Significant Improvement In UDVA Research Articles

Femto-LASIK after Deep Anterior Lamellar Keratoplasty to Correct Residual Astigmatism: A Long-Term Case Series Study.

Purpose: To evaluate the long-term outcomes of femtosecond laser-assisted in situ keratomileusis (Femto-LASIK) to correct residual astigmatism after deep anterior lamellar keratoplasty (DALK). Methods: This retrospective case series study included 10 eyes that underwent Femto-LASIK after a DALK. The refractive error, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, thinnest corneal thickness (TCT), and central corneal thickness (CCT) were registered. The postoperative follow-up ranged between 36 and 60 months. Results: All surgeries were uneventful, with no intra- or postoperative complications. The mean UDVA (Snellen scale) rose from 0.13 ± 0.05 to 0.47 ± 0.15 six months after Femto-LASIK (p < 0.001). All cases experienced a significant improvement in UDVA. None of the eyes lost lines of CDVA, and seven eyes (70%) improved the CDVA compared to preoperative values. The refractive cylinder changed from a preoperative value of −3.88 ± 1.00 D to −0.93 ± 0.39 six months after Femto-LASIK (p < 0.0001). In eight eyes (80%), the UDVA and refractive outcomes remained stable at postoperative follow-up visits. In contrast, one eye experienced a refractive regression over the follow-up. TCT and CCT were stable at the different postoperative follow-up visits. Conclusions: Our findings suggest that Femto-LASIK might safely and effectively corrects residual astigmatism after DALK. Despite these encouraging results, further long-term studies, including a larger number of cases, are required to confirm the safety of the procedure. The refractive stability in eyes with prior RK might be lower than for other DALK indications.

Visual outcomes in advanced keratoconus using different strategies: Scleral lens, intracorneal ring segment and lamellar keratoplasty

To compare VA outcomes in patients with advanced keratoconus wearing SCL or after ICRS or DALK. In addition, determine the percentage of complimentary treatments after ICRS and DALK, and which of these was fitting a SCL, and final visual acuity (f-VA) results. Retrospective case series analyzed 55 eyes with advanced keratoconus fitted with SCL, or after ICRS or a DALK between 2010 and 2018. The variables analyzed were sex, age, UDVA, CDVA, SEQ, K-readings, and f-VA after complimentary treatments. Twenty-eight eyes underwent a DALK, 14 were fitted with a SCL, and other 13 underwent ICRS insertion. Patients after DALK and after ICRS showed statistically significant improvement in UDVA and CDVA after surgery, with no difference between these groups. Patients fitted with SCL showed statistically higher CDVA improvement when compared to ICRS. After DALK and ICRS, respectively, nine eyes (32.14%) and seven eyes (53.85%) were fitted with SCL. Comparison between f-VA with SCL in three groups showed that the best result was achieved in DALK + SCL, with statistically significant difference to only SCL. We showed that the CDVA of eyes fitted with SCL without any surgical treatment was statistically better than CDVA of eyes after ICRS insertion. After DALK and ICRS insertion, many patients needed a complimentary treatment to improve CDVA. The most chosen treatment was fitting a SCL. After this, all eyes showed statistically significant improvement in f-VA, with statistically better results for DALK + SCL when compared to SCL fitted in advanced keratoconus without any surgical treatment.

FemtoLASIK After Descemet Membrane Endothelial Keratoplasty

To evaluate the efficacy and safety of femtosecond laser-assisted in situ keratomileusis (FemtoLASIK) to correct the residual refractive error after Descemet membrane endothelial keratoplasty (DMEK). This case series study included 7 eyes that underwent FemtoLASIK after a DMEK surgery. The refractive error, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, corneal topography (Sirius, CSO, Italy), and anterior segment optical coherence tomography (Visante, Carl Zeiss-Meditec AG, Jena, Germany) were registered at each postoperative follow-up visit. All surgeries were uneventful, with no intraoperative or postoperative complications. The follow-up time after DMEK (before FemtoLASIK surgery) ranged from 18 to 36 months. The post-FemtoLASIK follow-up period ranged from 12 to 60 months. All cases experienced a significant improvement in UDVA after FemtoLASIK, all of them reaching a postoperative UDVA value ≥20/32. None of the eyes lost lines of CDVA, and 1 case showed a gain of lines of CDVA. In all cases, the refractive error, UDVA, and CDVA values remained stable at their respective postoperative follow-up visits. Furthermore, all topographic and pachymetric parameters were stable at the different postoperative follow-up visits. Our findings suggest that the residual refractive error after DMEK surgery can be safely and effectively treated with FemtoLASIK.

