Preoperative Uncorrected Visual Acuity Research Articles

Visual Function and Change in Quality of Life After Bilateral Refractive Lens Exchange With the ReSTOR Multifocal Intraocular Lens

To evaluate vision and quality of life and explore the correlation between vision and change of quality of life after bilateral refractive lens exchange of the Acrysof SA60D3 ReSTOR multifocal intraocular lens (IOL) for correction of ametropia in presbyopic populations. Pre- and postoperatively, the National Eye Institute Refractive Error Quality of Life Instrument (NEI-RQL) was self-administered by 30 consecutive refractive lens exchange patients, including 19 myopes and 11 hyperopes. The change of NEI-RQL scores was determined for each subscale covering a specific aspect of quality of life. Refraction, visual acuity, and contrast sensitivity function were evaluated 3 and 6 months postoperatively. Postoperatively, all patients achieved binocular uncorrected distance and near visual acuity of 20/30 or better. Photopic contrast sensitivity function decreased significantly at high spatial frequencies (P < .05). Overall scores of expectations, activity limitations, dependence on correction, appearance, and satisfaction were significantly higher postoperatively (P < .05). Greater improvement in near vision and dependence on correction was achieved in hyperopes. However, glare scores were significantly lower postoperatively (P < .001). Lower preoperative uncorrected near visual acuity was associated with higher scores for dependence on correction in myopes (r = 0.51, P = .027), and overall patient satisfaction correlated significantly with postoperative uncorrected distance visual acuity (r = -0.44, P = .015). Refractive lens exchange with the ReSTOR IOL in presbyopic patients provided good visual function and better patient satisfaction compared with preoperative corrections. Improvement in vision-related quality of life was most evident in hyperopes. A slight reduction in contrast sensitivity function appears to have no influence on quality of life.

Primary piggyback implantation using the Tecnis ZM900 multifocal intraocular lens: Case series

To assess the postoperative outcomes of primary piggyback implantation using the Tecnis ZM900 multifocal intraocular lens (IOL) (Advanced Medical Optics). Hospital Oftalmológico de Brasília, Brasília, Brazil. Patients who had phacoemulsification with primary piggyback IOL implantation were analyzed prospectively. In all cases, a Tecnis ZM900 multifocal IOL was implanted in the capsular bag and a second silicone IOL was implanted in the ciliary sulcus. Information collected included near and distance uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and the spherical equivalent (SE) before and after the surgery. Twenty eyes of 12 patients were included in the study. They were followed for 6 months. The mean preoperative distance UCVA was 20/400. At the last follow-up (6 months), the mean distance UCVA was 20/29, significantly better than before referral (P<.001). The mean preoperative SE was +6.35 diopters (D) +/- 2.25 (SD). Six months after surgery, the mean SE was -0.25 +/- 0.40 D (range -1.00 to +0.50 D), significantly better than before referral (P<.001). No patient lost lines of BCVA after surgery. At the last follow-up, 90% of the eyes achieved a near UCVA of J1 and 83.3% of patients were spectacle independent for near and distance vision. A second refractive procedure was performed in 2 eyes. Primary piggyback implantation using the Tecnis ZM900 multifocal IOL was a simple, safe, and accurate option for patients with high hyperopia who wanted to reduce their dependency on spectacles.

Clinical study on laser subepithelial keratomileusis for extremely high myopia

目的 探讨准分子激光上皮瓣下角膜磨镶术(LASEK)矫治超高度近视的疗效与安全性.方法 应用德国Zeiss MEL 80准分子激光器对-10.00以上的超高度近视22例(40眼)施行LASEK术,术前平均裸眼视力0.02±0.02(0.01～0.05),平均等效球镜(-12.75±2.30)D.随访6个月,观察术后症状、裸眼视力和最佳矫正视力、显然屈光度、眼压、角膜愈合程度和并发症.结果 LASEK术后角膜上皮愈合时间1～4 d.6个月裸眼视力≥0.5者占95%,裸眼视力≥1.0者占27.5%.平均裸眼视力0.70±0.20,平均等效球镜(-1.25±1.78)D.haze发生14眼(35.0%),haze 0.5级10眼(25.0%),haze 1.0级4眼(10.0%).5例出现眩光.结论 LASEK术可以安全有效地进行超高度近视的矫治,可作为超高度近视治疗的一种较好选择。

