Refractive Astigmatism Research Articles

PREVELANCE OF REFRACTIVE ERRORS AMONG 4TH YEAR MEDICAL STUDENTS OF D.G.KHAN MEDICAL COLLEGE, DERA GHAZI KHAN, PUNJAB, PAKISTAN

Background: A refractive error is a very common eye disorder which occurs when the eye cannot clearly focus outside world images ending up with blurred vision but timely detection and intervention can enormously enhance student’s potential during his or her formative years. Medical student’s Refractive status is of immense importance considering the burden of medical studies and their role as future health care providers. Aim: To assess the Prevalence of Refractive errors among 4th Year Medical students of D.G. Khan Medical College, Dera Ghazi Khan, Punjab, Pakistan. Study Design was Cross sectional Comparative. Place of study was D.G Khan Medical College, Dera Ghazi Khan Duration: Six months. Results: Myopic were 42/80 (52.5%) out of which 2/42(4.76 %) also had Astigmatism while 1/80(1.25%) had Hyperopia. Severe Myopic were 3.0/80 (3.8%) in both right and left eyes while 10/80 (12.5%) and 11/80(13.8%) fall in moderate category in right and left eyes respectively. Mild were 29/80 (36.3%) in right while 28/80(35.0%) in left eye. Only 2.0/80(2.5%) were having Astigmatism in both eyes along with mild Myopia. Significant association found between Age and sex of medical students with the Refractive errors. Conclusion: According to currents study findings High prevalence of Refractive Errors especially Myopia among female medical students tends to be alarming. It demands implementation of more structured student awareness campaigns focusing genetic factors to help prevent and control more cases of eye defect among medical students, society and Nation at large. Future study can be focused on causes of high Refractive Errors among female medical students.
 Key Words: Refractive Error, Myopia, Hypermetropia, Astigmatism and Medical Students.

Efficacy of customized corneal crosslinking versus standard corneal crosslinking in patients with progressive keratoconus (C-CROSS study): study protocol for a randomized controlled trial

BackgroundKeratoconus is a degenerative disorder of the cornea leading to a protrusion and thinning with loss of visual acuity. The only treatment to halt the progression is corneal crosslinking (CXL), which uses riboflavin and UV-A light to stiffen the cornea. Recent ultra-structural examinations show that the disease is regional and does not affect the entire cornea. Treating only the affected zone with CXL could be as good as the standard CXL, that treats the entire cornea.MethodsWe set up a multicentre non-inferiority randomized controlled clinical trial comparing standard CXL (sCXL) and customized CXL (cCXL). Patients between 16 and 45 years old with progressive keratoconus were included. Progression is based on one or more of the following changes within 12 months: 1 dioptre (D) increase in keratometry (Kmax, K1, K2); or 10% decrease of corneal thickness; or 1 D increase in myopia or refractive astigmatism, requiring corneal crosslinking.DiscussionThe goal of this study is to evaluate whether the effectiveness of cCXL is non-inferior to sCXL in terms of flattening of the cornea and halting keratoconus progression. Treating only the affected zone could be beneficial for minimalizing the risk of damaging surrounding tissues and faster wound healing. Recent non-randomized studies suggest that a customized crosslinking protocol based on the tomography of the patient’s cornea may stop the progression of keratoconus and result in flattening of the cornea.Trial registrationThis study was prospectively registered at ClinicalTrials.gov on August 31st, 2020, the identifier of the study is NCT04532788.

Supplemental Toric Intraocular Lenses in the Ciliary Sulcus for Correction of Residual Refractive Astigmatism: A Review.

