Journal of cataract and refractive surgery最新文献

Purpose: To evaluate visual and refractive outcomes of Keratorefractive Lenticle Extraction (KLEx) for the treatment of moderate and high myopia, defined by an attempted spherical equivalent (SEQ) correction between -6.0 and -8.0 diopters (D) (moderate myopia) and from -8.0 to -10.0 D (high myopia), respectively.

Setting: Cornea and Refractive Surgery Unit, Department of Ophthalmology, Aarhus University Hospital, Denmark.

Design: Prospective longitudinal quality control study.

Methods: Prospective analysis of 1530 right eyes consecutively treated with KLEx for myopia correction between January 2011 and December 2023. Exclusion criteria included SEQ less than -6.0 D, refractive astigmatism larger than 2.0 D, or presence of other ocular diseases. Preoperative and 3-month evaluation included manifest refraction and uncorrected (UDVA) and corrected (CDVA) distance visual acuity.

Results: Attempted SEQ refraction was -7.03 ± 0.50 D and -8.71 ± 0.56 D in the moderate and high myopia group, respectively. 62% (n=586) and 52% (n=239) of moderate and high myopia eyes achieved postoperative UDVA ≥ 20/20, p<0.001, respectively. Efficacy index was 0.86 ± 0.26 and 0.83 ± 0.28, (p=0.044) for moderate and high myopia, respectively. 81% (n=825) and 71% (n=360) of moderate and high myopes were within ±0.50 D of intended refraction, p<0.001, respectively. Safety index was 1.07 ± 0.20 and 1.09 ± 0.19 for moderate and high myopia, (p=0.056), respectively.

Conclusions: The safety of KLEx for moderate and high myopia was similar in this large cohort. Predictability and efficacy were slightly better when treating moderate myopia and lower astigmatism. Nomogram adjustment for the correction of high myopia is suggested.

Purpose: To evaluate outcomes after implantation of two extended depth of focus IOLs, with emphasis on performance in dim light.

Setting: Two clinical practices in the USA.

Design: Prospective, double masked, randomized clinical trial.

Methods: Subjects were randomized to receive Symfony Optiblue or Vivity IOLs. Objective optical quality, aberrations, and simulated visual disturbances were measured before and 3 months after surgery. Binocular visual acuity (VA), the defocus curve and low contrast VA were measured under mesopic lighting conditions. Patient questionnaires were administered and undirected patient comments were recorded.

Results: Thirty-one subjects in each group completed the study. Refractive outcomes were not significantly different. The Symfony lens provided about a half line better monocular mesopic VA at distance when uncorrected and best corrected (p < 0.05). There were no differences in binocular visual function between lenses except for the mesopic defocus curve at -1.00 D and -1.50 D, with the Symfony lens providing better VA at those vergences (p < 0.02). Objective optical measures improved after surgery, with improvements not different by group. There were no differences in the size or intensity of simulated glare, but simulated halos and starburst size and intensity were significantly worse with the Symfony lens (p < 0.05). Satisfaction with distance and intermediate vision in both groups was high. Reported visual disturbances were not significantly different between groups.

Conclusions: The two lenses provided similar visual performance in dim light, with the Symfony lens showing slightly better VA, but with more reports of halos and starbursts.

Purpose: To examine geographic factors associated with the likelihood of receiving cataract surgery.

Setting: Administrative claims data from 2017 California Medicare Database.

Design: Cross-sectional.

Methods: Beneficiaries were included if they were 65 years or older, had a valid postal code, active coverage with Medicare parts A and B and cataract diagnosis defined by International Classification of Diseases, 10th Revision, Clinic Modification (ICD-10-CM) codes. Cataract surgery was defined using billing codes. The association between rural residence and distance and time traveled for cataract surgery was assessed using linear regression models. The odds of receiving cataract surgery were estimated using logistic regression models.

Results: Among 445,164 beneficiaries with cataract, 127,314 (28.6%) reported rural residency. Rural residence was associated with increased travel time and distance for cataract surgery (+0.16 hours [95% confidence interval (CI): 0.15-0.17]; +9.7 miles [95% CI 9.3-10.2]). For every additional 100 miles traveled, odds of cataract surgery decreased by 14% (adjusted odds ratio (aOR): 0.86; 95% CI: 0.84-0.87). Stratified analysis demonstrated that Black beneficiaries had the greatest reduced odds of cataract surgery per each 100 additional miles traveled (aOR: 0.38; 95% CI: 0.31-0.45), followed by Hispanic/Latino beneficiaries (a0R: 0.67; 95% CI: 0.63-0.72).