Bilateral Keratectasia After Photorefractive Keratectomy

To report the clinical features, management, and outcome of a patient who developed bilateral ectasia after photorefractive keratectomy (PRK). Case report of a 35-year-old man who underwent bilateral PRK. Preoperative uncorrected visual acuity was 20/200 in the right eye and 20/100 in the left eye. The patient's history was unremarkable and he denied a family history of ocular disorders. Two weeks after surgery, the patient presented with loss of visual acuity in both eyes. Uncorrected visual acuity was 20/80 in the right eye and 20/200 in the left eye. Objective refraction could not be obtained. Slit-lamp microscopy showed corneal thinning in both eyes. After examining the patient's family, his sister was found to have clinical and topographic keratoconus. Ectasia is a rare complication of PRK. We report the occurrence of bilateral ectasia after PRK in a patient with asymmetric bowtie topographies. We recommend that refractive surgery, even surface techniques such as PRK, be avoided in patients with a family history of keratoconus.

Combined Intacs and Posterior Chamber Toric Implantable Collamer Lens Implantation for Keratoconic Patients with Extreme Myopia

To evaluate the results of combined Intacs (Addition Technology, Fremont, California, USA) and posterior chamber toric implantable Collamer lens [ICLs] (Visian ICL; STAAR Surgical, Monrovia, California, USA) implantation in keratoconic patients with extreme myopia and irregular astigmatism. Prospective, single-center, noncomparative, interventional, consecutive case series. Three eyes of two consecutive highly myopic keratoconic patients who had undergone posterior chamber toric ICLs implantation after Intacs implantation. Implantation of posterior chamber toric ICLs was performed at intervals between six and 10 months after Intacs implantation. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, topographic findings, adverse events, and postoperative complications were noted. No intraoperative or postoperative complications were observed. An improvement in UCVA and BSCVA was found after the Intacs and toric Visian ICL procedures in all eyes. All eyes were emmetropic within 1 diopter (D), whereas the mean manifest refractive spherical equivalent refraction reduced from -18.50 +/- 2.61 D (range, -16.75 to -21.50 D) to 0.42 D (range, plano to -0.75 D). The mean difference between preoperative and last follow-up UCVA and BSCA was a gain of 6.67 +/- 1.15 lines (range, gain of six to eight lines) and 4.33 +/- 2.52 lines (range, gain of two to seven lines), respectively. Combined Intacs and posterior chamber toric phakic Visian ICL implantation in a two-step procedure is an effective method for correcting keratoconic patients with extreme myopia.

Frühe visuelle Rehabilitation nach Kataraktoperation in kombinierter topischer und intrakameraler Anästhesie

Topical anaesthesia in cataract surgery permits early visual rehabilitation due to the reduced impact on the optic nerve function. In this prospective study, we evaluated the course of visual improvement after surgery. 45 consecutive patients with senile cataract and no concomitant eye disease were included in the study. Cataract surgery by clear corneal phacoemulsifaction was performed with insertion of a foldable IOL in the capsular bag under topical anaesthesia. For anaesthesia topical lidocaine gel (2 %) and intracameral injection of 0.15 ml lidocaine (1 %) was used. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were measured in decimal fractions within 4 hours after surgery and 1 day postoperatively. The average preoperative UCVA was 0.23 +/- 0.39 and BCVA was 0.38 +/- 0.23 SD. Four hours postoperatively UCVA and BCVA improved significantly to 0.48 +/- 0.24 and 0.68 +/- 0.18, respectively. One day after surgery, the average UCVA was 0.65 +/- 0.15 and the BCVA was 0.89 +/- 0.07. 75 % (34) of the patients improved to a UCVA of 0.5 or better. The visual acuity improved in all patients one day after surgery, with 60 % (27) of the patients achieving a BCVA of 0.9 or better one day postoperatively. The postoperative corneal function had a significant influence on visual recovery (p = 0.01). A significant visual improvement was observed immediately after cataract surgery using the combination of topical and intracameral anaesthesia. 75 % of the patients reached a UCVA, which permitted sufficient visual function for mobility and orientation. Thus, the rapid recovery of visual function suggests an increased safety, particularly for out-patient surgery.

