Uncorrected Distance Visual Acuity Research Articles

Lamellar surgeries with SMILE-derived lenticules.

Lamellar surgeries with SMILE lenticules are an evolving field of refractive surgery. This chapter intends to discuss the reported clinical results of using SMILE derived lenticules in terms of feasibility, safety and predictability; or the potential management of hyperopia, keratoconus, SMILE ectasia and presbyopia. Donor SMILE lenticules were prepared under microscope tocreate doughnut shaped lenticules. For hyperopia, this tissue was then inserted into afemtosecond laser enabled pocket created using VisuMax FS Laser at a depth of 160µm. For ectasia induced by keratoconus and post refractive procedure (SMILE), 0.23% riboflavin dye was instilled into the interface and then lenticule was inserted followed by exposure to UV-A radiation with total energy of 6.3 J. Spherical equivalent (S.E.) of within ± 0.5 D was observed in 50% (n=21) eyes and within 1 D was seen in 71% eyes treated for hyperopia. A significant increase in the K mean anterior, central corneal thickness, Q-value and corneal aberrations was seen 2 weeks post-op. Clinical improvement in terms of S.E. and uncorrected distance visual acuity in eyes treated for ectasia after keratoconus and post refractive procedure (SMILE) was seen. With the ample availability of SMILE- derived lenticules, researchers are exploring the possibility of using this tissue for the treatment of various refractive and corneal conditions.

Analysis of visual quality improvement after implantation of PanOptix trifocal intraocular lens in cataract patients with different axial lengths.

To assess the visual quality, both subjective and objective, of cataract patients with varying axial lengths (AL) after PanOptix trifocal intraocular lens (IOL) implantation and investigated the lens tilt and its correlation with visual outcomes. From July 2020 to June 2022, 70 patients (140 eyes) diagnosed with age-related cataracts and undergoing PanOptix implantation at Chongqing Eye and Vision Care Hospital, Aier Eye Hospital Group, were included. Patients were assigned to either the observation group (35 cases, 70 eyes with PanOptix trifocal IOL) or the control group (35 cases, 70 eyes with bifocal IOL). Patients were further subdivided based on AL into AL < 24 mm (observation group: 23 eyes; control group: 26 eyes) and AL ≥ 24 mm (observation group: 47 eyes; control group: 44 eyes). Postoperative follow-up lasted three months. Visual acuity (distant, intermediate, near), objective visual quality (Strehl ratio: SR, total eye modulation transfer function (MTF)), and visual aberrations were measured preoperatively and at 3 months post-operation. Postoperatively, all groups saw significant improvements in uncorrected distance visual acuity (UCDVA), uncorrected intermediate visual acuity (UCIVA), and uncorrected near visual acuity (UCNVA) compared to preoperative values (T0) (all P < 0.05). Notably, UCIVA was significantly better in the observation group than in the control group (P < 0.05). At three months (T1), reductions in total high-order aberration (tHOA), internal high-order aberration (iHOA), coma, and trefoil aberrations were observed in both groups compared to baseline, with more significant decreases in the observation group (all P < 0.05). Both SR and MTF cutoff showed marked improvement from T0 to T1, with the observation group experiencing greater enhancements (both P < 0.05). The defocus curve of the observation group showed a gentle slope between +0.5 D and -3.0 D, maintaining superior visual acuity compared to the control group (P < 0.05). Subjective visual quality scores at T1 were significantly higher than at T0 for both groups (P < 0.05), with patients in the observation group scoring higher than those in the control group across all AL categories (P < 0.05). Spearman correlation analysis indicated that the tilt after PanOptix trifocal IOL implantation was associated with tHOA (r = 0.273, P = 0.022), iHOA (r = 0.433, P < 0.001), Trefoil (r = 0.360, P = 0.002) and coma (r = 0.688, P < 0.001). PanOptix trifocal IOL implantation in cataract patients across different AL significantly enhances visual quality compared to bifocal IOLs, suggesting a strong case for its clinical adoption.

Streptococcus equinus keratitis after small-incision lenticule extraction: A case report and literature review

A 20-year-old male patient underwent small-incision lenticule extraction (SMILE) due to compound myopic astigmatism in both eyes. On the first day after SMILE, the patient was diagnosed with infectious keratitis (IK) caused by Streptococcus equinus. Emergency surgery was performed, and 2.5% vancomycin solution was used to wash the corneal interlamine of both eyes. After surgery, intensive antibiotic treatment and glucocorticoids were administered to reduce haze in the corneal epithelium and prevent corneal scar hyperplasia. IK was controlled in both eyes, and the uncorrected distance visual acuity in both eyes was 20/20.

