refractive lens exchange (RLE) and in-the-bag toric IOL implantation (models T3 to T9, AcrySof SN60TT; Alcon Laboratories Inc). Age, pre- and postoperative uncorrected (UDVA) and corrected distance visual acuity (CDVA), objective and subjective refraction, spherical equivalent refraction, total keratometric power, total astigmatism, axis, and toric IOL model and power were analyzed. All cases had topographic and/or refractive stability for at least 1 year prior to undergoing IOL implantation. Nineteen eyes of 13 patients (mean age 48.15 ± 6.6 years), including 12 patients with a topographic diagnosis of keratoconus and 1 with pellucid marginal degeneration, were evaluated. Mean follow-up after RLE was 7.89 ± 6.61 months. Mean preoperative sphere was -5.25 ± 6.40 diopters (D), and mean postoperative sphere was 0.22 ± 1.01 D (P<.001). Mean preoperative cylinder was 3.95 ± 1.30 D, which decreased to 1.36 ± 1.17 D postoperatively (P<.001). Mean pre- and postoperative spherical equivalent refractions were -7.10 ± 6.41 D and -0.46 ± 1.12 D, respectively (P<.001). Preoperative mean UDVA was 1.35 ± 0.36 D (20/447 Snellen) and postoperative mean UDVA was 0.29 ± 0.23 D (20/39 Snellen) (P<.001). Toric IOL implantation may be an effective therapeutic option in the optical rehabilitation of patients with stable and nonprogressive keratoconus.

Wavefront-Optimized Ablation Versus Topography-Guided Customized Ablation in Myopic LASIK: Comparative Study of Higher Order Aberrations

To compare the outcomes of wavefront-optimized ablation and topography-guided ablation in fellow eyes of patients undergoing laser in situ keratomileusis (LASIK) for myopia. This prospective study included 84 patients who underwent LASIK in both eyes: wavefront-optimized ablation in one eye (group I) and topography-guided ablation in the fellow eye (group II). The Moria2 microkeratome with a 110 single-use head (Moria, Antony, France) was used to create a superior hinged flap and the Allegretto Wave Excimer Laser (Alcon/Wavelight Light Laser Technologie GmbH, Erlangen, Germany) for photoablation. The Allegretto wave analyzer was used to measure the ocular aberrations before and 6 months after LASIK. Refractive visual outcomes and ocular aberration changes were compared between the two treatment modalities. Six months postoperatively, the mean uncorrected visual acuity of group II was statistically better than that of group I (P = .02). Seventy percent of group I and 83% of group II achieved a postoperative spherical equivalent refraction of ±0.5 diopters. The postoperative total root-mean-square of higher order aberrations (HOAs) of group II was smaller than that of group I, but the difference was not statistically significant (P = .51). There was a decrease in most of the individual terms of HOAs in group II, but it was only statistically significant in Z(3) (-1) (P = .04). The reverse occurred in group I, where most of the individual terms of HOAs increased, but it was not statistically significant. Significant improvement was only noted in Z(5) (3) (P = .05) and Z(5) (5) (P = .04). Both wavefront-optimized ablation and topography-guided ablation provided good refractive results, but the latter induced fewer HOAs.

Straylight before and after hyperopic laser in situ keratomileusis or laser-assisted subepithelial keratectomy

To compare straylight values before and 3 months after hyperopic laser in situ keratomileusis (LASIK) or laser-assisted subepithelial keratectomy (LASEK) and determine the cause of any change. Private refractive surgery clinic, Driebergen, The Netherlands. Comparative case series. Straylight (by definition the measure for glare disability) was measured preoperatively and postoperatively with a C-Quant straylight meter and recorded as log(s). The main outcome measures were the difference between postoperative and preoperative straylight values. The mean increase in straylight from preoperatively to postoperatively was 0.051 log(s) ± 0.158 (SD) in the LASIK group (39 eyes) and 0.031 ± 0.146 log(s) in the LASEK group (26 eyes). Although neither change was statistically significant, it was clinically significant in some cases. Haze or interface debris was seen in some eyes with increased straylight. The mean postoperative spherical equivalent refraction was -0.05 ± 0.27 diopter. Although straylight increased slightly after hyperopic LASIK and LASEK, the increase was not statistically significant. Some eyes with increased straylight had haze or interface debris. The cause of the increased straylight could not be determined in some cases.