Resultados preliminares do implante de lente intra-ocular fácica artisan para correção de miopia

To observe the preliminary results based on the efficacy, stability and safety of Artisan anterior chamber intra-ocular lens for the correction of myopia in the first 6 months. A retrospective study of 18 patients (34 eyes) that received the implantation of Artisan anterior chamber intraocular lens for the correction of myopia was conducted. Best visual preoperative acuity, best visual postoperative acuity, dynamic preoperative and postoperative refraction, loss and improvement of lines of vision and complications were evaluated. Eighteen patients (34 eyes) were included in this study. Fourteen patients were females (77.8%) and 4 were males. The mean age was 30 years (SD +/- 7.3), range from 21 to 46 years. They were followed up for an average of 8.5 months (SD +/- 3.6). The mean endothelial cell loss was 4.75% at 6 months follow-up. The average preoperative uncorrected visual acuity was 0.02 (20/800) range from 0.01 to 0.13. The average preoperative spherical equivalent was -13.25 D, range from -5.75 D to -19,75 D. On the last follow-up, uncorrected visual acuity was 0.64 (20/32), range from 0.33 to 1.00; the average spherical equivalent was -1.18 D (DP +/- 0.92) range from +0.25 to -3.0. Complications were observed in 1 case (3.4%) of our study, in one patient who had a dislocation of the lens after an ocular trauma. The use of Artisan anterior chamber intraocular lens in phakic eyes for the correction of myopia was safe, effective and predictable. However, a larger prospective study with a higher number of cases and longer follow-up is necessary to determine long-term safety of the lens.

Contrast sensitivity after implantation of a spherical versus an aspherical intraocular lens in biaxial microincision cataract surgery

To determine whether implantation of a microincision intraocular lens (IOL) with a modified anterior surface, designed to compensate for the positive spherical aberration of the cornea in eyes of cataract patients, results in improved pseudophakic quality of vision in pseudophakic eyes after biaxial microincision phacoemulsification. Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. In a nonrandomized parallel cohort investigation, the visual performance of 52 eyes of 52 patients unilaterally implanted with the aspherical Acri. Smart 36 A IOL (Acri.Tec) were compared with those of 25 eyes of 25 age-matched patients unilaterally implanted with the spherical Acri. Smart 46 S IOL (Acri.Tec). Eight weeks after surgery, the following parameters were assessed: uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), pupil size under various illumination conditions, high-contrast and low-contrast visual acuities, photopic and mesopic contrast sensitivities, capsulorhexis size, and wavefront aberration of the cornea and eye. The primary clinical endpoint of the comparison was defined as the area under the cycles per degree (cpd) curve of the contrast sensitivity profile. The aspherical IOL group and the spherical IOL group did not differ in baseline characteristics. The median age was 71 years and 68% were women in the aspherical group versus 69 years and 62% women in the spherical group. The preoperative median UCVA was 20/80 in both groups. The UCVA, BCVA, pupil size, and capsulorhexis size were not statistically different between the 2 groups. Furthermore, no clinically relevant or statistically significant between-group differences were observed in the primary clinical endpoint. The median postoperative low mesopic contrast sensitivity without glare was 73 cpd in the aspherical group and 84 cpd in the spherical group (P = .624); a similar tendency was observed under high mesopic conditions (median 80 cpd and 83 cpd, respectively) (P = 1.000). Implantation of both IOL types resulted in a negative spherical aberration Z(4)(0), which was significantly different between the 2 groups (median -0.09 mum aspherical and -0.29 microm aspherical at a pupil size of 4.5 mm) (P<.001). No clinically relevant postoperative differences in contrast sensitivity were observed between the aspherical microincision IOL and the spherical equivalent model. The development of microincision IOLs, which fit through corneal incisions smaller than 2.0 mm and improve night-driving conditions (eg, reduction of glare), could optimize modern biaxial cataract surgery.