Clinical outcome of intrastromal corneal ring segment implantation with two different nomograms in keratoconus patients

Aim The aim of this study was to assess the clinical effects of Keraring implantation in patients with keratoconus (KC) using a newly created nomogram (NN) based on cone location and Q value compared with the manufacturer’s standard nomogram (SN). Patients and methods This is a prospective randomized controlled clinical trial that included 100 keratoconic eyes of 100 patients. The patients were randomly assigned into two groups: group NN and group SN. Group NN underwent Keraring implantation based on the newly developed nomogram, while group SN followed the manufacturer’s standard nomogram. The primary outcome measures included visual acuity, different refractive measurements, keratometry values, and Q values, while the secondary outcome measure was Belin ABCD KC grading. All outcome measures were evaluated at 12 months postoperatively. Results The mean age of group NN was 22.96±7.45 years and that of group SN was 24.12±7.00 years, with no statistically significant difference (P=0.46). At 3 months postoperatively, group NN demonstrated substantial improvements compared with group SN. Group NN exhibited a greater improvement in uncorrected distance visual acuity [mean difference (MD) in LogMAR visual acuity=−0.61 compared with −0.31 in group SN, P&lt;0.0001] and corrected distance visual acuity (MD: −0.34 LogMAR compared with −0.05 LogMAR in group SN, P&lt;0.0001). Significant reductions were noted in sphere (MD: 4.22 D in group NN compared with 2.33 D in group SN, P&lt;0.0001), refractive cylinder (MD: 2.87 D in group NN compared with 1.74 D in group SN, P=0.003), and spherical equivalent (MD: 5.56 D in group NN compared with 3.12 D in group SN, P&lt;0.0001). Keratometric values and Belin ABCD grading system (particularly A and D categories) also showed more pronounced improvements in group NN than in group SN (P&lt;0.0001). Conclusion The personalized approach of the new nomogram (NN) based on cone location and Q value resulted in superior visual, refractive, and corneal topographic outcomes compared with the standard nomogram (SN) during the implantation of Keraring in KC patients. The individualized nomogram allowed for more precise corneal reshaping and restoration of corneal asphericity.

Comparative Evaluation of Visual Outcomes in Combined Cataract and Vitrectomy for Idiopathic Epiretinal Membrane with an Advanced or Conventional Intraocular Lens

Introduction: The aim of this study was to investigate the efficacy of new monofocal intraocular lens (IOL) in comparison with conventional monofocal IOL in patients undergoing combined cataract and vitrectomy surgery for epiretinal membrane (ERM). Methods: This prospective non-randomized comparative study included 65 eyes of 65 patients who underwent combined cataract and vitrectomy for ERM with implantation of advanced monofocal IOL (Eyhance ICB00, 33 patients) and standard monofocal IOL (Tecnis ZCB00, 32 patients). Monocular visual acuities were measured 6 months post-operatively, including corrected and uncorrected distance visual acuity (CDVA, UCDVA), uncorrected intermediate visual acuity (UCIVA), and uncorrected near visual acuity (UCNVA). Furthermore, contrast sensitivity and metamorphopsia were measured. Results: There was no significant difference between two groups regarding operation time, post-operative CDVA, UCDVA, UCNVA, and spherical equivalent (p > 0.05). Monocular UCIVA was significantly higher in the Eyhance IOL group than in the Tecnis IOL group (p = 0.005). The photopic and mesopic contrast sensitivities were comparable between each group for any spatial frequency (p > 0.05). The correlation coefficients from correlations between retinal wrinkling ratio and M score did not differ significantly between groups (p = 0.877), and the degree of metamorphopsia was not significantly related to the type of IOL (p = 0.969). Conclusions: In combined cataract and vitrectomy for ERM, Eyhance IOL provided significant better visual performance at intermediate distance than standard monofocal IOL without compromising operation time, distance vision, contrast sensitivity, and evaluating metamorphopsia. Eyhance IOL can be a useful option for both surgeons and patients.

The association of pre-photorefractive keratectomy Schirmer-1 test value with postoperative corneal epithelial thickness, ocular surface discomfort, and visual acuity.