This study conducted a critical review of the peer-reviewed literature on the use of supplemental toric intraocular lenses (STIOL) in the ciliary sulcus to correct residual refractive astigmatism. This review used PubMed as a database from 1 January 2010 to 13 March 2023. According to the inclusion and exclusion criteria defined, 14 articles were selected for the current review. The data of 155 eyes were analyzed. Most of the studies reviewed had a short follow-up and poor or limited design, including case reports, case series, and retrospective cohorts. The follow-up period ranged from 43days to 4.5years. STIOL rotation was the most frequently described complication in the literature, with a mean rotation of 30.48 ± 19.90°. These patients required repositioning in 50 of 155 eyes (32.25%). Moreover, four eyes (2.58%) required scleral fixation sutures and two eyes (1.29%) iris fixation. Other complications were high intraocular pressure (3 eyes, 1.93%), transient corneal edema (2 eyes, 1.29%), corneal decompensation (2 eyes, 1.29%), and pigment dispersion (1 eye, 0.64%). From the total, 57.41% of eyes (89 eyes from 155) achieved within ± 0.50D of target refractive astigmatism. It is important to highlight that at least 52 eyes out of the 155 (33.54%) had an abnormal cornea with irregular astigmatism. STIOL seem to offer good visual and refractive outcomes. However, STIOL showed variable rotational stability, especially in some platforms. Further studies with a more robust design, methodology, and standardized analysis methods are needed to confirm these trends.

A Study on Refractive Error in Patients of Chennai City in India during Covid 19 Pandemic Period

Objectives: To compare the results of techniques Decision Tree, Discriminant, KNN, SVM applied to pre Covid-19 data collected in 2018 and data collected during Covid-19 pandemic period (2020) patients in Chennai city. Methods: The variables in the data are Refractive Error in both left and right eye, Age, Gender, Educational Status, Employment Status, Nature of Job, Working Hours, Working with Computer, Watching TV, Sleeping Hours, Type of Food, Extra Activity, Light in Residence, Light in Work Place, Family Members Wearing Specs, Parents Wearing Specs, Other Disease and Other eye disease. Findings: In this study, 22 classification algorithms were applied to the data, and accuracy results as well as comparisons in two distinct sample sizes were obtained. Although adhering to the strict lockdown regulations helps to prevent the spread of COVID-19, it also negatively affects the visual health of those who are confined to their homes and have limited access to outdoor activities, leading to an excessive confidence on digital screens for studies or leisure. Novelty: Due to public health restrictions, the present Covid 19 pandemic has altered people’s social lives all around the world. As a result, kids have spent more time in front of computer and television monitor screens, which is bad for their eyes. Refractive error affects a significant number of patients in Chennai. Across all kinds of refractive defects, myopia, hyperopia, astigmatism, and presbyopia constitute the most prevalent. Keywords: Covid19; Refractive error; KNN; SVM; Decision Tree; Discriminant

Outcomes of Phacoemulsification With Toric Intraocular Lenses in Addressing Postkeratoplasty Astigmatism.

The aim of this study was to assess the short-term and long-term effectiveness of toric intraocular lenses (IOLs) as a treatment for significant postkeratoplasty astigmatism. This was a retrospective case review study that analyzes postkeratoplasty eyes after phacoemulsification with toric IOL implantation. Seventy-five eyes were included. Previous surgery was penetrating keratoplasty (50.6%), deep anterior lamellar keratoplasty (34.6%), or automated anterior lamellar therapeutic keratoplasty (14.6%). The mean age at phacoemulsification with toric IOL implantation was 55.0 years (SD: ±14.4). The mean follow-up time was 48.2 ± 26.6 months. Preoperative mean topographic astigmatism was 6.34 ± 2.70 D (range 2-13.2 D). The mean IOL cylinder power was 6.00 ± 4.75 D (range 2-12 D). Both mean refractive astigmatism and mean refractive spherical equivalent decreased significantly from -5.30 ± 1.86 D to -1.62 ± 1.94 D ( P < 0.001) and from -4.00 ± 4.46 D to -0.25 ± 1.25 D ( P < 0.001), respectively. From preoperative to the last visit, there was a significant improvement in mean uncorrected distance visual acuity (UCVA) (from 1.3 ± 1.0 logMAR to 0.4 ± 0.3 logMAR, P < 0.001) and mean corrected distance visual acuity (CDVA) (from 0.7 ± 0.6 logMAR to 0.2 ± 0.3 logMAR, P < 0.001). Postoperative UDVA was 20/40 and 20/30 or better in 34% and 21% of eyes, respectively. Postoperative CDVA was 20/40 and 20/30 or better in 70% and 58% of eyes, respectively. Phacoemulsification and toric IOL implantation can effectively reduce moderate to high postkeratoplasty astigmatism, with a corresponding significant visual improvement.