Improvement of Best Spectacle-corrected Visual Acuity After LASIK in Highly Myopic Eyes With Reduced Preoperative Best Spectacle-corrected Visual Acuity

To evaluate the visual acuity after LASIK in patients with high myopia and in patients with preoperative best spectacle-corrected visual acuity (BSCVA) <0.6. This retrospective study comprised 97 consecutive eyes in 57 patients who underwent LASlK. Preoperative spherical refractive error ranged from -1.75 to -22.00 diopters (D) (mean: -11.77+/-3.61 D) with mean astigmatism of -1.54+/-10.6 (range: 0 to -4.00 D). Pre- and postoperative BSCVA and uncorrected visual acuity (UCVA) were measured and analyzed. The mean preoperative BSCVA was 0.54+/-0.07 (range: 0.3 to 0.6). The mean postoperative BSCVA was 0.75+/-0.16 (range: 0.5 to 1.2). The mean postoperative UCVA was 0.60+/-0.25 (range: 0.5 to 1.2). A statistically significant improvement was noted in the mean postoperative BSCVA compared with the mean preoperative BSCVA (t=12.78; P<.001) and mean postoperative UCVA compared with preoperative mean BSCVA (t=2.866; P<.01). The safety index was 1.38, which was statistically significant (P<.001). The efficacy index was 1.11, which was statistically significant (P<.01). LASIK improved the mean postoperative BSCVA and UCVA compared with preoperative BSCVA in highly myopic eyes with reduced BSCVA.

LASIK in Myopic Patients With Dermatological Keloids

To evaluate the visual and refractive out come of LASIK in myopic patients with a known history of dermatological keloid scar. This retrospective case series included 10 eyes of 5 white patients with a known history of dermatological keloids. All patients had low to moderate myopia with no corneal or limbal keloid. All underwent uneventful bilateral LASIK. Postoperatively, visual outcomes, refractive outcomes, and complications were evaluated. Minimum 1-year follow-up was indicated for all patients in this study. Mean preoperative uncorrected visual acuity (UCVA) was 20/320 and 1 year postoperative 20/20. Mean preoperative best spectacle-corrected visual acuity (BSCVA) was 20/25 and 1 year postoperative was 20/20. The mean preoperative spherical equivalent refraction was -5.00 +/- 2.6 diopters (D) and +0.1 +/- 0.2 D 1 year postoperative. The safety index was 1.02 and the efficacy index was 1.02. None of the included in this study underwent retreatment for correction of residual error or regression up to 1 year postoperatively. No sight-threatening complications were reported. No patient reported postoperative haze, severe dry eye syndrome, or flap-related problems. LASIK is a safe, effective, and predictable technique for correcting low and moderate myopia in patients with dermatological keloids.

Severe corneal epithelial sloughing during laser in situ keratomileusis as a presenting sign for silent epithelial basement membrane dystrophy

To report the occurrence of large intraoperative epithelial sloughing during laser in situ keratomileusis (LASIK) as a first diagnostic sign for silent epithelial basement membrane dystrophy (EBMD). Refractive Surgery and Cornea Unit, Alicante Institute of Ophthalmology, Alicante, Spain. In this retrospective case series, the medical records of all patients with large corneal epithelial sloughing/defects during LASIK from January 1995 to December 2004 were reviewed. All patients who presented normal corneas before LASIK and EBMD changes after LASIK were included in this study. The surgical procedures and postoperative course were recorded. The follow-up period was 12 months for all patients. Eleven eyes of 6 patients were included. The mean age was 35 years +/- 6.1 (SD). Mean preoperative uncorrected visual acuity (UCVA) was 20/500 (0.04 +/- 0.02); 12 months after surgery, mean UCVA increased to 20/27 (0.74 +/- 0.21). There was a significant decrease in best spectacle-corrected visual acuity 1 month after surgery. One year postoperatively, 10 of 11 eyes (91%) were within +/-1.00 diopter of emmetropia. Postoperatively, clinical manifestations of EBMD were observed in all eyes and complications were common. In the early postoperative period, diffuse lamellar keratitis was observed in 6 of 11 eyes (54.5%) and flap microfolds were noted in 2 of 11 (18.2%). One year after surgery, epithelial ingrowth was present in 8 of 11 eyes (72.7%) and flap melting was noted in 4 of 11 (36.4%). Occurrence of large intraoperative epithelium sloughing/defects during LASIK might be a diagnostic sign for subclinical EBMD. These patients are predisposed to multiple postoperative complications. Because of the high risk for epithelial sloughing in the second eye, LASIK should not be performed.