Corneal Cross-linking in Thin Corneas: 1-Year Results of Accelerated Contact Lens-Assisted Treatment of Keratoconus.

To evaluate the safety and efficacy of accelerated contact lens-assisted cross-linking (A-CACXL) for patients with keratoconus and thin corneas. This retrospective study included consecutive patients undergoing A-CACXL for progressive keratoconus from 2015 to 2017. Patients with a minimum corneal thickness of 400 µm or less after epithelium removal who underwent A-CACXL (9 mW/cm2 for 10 minutes, using iso-osmolar 0.1% riboflavin solution and a 90-µm thick, daily disposable bandage soft contact lens) with a follow-up time of 12 months or more were included. The main outcome measures were uncorrected (UDVA) and corrected (CDVA) distance visual acuity and minimum corneal thickness at the last visit. Progression (increase) and flattening (decrease) were defined as a change of 1.00 diopters (D) or greater in maximum keratometry or 1.50 D or greater in mean keratometry. Overall, 24 eyes of 24 patients were included with a follow-up time of 18.2 ± 6.3 months and a mean minimum corneal thickness, after epithelial debridement, of 353.13 µm. There was a significant improvement in UDVA (P = .009), maximum keratometry (P = .03), anterior steep keratometry (P = .04), anterior astigmatism (P = .02), and posterior astigmatism (P = .04) with no significant change in minimum corneal thickness (P = .11). There was a significant improvement in UDVA (0.90 ± 0.63 to 0.64 ± 0.47 logMAR, P = .009), maximum keratometry (61.20 ± 6.30 to 59.90 ± 5.70 D, P = .03), anterior steep keratometry (55.10 ± 3.90 to 54.50 ± 4.10 D, P = .04), anterior astigmatism (5.50 ± 2.40 to 4.60 ± 2.10 D, P = .02), and posterior astigmatism (0.90 ± 0.40 to 0.80 ± 0.40 D, P = .04) with no significant change in minimum corneal thickness (from 399.8 ± 30.7 to 391.0 ± 43.8 μm, P = .11). Flattening occurred in 45.8% (n = 11) and progression in 20.8% (n = 5). There were no serious adverse events. Persistent clinically significant stromal haze occurred in one case and completely resolved by 6 months. There was no significant change in endothelial cell density (P = .10). In patients with keratoconus and thin corneas, A-CACXL halted keratoconus progression in 80%, led to flattening in 45%, and significantly improved UDVA and keratometry values without any evidence of damage to the corneal endothelium or permanent adverse events. [J Refract Surg. 2019;35(10):642-648.].

Visual and keratometric outcomes of keratoconus patients after sequential corneal crosslinking and topography-guided surface ablation: Early United States experience

To evaluate a sequential treatment algorithm for visual and keratometric improvement in keratoconus patients after corneal crosslinking (CXL) followed by topography-guided photorefractive keratectomy (PRK). Ophthalmic Consultants of Long Island, Garden City, New York, USA. Retrospective case series. This study reviewed patients with keratoconus who had CXL followed by custom topography-guided PRK between April 2016 and December 2016. The following data were collected at baseline, the time of CXL, and 3months and 6months after PRK: uncorrected (UDVA) and corrected (CDVA) distance visual acuities, keratometric astigmatism, spherical equivalent, maximum and mean keratometry readings, and corneal thickness at the cone apex. Demographic data, age at time of CXL and PRK, and time elapsed between CXL and PRK were analyzed for significance and a correlation with visual and astigmatic outcomes. The study comprised 56 patients (62 eyes), 34 who had both topographic and refractive treatment and 28 patients who had treatment of topographic irregularities only. The mean age was 38.08years±13.07 (SD) at CXL and 40.33±13.44years at topography-guided PRK. Six months after PRK, there was a significant improvement in UDVA and CDVA in the refractive group (20/60 and 20/30, respectively) versus the nonrefractive group (20/100 and 20/40, respectively). Ninety-three percent of eyes that had refractive treatment had 20/40 or better CDVA. There were no significant adverse events in any case. The data support the use of refractive treatment in addition to topographic treatment for visual improvement in patients with keratoconus having CXL and PRK.