MEYEstro software: an automatic tool for standardized refractive surgery outcomes reporting

BackgroundStandardization for reporting medical outcomes enables clinical study comparisons and has a fundamental role in research reproducibility. In this context, we present mEYEstro, a free novel standalone application for automated standardized refractive surgery graphs. mEYEstro can be used for single and multiple group comparisons in corneal and intraocular refractive surgery patients. In less than 30 s and with minimal user manipulation, mEYEstro automatically creates the required journal standard graphs while simultaneously performing valid statistical analyses.ResultsThe software produces the following 11 standard graphs; Efficacy: 1. Cumulative uncorrected (UDVA) and corrected visual acuity (CDVA), 2. Difference between UDVA and CDVA, Safety: 3. Change in line of CDVA, Accuracy: 4. Spherical equivalent (SEQ) to intended target, 5. Attempted vs. achieved SEQ, 6. Defocus equivalent (DEQ) accuracy, 7. Refractive astigmatism accuracy, 8. Target-induced astigmatism vs. Surgically-induced astigmatism, 9. Correction index histogram, 10. Angle of error histogram, Stability: 11. SEQ stability over time. Percent proportions, means, standard deviations, Cohen's d effect sizes, and p-values are calculated and displayed on each graph. All graphs can be easily exported as high-resolution TIFF images for figures to use in scientific manuscripts and presentations.ConclusionsmEYEstro software enables clinicians, surgeons, and researchers, to easily and efficiently analyze refractive surgery outcomes using the standardized methodology required by several peer-reviewed ophthalmology journals.

Combined simultaneous photorefractive keratectomy and collagen cross-linking in keratoconus suspect patients

To evaluate the safety and efficacy of combined simultaneous photorefractive keratectomy (PRK) with collagen cross-linking (CXL) in keratoconus suspects (KCS). This was a retrospective, non-randomized study of KCS patients who underwent combined simultaneous PRK with CXL. The efficacy, safety, refractive outcomes, and corneal wavefront aberration changes were assessed after the surgery and compared with existing preoperative data. Fifty-six eyes of 28 patients, including 20 females (71.4%), with a mean age of 30.92±4.09 years, were enrolled. The mean follow-up was 19.46±8.48 months (range: 7-35). At the conclusion of the study, mean uncorrected distance visual acuity LogMAR improved from 0.89±0.44 preoperatively to 0.04±0.09 postoperatively (P<0.001). In addition, a statistically significant corneal flattening was observed postoperatively, with a decrease in manifest refraction. A statistically significant increase was found in higher-order aberrations (P<0.001), horizontal coma (P<0.001), and spherical aberration (P<0.001) compared with preoperatively. Postoperatively, 41% exhibited refractive astigmatism of 0.50 diopter (D) or less; 83.8% showed 1.00 D or less. The results of our study indicate that combined simultaneous PRK with CXL can be a safe and effective method for treating refractive instability in KCS patients.