Moria M2 Single Use Microkeratome Head in 100 Consecutive LASIK Procedures

To evaluate the safety and efficacy of the Moria M2 single use 130 microkeratome head in consecutive LASIK procedures for correction of myopia and myopic astigmatism. One hundred eyes of 55 patients underwent LASIK in which the flaps were created with the Moria M2 microkeratome using the single use 130 head and excimer laser ablation was done with the Allegretto Wave-light laser. Flap parameters measured were: thickness, diameter, hinge length, and overall quality. Preoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, wavefront aberrations, and low contrast sensitivity were compared to postoperative values at 6-month follow-up. Mean flap thickness was 145 +/- 17.5 microm, mean flap diameter was 8.5 +/- 0.40 mm, and mean hinge cord length was 4.05 +/- 0.35 mm. At 6-month follow-up, UCVA improved from 20/200 (+/-0.24) to 20/18.5 (+/-0.12) and BSCVA improved from 20/20.5 (+/-0.18) to 20/17.5 (+/-0.11). The Moria M2 single use 130 microkeratome head appears to be safe and effective in performing LASIK procedures.

Artisan Toric Phakic Intraocular Lens for Correction of Astigmatism

To assess the safety and efficacy of implanting Artisan toric phakic intraocular lenses (PIOLs) (Ophtec BV, Groningen, The Netherlands) in eyes with high degrees of compound myopic, hyperopic, and mixed astigmatism. Twenty-five eyes (20 patients) presenting with high astigmatism were implanted with Artisan toric PIOLs and followed for 1 year. Group 1 included 8 eyes (myopic astigmatism), group 2 included 9 eyes (hyperopic astigmatism), and group 3 included 8 eyes (mixed astigmatism). In the myopic astigmatism group, 8 (100%) of 8 eyes had preoperative uncorrected visual acuity (UCVA) of < or = 20/50, and at 6-month follow-up, 5 (62.5%) of 8 eyes had UCVA of > or = 20/40 (P = .005). In this group, 75% of eyes were within +/- 1.00 diopter (D) of the intended correction. In the hyperopic astigmatism group, 8 (88.9%) of 9 eyes had preoperative UCVA of < or = 20/40, and at 6-month follow-up, 6 (66.6%) of 9 eyes had UCVA of > or = 20/32 (P = .199). Approximately 77.8% of eyes were within +/- 1.00 D of the intended correction. In the mixed astigmatism group, 8 (100%) of 8 eyes had preoperative UCVA of < or = 20/50, and at 6-month follow-up, 6 (87.5%) of 8 eyes had UCVA of > or = 20/40 (P = .007). In this group, 87.5% of eyes were within +/- 1.00 D of the intended correction. The safety index of the procedure was 1.6, 1.3, and 1.3 in the myopic, hyperopic, and mixed astigmatism groups, respectively. The efficacy index of the procedure was 1.2, 1.0, and 1.0 in the myopic, hyperopic, and mixed astigmatism groups, respectively. Artisan toric PIOLs are safe for the correction of high degrees of astigmatism associated with myopic or hyperopic spherical refractive defect.

Experience with the Artisan phakic intraocular lens in Asian eyes

To investigate the efficacy and safety of implantation of an iris-claw phakic intraocular lens (PIOL), Artisan Myopia, in Asian eyes. Minamiaoyama Eye Clinic, Tokyo, Japan. Forty-four eyes of 32 Japanese patients and 1 Korean patient with high myopia had Artisan Myopia lens implantation to correct their refractive errors. Lens models, 5/8.5 or 6/8.5 (optic diameter/overall diameter), were chosen as standard lens model. A smaller lens model (5/7.5-Artisan Myopia Small) was implanted in eyes with corneal diameter less than 11.0 mm. Postoperative examinations were performed on 1 day, 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years after surgery. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest refraction, corneal endothelial cell counts, intraocular pressure, and complications were evaluated. Artisan Myopia Small lenses were implanted in 4 eyes (9.1%) and 8.5 mm diameter lenses were implanted in 40 eyes. Preoperative UCVA (logMAR) improved from 1.57 to 0.09 at 1 month after surgery and no regression was observed thereafter. Postoperative manifest refraction was -1.02 +/- 0.87 D (-3.25 to -0.00 D), and within 1.0 D in 20 eyes (55.6%), within 2.0 D in 32 eyes (88.9%) at 1 month after surgery, and stable during the follow-up period. The final BCVA decreased 2 lines in 2 eyes (4.5%) due to progression of age-related cataract. No serious complications such as angle closure or progressive endothelial cell loss were observed. Implantation of an Artisan iris-claw PIOL implantation may be a safe and effective procedure for Asian eyes.