Conclusions: Beneficiaries living in rural California had increased travel distance and time for cataract surgery. Black beneficiaries had the strongest association between increased travel distance and decreased odds of cataract surgery. These findings suggest possible disparities in surgical treatment for cataract among rural populations. Further studies are needed to better understand and address geographic disparities to eye care.

Purpose: To evaluate the correlation between the preoperative vertex-scleral spur angle (Vtx-SSA) and postoperative horizontal intraocular lens (IOL) tilt following routine cataract surgery.

Setting: Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA.

Design: Prospective case series.

Methods: This study enrolled patients who underwent uncomplicated phacoemulsification cataract extraction with IOL implantation. The Anterion and Eyestar 900 swept-source optical coherence tomographers (SS-OCTs) were used to determine Vtx-SSA and lens tilt (crystalline and IOL) measurements, respectively. Tilt vectors were decomposed into orthogonal, vertical and horizontal components to explore preoperative correlations independently. The Pearson correlation coefficient and linear regression analysis were used to evaluate the relationships between select variables.

Results: In a cohort of 72 eyes of 72 patients, the preoperative Vtx-SSA was highly correlated with horizontal IOL tilt (r2 = 0.97, P < 0.01). On average, tilting of the IOL in the horizontal axis accounted for nearly 80% of the total tilt magnitude. Crystalline lens measurements revealed a similarly strong correlation between horizontal tilts of the crystalline lens and IOL (r2 = 0.97, P < 0.01). However, IOL tilt along the vertical meridian may be more difficult to anticipate using crystalline lens measurements (r2 = 0.78, P < 0.01) and showed no correlation with axial length (r2 = 0.00, P = 0.92).

Conclusions: The Vtx-SSA may be utilized as an easy-to-interpret presurgical surrogate for estimating horizontal IOL tilt. Still, it does not account for more minor contributions of tilt in the vertical plane.

Purpose: To assess the incidence of primary opacification, and analyze the outcomes of IOL exchange procedures.

Setting: Private clinics, United Kingdom.

Design: Retrospective study.

Methods: Electronic charts of all patients implanted with LENTIS lenses between 2010 and 2015 were reviewed, and the incidence of opacification was calculated. The data of patients who developed opacification were compared to those who did not. In eyes requiring IOL exchange due to opacification, visual and refractive outcomes of the last available post-exchange visit were analyzed. The analysis was performed separately for eyes with multifocal and monofocal secondary IOLs.

Results: A total of 47,171 LENTIS IOLs were implanted, of which 2,426 (5.1%) opacified. Of the opacified lenses, 1,568 (3.3% of the whole cohort) required an IOL exchange. The mean time from primary treatment to opacification diagnosis was 6.9±2.2 years. Patients who developed opacification had a higher prevalence of preoperative myopia. Of all eyes requiring an IOL exchange, the secondary IOL was monofocal in 43.0% and multifocal in 57.0% of eyes. Post-exchange corrected visual acuity was 0.00±0.13 logMAR (20/20) in eyes with monofocal secondary IOLs and -0.02±0.08 logMAR (20/20+1) in eyes with multifocal secondary IOLs. The final anatomical position of the secondary IOL was as follows: in-the-bag fixation 67.9%, ciliary sulcus fixation 30.1%, iris-claw fixation 0.6%, iris suturing or scleral fixation 1.4%.

Conclusions: Exchange of opacified IOL was performed safely in the majority of patients who developed opacification, including those with prior Nd:YAG capsulotomy, with good visual and refractive outcomes.

Purpose: To evaluate how variations in suture type, suture length, and scleral outlet angle affect intraocular lens (IOL) positioning and fixation stability in the Canabrava technique, given ongoing concerns such as iris chafing and the lack of prior quantitative assessment.

Setting: Laboratory-based experimental study using 3D-printed model eyes.

Design: Experimental study using 3D-printed ocular models with controlled variation of fixation parameters.