EVALUATION THE RESULTS OF PHAKIC ICL SURGERY AFTER ONE MONTH IN 23 PATIENTS AT SAIGON - CAN THO EYE HOSPITAL FROM JULY 2020 TO DECEMBER 2021

Objectives: To evaluate the results of Phakic ICL surgery after one month at Saigon Can Tho Eye Hospital. Subjects and methods: A retrospective descriptive study evaluated one-month results in 45 eyes of 23 patients undergoing Phakic ICL surgery with Visian Staar Lens of Staar Surgical Company, from July 2020 to December 2021. Ocular biometry was evaluated using the Anterior Chamber Depth index (ACD), the White-to-White measurement (WTW), and the Vault index. Patient satisfaction was evaluated using a visual analogue scale ranging from 0 (very dissatisfied) to 10 (very satisfied). Results: The pre- and postoperative equivalent sphericalness were: -9.26 ± 2.91 (-16 to -3.75) and -1.15 ± 1.06, respectively, which was statistically significant (P&lt;0.0001). The number of incremental postoperative glassless visual rows after 1-week and 1-month surgery were 7.16 and 7.25 rows, respectively. Patient satisfaction was 96%. No postoperative complication was reported. Conclusions: Phakic ICL surgery is highly effectively, safely, and accurately in treatment of refractive errors, including nearsightedness and astigmatism, which results in very good vision after surgery. Patient satisfaction was very high (96%). Phakic ICL could minimize postoperative dry eyes. The techinique is simple and quick technique with simple postoperative care but requires high precision.

Clinical Outcomes of Toric Intraocular Lenses in Patients with Fuchs Endothelial Corneal Dystrophy.

Implantation of toric intraocular lenses (IOLs) in patients with Fuchs endothelial corneal dystrophy (FECD) is still considered relatively contraindicated, without sufficient clinical evidence. Therefore, this study was designed to evaluate the results of toric IOL implantation in patients with FECD. A retrospective case-control study of 28 eyes of FECD patients and 84 eyes of healthy control patients who received toric IOLs during routine cataract surgery was performed. The outcome measures were uncorrected and corrected distance visual acuity, spherical equivalent, and refractive residual astigmatism. The mean postoperative uncorrected and corrected distance visual acuity in the FECD eyes compared to the control eyes were 0.15 ± 0.14 vs. 0.13 ± 0.17, respectively (P = 0.32), and 0.05 ± 0.08 vs. 0.06 ± 0.10, respectively (P = 0.95). The spherical equivalent in the FECD eyes compared to the control eyes was -0.29 ± 0.43 vs. -0.21 ± 0.50, respectively (P = 0.19). The preoperative corneal centroid astigmatism in the FECD eyes compared to the control eyes was 0.85D@93° ± 2.42° vs. 0.23D@68° ± 2.50°, respectively (P = 0.43), and the mean preoperative corneal astigmatism magnitude was 2.26 ± 1.1D vs. 2.28 ± 1.03D, respectively (P = 0.82). A trend toward higher postoperative refractive centroid astigmatism was found in the FECD eyes compared with the control eyes: 0.24D@28° ± 0.57° vs. 0.03D@127° ± 0.53°, respectively (P = 0.09). However, the mean refractive astigmatism magnitude was similar in FECD eyes and the healthy control eyes: 0.52 ± 0.31D vs. 0.42 ± 0.31D, respectively (P = 0.44) (D diopters). The postoperative refractive astigmatism (both centroid astigmatism and mean magnitude astigmatism) was no higher than 0.52D in both groups. Therefore, FECD patients without corneal edema can be considered for toric IOLs.

Long-Term Clinical and Functional Results of High-Grade Myopia Correction by Intrastromal Implantation of the MyoRing Ring with Femtolaser Support