To investigate the association of pre-photorefractive keratectomy Schirmer-1 test value with post-photorefractive keratectomy central corneal epithelial thickness, ocular surface disease index score, and uncorrected distance visual acuity. Patients were categorized according to preoperative Schirmer-1 value: the normal Schirmer Group (n=54; Schirmer-1 test value, >10 mm) and the low Schirmer Group (n=52; Schirmer-1 test value, between 6 and 10 mm). We analyzed ablation depth, visual acuity, result of Schirmer-1 test (with anesthesia), tear film break-up time, ocular surface disease index score, central corneal epithelial thickness, and spherical equivalent refraction. We found significant differences between the groups in Schirmer-1 test value, tear film break-up time, and ocular surface disease index score, both preoperatively and postoperatively (p<0.001). The preoperative central corneal epithelial thicknesses of the two groups were similar (p>0.05). After photorefractive keratectomy, the Schirmer-1 test value and spherical equivalent refraction decreased in both groups (p<0.05), and ocular surface disease index scores and central corneal epithelial thickness values increased in the low Schirmer Group (p<0.001) but not in the normal Schirmer Group (p>0.05). The postoperative central corneal epithelial thicknesses of the low Schirmer Group were significantly higher than those of the normal Schirmer Group (p<0.001). Postoperative uncorrected distance visual acuity did not differ significantly between the two groups (p>0.05). In patients with low Schirmer-1 test values before photorefractive keratectomy, the corneal epithelium thickened and ocular surface complaints increased during the postoperative period. However, changes in the corneal epithelium did not affect the postoperative uncorrected distance visual acuity. To reduce postoperative problems on the ocular surface in these patients, we recommend that dry eye be treated before photorefractive keratectomy.

A Comparative Study of the Effect of Femtosecond Laser-Assisted Cataract Surgery on Corneal Astigmatism in Post-LASIK Eyes and Virgin Eyes.

To evaluate and compare the effect of femtosecond laser-assisted cataract surgery on corneal astigmatism in post-LASIK eyes and virgin eyes. Patients who underwent femtosecond laser-assisted cataract surgery were included in the study and categorized into two groups: Group A, consisting of patients with post-LASIK eyes, and Group B, consisting of patients with virgin eyes. Visual acuity, corneal astigmatism, and surgically induced astigmatism (SIA) were evaluated. Additionally, the correlation between SIA and preoperative corneal astigmatism, mean corneal curvature, and central corneal thickness was also analyzed. A total of 168 eyes were enrolled in this study, with 62 eyes in Group A and 106 eyes in Group B. Significant differences in corneal astigmatism and SIA were observed between the two groups in the early postoperative period following cataract surgery (P<0.05). However, there was no significant difference at 6 months postoperatively (P>0.05). Corneal astigmatism demonstrated an against-The-rule shift in both groups postoperatively. No significant correlation was identified between SIA and preoperative corneal astigmatism, corneal curvature or corneal thickness. Additionally, there was no significant difference observed between the two groups in terms of uncorrected distance visual acuity (UDVA) at 6 months postoperatively. The effect of femtosecond laser-assisted cataract surgery on corneal astigmatism in post-LASIK eyes and virgin eyes was different in the early postoperative period. However, there was no significant difference at 6 months postoperatively. The post-LASIK eyes exhibited a delayed recovery compared to the virgin eyes.

Keratoconus Treatment Using Femtosecond Laser–Assisted Innovative Intracorneal Ring–Supported Graft Surgery: A Pilot Investigation

Purpose: To investigate clinical manifestations and response to a revision in the intrastromal corneal ring and implantation technique for the treatment of severe keratoconus at two private clinics in Iran. Methods: This prospective, non-comparative clinical study included 6 eyes from 6 patients treated with a new innovative sutureless ring-supported graft insertion technique. Refractive, topographic, corneal biomechanical, and anterior aberrometry outcomes were analyzed during the 6-month follow-up. Secondary variables included corneal stiffness and confocal microscopy. Results: No intraoperative and postoperative complications occurred. Six months after implantation of the RinGraft, the ring was centered at the pupil reflex, the eye was white and quiet, and the graft was clear. The mean topographic keratometry values decreased significantly postoperatively ( P = .025). Additionally, corneal stiffness increased significantly postoperatively ( P = .004). Anterior and posterior corneal aberrometry data collected over a 5-mm diameter revealed a significant decrease in higher order aberrations, spherical aberration, primary coma, and trefoil 6 months after surgery ( P = .019). Intraocular pressure changes were significantly greater than before surgery ( P = .006). Uncorrected distance visual acuity increased from 0.96 ± 0.52 logMAR preoperatively to 0.71 ± 0.22 logMAR postoperatively ( P = .078). No statistically significant change was found in corrected distance visual acuity ( P = .0221) Conclusions: Excellent structural support and stability of the cornea were observed immediately postoperatively and 6 months after RinGraft insertion. Considering the corneal instability and asymmetry, it appears to be a possible and safe therapy option for keratoconic eyes that can be performed easily. [ Journal of Refractive Surgery Case Reports. 2024;4(1):e1–e10.]

