Postoperative Uncorrected Distance Visual Acuity Research Articles

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

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

Inferior Decentration of Multifocal Intraocular Lenses in Myopic Eyes

To investigate the tilt and decentration of multifocal intraocular lenses (MfIOLs) implanted in myopic eyes. A prospective cohort study. Twenty-eight myopic eyes and 56 emmetropic eyes were evaluated. Phacoemulsification with Tecnis ZMB00 MfIOL (Abbott Medical Optics, Santa Ana, California, USA) implantation was performed. At 1 year post-surgery, routine postoperative examinations were performed, and tilt and decentration of the MfIOLs, high-order aberrations, and modulation transfer function (MTF) were evaluated using the OPD-Scan III aberrometer (Nidek Co, Ltd, Gamagori, Japan). Subjective symptoms were assessed with a Quality of Vision questionnaire. Postoperative uncorrected distance visual acuity (VA), best-corrected distance VA, and uncorrected near VA did not differ between the 2 groups. The mean IOL tilt and horizontal decentration were not different between the control and myopic groups. However, the myopic group presented significantly inferior decentration in the capsular bag compared with the control group (-0.03 ± 0.22mm vs-0.21 ± 0.29mm, P= .002). The overall decentration values were 0.32 ± 0.14mm in the controls and 0.40 ± 0.18mm in the myopic group (P= .023). Axial length was negatively correlated with vertical decentration (r=-0.268, P= 0.014) and positively correlated with overall decentration (r= 0.334, P= .002). Worse aberration data, poorer MTF, and more subjective symptoms were also found in the myopic group than in the controls. Greater inferior decentration of MfIOLs and a consequent decrease in visual quality were found in myopic eyes, indicating that the increasing incompatibility between IOL and capsular bag size with axial length elongation should not be underestimated.

Clinical observation on corneal transparency after small incision lenticule extraction surgery

Objective: To evaluate the changes of corneal transparency over the 1-year period after small incision lenticule extraction (SMILE) according to corneal Scheimpflug densitometry. Methods: Prospective cohort study. Fifty-five patients (100 eyes) with myopia (19 male and 36 female, aged 18 to 39 years with average of 24) who underwent SMILE and regular follow-up for at least 1 year at Tianjin Eye Hospital were enrolled. Examinations took place before SMILE and postoperatively at 1 day, 1 week, and 1, 3, 6, and 12 months. The preoperative spherical equivalent of surgical refractive correction was (-5.75±1.64) D. Corneal densitometry (CD) data were calculated automatically by the Pentacam Scheimpflug system and expressed in gray scale units (GSU), from 0 (completely transparent) to 100 (completely opaque). During the analysis of corneal densitometry, the average corneal optical density of three concentric radial zones centered on the apex of the cornea ≤2 mm, >2 mm and ≤6 mm, >6 mm and ≤10 mm diameter) were applied, and three layers were defined according to different corneal depths (the anterior 120 μm as 1st layer, and the posterior 60 μm as 3rd layer, and the center part between them of the cornea as 2nd layer). The automatic release mode was applied in order to avoid operator-induced errors. The preoperative and postoperative values in different corneal layers and different concentric radial zones were compared using Kruskal-Wallis. Results: Ninty-three eyes(93%) of all eyes achieved uncorrected distance visual acuity (UCVA) of 0.8 or better on the first day postoperatively, and 96% (96 of 100 eyes) achieved UCVA of 0.8 or better in the first week postoperatevely, and all eyes 100% (100 of 100 eyes) achieved UCVA 0.8 or better until the end of our follow-up (in 1 year postoperatively). In general, the difference preoperative and postoperative corneal average optical density is of no statistical significance (χ(2)=8.446, P=0.207), specifically, the overall postoperative CD increased in the first week after surgery (1 day to 15.90, 1 week to 15.65), and then decreased to the equivalent of baseline levels and maintained such level until 6 months after surgery (1 month to 15.60; 3 month to 15.50, 6 month to 15.55), though at the 12-month follow-up, densitometry values had spiked significantly again (12 month, 15.90). The difference between the preoperative and postoperative CD values in the central two zones (≤2 mm, >2 mm and ≤6 mm), but not the outer (>6 mm and ≤10 mm), were of statistical significance (χ(2)=61.961, 52.397, P<0.000). When subdivided by corneal layer, significant changes in CD were detected in the anterior 120 μm layer (χ(2)=27.774, P<0.000). The CD increased significantly (i.e., corneal transparency decreased) as compared to the preoperative baseline on the first postoperative day, and lasted through the first week. There were no significant changes in the CD of the central layer (χ(2)=0.918, P=0.986). Significant increases in the posterior 60 μm of the cornea after surgery were found only at the 6-month and 1-year follow-up examinations (χ(2)=17.469, P=0.008). No correlation was found in the preoperative refractive error, ablation depth, postoperative UCVA and the CD. The CD at 6 months was found negatively correlated with SE at 6 months (r=-0.219, P=0.028). Conclusions: SMILE reduced corneal transparency temporarily and primarily within the surgically altered area, however such change has no significant correlation with the ablation depth, SE, and the postoperative UCVA. Transparency recovered within a month, but patients should be monitored for at least 1 year. (Chin J Ophthalmol, 2018, 54: 27-32).