Refractive Stability of LASIK with the VISX 20/20 Excimer Laser vs ZB5M Phakic IOL Implantation in Patients with High Myopia (&gt;−10.00 D): A 10-Year Retrospective Study

To compare the long-term outcomes of LASIK and ZB5M phakic intraocular lens implantation (PIOL) (Domilens) for high myopia (>-10.00 diopters [D]). This long-term (10 years) follow-up retrospective interventional case series study included 126 eyes that underwent LASIK and 52 eyes that underwent ZB5M angle-supported PIOL implantation. Both groups of eyes were similar in terms of preoperative spherical equivalent refraction (SE), corrected distance visual acuity (CDVA), and age. Mean preoperative SE was -14.33 D in the LASIK group and -14.84 D in the PIOL group. At 10-year follow-up, mean postoperative SE was -1.47±2.00 D in the LASIK group and -1.01±1.36 D in the PIOL group (P=.21). In the LASIK group, 67% of eyes were within ±1.00 D of emmetropia at 2 years after surgery, compared to 42% at 10 years. In the PIOL group, 68% of eyes were within ±1.00 D of emmetropia 2 years after implantation compared to 53% at 10 years. In the LASIK group, 43.5% of eyes achieved UDVA of 20/40 or better 10 years after surgery compared to 67.9% in the PIOL group (P=.02). The ZB5M angle-supported PIOL was shown to have better predictability and stability compared to LASIK over 10 years. However, reductions in endothelial cell count over time were observed in eyes with PIOLs.

High and Low Contrast Visual Acuity After Artiflex Phakic Intraocular Lens Implantation for the Correction of Myopia

To determine the effects of Artiflex phakic intraocular lens (PIOL) implantation on best spectacle-corrected high and low contrast visual acuity under photopic and mesopic conditions. Forty-two consecutive eyes had implantation of a foldable iris-supported PIOL to correct myopia. The mean preoperative spherical equivalent refraction was -7.26+/-1.91 diopters (D) (range: -4.90 to -13.60 D). The high (100%) and low (2.5%) contrast visual acuity with best spectacle correction was tested with translucent logarithmic visual acuity charts (Precision Vision) under photopic and mesopic conditions. At mean 7.6+/-5.4 months after PIOL implantation, the mean high and low contrast visual acuity under photopic and mesopic conditions had significantly increased from preoperatively: photopic high contrast visual acuity from -0.07+/-0.11 logMAR to -0.14+/-0.08 logMAR (P<.001); photopic low contrast visual acuity from 0.48+/-0.14 logMAR to 0.36+/-0.11 logMAR (P=.011); mesopic high contrast visual acuity from -0.09+/-0.09 logMAR to -0.16+/-0.08 logMAR (P<.001); and mesopic low contrast visual acuity from 0.50+/-0.13 logMAR to 0.33+/-0.10 logMAR (P<.001). Mean postoperative spherical equivalent refraction was -0.21+/-0.28 D (range: +0.50 to -0.75 D). Of all eyes, 91.9% were within 0.50 D of attempted correction, and 67% gained 1 or more lines of best spectacle-corrected visual acuity (BSCVA). No eye lost 2 or more lines of BSCVA. Artiflex PIOL implantation for the correction of moderate to high myopia seems to be a safe and predictable procedure, which resulted in increased high and low contrast visual acuity under photopic and mesopic conditions.