Mechanical versus transepithelial phototherapeutic keratectomy epithelial removal followed by accelerated corneal crosslinking for pediatric keratoconus: Long-term results

To compare the 36-month outcomes of mechanical or transepithelial phototherapeutic keratectomy (PTK) epithelial removal before accelerated corneal crosslinking (CXL) for pediatric keratoconus. Atatürk Training and Research Hospital, Ankara, Turkey. Retrospective case series. Eyes that had accelerated CXL after mechanical (Group 1) or transepithelial PTK (Group 2) epithelial removal were evaluated preoperatively and 12, 24, and 36months postoperatively. The uncorrected (UDVA) and corrected distance visual acuities, spherical equivalent (SE), manifest astigmatism, and corneal tomographic and aberrometric parameters were assessed. The study included 40 eyes of 35 consecutive keratoconus patients younger than 18years with a 36-month follow-up. Group 1 comprised 15 patients, and Group 2 comprised 20 patients. Both groups had a significant improvement in UDVA (P=.001 and P=.02, respectively) and a significant decrease in maximum keratometry (K) and thinnest corneal thickness (all P<.001) 36months postoperatively. The improvements in maximum K, topographic astigmatism, and spherical aberration were greater in Group 2 than in Group 1 at 12months (P=.03, P=.01, and P=.04, respectively). After 12months, the outcomes in the 2 groups were more similar. The initial visual and topographic outcomes of transepithelial PTK ablation were better than those of mechanical epithelium removal before accelerated CXL in pediatric patients with keratoconus. Over the long-term, the results were similar between the 2 groups.

Photorefractive intrastromal corneal crosslinking for treatment of myopic refractive error: Findings from 12-month prospective study using an epithelium-off protocol

To assess the long-term effectiveness and safety of photorefractive intrastromal corneal crosslinking (CXL) in patients with low myopia. Ruhr University Eye Hospital, Bochum, Germany. Prospective case series. Healthy eyes with myopia were treated with photorefractive intrastromal CXL using the Mosaic System. Riboflavin 0.1% solution (VibeX Rapid) was topically administered, followed by 365nm ultraviolet-A (30mW/cm2) irradiance. Efficacy was assessed by theuncorrected distance visual acuity (UDVA), manifest refraction spherical equivalent (MRSE), and keratometry. Safety was assessed by corrected distance visual acuity (CDVA), slitlamp biomicroscopy, endothelial cell count, and adverse event rates. Fourteen patients (24 eyes) with a mean age of 35.7years were included. At all follow-ups, a statistically significant improvement in UDVA was observed (all P<.001). The CDVA progressively improved from 1month postoperatively and a statistically significant improvement was achieved at 12months (P<.001). The average reduction in manifest sphere was 0.90 diopter (D)±0.40 (SD) by 12months. There were no significant differences in mean manifest sphere and MRSE at 3, 6, or 12months. Compared with baseline, significant reductions in corneal curvature were also observed at all follow-ups (all P<.05). There were no significant changes in endothelial cell density (P=1.00) or number of cells (P=.95) at 12months postoperatively, and no adverse events were reported. Photorefractive intrastromal CXL was a safe and efficacious treatment of refractive error in patients with low myopia.

Sulcoflex Piggyback Intraocular Lens Implantation For Correction Of Refractive Errors Following Cataract Surgery

Purpose: To investigate the visual and refractive outcomes following implantation of a Sulcoflex intraocular lens (IOL) to correct pseudophakic refractive error.&#x0D; Methods: This retrospective chart review included 14 pseudophakic eyes of 13 patients who underwent implantation of a Sulcoflex IOL. The Sulcoflex IOL is a piggyback IOL technique where a secondary, supplementary lens is implanted in the ciliary sulcus.&#x0D; Results: Eleven eyes (78.6%) had a postoperative SE within 0.50 D of the targeted SE. Preoperative UDVA was 20/30 in 4 eyes (28.6%), and 20/40 or worse in 10 eyes (71.4%). Postoperative UDVA was 20/30 or better in all eyes, where half (50.0%) of eyes were 20/20 or better. The mean preoperative logMAR (0.50 ± 0.33) significantly improved to 0.06 ± 0.09, p&lt;.01. There were no complications.&#x0D; Conclusions. The significant improvement in UDVA and the precision in reaching the target refraction suggest that the Sulcoflex is a viable and successful treatment option for pseudophakic refractive error.