Energy Setting and Visual Outcomes in SMILE: A Retrospective Cohort Study.

To assess the independent effect of energy setting on postoperative uncorrected distance visual acuity (UDVA) in small incision lenticule extraction (SMILE) and further investigate an optimal energy setting for the 4.5-μm spot-track-distance, which is in wide clinical use. A total of 1,130 eyes were included in a retrospective cohort study from Tianjin Eye Hospital, Tianjin Medical University from April 2015 to July 2016. Energy settings and baseline characteristics were recorded and 3-month UDVA was tested by a nurse blinded to the energy settings used. Multiple regression analysis and generalized estimating equations were used to take into account the correlation between the measurements from two eyes. The 3-month UDVA (mean ± standard deviation) of 125 to 160 nJ (by 5-nJ increments) was 1.39 ± 0.19, 1.40 ± 0.32, 1.33 ± 0.27, 1.36 ± 0.27, 1.34 ± 0.25, 1.29 ± 0.19, 1.36 ± 0.27, and 1.19 ± 0.22, respectively. Energy was significantly associated with postoperative logMAR UDVA in different models and the regression coefficient (β) was robust (β = 0.01, 95% confidence interval = 0.00 to 0.01). The regression coefficient β (0.01, 95% confidence interval = 0.00 to 0.02, P = .0029) of energy (125 to 150 nJ, by 5-nJ increments) on 4.5-μm spot-track-distance was still associated with the logMAR UDVA when adjusted for sex, age, myopia, astigmatism, mean keratometry, central corneal thickness, preoperative logMAR CDVA, and side spot-track-distance. The lower end of the energy studied was associated with a better postoperative UDVA in this population. The spot-track-distance of 4.5 μm with 125 nJ energy was the optimal combination within this range. [J Refract Surg. 2018;34(1):11-16.].

Myoring and Ferrara ring segment implantation using femtosecond laser for treatment of keratoconus

Purpose To compare visual acuity, refraction, and topographic corneal changes after implantation of a MyoRing versus Ferrara ring segment for management of keratoconus. Patients and methods This is a prospective nonrandomized clinical comparative study. Forty eyes of 25 patients with keratoconus grades 2–4 were included in the study and were divided into two groups: group A (MyoRing group) included 20 eyes of patients with keratoconus subjected to femtosecond laser-assisted MyoRing implantation and group B included 20 eyes of patients with keratoconus subjected to femtosecond laser-assisted Ferrara ring segment implantation. Results Forty eyes of 25 patients (12 males and 13 females) with keratoconus grades 2–4 were enrolled in this study. The mean age of the patients in group A was 26.62±6.18 years and in group B was 24.72±5.06 years. The mean central corneal thickness improved from 440.25 to 476.57 µm in group A and from 441.35 to 470.63 μm in group B. The mean keratometric (K) reading decreased from 49.97±14.26 to 44.55±2.16 D in group A and from 48.69+4.26 to 44.85±1.92 D in group B. There was a statistically significant improvement in the postoperative uncorrected distance visual acuity, corrected distance visual acuity, K readings, manifest spherical and cylindrical refractive errors, and spherical equivalent in both groups. No serious intraoperative complications were reported. Conclusion Both MyoRing and Ferrara ring segments are effective modalities for treatment of grades 2–4 keratoconus, but MyoRing had a superior capability in improving the keratoconus parameters as well as in halting the progression of the disease.