Purpose: Analysis of remote clinical functional results of high myopia correction in patients with thin cornea by method of intrastromal MyoRing implantation with Femtolaser assistance.Materials and methods. 22 eyes of 22 patients were included into investigation, the мean age of patients was 30.20 ± 5.37 (from 24 to 40) years. Mean spherical equivalent (SE) of refraction was –11.52 ± 1.96 D, cylindrical component of refraction was –2.04 ± 1.64 D. Minimal pachymetry index in center was 491.6 ± 20.0 mkm. Corneal hysteresis (CH) was 8.60 ± 1.19 mm Hg. The average pupil diameter in mesopic conditions was 5.60 ± 0.23 mm. All patients had a history of mild amblyopia. Period of control in average 2 years.Results. In 2 years after the surgery uncorrected visual acuity was 0.60 ± 1.22, corrected visual acuity 0.70 ± 0.20. Mean spherical equivalent (SE) of refraction was 0.61 ± 1.43 D, cylindrical component of refraction was –0.13 ± 0.50 D. Predictability of SE within ±0.5 D was 84 %, ±1.0 — 84 %. Index of safety was 1.16, index of efficacy — 1.0. CH was 9.50 ± 0.03 mm Hg. Mean pachymetry at center after the surgery did not change statistically significant in comparison with initial data (p = 1.00).Conclusion. MyoRing implantation is an effective and safe method, it provides: refraction spherical component correction, astigmatism correction and CH increase (p = 0.01).

Total Keratometry Measured With a Swept-Source Optical Biometer Versus Anterior Keratometry: From Planning to Postoperative Results.

To compare the influence of total keratometry (TK) versus anterior keratometry (K) measured with the swept-source optical biometer IOLMaster 700 (Carl Zeiss Meditec AG) on the planning of toric intraocular lenses (IOLs), and the error in predicted residual astigmatism (PRA). This single-center retrospective study included 247 eyes of 180 patients. In eyes undergoing cataract surgery, the optimal toric IOL was calculated based on K or TK measured with the IOLMaster 700. Two formulas were used to estimate IOL power: Holladay and Barrett Toric. Optimal cylinder power and alignment axis change induced by using TK versus K were reported. PRA by each calculation method was compared with manifest refractive astigmatism. Postoperative refractive astigmatism prediction error was calculated using vector analysis. The optimal toric IOL based on TK compared with K was different in 39.3% of cases with the Holladay formula and 31.6% of cases with the Barrett Toric formula. The use of TK rather than K reduced the centroid error in PRA when calculated with the Holladay formula (P < .001), but not when calculated with the Barrett Toric formula (P = .19). The against-the-rule astigmatism subgroup analysis with the Barrett Toric formula showed a statistically significant decrease of centroid error in PRA with the use of TK compared with K (P = .01). TK compared with K measured with the IOL-Master 700 resulted in a change of optimal toric IOL in almost one-third of cases and decreased the error in PRA in patients with against-the-rule astigmatism. [J Refract Surg. 2023;39(4):257-264.].

Topography-Guided Transepithelial Photorefractive Keratectomy for the Treatment of Persistent and Visually-Significant Adenoviral Corneal Infiltrates.

To evaluate visual and refractive outcomes of customized photorefractive keratectomy (PRK) in subjects with persistent subepithelial corneal opacities secondary to adenoviral epidemic keratoconjunctivitis (EKC). Prospective study, which recruited patients with persistent and visually-significant post-EKC corneal opacities unresponsive to prolonged topical therapy (6 months or more). Outcome measures: uncorrected and best-corrected distance visual acuity, subjective refractive astigmatism, keratometric astigmatism, spherical equivalent, minimum corneal thickness, and corneal morphological irregularity index. Subjects were followed for 12 months post-treatment. Eighteen eyes of 18 patients aged between 32 and 75 years treated with topography-guided transepithelial PRK with iRes excimer laser (iVIS Technologies, Taranto, Italy) from June 2020 to July 2021. After 12 months, the mean UDVA improved from 1.0±0.00LogMAR pre-op to 0.15±0.154LogMAR, and the mean CDVA improved from 0.4±0.41LogMAR pre-op to 0.0±0.00LogMAR. With respect to UDVA, all treated eyes (100%) showed an improvement of 6 ETDRS lines or more and with respect to CDVA, 9 out of 18 eyes (50%) showed an improvement of 6 ETDRS lines or more. The mean ablation depth was 54.7±5.9μm. A statistically significant improvement was observed in all topographic indices. No infiltrate recurrence, post-treatment corneal haze, ocular hypertension or other side effects were observed throughout the follow-up period. Topography-guided PRK could be considered an effective and safe treatment option to improve visual acuity in patients affected by persistent and visually-significant subepithelial corneal infiltrates caused by EKC.