Application of sutureless corneal incision for patients with congenital ectopia lentis - Is it feasible, effective and safe?

Purpose: To compare the clinical outcomes, feasibility, and safety between groups with sutured and sutureless wound closure in congenital ectopia lentis (CEL) patients. Methods: Patients with CEL who received phacoemulsification combined with intrascleral fixation of capsular hook (CH) and implantation of capsular tension ring (CTR) and in-the-bag intraocular lens (IOL) were included in this study. Results: A total of 68 eyes of 34 patients aged 18 years or younger were enrolled in this study. Incisions of 21 patients (34 eyes) did not require sutures while sutures were applied in 21 patients (34 eyes). Postoperative uncorrected distance visual acuity, best corrected distance visual acuity and intraocular pressure measurements were comparable on follow-up visits (P > 0.05). The magnitude of surgically induced astigmatism was significantly greater (P = 0.001) in the suture group (Median: 0.47; IQ: 1.63, 2.97) than in the sutureless group (Median: 0.88; IQ: 0.63, 1.35). No cases of endophthalmitis and retinal detachment were found postoperatively in either group, while suture-related complications were observed in the sutured group, including loose suture with discomfort in 5 (14.71%) eyes, loose suture with mucus infiltration in 3 (8.82%) eyes. In total, 22 sutures (64.71%) of 34 eyes required removal. Conclusions: Sutureless clear corneal incision in CEL patients can achieve satisfactory clinical results comparable to sutured wound closure in terms of the efficacy and safety. Advantages of this approach are the reduced risk of suture-related complications, no need for additional surgery under general anesthesia for suture removal, and less cost.

Three-Month Clinical Outcomes to Correct Myopia or Myopic Astigmatism Using a Femtosecond Laser for Lenticule Creation With Automated Centration and Cyclotorsion Compensation.

To individually evaluate the clinical outcomes for right and left eyes in the first 3 months after laser-assisted lenticule extraction for myopia and myopic astigmatism with the use of the new ATOS femtosecond laser system (Smart-Sight; SCHWIND eye-tech-solutions). A total of 331 eyes from 168 patients (166 right eyes and 165 left eyes) consecutively treated with SmartSight lenticule extraction were retrospective analyzed after a 3-month follow-up period. Patients' mean age was 26 ± 6 years (range: 18 to 47 years) and mean preoperative spherical equivalent (SEQ) was -5.07 ± 1.92 diopters [D] (range: -1.50 to -11.25 D) with a mean astigmatism of -1.04 ± 0.85 D (range: 0.00 to -4.00 D). At 3 months of follow-up, visual acuity, SEQ and cylinder, safety index, efficacy index, corneal higher order aberrations, and intraocular pressure (IOP) were analyzed. Furthermore, refractive and visual outcomes were also analyzed for the right and left eyes individually. All lenticule extraction treatments were performed with the SmartSight treatment method of the SCHWIND ATOS femtosecond laser. At 3 months after surgery, mean SEQ was -0.12 ± 0.19 D and 98% of eyes were within ±0.50 D of the SEQ. All eyes were within ±1.00 D of the SEQ. Astigmatism of 0.50 D or less was achieved in 99% of eyes. The change in Snellen lines (difference between preoperative corrected distance visual acuity and postoperative uncorrected distance visual acuity) showed a gain of one or more lines in 13% and in 85% of the eyes the same was achieved. There was a loss of one or more lines at 3 months of follow-up in 1.6%. The safety index was 1.03 and efficacy index was 1.02. No significant difference between the right and left eyes was found. The 3-month follow-up data show that SmartSight treatment for correction of myopia and myopic astigmatism with the SCHWIND ATOS is a safe, efficient, and accurate procedure. It provided excellent results in terms of visual recovery, predictability, and higher order aberrations. [J Refract Surg. 2024;40(1):e30-e41.].