Evaluation of Clinical Outcomes after LASIK for the Correction of Myopia Using the Advanced Customvue Excimer Laser Platform

-Purpose: To evaluate early visual, refractive and aberrometric outcomes after wave front-guided LASIK for the correction of low to moderate myopia and myopic astigmat is musing the excimer laser platform Advanced Custom Vue. Methods: A prospective, non-comparative study in 100 myopic eyes of 50 patients evaluating LASIK results over a period of 3 months. Main outcome variables included visual acuity, refraction, total higher-order aberrations (HOAs), spherical aberration (SA) and coma-like aberration. The surgery was performed using the VISX STAR S4 (Johnson and Johnson Vision) excimer laser and a wave front-guided ablation designed according to the iDesign aberrometer data (Johnson and Johnson Vision). Results: Mean preoperative sphere decreased from -4.07 ± 1.78 D to 0.32 ± 0.30 D at 3 months after surgery. Mean preoperative cylinder was reduced from -1.09 ± 0.88 D to -0.26 ± 0.28 D after the complete follow-up. Postoperative uncorrected distance visual acuity (UDVA) was 0.00 logMAR (20/20) or better in 100% of eyes, and 65.3% of eyes reached an UDVA of -0.20 logMAR (20/12.5) or better (p < 0.05). For a 6-mm pupil, the root mean square (RMS) for total ocular HOAs increased with surgery by 0.03 μm (p = 0.050), whereas the coma-like RMS increased by 0.05 μm (p < 0.001). The change in spherical aberration was +0.08 μm (p < 0.001). Conclusion: Wavefront-guided LASIK using the new generation excimer laser platform Advanced Custom Vue is safe and effective for treating myopia and myopic astigmatism, minimizing the postoperative level of HOAs.

Usefulness of bandage contact lenses in the immediate postoperative period after uneventful myopic LASIK.

To determine the usefulness of a silicone-hydrogel bandage contact lens (BCL) in the immediate postoperative period after uneventful myopic laser in-situ keratomileusis (LASIK). The study design was randomized but not masked and data collection was prospective. This study comprised 51 consecutive myopic eyes intervened by means of the LASIK technique to compensate their refractive error. Patients were randomly assigned to two different groups. The experimental group included 24 eyes of 12 patients that were fitted with a BCL immediately after the flap replacement. The control group included 27 eyes of 14 patients with no BCL. Patients were examined 24h after the surgery; the experimental group was analyzed immediately after the extraction of the BCL. Postoperative uncorrected distance visual acuity (UDVA) and postoperative topographic indexes were compared to baseline in both groups. The experimental group achieved worse results in the majority of the studied variables. Postoperative UDVA was worse in experimental group (p<0.01). Likewise, corneal asphericity (Q) was significantly higher in experimental group (p=0.024). Topographic indexes showed higher asymmetry in the corneal maps pertaining to experimental group. Specifically, the index of surface variance (ISV) (p=0.017) and index of vertical asymmetry (IVA) (p=0.031) were higher in experimental group. Also, the postoperative central corneal thickness (CCT) resulted in higher values for eyes pertaining to experimental group. The fitting of a silicone-hydrogel BCL after uneventful LASIK provokes morphological changes in the ocular structures that may lead to a worse UDVA secondary to a higher postoperative CCT and corneal edema.