Analysis of posterior donor corneal parameters 1 year after Descemet stripping automated endothelial keratoplasty (DSAEK) triple procedure

Although Descemet stripping automated endothelial keratoplasty (DSAEK) was demonstrated to be effective for the treatment of endothelial corneal diseases, a variable hyperopic shift has been measured as a common occurrence postoperatively. The aim of this work was to investigate the variance in the corneal and refractive responses to DSAEK combined with phacoemulsification and implantation of intra-ocular lens (IOL), namely the DSAEK triple procedure. The refractive, topographic, and anterior segment optical coherence tomography (AS-OCT) data of 23 eyes treated with DSAEK triple procedure were analyzed. A mean refractive IOL target of -1.04 +/- 0.09 D was calculated based on empirical data of our early experience to achieve emmetropia in all the eyes included in the study. Donor corneal parameters, i.e., graft diameter, thickness, and profile, were investigated in order to verify their possible role in the variable refractive shift after DSAEK. Although the 1-year mean refractive outcome was close to emmetropia (-0.01 +/- 0.89 D), the average difference between the targeted postoperative refraction and the 1-year postoperative spherical equivalent refraction was +0.98 +/- 0.87 D. Correlations of refractive change with central graft thickness (r = 0.36, p = 0.05) and graft diameter (r = 0.45; p = 0.03) were statistically significant. AS-OCT analysis revealed how the graft shape, with graft thicker in the periphery compared with the center, contributed to reduce the radius of curvature of the posterior cornea, thus favoring the hyperopic shift postoperatively. DSAEK triple procedure provides negligible changes in the surface topography, however with a variable amount of hyperopic shift postoperatively. Central graft thickness and graft profile together contributed to approximately two-thirds of the variance in refractive shift postoperatively. Lenticule diameter provided a minor influence on postoperative hyperopic shift than other graft parameters.

Outcomes and Patient Satisfaction After Presbyopic Bilateral Lens Exchange with the ResTOR IOL in Emmetropic Patients

To assess efficacy, safety, predictability, stability, and patient satisfaction after presbyopic lens exchange in emmetropic patients. A prospective, nonrandomized, masked, observational case series (self-controlled) of 46 emmetropic eyes of 23 consecutive patients (age range: 50 to 60 years) after presbyopic lens exchange with bilateral AcrySof ReSTOR Natural (SN60D3) intraocular lens (IOL) (Alcon Laboratories Inc) implantation were evaluated. Mean spherical equivalent refraction (SE) was -0.04±0.14 diopters (D) (range: +0.25 to -0.25 D). Monocular and binocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), distance-corrected near visual acuity (DCNVA), and patient satisfaction were recorded preoperatively and 6 months after surgery. At 6 months postoperative, efficacy index at distance was 1.00. No eye lost ≥2 lines of CDVA, 5 eyes lost 1 line, 24 eyes did not change after surgery, 14 eyes gained 1 line, and 3 eyes gained 2 lines of visual acuity. Safety index at distance was 1.03. All eyes had a manifest SE within ±0.50 D of emmetropia. Mean postoperative SE was +0.14±0.22 D (range: -0.25 to +0.37 D). No eye lost >2 lines of DCNVA, 1 eye lost 2 lines, 3 eyes lost 1 line, 34 eyes did not change after surgery, and 8 eyes gained 1 line of visual acuity. Uncorrected near visual acuity was 0.95±0.07. Safety and efficacy indexes at near were 1.01 and 1.03, respectively. A patient satisfaction questionnaire showed that patients had a high level of satisfaction after presbyopic lens exchange surgery. Presbyopic lens exchange with implantation of the ReSTOR multifocal IOL in emmetropic eyes is an effective and safe procedure for presbyopia correction.