Outcomes of a new diffractive trifocal intraocular lens

To evaluate refractive and visual parameters related to distance, intermediate, and near vision after cataract surgery and the optical quality of a new diffractive trifocal intraocular lens (IOL). Vissum Instituto Oftalmologico de Alicante, Alicante, Spain. Case series. Patients had bilateral refractive lens exchange and multifocal diffractive IOL (AT Lisa tri 839 MP) implantation. A complete ophthalmology examination was performed preoperatively and postoperatively. The follow-up was 6 months. The main outcome measures were uncorrected distance (UDVA) and corrected distance (CDVA), intermediate, and near visual acuities; keratometry; manifest refraction; and aberrations (total, corneal, internal). The study comprised 60 eyes of 30 patients (mean age 57.9 years ± 7.8 [SD]; range 42 to 76 years). There was significant improvement in UDVA, uncorrected intermediate visual acuity, uncorrected near visual acuity, CDVA, and distance-corrected intermediate and near visual acuity. The postoperative refractive status was within the range of +1.00 to -1.00 diopter. Total internal aberrations decreased significantly (P<.001). The trifocal IOL improved near, intermediate, and distance vision in presbyopic patients. The use of 3 foci provided significant intermediate visual results without sacrificing near or distance vision.

Corneal collagen cross-linking using riboflavin and ultraviolet A for the treatment of mild to moderate keratoconus: 2-year follow-up

ObjectiveTo evaluate the safety and efficacy of corneal ultraviolet A/riboflavin collagen cross-linking (CXL) in patients with mild-to-moderate keratoconus. DesignRetrospective cohort study. ParticipantsThirty-nine eyes from 30 patients who underwent CXL for progressive mild and moderate keratoconus were included. MethodsClinical charts for keratoconus patients who had undergone CXL alone from November 2008 to February 2011 were reviewed for preoperative and postoperative uncorrected and best corrected distance visual acuity (UDVA and BDVA, respectively), manifest refraction, topographical and Scheimpflug imaging, as well as ultrasound pachymetry and haze. Mean and steepest keratometry, central corneal thickness, and root mean-square from corneal aberrations were extracted from the topography. Central and thinnest corneal thicknesses were extracted from the Scheimpflug imaging ResultsA significant improvement in UDVA was seen at 3, 6 and 24 months with an average change in logMAR of 0.39 (p = 0.003) at 24 months compared with baseline. Change in BDVA failed to reach significance, but subgroup analysis showed that a baseline BDVA worse than 0.1 logMAR was associated with better improvement. Stability of refraction, keratometry, and aberrations was demonstrated. Presence of haze was statistically significant up to 12 months (p≤0.001), being maximal at 3 months, then insignificant by 24 months. No complications were observed during the follow-up period. ConclusionsCXL is a safe and effective stabilizing strategy for progressive mild-to-moderate keratoconus with significant improvement of the UDVA. There was a trend toward improvement of BDVA in patients with lower preoperative BDVA value.

Toric implantable collamer lens for moderate to high myopic astigmatism: 3-year follow-up