Outcomes and complication rates of primary resident-performed cataract surgeries at a large tertiary-care county hospital

To identify the preoperative risk factors, intraoperative events, and postoperative complications increasing the risk for poor visual outcomes in resident-performed cataract surgeries at a tertiary-care county hospital. Ben Taub General Hospital, Houston, Texas, USA. Retrospective case series. Resident-performed cataract surgeries were analyzed for risk factors, comorbidities, and intraoperative and postoperative complications. The main outcome measures were preoperative and postoperative uncorrected distance visual acuity and corrected distance visual acuity (CDVA), which were correlated with preoperative demographics, intraoperative and postoperative events, and resident training level. The data were subdivided into cases without events and cases with events to determine which complications led to poor visual outcomes. The study analyzed 1290 resident-performed cataract surgeries. The mean visual acuity improved significantly after surgery in all patients (P<.001), with 80.5% of patients without complications and 70.7% with complications attaining a CDVA of 20/40 or better (P<.002). Poor visual outcomes were associated with α-antagonist use (P=.043) and pseudoexfoliation syndrome (P=.001). The most common intraoperative complications were vitreous loss (6.7%) and posterior capsule tear (7.0%). The mean postoperative visual acuity did not vary by trainee year, and the rate of dropped nucleus during surgery declined as residents progressed in training (P<.05). All other complication rates were similar between levels of training. Despite more complicated cataracts and advanced comorbidities, primary resident-performed cataract surgery in a tertiary-care county hospital system achieved visual outcomes and complication rates similar to those found in other training hospitals.

Clinical outcomes of laser in situ keratomileusis with an aberration-neutral profile centered on the corneal vertex comparing vector planning with manifest refraction planning for the treatment of myopic astigmatism

To evaluate clinical outcomes of laser insitu keratomileusis (LASIK) with an aberration-neutral profile centered on the estimated visual axis (considering 70% of the pupil offset toward the corneal vertex) comparing vector planning with manifest refraction planning for the treatment of myopic astigmatism. Muscat Eye Laser Center, Muscat, Sultanate of Oman, Muscat, Oman. Retrospective case series. The outcomes were evaluated at a 6-month follow-up in eyes showing ocular residual astigmatism (ORA) over 0.75 diopters (D) preoperatively. Eighty-five treatments were based on manifest astigmatism (preoperative sphere -2.11 D±1.3 [SD], cylinder -0.90±1.0 D), and 79 treatments were based on vector planning (preoperative sphere -2.46±1.5 D, cylinder -0.78±0.79 D). At a 6-month follow-up, 128 patients (164 eyes) were evaluated and no significant differences were observed between the 2 groups in terms of difference between corrected distance visual acuity and uncorrected distance visual acuity (UDVA) (P=.1, t test and Fisher exact test Snellen lines 1 or better, P=.4) and postoperative UDVA (P=.05, t test and Fisher exact test for UDVA 20/16 or better, P=.3). Significant differences were observed between the 2 groups in terms of achieved spherical equivalent (P=.04), corneal toricity, and ORA (P<.001, t test and Fisher exact test for ORA ≤0.75 D, P<.001). Performing LASIK for myopic astigmatism with the vector planning approach resulted in comparable visual outcomes to manifest refraction planning.

Visual performance, reading ability and patient satisfaction after implantation of a diffractive trifocal intraocular lens.

PurposeTo evaluate visual outcome, reading performance, contrast sensitivity, and patient satisfaction after cataract surgery with implantation of a diffractive trifocal intraocular lens (IOL).Patients and methodsA total of 42 eyes (21 patients) underwent cataract surgery with implantation of the trifocal IOL AT LISA tri 839MP. Visual acuity, contrast sensitivity, and patient satisfaction were evaluated 3 months postoperatively. Reading performance was evaluated at 3 months postoperatively with the MNREAD charts.ResultsAll eyes achieved a 3-month postoperative monocular uncorrected distance visual acuity of 0.10 logMAR or better (Snellen 20/25). Likewise, 97.62% and 85.71% of eyes achieved a postoperative monocular uncorrected intermediate, and near visual acuity of 0.20 logMAR (Snellen 20/30) or better. All patients achieved postoperative binocular uncorrected distance visual acuity, uncorrected intermediate, and uncorrected near visual acuity of 0.20 logMAR (Snellen 20/30) or better. Mean photopic reading acuity and speed were 0.24±0.07 logMAR and 177.61±20.67 words per minute, respectively. Postoperative contrast sensitivity values were within the ranges of normality for all spatial frequencies evaluated. Postoperative spectacle independence and patient satisfaction was very high, with most of the patients reporting a good or very good visual quality at far, intermediate, and near distances. All patients would choose the same lens again.ConclusionThe evaluated trifocal IOL provides an effective restoration of the visual function after cataract surgery, with high levels of distance, intermediate, and near visual acuity, strong reading performance, and patient satisfaction.