A STUDY ON EFFECT OF PTERYGIUM EXCISSION ON PTERYGIUM INDUCED ASTIGMATISM

Purpose: Methods: To determine the effect of pterygium excision on pterygium induced astigmatism. A statistical comparison of the refractive astigmatism before and after effective pterygium surgery was done on 30 patients who underwent preoperative and postoperative refraction testing. pterygium surgery caused si Results: gnicant improvements in visual acuity, with the rule astigmatism. The corneal astigmatism tended to decrease s Conclusion: ignicantly following pterygium excision with conjunctival limbal autograft transplantation.

PEMERIKSAAN PENDERITA PRESBYOPIA DENGAN STATUS REFRAKSI HYPERMETROPIA, MYOPIA, ASTIGMAT DAN EMETROPIA MASYARAKAT CILANDAK PERIODE JANUARI 2023

The inability of a person to see close objects clearly can occur for several reasons, including presbyopia. Meanwhile, a person's inability to see distant objects clearly can occur for several reasons, including because his eyes have hypermetropic refractive status, myopia, astigmatism and emmetropia. This research was carried out using a descriptive method through a quantitative approach. The results showed that of the 53 Cilandak people who received a subjective refraction examination with optic 688, they were presbyopic patients with right (26.4%) and left (28.3%) hypermetropia refractive status, right and left myopia (41.5%), left com astigmatism (22.6%), right com astigmatism (18.9%), right sim astigmatism (13.2%), left sim astigmatism (15.1%), and right emmetropia (31.1%) and Emmetropia left 28.3%). In the examination of subjective refraction, determining the size of spectacle lenses for far vision for patients with hypermetropia is based on a concept, namely by providing the largest spherical lens that can produce the best vision. Meanwhile, for myopia, the weakest spherical correction lens is provided. For astigmatism, cylindrical correction lenses are given, determining the size of spectacle lenses for near vision for presbyopia sufferers with hypermetropia refractive status, which is the accumulation of lens diopters for far vision and addition. It can be concluded that the ultimate goal of examining subjective refraction in patients with presbyopia with hypermetropia, myopia and astigmatism is to determine the appropriate lens size, so that glasses made with these sizes can function as a visual aid.

Outcomes of Single-Step Transepithelial Photorefractive Keratectomy Compared With Alcohol-Assisted Photorefractive Keratectomy Using Wave-Light EX500 Platform.

Purpose To compare the visual outcome of transepithelial photorefractive keratectomy (PRK) against alcohol-assisted PRK in treating low-to-moderate myopia with or without astigmatism. Setting Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia. Design This is a retrospective study. Methods Forty eyes of 22 patients with myopia from -0.75 to -6.00 diopters (D) with or without astigmatism from 0 to -3D were included in this study. Preoperative and postoperative data of 20 eyes from 11 patients who underwent transepithelial PRK were compared with 20 eyes from 11 patients who underwent alcohol-assisted PRK were collected and analyzed. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest spherical equivalence (SE), manifest cylinder, vector analysis of astigmatism, and efficacy and safety indices were compared between the groups at a mean follow-up of one year postoperatively. Results Baseline characteristics were similar between groups, except the transepithelial PRK group had lower cylinder values than the alcohol-assisted PRK group by 0.69D. Regression analysis was used to control for the difference in the cylinder in all outcome parameters. Both groups had similar mean UDVA (p=0.73), CDVA (p=0.98), the proportion of eyes in either group achieved (20/20, 20/25, and 20/30) UDVA (p=0.72, 0.68 and 0.31 respectively) and percentage of eyes lost two lines of CDVA (p=1.0). There was no statistically significant difference between the two groups in regard to both efficacy and safety indices (p=0.55 and 0.67, respectively). Both groups had similar residual SE (p=0.72), the proportion of eyes within ±0.5D of SE (p=0.29), and residual refractive astigmatism (p=0.87). Both groups had similar difference vectors, surgically induced astigmatism, and correction index (p=0.82, 0.10, and 0.26, respectively). However, the transepithelial PRK group had lower target-induced astigmatism (TIA; p=0.01), higher magnitude of error (ME; p=0.05), and higher angle of error (AE; p=0.02) than the alcohol-assisted PRK group. Conclusion Transepithelial PRK had similar visual and refractive outcomes as alcohol-assisted PRK. This approach was considered as safe and effective as alcohol-assisted PRK in treating patients with low-to-moderate myopia with or without astigmatism.