Positive dysphotopsia after implantation of an EDOF intraocular lens

Introduction: This report describes a case of positive dysphotopsia (PD) after refractive lens exchange (RLE) with implantation of an extended depth-of-focus (EDOF) intraocular lens (IOL). Patient and Clinical Findings: A healthy 48-year-old man underwent RLE with bilateral implantation of a nontoric EDOF IOL and suffered from monocular triplopia in both eyes. The visual acuity was suboptimal with an uncorrected distance visual acuity of 20/25 in the right eye and 20/30 in the left eye. Diagnosis, Intervention and Outcomes: Slitlamp examination showed well-centered implanted IOLs, without capsular distension syndrome. Bilateral IOL exchange was performed with an aspheric monofocal IOL with a 7.0 mm optic diameter, which diminished the PD complaints. Conclusions: This case report describes disturbing PD after bilateral implantation of an EDOF IOL. Exchange of these EDOF IOLs with a larger optical diameter monofocal IOL resulted in resolution of symptoms.

Factors Predicting Slow Visual Recovery Following Hyperopic LASIK.

To identify factors predicting slow visual recovery following hyperopic laser in situ keratomileusis (LASIK). The study included consecutive patients who underwent hyperopic LASIK between January 2005 and December 2019 at a single medical center. Patients were divided into two groups according to whether they experienced normal recovery of visual acuity (1-week visit) or slow visual recovery (1-month visit). Visual recovery was defined as achieving an efficacy index of 0.9 or greater. Efficacy index was calculated as postoperative uncorrected distance visual acuity / preoperative corrected distance visual acuity. A comparison of baseline and intraoperative parameters was performed. Binary logistic regression was performed to identify potential predictors of slow visual recovery. Overall, 861 eyes of 861 patients were included. Mean age was 48.0 ± 9.5 years and 55.9% were women. Two hundred forty-nine patients (28.9%) experienced slow visual recovery. Younger age (P = .01), a larger preoperative spherical equivalence (P = .002), and greater maximum ablation depth (P = .002) were predictors of slow visual recovery. In binary logistic regression, female gender (P = .036) and greater spherical equivalence (P = .007) remained significant predictors of slow visual recovery. Female gender and greater preoperative spherical equivalence were associated with slow visual recovery. Patients may be advised accordingly. [J Refract Surg. 2024;40(1):e42-e47.].

Comparison of visual quality after wavefront-guided LASIK in patients with different levels of preoperative total ocular higher-order aberrations: a retrospective study.

To compare the visual quality after wavefront-guided femtosecond LASIK (WFG FS-LASIK) in patients with different levels of preoperative total ocular higher-order aberrations to guide clinical decision-making regarding patient selection and treatment strategies. This study included 112 right eyes of 112 patients who previously underwent WFG FS-LASIK for correcting myopia and myopic astigmatism. The patients were divided into two groups based on the mean values of preoperative total ocular HOAs (0.30 ± 0.09 µm): HOA ≤ 0.3 and > 0.3 groups. The visual acuity, manifest refraction, corneal Strehl ratio (SR), root mean square (RMS) of corneal and ocular aberrations, and area under the log contrast sensitivity function (AULCSF) of both groups were compared preoperatively and at 1, 3, 6, and 12 months postoperatively. The induced ocular HOAs and coma (Δ = 1 mo - Preop) were significantly lower in the HOAs > 0.3 group than in the HOAs ≤ 0.3 group (ΔHOAs: 0.39 ± 0.19 vs. 0.29 ± 0.18 μm, t = 2.797, P = 0.006; Δ coma: 0.30 ± 0.19 vs. 0.20 ± 0.21 μm, t = 2.542, P = 0.012). In the HOAs > 0.3 group, ΔHOAs were negatively correlated with the preoperative ocular HOAs (r = -0.315, P = 0.019). In the HOAs ≤ 0.3 group, the regression equation for Δ HOAs = 0.098 + 0.053 |SE| (F = 21.756, P < 0.001). In the HOAs > 0.3 group, the regression equation for ΔHOAs = 0.534 - 1.081 HOAs + 0.038|Sphere| (F = 7.954, P = 0.001). The postoperative uncorrected distance visual acuity, spherical equivalent, corneal aberrations, SR and AULCSF of both groups were similar (all P > 0.05). Furthermore, the ocular aberrations were not significantly different between both groups at 3, 6, and 12 months postoperatively (all P > 0.05). In addition, compared with the preoperative period, the AULCSF of both groups were significantly increased in the postoperative period (all P < 0.05). The induced ocular HOAs and coma in HOAs > 0.3 group were lower. However, both groups achieved equivalent and excellent visual quality after WFG FS-LASIK. WFG FS-LASIK may provide significant visual benefits for a wider range of patients.