One or 2 Intacs segments for the correction of keratoconus

To evaluate the effect of implanting 1 or 2 intracorneal rings (Intacs, KeraVision) as a device to correct, stabilize, and/or improve the best corrected visual acuity in patients with clear cornea keratoconus oriented by the preoperative corneal topography pattern. Vissum/Instituto Oftalmológico de Alicante, Miguel Hernandez University, Alicante, Spain. In this prospective comparative consecutive study, Intacs segments were implanted in 26 keratoconic eyes with clear central corneas of 19 consecutive patients (9 women and 10 men). Corneas were divided into 2 groups according to the topographic pattern of the cone. Group I included keratoconus not crossing the 180 degrees meridian and Group II included keratoconus crossing the 180 degrees meridian. The Intacs were horizontally placed through a lateral clear corneal incision. According to the corneal topography 1 segment was implanted 0.45 mm inferior in Group I, and 2 segments were implanted, 1 0.25 mm superior and the other 0.45 mm inferior, in Group II. All cases completed a minimum follow-up of 1 year. Differences between preoperative and postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, and keratometry were clinically and statistically evaluated. Spherical equivalent error and refractive astigmatism were significantly reduced. The mean keratometric values were reduced following Intacs insertion in both groups. At the end of the first year of the postoperative follow-up, Group I (1 segment) had an improvement in mean UCVA to 20/50 (0.4 +/- 0.22 decimal value), which was statistically significant when compared to the preoperative UCVA of 20/100 (0.2 +/- 0.13 decimal value) (P=.011). Mean BSCVA was 20/32 (0.62 +/- 0.24 decimal value), which was also statistically significant when compared to the preoperative BSCVA, which was 20/50 (0.4 +/- 0.21 decimal value) (P=.002). In Group II (2 segments), UCVA after 1 year was 20/63 (0.34 +/- 0.17 decimal value), which was statistically significant when compared to the preoperative UCVA of 20/400 (0.06 +/- 0.02 decimal value) (P=.001). Mean BSCVA was 20/32 (0.62 +/- 0.27 decimal value), which was significantly better than the preoperative UCVA of 20/50 (0.38 +/- 0.22 decimal value) (P=.001). In 4 eyes, the inferior segment was removed because of partial extrusion during the postoperative follow-up. Treatment of keratoconus with 1 or 2 Intacs segments oriented by the preoperative corneal topography used in this study proved to be effective in decreasing the corneal steepening and astigmatism and improving BSCVA. Further follow-up is needed to determine the final effect of Intacs on the progression of the corneal disease.

Intraocular telescopic lens evaluation in patients with age-related macular degeneration

Purpose: To evaluate the improvement of distance and near visual acuity after removal of cataract and implantation of an 3.0× intraocular miniaturized telescope (IMT) in patients with stable atrophic type age-related macular degeneration (ARMD). Settings: Instituto Oftalmológico de Alicante and a multicenter group. Methods: In this prospective noncomparative multinational consecutive study, 40 eyes of 40 patients with dry-type ARMD were implanted with IMTs at multiple centers. Standard phacoemulsification procedure followed by enlargement of the incision to 10 mm and implantation in the capsular bag of an 3.0× IMT was carried out in all the cases. Patients were followed for 12 months. Evaluation included the differences between preoperative and postoperative uncorrected and best corrected visual acuity for far and near, position of the IMT, intraocular pressure, and occurrence of any postoperative complications. Results: Mean preoperative uncorrected distance visual acuity (UCDVA) in the operated eye was 0.9 logMAR (0.125 ± 0.01, range 0.1 to 0.3 in decimal values); at 1 year postoperatively, mean UCDVA in the operated eye was 0.6 logMAR (0.25 ± 0.14, range 0.1 to 0.5 in decimal values). Mean preoperative uncorrected near visual acuity (UCNVA) in the operated eye was 0.8 logMAR (0.16 ± 0.13, range 0.1 to 0.5 in decimal values); at 1 year postoperatively, mean UCNVA in the operated eye was 0.4 logMAR (0.4 ± 0.26, range 0.1 to 1.0 in decimal values). The differences between pre- and postoperative distance and near visual acuities were statistically significant. Six cases were explanted, and 14 developed adverse effects, 7 of which were persistent. The corneal endothelium tolerated the procedure well. Conclusion: Implantation of IMT is feasible and plays an effective role in improving far and near visual acuity in patients with stable dry-type ARMD.