Postoperative visual performance with a bifocal and trifocal diffractive intraocular lens during a 1-year follow-up.

To evaluate and compare the clinical outcomes with a diffractive bifocal and trifocal intraocular lens (IOL) during a 12-month follow-up. Prospective comparative study including 75 eyes of 38 patients (44-70y) undergoing uneventful cataract surgery. Each patient was randomly assigned to one type of IOL, bifocal (35 eyes) or trifocal (40 eyes). Visual, refractive, and contrast sensitivity changes were evaluated in a 12-month follow-up. The binocular defocus curve was also measured at 12mo postoperatively. No statistically significant differences between groups were found in postoperative uncorrected and corrected distance visual acuities (P≥0.276). Postoperative corrected near visual acuity (33 cm) was significantly better in the trifocal group during all follow-up (P≤0.004) as well as 6-month uncorrected near (P=0.008) and distance-corrected near visual acuities (P=0.016) (33/40 cm). Significantly better uncorrected intermediate and distance corrected-intermediate visual acuity were found during all follow-up in the trifocal group (P<0.001), which was consistent with differences among groups in binocular defocus curve. Differences among groups in contrast sensitivity were minimal, being only significant at 6 months for some low to medium spatial frequencies (P≤0.006). Bifocal and trifocal diffractive IOLs are able to provide an effective visual restoration which is maintained during a 12-month follow-up, with a clear benefit of the trifocal IOL for the intermediate vision.

Evaluation of Human Corneal Lenticule Quality After SMILE With Different Cap Thicknesses Using Scanning Electron Microscopy.

To evaluate the surface characteristics of lenticules created by small-incision lenticule extraction (SMILE) with different cap thicknesses. This prospective study included 20 consecutive patients who underwent bilateral SMILE. Surface regularity of the extracted corneal lenticule was analyzed using scanning electron microscopy (SEM) combined with 2 methods: qualitative and quantitative regularity. Qualitative regularity of SEM images was graded by masked observers using an established scoring system. Quantitative regularity of SEM images was assessed by counting the total number and areas of tissue bridges using Image-Pro Plus software. Four different cap thickness of 120, 130, 140, and 150 μm were compared. Refractive outcomes of patients were measured at baseline and 1 month after surgery. As 10 specimens were not analyzable, only 30 eyes were included. Postoperatively, all eyes had postoperative uncorrected distance visual acuity of 20/20 or better; 43% had an unchanged corrected distance visual acuity; 43% gained 1 line; 10% lost 1 line. Ultrastructurally, surface irregularity was primarily caused by tissue bridges. The average surface regularity score obtained was 10.87 ± 2.40 for 120 μm, 10.78 ± 2.60 for 130 μm, 8.76 ± 2.16 for 140 μm, and 8.70 ± 2.66 for 150 μm (P < 0.001). The total number and areas of tissue bridges of 120 to 130 μm were significantly less than 140 to 150 μm (P < 0.05). Surface regularity decreased as cap thickness increased (P < 0.05). There is smoother appearance of the lenticular surface as seen through SEM when a thin cap is created compared with a thick cap qualitatively and quantitatively.

Comparison of visual outcomes after bilateral implantation of a diffractive trifocal intraocular lens and blended implantation of an extended depth of focus intraocular lens with a diffractive bifocal intraocular lens.