Relentless bilateral accommodation spasm in an adolescent treated with clear lens extraction

Introduction: Pathologic accommodation spasm occurs when persistent contraction of the ciliary muscle of the eye induces pseudomyopia. The purpose of this report was to describe the case of an adolescent with recurrent ciliary spasm, refractory to medical treatment for several years. Patient and Clinical Findings: A 10-year-old girl was evaluated because of complaints of decreased visual acuity (VA) and frequent headaches. Diagnosis, Intervention and Outcomes: The diagnosis of pseudomyopia due to accommodation spasm was established. No organic causes were detected. She started treatment with cycloplegics, which were successively titrated at different doses, along with the use of spectacles, over the following years. After 7 years of follow-up, the lack of efficacy of treatment and intolerance to its side effects demanded further action, so a clear lens extraction was performed, with the implantation of continuous focus transition multifocal intraocular lenses. Her final uncorrected distance VA was 6/6 in each eye, with good intermediate vision and J1 near vision with +2.00 addition. Conclusions: In severe cases of ciliary spasm, medical therapy and spectacle prescription may not be sufficient to control the disease. Intraocular lens implantation may be the only remaining therapeutic option to provide quality of life to the patient.

Outcomes of the Q value-based nomogram in managing pediatric versus adult keratoconus: a prospective interventional study.

Keratoconus (KCN) is an ectatic disorder of the cornea characterized by stromal weakness and apical protrusion of the cornea, and is associated with a gradual and painless reduction in visual acuity. KCN in pediatric patients has certain important characteristics, such as a progressive and aggressive nature. We aimed to analyze the visual, refractive, and topographic outcomes of implanting a single 210° arc-length Keraring segment according to a novel, objective, Q value-based nomogram (Q-N) for the treatment of pediatric versus adult KCN. This prospective, multicenter, non-randomized, open-label trial included 47 eyes of 47 patients who were allocated to one of two groups. The adult group included 33 eyes of patients ≥ 18 years of age, whereas the pediatric group included 14 eyes of patients aged 14 - 17 years. All patients underwent femtosecond laser-assisted implantation of a single 210° arc-length Keraring segment according to the Q-N and were followed up for 6 months. All eyes underwent visual acuity measurement, cycloplegic refraction, and corneal topography at baseline and 6 months after surgery. The study groups were comparable in terms of sex proportions and KCN grades (both P > 0.05). The adult group exhibited significant postoperative improvements in mean uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), sphere, cylinder, spherical equivalent (SE), and Kmax (all P < 0.001) with a mean change of -0.56 logarithm of the minimal angle of resolution (logMAR), - 0.40 logMAR, 3.07 diopters (D), 0.70 D, 3.42 D, and - 5.26 D, respectively. The pediatric group exhibited significant postoperative improvements in mean UDVA, CDVA, sphere, SE, and Kmax (all P < 0.05) with a mean change of - 0.62 logMAR, - 0.34 logMAR, 3.18 D, 3.67 D, and - 5.37 D, respectively. There were no significant differences between the groups in terms of the mean change in visual, refractive, and topographic variables (all P > 0.05). No postoperative complications were observed in either group. Use of the objective Q-N was efficient in the treatment of pediatric KCN, with postoperative improvements in the mean visual, refractive, and topographic parameters, comparable to outcomes in adult keratoconus. Q-N achieved good corneal remodeling with subsequent improvements in visual, refractive, and topographic outcomes in both adult and pediatric patients with keratoconus. To verify our preliminary findings, we recommend further multicenter randomized clinical trials using the Q-N nomogram in a larger sample of pediatric patients with KCN as an adjunct treatment before or after CXL.

Comparative Analysis of the Visual, Refractive and Aberrometric Outcome with the Use of 2 Intraocular Refractive Segment Multifocal Lenses.