Methods: Using 3D-printed eye models, IOL fixation was performed with the Canabrava technique using Artis PLE IOLs. Suture types (5-0 Prolene, 6-0 Prolene, 6-0 Pronova), suture lengths (8 mm, 10 mm), and scleral outlet angles (30°, 45°) were systematically varied. IOL tilt and optic-haptic distance were measured using ImageJ. Fixation strength was assessed using a universal testing machine (UTM) to measure the force required to produce a 2.5 mm linear displacement of IOL.

Results: IOL tilt was not significantly affected by suture type but increased with longer suture length (10.0 mm vs. 8.0 mm) for both 5-0 and 6-0 Prolene. Optic-haptic distance showed minimal variation, with differences noted only in the 5-0 Prolene and 6-0 Pronova groups at 8.0 mm. Scleral outlet angle also had no significant impact on optic-haptic distance. Displacement force did not differ significantly between suture types.

Conclusions: Caution is advised in patients with a predisposition to iris chafing as the risk may persist regardless of fixation parameters.

Purpose: To evaluate the effectiveness of astigmatism correction using low-cylinder-power monofocal toric intraocular lenses (IOLs) in eyes with mild corneal astigmatism.

Setting: Tertiary care center in Osaka, Japan.

Design: Single-center ambispective observational cohort study.

Methods: Eyes were categorized into the T2 group (toric IOL with 1.0 diopter (D) cylinder power at the IOL plane), nontoric IOL (T0) group, or Tx group (T3 or higher toric IOLs; ≥1.5 D cylinder power). Eyes with irregular corneal astigmatism or prior ocular surgery were excluded. Three-month outcomes included uncorrected distance visual acuity (UDVA), refractive and subjective astigmatism, and vector analysis.

Results: Seventy-five eyes (25 per group, 46 patients) were analyzed. At 3 months, the T2 group showed significantly lower mean refractive astigmatism (0.45 ± 0.25 D) and subjective astigmatism (0.28 ± 0.34 D) than the T0 group (0.92 ± 0.31 D and 0.69 ± 0.33 D; both P = .000), with better UDVA (logMAR -0.05 ± 0.12 vs 0.08 ± 0.15; P = .002). In paired-eye analyses, T0 eyes had greater refractive astigmatism (0.92 ± 0.32 D) and subjective astigmatism (0.69 ± 0.33 D) than their Tx fellow eyes (0.53 ± 0.33 D; P < .001 and 0.39 ± 0.32 D; P = .002). T2 achieved astigmatism correction comparable to that of Tx in mild-astigmatism eyes. Tx eyes trended toward better UDVA than their T0 fellows (P = .060).

Conclusions: Low-cylinder-power toric IOLs effectively corrected astigmatism and improved visual outcomes in eyes with mild corneal astigmatism, a population previously excluded from toric IOL implantation.

Purpose: To compare the visual and refractive outcomes of KLEx using the VISUMAX 800 femtosecond laser and FS-LASIK performed using the VISUMAX 800 femtosecond laser and the EX500 excimer laser in the treatment of myopic astigmatism.

Setting: Single-center, private ophthalmology center.

Design: Retrospective comparative study.

Methods: A total of 237 eyes (133 KLEx, 104 FS-LASIK) were evaluated. Cyclotorsion alignment in KLEx was achieved using the Callisto Eye system integrated with VISUMAX 800. Refractive outcomes, vector analysis (Alpins method), and safety and efficacy indices were compared between groups at 1 and 6 months postoperatively.

Results: At 6 months, both groups achieved comparable UDVA (0.01 ± 0.04 logMAR) and CDVA. Mean SE was closer to emmetropia in the KLEx group (-0.04 ± 0.18 D vs. -0.10 ± 0.15 D, p=0.007). Residual cylinder was lower in KLEx (-0.14 ± 0.19 D vs. -0.20 ± 0.20 D, p=0.010). Vector analysis showed lower DV in KLEx (0.14 ± 0.19 D vs. 0.21 ± 0.21 D, p=0.009), while FS-LASIK had a slightly higher correction index (CI: 1.02 vs. 0.97, p=0.005).

Conclusions: Both KLEx and FS-LASIK performed using the VISUMAX 800 achieved excellent refractive outcomes, with KLEx procedures incorporating an image-guided static cyclotorsion alignment strategy and demonstrating excellent refractive and vector analysis results.