PurposeThe purpose of this study was to compare the visual outcomes and subjective visual quality between bilateral implantation of a diffractive trifocal intraocular lens, Alcon Acrysof IQ® PanOptix® TNFT00 (group A), and blended implantation of an extended depth of focus lens, J&J Tecnis Symfony® ZXR00 with a diffractive bifocal intraocular lens, J&J Vision Tecnis® ZMB00 (group B).MethodsThis prospective, nonrandomized, consecutive, comparative study included the assessment of 40 eyes in 20 patients implanted with multifocal intraocular lens. Exclusion criteria were existence of any corneal, retina, or optic nerve disease, previous eye surgery, illiteracy, previous refractive surgery, high axial myopia, expected postoperative corneal astigmatism of >1.00 cylindrical diopter (D), and intraoperative or postoperative complications. Binocular visual acuity was tested in all cases. Ophthalmological evaluation included the measurement of uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), and uncorrected intermediate visual acuity (UIVA), with the analysis of contrast sensitivity (CS), and visual defocus curve.ResultsPostoperative UDVA was 0.01 and −0.096 logMAR (p<0.01) in groups A and B, respectively; postoperative CDVA was −0.07 and −0.16 logMAR (p<0.01) in groups A and B, respectively; UIVA was 0.14 and 0.20 logMAR (p<0.01) in groups A and B, respectively; UNVA was −0.03 and 0.11 logMAR (p<0.01) in groups A and B, respectively. Under photopic conditions group B had better CS at low frequencies with and without glare.ConclusionBoth groups promoted good quality of vision for long, intermediate, and short distances. Group B exhibited a better performance for very short distances and for intermediate and long distances ≥−1.50 D of vergence. Group A exhibited a better performance for UIVA at 60 cm and for UNVA at 40 cm.

A comparative study of visual quality between implantable collamer lens implantation and femtosecond LASIK for myopia

Background The incidence of myopia is gradually increasing, and how to choose a better corrective method of myopia for the best visual demand is very important. Objective This study was to compare visual quality of implantable collamer lens (ICL) implantation with femtosecond laser in situ keratomileusis (FS-LASIK) for moderate and high myopia using double-pass optical quality analysis system (OQAS). Methods A non-randomized controlled clinical trail was performed.Fifty-two eyes with -4.00 to -9.00 D of 26 consecutive patients were included in NO.1 Hospital of Xi'an from January 2015 to January 2016.Twenty-four eyes of 12 patients with the corneal thickness 0.05). All the patients were followed-up for 3 months after surgery.The preoperative best corrected distance visual acuity (BCDVA), spherical equivalent (SE), postoperative uncorrected distance visual acuity (UCDVA), BCDVA and SE were examined and compared between two groups.The parameters from OQAS were evaluated and intergrouply compared, including the objective scattering inders (OSI), modulation transfer function (MTF) cut off frequency, Strehl ratio and OQAS values under the contrast of 100%, 20% and 9%(OV100, OV20, OV9). Results The postoperative BCDVA was not significantly different from preoperative UCDVA in both ICL group and FS-LASIK group (-0.04±0.10 vs. 0.05±0.12; -0.07±0.12 vs.0.00±0.12) (t=3.128, 2.358, both at P>0.05). No statistically significant differnces were found in SE, UCDVA and BCDVA after operation between ICL group and FS-LASIK group (t=1.292, 0.900, -0.653, all at P>0.05). OQAS examination showed that MTF cut off, OSI, Strehl ratio, OV100 were not significantly different after operation between ICL group and FS-LASIK group (t=-2.032, -1.440, -0.224, all at P>0.05). The postoperative OV20 and OV9 were 0.82±0.14 and 0.80±0.21 in the ICL group, which were significantly higher than those in the FS-LASIK group(0.59±0.15 and 0.47±0.13)(t=4.105, 4.702, both at P<0.05). Conclusions Both ICL implantation and FS-LASIK provide good optical and visual quality for moderate to high myopic eyes, and ICL appears to have a better visual quality in comparison with FS-LASIK under the contrasts of 20% and 9%. Key words: Myopia/surgery; Refractive surgical procedure; Phakic intraocular lenses; Keratomileusis, laser in situ; Visual quality; Implantable collamer lens; Double-pass optical quality analysis system

Refractive lens exchange and piggyback intraocular lens implantation in nanophthalmos: Visual and structural outcomes

