Journal of cataract and refractive surgery最新文献

Purpose: To investigate the spatial placements of the horizontal and vertical ciliary sulcus through ultrasound biomicroscopy (UBM) analysis.

Setting: Eye and ENT Hospital of Fudan University, Shanghai, China.

Design: Prospective observational clinical study.

Methods: This study comprised 82 eyes of preoperative implantable collamer lens (ICL) candidates with myopic ICL. UBM was used to measure the ciliary sulcus-to-sulcus (STS), central distance from endothelium to STS (ASL) crystalline lens to STS (STSL), the angle-to-angle distance (ATA), and anterior chamber depth (ACD) to crystalline lens in both the horizontal and vertical orientations. Mean keratometry, axial lengths, and horizontal white-to-white distance were also recorded.

Results: The mean ASL was 3.574 ± 0.183 and 3.725 ± 0.198 mm, while the mean STSL was 0.488 ± 0.175 and 0.629 ± 0.161 mm in the horizontal and vertical orientations, respectively ( P < .001). The vertical STSL (vSTSL) exceeded the horizontal STSL (hSTSL) by a mean difference of 0.141 ± 0.128 mm, and similarly, the vASL exceeded the hASL by a mean difference of 0.151 ± 0.137 mm. Both the hSTSL and vSTSL showed a negative correlation with ACD ( P < .001). The difference in STSL (vSTSL - hSTSL) was positively correlated with vSTSL, vASL, and the difference in STS (all P < .05) and negatively correlated with hSTSL and hASL (both P < .05).

Conclusions: The ciliary sulcus is typically located more posteriorly in the vertical orientation than in the horizontal orientation.

Purpose: To explore the effects of the 2 surgical methods on the short-term and long-term visual outcome of patients with congenital ectopia lentis (CEL).

Setting: Eye & ENT Hospital of Fudan University, Shanghai, China.

Design: Prospective comparative study.

Methods: All patients were divided into 4 groups according to age and operation method: children underwent in-bag or out-of-bag surgery and adult underwent in-bag or out-of-bag surgery. They were followed up 1 month, 3 months, and every 6 months postoperatively. Their corrected distance visual acuity (CDVA), axial length (AL) growth, prediction error (PE), and other parameters were recorded, compared, and analyzed.

Results: There was no significant difference between CDVA and PE in the same age group compared by surgical methods. CDVA in adults was better than that in children, but greater myopic drift occurred in PE. In general, CDVA of the 4 groups all showed a trend of improvement with the addition of follow-up years, while PE increased gradually. The rate of AL growth was lower in patients undergoing in-bag surgery than in patients undergoing out-of-bag surgery.

Conclusions: Both in-bag and out-of-bag surgeries are safe and effective for patients with CEL. CDVA and PE were not affected by the type of surgery and were only related to the patient's age. However, the growth rate of AL will slow down in in-bag surgery. No matter children or adults, half a year after surgery is the window period for recovery, and active amblyopia training has significant implication for the recovery of visual quality.

Purpose: To compare the prediction accuracy of new-generation and traditional intraocular lens (IOL) power calculation formulas in pediatric primary IOL implantation and identify factors influencing refractive prediction errors.

Setting: Zhongshan Ophthalmic Center, Guangzhou, China.

Design: Retrospective consecutive case-series study.

Methods: The prediction error (PE) was calculated for Holladay 1, SRK/T, Hoffer Q, Haigis, Barrett Universal II, Kane, Emmetropia Verifying Optical 2.0, and Ladas Super Formula (LSF) in pediatric primary IOL implantation. Subgroup analyses were conducted based on age, axial length (AL), average keratometry, surgical procedure, and IOL type. Multivariate regression analysis was used to identify factors associated with significant refractive surprise.

Results: 83 patients (108 eyes) were included in the study. Significant differences in both PE and absolute PE were observed among formulas ( P < .001). The SRK/T and Kane formulas demonstrated lower mean predicted error (ME) and median absolute error (MedAE), whereas LSF and Haigis formulas showed higher ME and MedAE, respectively. Patients who were older age and had longer AL exhibited improved predictive accuracy. No significant differences in prediction accuracy were found between eyes with different surgical procedures or different IOL types. Multivariate regression analysis showed that younger age and shorter preoperative AL were predictors of significant refractive surprise across formulas.

Conclusions: The predictive accuracy of IOL formulas in pediatric primary IOL implantation remains suboptimal, with the SRK/T and Kane formulas performing relatively better. Younger age and shorter AL remain major predictors of refractive surprise, while surgical procedure and IOL type show no significant association. Further development of pediatric-specific IOL power formulas is warranted.

Purpose: To investigate if patients had a subjectively inferior experience during second-eye surgery vs first-eye surgery during immediate sequential bilateral cataract surgery (ISBCS) as both operations were performed within the same surgical visit.

Setting: Multisurgeon ophthalmic surgical center.

Design: Survey-based prospective design.

Methods: Patients of the center undergoing routine cataract surgery who enrolled in the study completed a questionnaire immediately after surgery to describe their surgical experience for each eye. Survey questions measured patient pain, discomfort or pressure, comfort, relaxation, estimated length of surgery, and predicted visual outcome.

Results: Patient-reported level of pain during the second-eye surgery was significantly greater than for the first eye ( P < .001). Furthermore, the order of surgery was found to be a strong predictor of patient-reported pain ( P < .001), more so than surgical length ( P < .008), additional anesthesia ( P < .35), patient age ( P < .44), or patient sex ( P < .88). Overall, surgery during the first eye was reported as more comfortable ( P < .001) and shorter in duration ( P < .001), while discomfort and pressure were reported as worse for the second eye ( P < .001).

Conclusions: Understanding differential experiences between eyes can help surgeons when counselling patients regarding expectations for ISBCS and related visual outcomes.

Keratorefractive lenticule extraction (KLEx) is a cutting-edge refractive surgery technique that has garnered considerable attention in recent years due to its minimally invasive nature and the absence of a corneal flap both of which are notable advantages over traditional laser-assisted in situ keratomileusis surgery. Currently, the technology for myopia correction using KLEx has been refined and is widely recognized. Consequently, hyperopic KLEx surgery is highly anticipated, having undergone nearly a decade of evolution and development, and it seems to have finally achieved stable and reliable postoperative outcomes. This article reviews the emerging hyperopic KLEx in clinical outcomes, challenges, complications, and outlook.