Laser in situ keratomileusis versus Artisan lens implantation in correcting ametropia after penetrating keratoplasty for keratoconus

PurposeTo compare the long-term safety and efficacy of laser in situ keratomileusis (LASIK) with Artisan phakic intraocular lens implantation to correct refractive errors after penetrating keratoplasty (PK) for keratoconus.MethodsThis retrospective comparative interventional case series included a total of 33 consecutive keratoconus eyes that had previous PK and received subsequent LASIK (n = 16) or Artisan lens implantation (n = 17) were included in this study. Outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive error, and complications.ResultsPostoperatively, the UDVA of ≥20/40 was achieved in none of the LASIK group compared to 62.5% of eyes in the Artisan group (P < 0.001); the respective values for CDVA of ≥20/40 were 87.5 and 94.1% (P = 0.51). Spherical equivalent refraction decreased from − 6.97 ± 1.50 D preoperatively to − 4.20 ± 2.05 D postoperatively in the LASIK group (P < 0.001) and from − 10.79 ± 2.15 D preoperatively to − 2.13 ± 1.23 D postoperatively in the Artisan group (P < 0.001). There was no significant change in the refractive astigmatism in LASIK group (P = 0.30) or Artisan group (P = 0.11). The efficacy and safety indices were significantly better for Artisan (0.82 ± 0.34 and 1.13 ± 0.30, respectively) than for LASIK (0.22 ± 0.17 and 0.85 ± 0.24, respectively, P ≤ 0.006 for both comparisons). While refractive error changed significantly from postoperative year 3 to the final visit in the LASIK group, it remained stable in the Artisan group through follow-up period. No significant complications were observed in any group.ConclusionArtisan lens implantation provided superior and stable visual outcomes compared to LASIK for the management of post PK refractive errors in keratoconus eyes.

Rotational stability and refractive outcomes of the DFT/DATx15 toric, extended depth of focus intraocular lens

PurposeTo quantitatively assess postoperative rotational stability and visual acuity with the DFT/DATx15 extended depth of focus (EDOF) toric intraocular lens (IOL).MethodsIn this prospective case series, thirty-five patients with a calculated IOL power between + 15.0 D and + 25.0 D, corneal astigmatism between 0.75 D and 2.25 D, and no significant ocular pathology underwent cataract surgery. Primary outcome was rotational stability of the IOL at 1 month post-operatively. Secondary outcomes included residual refractive astigmatism, absolute residual astigmatism prediction error, and monocular distance and intermediate visual acuities.ResultsMean absolute postoperative IOL rotation was 1.1 ± 0.2 degrees, with no rotation of more than 3 degrees at the final visit. Monocular mean best spectacle-corrected distance visual acuity (BSCDVA) improved from logMAR 0.27 ± 0.030 to 0.078 ± 0.017 (P < .001). Monocular uncorrected distance visual acuity (UCDVA) improved from 0.93 ± 0.096 to 0.18 ± 0.022 (P < .001). Best spectacle-corrected intermediate visual acuity (DSCIVA) was 0.17 ± 0.025, and uncorrected intermediate visual acuity (UCIVA) was 0.27 ± 0.040. Residual regular astigmatic refractive error was 0.21 ± 0.047 D.ConclusionsThe toric DFT/DATx15 EDOF lens showed excellent rotational stability and effective and predictable correction of astigmatism. Its refractive outcomes and safety profile were similar to those identified in prior studies of the non-toric DFT/DAT015 EDOF IOL. A small difference in monocular BSCDVA, of uncertain clinical significance, was found when comparing these outcomes with prior DFT/DAT015 data. The trial was retrospectively registered on November 5, 2021 (TRN ​​NCT05119127).