To evaluate the best piggyback intraocular lens (IOL) implantation method and the outcomes in nanophthalmos eyes and to define the postoperative structural changes. Farabi Eye Hospital, Tehran, Iran. Prospective case series. Candidates for refractive surgery who were nanophthalmic were recruited. Patients had refractive lens exchange followed by implantation of both IOLs in the bag or 1 IOL in the bag and 1 IOL in the sulcus. The baseline and follow-up visual acuity, refractive status, and structural Scheimpflug imaging were evaluated. Ultrasound biomicroscopy (UBM) was performed 6months postoperatively. The study comprised 9 nanophthalmic patients (18 eyes) with a mean preoperative uncorrected distance visual acuity (UDVA) of 1.53 logarithm of the minimum angle of resolution (logMAR)±0.3 (SD), mean corrected distance visual acuity (CDVA) of 0.34±0.2 logMAR, and mean spherical equivalent (SE) of +13.55±4.0 diopters (D). The mean postoperative UDVA improved from baseline. There was no significant difference in the mean UDVA and CDVA between the 2 IOL groups. Postoperatively, both groups had a significant improvement in SE, a significant rise in anterior chamber depth and angle, and similar UBM measurements. Piggyback IOL implantation was an effective refractive procedure in nanophthalmic eyes. Both implantation methods resulted in similar outcomes; however, the small number of patients in each group made it less likely that possible differences would be found. The increase in angle values might help prevent the development of closed-angle glaucoma.

Visual outcomes after balanced salt solution infiltration during lenticule separation in small-incision lenticule extraction for myopic astigmatism.

To evaluate the refractive outcomes of balanced salt solution infiltration during small-incision lenticule extraction (SMILE).This randomized prospective study enrolled 52 patients (104 eyes) with myopic astigmatism. Patients underwent SMILE to correct the myopic astigmatism in Daping Hospital of the Third Military Medical University between January and July 2013. One eye of each patient received traditional SMILE (control group) and the other received a modified SMILE procedure (liquid infiltration group). The corrected distance visual acuity (CDVA), postoperative uncorrected distance visual acuity (UDVA), refraction, wavefront aberration, intraocular pressure (IOP), modulation transfer function (MTF) cut-off frequency, and objective scattering index (OSI) were evaluated.UDVA in the liquid infiltration group was significantly higher than that in the control group at 1 day postoperatively, but not at 1 month after surgery. Moreover, OSI and MTF cut-off frequency in the liquid infiltration group were higher than those in the control group at early follow-up. However, no significant intergroup difference was observed in the OSI and MTF cut-off frequency at 3 months after surgery. In addition, the predictability was better in the liquid infiltration group than in the control group. The changes of horizontal coma in the liquid infiltration group were lesser than those in the control group. However, no intergroup difference was observed in the reduction of IOP at 1 month after surgery.The modified SMILE procedure results in better visual outcomes than did the traditional SMILE procedure when used for treating myopic astigmatism.

Multifocal intraocular lens implantation after previous corneal refractive laser surgery for myopia

To describe the refraction and visual acuity outcomes of multifocal intraocular lens (IOL) implantation in patients with previous corneal refractive laser surgery for myopia. Academic Medical Center, University of Amsterdam, Amsterdam, and Retina Total Eye Care, Driebergen, the Netherlands. Retrospective cohort study. The 3-month results after implantation of a multifocal IOL (Acrysof Restor) in patients who had corneal refractive laser surgery for myopia were analyzed. The primary outcome measures were corrected distance visual acuity, uncorrected distance visual acuity (UDVA), and refraction. The secondary outcome measures were number of laser enhancements, corneal irregularity, pre-laser magnitude of myopia, and posterior capsule opacification (PCO) rate. Seventy-seven eyes of 43 patients were included. Twenty-nine eyes had lens extraction because of cataract, and 48 eyes had a refractive lens exchange. The mean postoperative UDVA was 0.14 logarithm of minimum angle of resolution ± 0.22 (SD). The mean postoperative spherical equivalent was -0.38±0.78 diopter (D). Fifty-seven percent of eyes were within ±0.50 D of emmetropia, and 86% were within ±1.0 D. Sixteen eyes (20.8%) had laser enhancement because of residual refraction. Fourteen eyes (18.2%) had a neodymium:YAG laser capsulotomy because of PCO. Eyes with pre-laser myopia greater than 6.0 D had a less predictable outcome than eyes with pre-laser myopia less than 6.0 D (P=.026). Multifocal IOL implantation after corneal refractive laser surgery for myopia resulted in good visual acuity and refraction. Results were less predictable with myopia greater than 6.0 D.