Wavefront- and topography-guided ablation in myopic eyes using Zyoptix

Purpose: To evaluate the results of wavefront- and topography-guided ablation in myopic eyes using Zyoptix (Bausch & Lomb). Setting: Eye Research Center and Dr. Agarwal's Eye Hospital, Chennai, India. Methods: This observational case study comprised 150 eyes with myopia and compound myopic astigmatism. Preoperatively, the patients had corneal topography with Orbscan ® IIz (Bausch & Lomb) and wavefront analysis with the Zywave ® aberrometer (Bausch & Lomb) in addition to the routine workup before laser in situ keratomileusis (LASIK). The results were assimilated using Zylink ® software (Bausch & Lomb), and a customized treatment plan was formulated. Laser in situ keratomileusis was performed with the Technolas ® 217 system (Bausch & Lomb). The patients were followed for at least 6 months. Results: The mean preoperative best corrected visual acuity (BCVA) (in decimal equivalent) was 0.83 (20/25) ± 0.18 (SD) (range 0.33 to 1.00) and the mean postoperative (6 months) BCVA, 1.00 (20/20) ± 0.23 (range 0.33 to 1.50). Three eyes (2%) lost 2 or more lines of best spectacle-corrected visual acuity. The safety index was 1.20. The mean preoperative uncorrected visual acuity (UCVA) was 0.06 (20/350) ± 0.02 (range 0.01 to 0.50) and the mean postoperative UCVA, 0.88 (20/25) ± 0.36 (range 0.08 to 1.50). The efficacy index was 14.66. The mean preoperative spherical equivalent (SE) was −5.25 ± 1.68 diopters (D) (range −0.87 to −15.00 D) and the mean postoperative SE (6 months), −0.36 ± 0.931 D (range −4.25 to +1.25 D). At 6 months, the UCVA was 1.00 (6/6) or better in 105 eyes (69.93%) and 0.5 (6/12) or better in 126 eyes (83.91%). The postoperative aberrations were decreased compared with the preoperative aberrations. One eye (0.66%) had a free cap during LASIK with subsequent loss of 2 lines of BCVA and induced higher-order aberrations (HOAs). Nine patients (11.2%) complained of halos at night. Conclusions: Wavefront- and topography-guided LASIK leads to improve visual performance by decreasing HOAs. Scotopic visual complaints may be reduced with this method.

Outcome after treatment of ametropia with implantable contact lenses

Objective To evaluate long-term results after insertion of implantable contact lenses (ICLs) in phakic eyes. Design Prospective, noncomparative, interventional case series. Participants Seventy-five phakic eyes (65 myopic, 10 hyperopic eyes) of 45 patients aged 21.7 to 60.6 years were included. Intervention STAAR Collamer Implantable Contact Lenses (STAAR Surgical Inc., Nidau, Switzerland) were implanted for correction of high myopia and hyperopia. Main outcome measures Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were determined. Presence of lens opacification and the distance between the ICL and the crystalline lens were assessed by slit-lamp examination before surgery and at 1, 3, 6 months, and yearly after lens implantation. Results Preoperative mean spherical equivalent was −16.23±5.29 diopters (D) for myopic eyes and +7.88 ±1.46 D for hyperopic eyes. After ICL implantation, mean residual refractive error was −1.77±2.17 D in myopic patients and +0.44±0.69 D in hyperopic patients. Preoperative mean UCVA was Snellen 0.03±0.03 for myopic patients and Snellen 0.12±0.16 for hyperopic patients. Preoperative mean BCVA was Snellen 0.49±0.23 for myopic patients and Snellen 0.82±0.23 for hyperopic patients. After ICL implantation, mean UCVA up to the end of individual observation time was Snellen 0.36±0.36 for myopic patients and Snellen 0.58±0.28 for hyperopic patients. Mean BCVA was Snellen 0.73±0.26 for myopic and Snellen 0.80±0.24 for hyperopic patients. Mean preoperative IOP was 14.2±2.7 mmHg, and mean postoperative IOP was 13.46±2.1 mmHg over all follow-up investigations. The main complication was the development of subcapsular anterior opacifications of the crystalline lens in 25 eyes (33.3%), 2 of which showed direct contact to the ICL. Eleven eyes (14.7%) were stable in opacification and 14 eyes (18.7%) had progressive opacifications. The median time to opacification was 27.1 months. In 8 patients (10.7%), the subjective visual impairment mandated cataract surgery. Conclusions The most significant long-term complication after ICL implantation is the formation of opacifications of the crystalline lens with the risk of the necessity of subsequent cataract surgery (10.7%). Old age, female gender, and contralateral opacification are independent significant risk factors for early formation of opacifications in this patient group.