Elliptical deep anterior lamellar keratoplasty in severe Acanthamoeba keratitis.

Acanthamoeba keratitis (AK) is an intractable infection of the cornea. Penetrating keratoplasty is widely used for the management of severe AK but suffers from complications like graft rejection, endophthalmitis, and glaucoma. Herein, we aimed to describe the surgical technique and the results of elliptical deep anterior lamellar keratoplasty (eDALK) for the management of severe AK. In this retrospective case series, records of consecutive patients with AK poorly responsive to medical treatment who underwent eDALK from January 2012 to May 2020 were reviewed. The largest diameter of infiltration was ≥8 mm and did not involve the endothelium. The recipient bed was made by an elliptical trephine, and big bubble or wet-peeling technique was performed. Postoperative best spectacle-corrected visual acuity, endothelial cell density, corneal topographic data, and complications were evaluated. Thirteen eyes of thirteen patients (eight men and five women, 45.54 ± 11.78 years old) were included in this study. The mean follow-up interval was 21.31 ± 19.59 months (range, 12-82 months). At the last follow-up, the mean best spectacle-corrected visual acuity was 0.35 ± 0.27 logarithm of the minimum angle of resolution. The mean refractive and topographic astigmatism were - 3.21 ± 1.77 and 3.08 ± 1.14 D, respectively. Intraoperative perforation was encountered in one case and double anterior chambers occurred in two cases. One graft developed stromal rejection and one eye developed amoebic recurrence. eDALK can serve as the first-line surgical management of severe AK poorly responsive to medical treatment.

Comparison of Anterior Corneal Astigmatism with Total Refractive Astigmatism

Comparison of Anterior Corneal Astigmatism with Total Refractive Astigmatism

Trans-Epithelial Photorefractive Keratectomy in the Treatment of Myopia, Hyperopia and Astigmatism: Five-Year Results

We aimed to report the five-year results of Trans-epithelial Photorefractive Keratectomy (TPRK) in treating all kinds of refractive errors. In this retrospective cohort study, we quantitatively compared the clinical findings and assessment of optical and refractive parameters, including slit-lamp, corneal topography, Best Corrected Visual Acuity (BCVA), and Uncorrected Distance Visual Acuity (UDVA) in 172 eyes of myopic, hyperopic, and astigmatic patients before and five years after trans-PRK. The average time for post-surgery epithelial healing was 2.97 0.83 days in male and 2.94 0.87 days in female patients; the pain score in a week following the operation was 1.88 0.68 in males and 2.25 0.73 in females. Corneal haze was observed in five patients. No long-term adverse effect was reported. The pre-operative UDVA was 0.84 0.32 in male and 0.87 0.34 in female patients; while the postoperative UDVA was -0.02 0.04 in male and -0.01 0.02 in female patients. There was a highly significant correlation (P&lt;0.001) in all indices except UDVA, which was almost near to being significant (P=0.07). In this survey, the mean safety and index were nearly 1.00. TPRK is a safe and efficient therapeutic procedure to treat all types of refractive errors, including myopia, hyperopia, and astigmatism, with no significant adverse effect. Being touchless and having a short recovery time are two main characteristics of this refractive surgery.