Journal of cataract and refractive surgery最新文献

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.

Purpose: To use ray-tracing simulations to assess the dependency of add-power demand on ocular biometry.

Setting: David J. Apple Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.

Design: Experimental study.

Methods: Optical biometry of 34 patients scheduled for routine cataract surgery was collected and the following parameters used to build a personalized eye model: keratometry (K), anterior chamber depth (ACD), and axial length (AL). Ray-tracing software was applied for pseudophakic-eye simulations. Each model featured a biconvex lens with radii of curvature adjusted for best distance vision. Trial spectacles with -4 diopters (D), -3 D, -2 D, and -1.5 D were placed in front of a virtual eye. The intraocular lens (IOL)-power change required to induce a desirable near/intermediate effect at the spectacle plane was calculated for the far-point condition.

Results: Mean values for K, ACD, and AL were 7.79 ± 0.24 mm, 3.22 ± 0.60 mm, and 23.77 ± 1.34 mm, respectively. The lowest and highest add power (IOL plane) varied by 0.39 D, 0.52 D, 0.76 D, and 0.98 D for -1.5 D, -2 D, -3 D, and -4 D trial spectacles, respectively. High correlation was found between the observed add-power change and the ACD, indicating a linear increase of the add-power demand for larger ACD values. The AL and the K demonstrated poor or no correlation with the required IOL-power adjustment.

Conclusions: The ACD, which determines the effective lens position in our model, has greater impact on add-power demand than AL or K. The reported change may contribute to interparticipant variability in defocus curves of multifocal patients.

Purpose: To describe and compare the efficacy and safety profile of posterior chamber implantable collamer lens (ICL) implantation in eyes with low-vault and non-low-vault over a 5-year follow-up period.

Setting: Hospital de Braga, Braga, Portugal.

Design: Retrospective, comparative, cohort study.

Methods: 2 groups were created based on the first postoperative vault measurement evaluation (1 month): group 1 (<250 μm) and group 2 (≥250 μm). Patients with previous ocular surgery or pathologies that would affect visual outcomes were excluded. The parameters evaluated were uncorrected and corrected visual acuity, subjective refraction, efficacy and safety index, predictability, endothelial cell density, central vault, and postoperative complications. 107 eyes from 67 patients in group 1 and 289 eyes from 164 patients in group 2 were evaluated.

Results: At 5 years, the safety and efficacy index was similar ( P = .224 and P = .390, respectively). Respectively, 80 (76.2%) and 201 (70.5%) eyes were within ±0.50 diopter of targeted refraction. There was a significant reduction in vault measurements in both groups ( P = .034 and P < .001, respectively). No significant differences between groups in endothelial cell density loss were noted ( P = .096). The low-vault group presented a higher incidence of crystalline lens opacities/cataracts (5.6% vs 1.7%), although only 1 patient in group 2 was submitted to cataract surgery.

Conclusions: ICL implantation for surgical correction of myopia yielded stable visual results with excellent safety and efficacy indexes in patients with low vault.

Purpose: To evaluate the clinical outcomes of scleral fixation using the flanged belt-loop technique in patients with in-the-bag intraocular lens (IOL) subluxation after cataract surgery.

Setting: Beyoglu Eye Training and Research Hospital, Turkey.

Design: Retrospective.

Methods: 23 eyes of 23 patients who underwent scleral fixation of subluxated in-the-bag IOLs using the flanged belt-loop technique, with a minimum follow-up of 6 months, were included. All surgeries were performed by a single experienced surgeon. The procedure involved transscleral fixation of the existing IOL using 6-0 polypropylene sutures with flanged ends, without conjunctival dissection or use of scleral flaps. Preoperative and postoperative data were collected, including corrected distance visual acuity (CDVA), intraocular pressure (IOP), corneal endothelial cell density (ECD), and central corneal thickness (CCT).