To demonstrate the results of ray tracing higher- and lower-order aberrations in pseudophakic eyes with rotationally asymmetrical segment multifocal lenses, total high- and low-order aberrations, measured by root mean square value (RMS), refraction, uncorrected distance and uncorrected near visual acuity (UCDVA and UCNVA), and tear break-up time, were measured at scotopic size in 42 eyes of patients implanted with bifocal refractive Mplus15/Mplus30 IOL with +1.5 dpt near addition (42 eyes of patients implanted with Mplus15)/+3.0 dpt near addition (91 eyes of patients implanted with Mplus30), and 107 eyes of control group. No significant differences were noticed between the examined groups concerning UCDVA, UCNVA, and tear break-up time (p < 0.001). Coma and total high-order aberrations were significantly higher for the Mplus30 lens in comparison to the Mplus15 lens and the control group (Coma, Trefoil p < 0.001, Secondary Astigmatism p = 0.002). The spherical aberrations were significantly higher in the lower-addition lens (p = 0.016) in comparison to the control group and to the higher-addition lens group (p < 0.001). Both intraocular lens models were successful at reaching refractive aim, good distance, and near function with the lower higher-order aberrations for the low-addition lens.

Soczewka wewnątrzgałkowa o wydłużonej głębi ostrości AcrySof&lt;sup&gt;®&lt;/sup&gt; IQ Vivity&lt;sup&gt;®&lt;/sup&gt; – doświadczenia własne

PurposeTo present preliminary results of distance, intermediate and near visual acuity, objective and manifest refraction in two groups of patients: targeted on emmetropia and targeted on small myopia after cataract surgery with an implantation of Extended Depth-of-Focus AcrySof&lt;sup&gt;®&lt;/sup&gt; IQ Vivity&lt;sup&gt;®&lt;/sup&gt; DFT015 (Alcon Inc., Fort Worth, TX, USA) intraocular lens in three months follow-up.Material and MethodsA total of 18 eyes of 15 patients underwent 2.4 mm coaxial cataract surgery with an implantation of AcrySof&lt;sup&gt;®&lt;/sup&gt; IQ Vivity&lt;sup&gt;®&lt;/sup&gt; DFT015 intraocular lens (Alcon Inc., Fort Worth, TX, USA). Before surgery best-corrected distance visual acuity, objective and manifest refraction and corneal keratometry were evaluated. Three months after the surgery uncorrected and best-corrected distance visual acuity, uncorrected intermediate visual acuity uncorrected and best-corrected near visual acuity, objective and manifest refraction and corneal keratometry were analyzed in both groups.ResultsThree months after the surgery in the emmetropic group refractive outcomes were: mean uncorrected distance visual acuity 0.04 ± 0.05, mean best-corrected visual acuity 0.01 ± 0.04, mean uncorrected intermediate visual acuity 0,01 ± 0,03, mean uncorrected near visual acuity 0.15 ± 0.09 and mean best-corrected near visual acuity 0.00 ± 0. In the mini monovision group: mean uncorrected distance visual acuity was 0.13 ± 0.11, mean best corrected visual acuity 0.01 ± 0.02, mean uncorrected intermediate visual acuity 0.00 ± 0, mean uncorrected near visual acuity 0.09 ± 0.13 and mean best-corrected near visual acuity 0.00 ± 0. There was no significant change in corneal keratometry in flat and steep meridian (&lt;i&gt;p&lt;/i&gt; = 0.59 and &lt;i&gt;p&lt;/i&gt; = 0.4) in whole group. There were no intra- and post-operative complications in any of the patients.ConclusionsAcrySof&lt;sup&gt;®&lt;/sup&gt; IQ Vivity&lt;sup&gt;®&lt;/sup&gt; DFT015 (Alcon Inc., Fort Worth, TX, USA) provided good distance and intermediate visual acuity with the functional near. It is well tolerated with poor impact of post-operative optical phenomena. Significant gains in binocular near vision can be achieved by leaving the nondominant eye of patients with 0.50 D to 1.00 D of myopia.