To evaluate the 3-year clinical outcomes after toric implantable collamer lens (ICL) implantation for the management of moderate to high myopic astigmatism. Thirty-four eyes of 20 patients who underwent toric ICL implantation were reviewed. All eyes completed 3-year follow-up. Uncorrected (UDVA) and corrected (CDVA) distance LogMAR visual acuities, refraction, endothelial cell density (ECD), and surgical complications were evaluated. Vectorial analysis of astigmatic correction was also done. A significant improvement in UDVA, CDVA, manifest spherical and cylindrical refraction was observed at 1 week and remained stable after 3 years. Twenty-six eyes (76.5%) gained lines of CDVA, and two eyes (5.9%) showed a loss of 1 line of CDVA. The spherical equivalent (SE) was within ±0.50 D of emmetropia in 18 eyes (52.9%) and within ±1.00 D in 28 eyes (82.4%). Differences between target-induced astigmatism (TIA) and surgically-induced astigmatism (SIA) were statistically significant (p < 0.01), and a trend to undercorrection of the refractive astigmatism was present after 3 years. The magnitude of flattening effect (FE) was found to be significantly lower than the magnitude of TIA (p < 0.01). The magnitude of the torque vector was always positive, with a value below 0.50 D in all cases. No vision-threatening complications were observed during the follow-up. Toric ICL implantation is an effective and safe surgical option that provides a relatively predictable and stable refractive correction of myopic astigmatism. Further improvements are needed to minimize the degree of undercorrection.

Comparison of mechanical and femtosecond laser tunnel creation for intrastromal corneal ring segment implantation in keratoconus: Prospective randomized clinical trial

To compare the outcomes of mechanical and femtosecond laser-assisted tunnel creation for intrastromal corneal ring segment (ICRS) implantation in eyes with keratoconus. Kartal Training and Research Hospital, Istanbul, Turkey. In this prospective study, consecutive eyes with keratoconus were randomly assigned to have ICRS tunnel creation with a mechanical device or a femtosecond laser. Keraring ICRS with a 5.0 mm diameter and 160-degree arc length were implanted in all cases. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, and keratometry (K) readings were measured preoperatively and 1 year postoperatively, and the data in the mechanical group and the femtosecond group were compared statistically. One year postoperatively, there was significant improvement in UDVA, CDVA, K readings, spherical equivalent (SE), and manifest sphere and cylinder in both groups (P<.05). The UDVA improved by 2.4 lines in the mechanical group and 2.0 lines in the femtosecond group and the CDVA by 3.3 lines and 2.7 lines, respectively; the mean reduction in maximum keratometry was 4.50 diopters (D) and 4.70 D, respectively, and the mean reduction in SE, 3.18 D and 3.09 D, respectively. There were no statistically significant differences between the 2 groups in visual or refractive results (P>.05). Anterior corneal perforation, superficial segment placement, and segment extrusion occurred in 1 eye each in the mechanical group. Segment migration occurred in 1 eye in the femtosecond group. Despite intraoperative complications in the mechanical group, the visual and refractive outcomes were similar to those in the femtosecond group.

Intrastromal corneal ring segment SK implantation for moderate to severe keratoconus

To report the efficacy and safety of intrastromal corneal ring segment (ICRS) implantation using a femtosecond laser in the management of advanced keratoconus. Private laser center, Toronto, Ontario, Canada. In this retrospective nonrandomized study, Intacs SK ICRS were implanted using an IntraLase femtosecond laser in eyes with moderate to severe keratoconus. Evaluation included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refraction, slitlamp examination, corneal topography, and wavefront analysis of higher-order aberrations. Postoperative visits were at 1, 7, and 30 days and 3 and 6 months. The study evaluated 10 eyes of 8 patients with a mean age of 28 years (range 21 to 42 years). The mean UDVA was significantly better 6 months postoperatively than preoperatively (0.66 logMAR +/- 0.21 [SD] versus 1.19 +/- 0.57 logMAR) (P = .004), as was the mean CDVA (0.25 +/- 0.15 logMAR versus 0.51 +/- 0.20 logMAR) (P = .018). The mean spherical equivalent refractive error was -8.08 diopters (D) preoperatively and -5.03 D at 6 months (P = .65); the mean refractive astigmatism, -5.05 D and -3.90 D, respectively (P = .22); and the mean simulated keratometry value, 57.94 D and 50.07 D, respectively (P = .15). The mean total aberration improved significantly, from 13.48 +/- 4.64 mum preoperatively to 9.42 +/- 1.80 mum postoperatively (P = .007). There were no complications. Implantation of ICRS for advanced keratoconus was safe and effective, leading to significant improvement in UDVA, CDVA, and total aberrations. No author has a financial or proprietary interest in any material or method mentioned.