Central Ablation Depth and Postoperative Refraction in Excimer Laser Myopic Correction Measured With Ultrasound, Scheimpflug, and Optical Coherence Pachymetry

To compare measurements of ultrasound, Scheimpflug, and optical coherence pachymetric techniques to describe ablated depth after myopic astigmatic corneal laser refractive surgery and achieved refractive correction. Ninety-six myopic astigmatism treatments using LASIK or LASEK in 58 patients with 3-month followup were retrospectively analyzed. In all cases, standard examinations, pre-/postoperative corneal topography, ocular aberrometry, and pachymetry were performed. SCHWIND Custom Ablation Manager (CAM) software and the ESIRIS laser were used for planning treatments and performing ablations. Outcomes were evaluated in terms of predictability, safety, and wavefront aberration. Pachymetry was taken before treatment (ultrasound [DGH Pachette 2], Scheimpflug [Oculus Pentacam HR], and optical coherence pachymetry [OCP] [Heidelberg-Engineering OCP]), after lifting the flap (Pachette 2, OCP), immediately after finishing ablation (Pachette 2, OCP), and at 3-month follow-up (Pachette 2, Pentacam HR). At 3 months, 87 (91%) of eyes achieved 20/20 UCVA, and 89 (93%) of eyes were within +/-0.50 diopters (D). Postoperative mean spherical equivalent refraction was -0.15 +/- 0.30 D. Best spectacle-corrected visual acuity improved in 30 (31%) of eyes. Differential pachymetry correlated to intended central ablation depth for all techniques: r2 = 0.60, P < .0001, slope 0.81 for ultrasound; r2 = 0.75, P < .0001, slope 0.97 for Scheimpflug; and r2 = 0.76, P < .0001, slope 1.03 for OCR Relative differential pachymetry correlated only marginally to achieved refractive correction for ultrasound and OCP. Differential pachymetry is a metric useful for describing intended central ablation depth but not for achieved refractive correction. The rotating Scheimpflug technique offers the best estimation (closest slope to 1) and OCP offers the best correlation (closest r2 to 1) for describing intended central ablation depth achieved. The three techniques give different measurements for ablation depth, with OCP being substantially different from ultrasound and Scheimpflug. Only borderline correlations were obtained for achieved refractive correction with ultrasound and OCP.

Comparison of early postoperative clinical outcomes of photorefractive keratectomy and lamellar epithelial debridement

To compare early postoperative clinical outcomes of photorefractive keratectomy (PRK) and lamellar epithelial debridement (LED). Department of Ophthalmology, Kangbuk Samsung Hospital, Seoul, Korea. This prospective study was of patients randomly assigned to have PRK or LED. In the LED group, an epithelial flap was created using an Amadeus II epikeratome. Postoperative follow-up was at 1, 3, and 7 days and 1, 3, and 6 months. The outcome parameters were uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), higher-order aberrations (HOAs), epithelial healing time, and corneal haze. The study comprised 39 patients (76 eyes). The mean preoperative spherical equivalent (SE) was -3.96 diopters (D) +/- 1.24 (SD) in the PRK group and -4.06 +/- 1.39 D in the LED group. Postoperative UCVA was significantly better in the LED group 1 day postoperatively. The UCVA was 20/20 or better in 14.6% in the PRK group and 42.9% in the LED group (P = .006); 20/25 or better in 41.5% and 82.9%, respectively (P = .000); and 20/40 or better in 80.5% and 100%, respectively (P = .006). On subsequent follow-up visits, the UCVA was comparable between groups. No eye lost lines of BCVA at 3 months. There was no difference between groups in postoperative SE refraction, HOAs, or corneal haze. Lamellar epithelial debridement and PRK had comparable safety and efficacy in the surgical correction of low to moderate myopia. The UCVA was significantly better after LED than after PRK 1 day postoperatively and equivalent thereafter.