Comparative Evaluation of the Defocus Curve of Monofocal IOL, Extended Depth of Focus IOL, and Trifocal IOL

Purpose. Comparative evaluation of the defocus curve (DC) of monofocal IOLs (MIOLs), extended depth of focus IOLs (EDОF) and trifocal IOLs (TIOLs). Patients and methods. We observed 90 patients (average age 57.8 ± 1.8 years) who underwent standard binocular phacoemulsification of cataracts in both eyes with emmetropic “target” refraction and postoperative monocular uncorrected distance visual acuity (UCVA) of at least 1.0 rel. units. All patients were divided into three groups equal in number of patients, age, gender and visual status, corresponding to three options of implantable IOLs: MIOL (“RayOne Aspheric”, model RAO600C); EDOF (RayOne EMV, model RAO200E) and THYOL (RayOne Trifocal). DC was performed binocularly based on a standard BCVA measurement with an optical load for defocusing from +3.0 D to -4.0 D with a “step” of +1.0 D and -0.5 D. Results. Under conditions of optical defocusing with positive lenses (1.0; 2.0; 3.0 D), all three types of IOLs maintained almost the same average BCVA (at +1.0 D, the BCVA range was 0.72–0.76 rel. units; at +2.0 diopters — 0.66–0.72 relative units; at +3.0 diopters — 0.52–0.56 relative units). In relation to the analysis of BCVA in conditions of defocusing with negative lenses, it was found that visual acuity was significantly better with EDOF than with MIOL, with a load from -1.0 to -4.0 diopters, while these differences were statistically significant and ranged from 0.14 to 0.27 relative units (p &lt; 0.01). Along with this, it was determined that UCVA was significantly better in the group with TIOL than in the group with EDOF, with a load from -2.5 to -4.0 D. Moreover, these differences were statistically significant and ranged from 0.09 to 0.14 rel. units (p &lt; 0.01). Conclusion. The design features of IOLs make it possible to consider implantation of EDOF as an option for an individual approach to the selection of IOLs, especially taking into account the possibility of use in patients whose professional activities involve long-term visual work at intermediate distances (for example, users of personal computers).

Toric Monofocal Intraocular Lenses for the Correction of Astigmatism during Cataract Surgery: A Report by the American Academy of Ophthalmology

To review the published literature evaluating the visual and refractive outcomes and rotational stability of eyes implanted with toric monofocal intraocular lenses (IOLs) for the correction of keratometric astigmatism during cataract surgery and to compare those outcomes with outcomes of eyes implanted with nontoric monofocal IOLs and other astigmatism management methods performed during cataract surgery. This assessment was restricted to the toric IOLs available in the United States. A literature search of English-language publications in the PubMed database was last conducted in July 2022. The search identified 906 potentially relevant citations, and after review of the abstracts, 63 were selected for full-text review. Twenty-one studies ultimately were determined to be relevant to the assessment criteria and were selected for inclusion. The panel methodologist assigned each a level of evidence rating; 12 studies were rated level I and 9 studies were rated level II. Eyes implanted with toric IOLs showed excellent postoperative uncorrected distance visual acuity (UCDVA), reduction of postoperative refractive astigmatism, and good rotational stability. Uncorrected distance visual acuity was better and postoperative cylinder was lower with toric IOLs, regardless of manufacturer, when compared with nontoric monofocal IOLs. Correcting pre-existing astigmatism with toric IOLs was more effective and predictable than using corneal relaxing incisions (CRIs), especially in the presence of higher magnitudes of astigmatism. Toric monofocal IOLs are effective in neutralizing pre-existing corneal astigmatism at the time of cataract surgery and result in better UCDVA and significant reductions in postoperative refractive astigmatism compared with nontoric monofocal IOLs. Toric IOLs result in better astigmatic correction than CRIs, particularly at high magnitudes of astigmatism. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Scleral Fixation of a Single-Piece AcrySof Toric Intraocular Lens: A Case Report

Purpose: To describe a simple and least invasive surgical method of transscleral fixation of a dislocated single-piece AcrySof® toric intraocular lens (IOL).Case summary: A 62-year-old male was referred with dislocated toric IOL (SN6AT4, AcrySof® IQ Toric; Alcon Laboratories, Fort Worth, TX, USA) in his right eye after an uneventful cataract surgery. Scleral fixation using the toric IOL was performed by placing the suture knot at the optic-haptic junction right beside the toric axis markings which easily achieved the desired positioning of the axis. The preoperative uncorrected distance visual acuity was 20/400 and it improved to 20/60 at 1 week after repositioning of the IOL and the IOL was well-centered with its toric alignment within 5 degrees of the intended axis.Conclusions: Transscleral fixation of single-piece AcrySof toric IOLs is easy to learn technique, which reduces surgical time with minimal manipulation and enables IOL stability with good postoperative toric axis alignment.