Ten-year follow-up of epikeratophakia for the correction of high myopia

Objective To determine the long-term functional results of epikeratophakia for myopic patients. Design Retrospective, noncomparative, interventional case series. Participants Twenty-two patients (32 eyes; average age, 43±6 years) who underwent epikeratophakia surgery for high myopia. Mean preoperative myopia was −18.74±9.16 diopters (D; range, −7 D to −49 D). Follow-up was 12±2 years. Main outcome measures Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), change in mean keratometry, visual acuity under glare conditions, BCVA versus potential acuity meter reading, and patient satisfaction with the visual outcome. Results Mean preoperative UCVA increased from 20/800±20/400 (range, counting fingers–20/400) to 20/80±20/200 (range, 20/250–20/32) in 24 eyes. Mean preoperative BCVA of 20/32±20/64 increased only in five eyes, whereas six eyes had no change and 18 eyes had a more than one line loss of Snellen BCVA. Mean preoperative keratometry reading decreased from 43.67±0.90 D (range, 41.0–46.25 D) to 37.40±2.92 D (range, 29.43–47.68 D). In the presence of glare, mean BCVA decreased to 20/100±20/100 (range, counting fingers–20/32). Potential acuity meter (PAM) readings were significantly ( P<0.05) higher than BCVA. Mean PAM reading was 20/25±20/100 (range, 20/100–20/16). Seven patients (11 eyes) were extremely satisfied with the operative result more than 10 years after the operation, whereas four patients (four eyes) were not satisfied at all. Conclusions Epikeratophakia for the correction of myopia improved UCVA significantly, but BCVA decreased. The removal of the lenticules in patients who were not satisfied with their visual acuity was uncomplicated, and acceptable vision could be achieved with either contact lenses or intraocular lens implantation.

Two-Year follow-up of noncontact holmium laser thermokeratoplasty for the correction of low hyperopia

Purpose: To summarize the 2-year results of laser thermal keratoplasty with a holmium:yttrium-aluminumgarnet (Ho:YAG) laser and the Sunrise Corneal Shaping System and assess the procedure's safety, efficacy and predictability in correcting hyperopia in a phase III clinical intervention case series.Methods: The Ho:YAG laser was used to correct low hyperopia (manifest spherical equivalent of +0.75 to +2.50 dioptres [D], with manifest cylinder of 1.00 D or less) in 38 eyes of 28 patients 40 years of age or older. Laser pulses were delivered to the cornea in 2 radially placed, concentric, 8-spot rings 6.0 and 7.0 mm in diameter. The last follow-up was at 2 years.Results: The preoperative uncorrected visual acuity (UCVA) at distance was less than 20/40 in 82% of the eyes and at near was less than 20/32 in 42%. At 2 years the distance UCVA was 20/40 or better in 100% of the eyes and 20/20 or better in 84%, and the near UCVA was 20/32 or better in 97% of the eyes and 20/20 or better in 8%. The difference between the preoperative and postoperative UCVA was statistically significant (p < 0.01). The correction at 2 years was within 0.50 D of that intended in 92% of the eyes and within 1.00 D in 100%. The reduction in mean spherical equivalent at 2 years was statistically significant (p < 0.0001). No loss of 2 lines or more in best-corrected visual acuity occurred after the I st month of follow-up.Interpretation: The Ho:YAG Sunrise Corneal Shaping System is safe and effective for the treatment of low hyperopia and astigmatism. It provides a predictable refractive outcome at 2 years of follow-up. However, our results show a tendency towards regression by 2 years.