Prospective Evaluation of Outcomes in Patients Undergoing Treatment for Myopia Using the WaveLight Refractive Suite.

To evaluate outcomes in patients with myopia up to -12.00 diopters (D), with or without astigmatism up to 6.00 D, who underwent LASIK with the WaveLight Refractive Suite (Alcon Laboratories, Inc., Fort Worth, TX). This multicenter, prospective, single-arm study evaluated patients at baseline, on the day of surgery, and 1 day and 1, 3, and 6 months postoperatively. The primary outcome was comparison of 1-month postoperative binocular uncorrected distance visual acuity (UDVA) with preoperative binocular corrected distance visual acuity (CDVA). Noninferiority was defined as the upper bound of the 95% confidence interval less than 0.1 logMAR. Post-hoc analyses for superiority were conducted for monocular and binocular CDVA at 1, 3, and 6 months. Continuous variables were summarized using mean (95% confidence interval), median, quartiles, standard deviation, minimum and maximum, and categorical variables as counts and percentages. Of the 96 patients (54% female, mean age: 31 years), 5 underwent monocular and 91 binocular LASIK surgery (187 eyes). Preoperatively, mean binocular CDVA was -0.025 ± 0.126 logMAR, mean binocular UDVA was 1.148 ± 0.626 logMAR, and mean manifest spherical refraction equivalent was -3.67 ± 1.98 D. Postoperative binocular UDVA at 1 month (-0.088 ± 0.107 logMAR) was noninferior to preoperative binocular CDVA. Postoperative binocular UDVA at 1, 3 (-0.098 ± 0.107 logMAR), and 6 months (-0.105 ± 0.113 logMAR) were significantly superior to preoperative binocular CDVA (P < .0001 each). The primary study objective was exceeded; postoperative UDVA was significantly superior to preoperative CDVA in patients with myopia and myopia with astigmatism who underwent LASIK with the WaveLight Refractive Suite. [J Refract Surg. 2017;33(5):322-328.].

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

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

Glaucoma Mini-Shunt Implantation After Keratoplasty.

To report the outcomes of patients who underwent miniature glaucoma shunt implantation after secondary glaucoma due to keratoplasty. Prospective study of consecutive clinical cases who underwent mini-glaucoma shunt implantation following keratoplasty. In brief, a fornix-based conjunctival flap was performed, approximately 50% thickness scleral flap. Mitomycin C 0.025% placed under Tenon's capsule. A 25-G needle created entry for mini-shunt. Ex-PRESS model P-50 was inserted. Scleral flap and conjunctiva were closed with 10-0 Nylon. STATA 8.0 and SPSS software were used for statistical analysis. Seventeen eyes of 17 patients with a mean age of 39.70 years (SD=18.33, range: 18 to 76). A total of 64.70% were male and 35.30% female. Eleven cases after penetrating keratoplasty, 3 cases after triple procedure, 2 after deep anterior lamellar keratoplasty, and 1 following endothelial keratoplasty. Most of the indications for keratoplasty were keratoconus in 9 cases (52.94%), 4 due to endothelial failure (23.52%), 3 cases of herpetic keratitis (17.64%), and 1 case of post-LASIK ectasia (5.88%). Mean preoperative intraocular pressure was 35.94 mm Hg with maximal medical therapy (SD=9.65, range: 18 to 55). Decreasing intraocular pressure to 12.76 mm Hg postoperatively (SD=2.51, range 10 to 18) (P=0.001). Mean follow-up after mini-glaucoma shunt implantation was 23.76 months (SD=8.73, range: 10 to 35 mo). Preoperative mean uncorrected distance visual acuity (UDVA) was 1.31±0.63 (20/408 Snellen) and postoperative mean UDVA was 0.85±0.40 (20/141 Snellen) (P=0.001). Preoperative mean corrected distance visual acuity (CDVA) was 0.83±0.76 (20/135 Snellen) and postoperative mean CDVA was 0.56±0.44 (20/72 Snellen) (P=0.032). Ex-PRESS miniature glaucoma shunt could be an alternative treatment in postkeratoplasty glaucoma resistant to medical treatment. This technique may be helpful, in trying to avoid corneal damage produced by conventional glaucoma procedures.