Results: The mean postoperative CDVA improved significantly ( P = .001). IOLs remained well-centered in 91.3% of eyes. Mild, asymptomatic decentration occurred in 2 eyes. There were no significant changes in IOP, ECD, or CCT ( P > .05). No major intraoperative or postoperative complications were reported. The surgical time was relatively short, and the technique caused minimal trauma to anterior segment structures. Bilateral haptic fixation was associated with better centration, especially after the initial learning curve.

Conclusions: The flanged belt-loop technique is a safe and effective option for repositioning subluxated in-the-bag IOLs, avoiding the need for IOL explantation. Its minimally invasive nature, short operative time, and stable outcomes make it a favorable alternative. Larger studies with longer follow-up are necessary to validate these findings and compare efficacy with other fixation methods.

Purpose: To evaluate the performance of a new deep learning-based implantable collamer lens (ICL) sizing model that uses raw swept-source optical coherence tomography (SS-OCT) images as an input.

Setting: Multicenter European study.

Design: Retrospective external validation study.

Methods: Patients implanted with EVO ICL V4 at 2 European clinics between October 2019 and April 2024 were analyzed. Preoperative OCT images and implanted ICL data were processed by the model under study, which predicted vault, confidence levels, and the probability of achieving a postoperative vault within 250 to 750 μm (P250-750). Predictions were compared with actual postoperative vaults, and performance metrics such as mean absolute error (MAE), P250-750 accuracy, and postoperative vault distribution were assessed. Preoperative images were evaluated blinded from the postoperative results.

Results: 848 eyes from 429 patients were included. The mean postoperative vault was 476 ± 235 μm, with a model MAE of 146 ± 113 μm, significantly outperforming the STAAR nomogram (186 ± 149 μm; P < .001). The model correctly predicted vaults within ±250 μm in 81.7% of cases and ±300 μm in 90.7%. Among cases outside the 250 to 750 μm range (28.9%), the model recommended more appropriate sizes in 70.6%. P250-750 was comparable with the actual proportion of eyes achieving a satisfactory vault for P250-750 >60%. In cases requiring lens exchange, the model's suggested size aligned with the final implanted size in 81.8% of cases.

Conclusions: This deep learning-based model, using raw OCT images, provided accurate ICL sizing predictions and valuable metrics such as P250-750 to assist clinical decision-making. This approach may reduce sizing errors and improve patient outcomes. The model is available for ANTERION SS-OCT users at safevaulticl.com .

Purpose: To evaluate the postoperative outcomes of laser in situ keratomileusis (LASIK) enhancements performed on eyes implanted with trifocal intraocular lenses (IOLs).

Setting: Shinagawa LASIK Center, Tokyo, Japan.

Design: Retrospective, consecutive case series.

Methods: 59 cases (89 eyes) underwent femtosecond laser-assisted cataract surgery with trifocal IOL implantation between October 2014 and May 2021 and were followed for a minimum of 3 months after LASIK enhancements. A new systematic 5-step refraction methodology was used to accurately identify multiple focal points created by trifocal IOLs and determine optimal enhancement targets. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity, uncorrected intermediate visual acuity, and uncorrected near visual acuity (UNVA) were evaluated at distance (5 m), intermediate (70 cm), and near (30 cm) at precataract surgery, pre-enhancement, and 3-month, 6-month, and 1-year postenhancement.

Results: At 1-year post-LASIK enhancement, the mean manifest refraction spherical equivalent improved from +0.35 ± 0.75 diopters (D) to -0.05 ± 0.36 D ( P < .0001), with 80.9% of eyes achieving ±0.50 D of emmetropia. The percentage of eyes with ≤0.50 D cylinder increased from 37.1% to 83.3%. UDVA of 20/20 or better was achieved in 83.3% of eyes, with 56.3% achieving J1 UNVA.

Conclusions: LASIK enhancements after trifocal intraocular lens implantation demonstrated both safety and efficacy in improving visual outcomes. A systematic approach to measuring refractive error, accounting for the multifocal nature of these IOLs, is crucial for optimal outcomes. This methodology can be applied to various trifocal IOL designs to enhance visual results and patient satisfaction.