Seven-year Follow-up of LASIK for Myopia

To assess the long-term refractive results, subjective parameters, and late sequelae of LASIK. A retrospective follow-up study was conducted on 38 eyes of 21 patients (17 with bilateral treatment and 4 with unilateral treatment) who had LASIK surgery between 1999 and 2000. Laser ablations were done with an excimer laser (VISX STAR and STAR S2). Follow-up was 2 months, 2 years, and > 7 years postoperatively. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, indirect ophthalmoscopy, and wavefront analysis were measured at the last follow-up and a questionnaire was answered. Postoperatively, BSCVA < or = 0.0 (logMAR) was obtained in 91%, 100%, and 89% of eyes at 2 months, 2 years, and at last follow-up, respectively. Postoperative spherical equivalent refraction within +/- 0.50 diopters (D) was obtained in 75%, 63%, and 42% of eyes at 2 months, 2 years, and 7 to 8 years, respectively. At 2 months and 2 years, 83% of eyes were within +/- 1.00 D, which decreased to 42% at 7 to 8 years. Mean spherical equivalent refraction at 2 months was -0.41 D, at 2 years -0.57 D, and at 7 to 8 years continued to decrease to -1.38 D. Patient satisfaction was high--100% of patients would have LASIK again. LASIK outcomes tend to shift toward undercorrection over time. Postoperative ectasia was not noted 7 to 8 years after LASIK. All patients were satisfied with the postoperative results although emmetropia was not reached.

Multizone LASIK With Peripheral Near Zone for Correction of Presbyopia in Myopic and Hyperopic Eyes: 1-year Results

To investigate the refractive outcomes of multifocal LASIK to create a center far, peripheral near zone in presbyopes. This prospective study using LASIK with a center far, peripheral near ablation algorithm comprised 68 eyes of 34 hyperopes and 78 eyes of 39 myopes. Mean patient age was 49 +/- 5.60 years for hyperopes and 46.0 +/- 3.80 years for myopes. Mean baseline manifest refraction spherical equivalent was +1.76 +/- 0.96 diopters (D) in hyperopes and -3.06 +/- 1.73 D in myopes. The mean baseline addition was +1.94 +/- 0.40 D in hyperopes and +1.67 +/- 0.44 D in myopes. One-year postoperative outcomes are reported. The mean postoperative spherical equivalent refraction was -0.10 +/- 0.55 D in hyperopes and -0.48 +/- 0.51 D in myopes. Two percent of eyes in each group lost two lines of best spectacle-corrected visual acuity. With the distance correction in place, 20/40 or better near uncorrected visual acuity (UCVA) (Sloan acuity) was achieved in 33% of hyperopes and 36% of myopes. A statistically significant difference was noted in postoperative near visual acuity measured by the Sloan and Rosenbaum charts (P < .05). Fifty-four percent of hyperopes and 48% of myopes were satisfied or very satisfied with their postoperative near UCVA. Multifocal LASIK to create a center far and peripheral near zone is safe and allows half of the patients to achieve spectacle independence. A peripheral near zone was only created in myopic treatments.

The Refractive Change After Cataract Surgery in Patients With Acute Primary Angle Closure

Purpose: To evaluate the change of postoperative refraction after cataract surgery in patients with a history of acute primary angle closure. Methods: A survey was conducted on 40 eyes of 40 patients who underwent cataract surgery with a history of acute primary angle closure, and 40 eyes of 40 patients who underwent cataract surgery only during the follow-up period of six months. We reviewed changes in the postoperative refraction and compared the difference between the postoperative spherical equivalent and target refraction in both groups. Results: In the group with a history of acute primary angle closure, target refraction was -0.200.27D and the six months postoperative spherical equivalent was -0.761.12D. In the group with cataract only, target refraction was -0.300.20D and the six months postoperative spherical equivalent was -0.220.57D. In the group with the history of acute primary angle closure, the postoperative refraction shifted to myopic refractive power significantly. Conclusions: In cataract patients with a history of acute primary angle closure, there was a myopic shift in postoperative refraction after cataract surgery. Therefore, this finding should be considered during cataract surgery.