Journal of cataract and refractive surgery最新文献

Topic: To systematically investigate the safety and efficacy of photorefractive keratectomy (PRK) or transepithelial PRK (transPRK) in patients with thin corneas.

Clinical relevance: Concerns exist regarding the outcomes of refractive surgeries including PRK/transPRK in patients with thin corneas.

Methods: This study was registered prospectively in PROSPERO with an ID of CRD42023457156. It was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and reported in line with the PRISMA 2020 Consensus Statement. We searched 7 databases and 3 registries from January 1, 1985, until November 30, 2024: PubMed, Web of Science, Scopus, Google Scholar, Embase, ProQuest, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov , and International Clinical Trials Registry Platform. Our primary outcomes include the safety index (SI), efficacy index (EI), and corrected distance visual acuity (CDVA) changes, while our secondary outcomes include predictability and the rate of complications (including corneal ectasia and haze). We included any observational or interventional study reporting data on the primary or secondary outcomes of PRK or transPRK in patients with a mean central corneal thickness <500 μm, with no history of previous ocular pathology or surgery. The outcome estimates and 95% CIs were derived from a random-effects model meta-analysis to account for possible heterogeneity.

Results: 946 eyes from 10 studies were included. All included studies were case series, either retrospective (n = 4) or prospective (n = 6). 4 studies (n = 4) reported the SI and EI, with pooled estimates of 1.01 (95% CI 0.73-1.29) and 1.01 (95% CI 0.98-1.04) after sensitivity analysis, respectively. The mean postoperative change in CDVA was -0.01 (95% CI -0.07 to 0.05). Compared with baseline values, a mild yet non-significant improvement in CDVA was observed (standardized mean difference -0.20 95% CI -0.89 to 0.49). The pooled predictability within ±0.5 diopter of emmetropia, based on data from 6 studies, was 0.83 (95% CI: 0.98 to 1.04). No study reported any cases of corneal ectasia after surgery.

Conclusions: PRK/transPRK seems to be a safe and effective refractive surgery for thin corneas with simple or astigmatic myopia and without any other ocular pathologies/topographic abnormalities. However, the power analysis and insufficient follow-up call for future studies to draw definitive conclusions about safety and efficacy.

Cataract surgery is among the most frequently performed procedures globally, with over 176,000 surgeries conducted in Belgium in 2024. Postoperative care traditionally involves daily administration of antibiotic, steroid, and non-steroidal anti-inflammatory eye drops for four weeks, often requiring home nursing support due to poor patient compliance and technique. This conventional approach incurs significant costs for the Belgian healthcare system. A nationwide transition to dropless surgery would have reduced Belgium's 2024 healthcare expenditure from €4,016,573 to €1,816,020. For patients, out-of-pocket costs would drop from €176.93 to €1.62 per eye. Additional benefits include reduced hospital staff workload, decreased ocular surface toxicity, and lower environmental waste from discarded eye drop bottles. Provided clinical outcomes remain equivalent, adopting dropless cataract surgery in Belgium presents a compelling opportunity to enhance cost-efficiency, patient convenience, and sustainability.

Purpose: Evaluating anterior chamber (AC) stability of UNITY® Vitreoretinal Cataract System (UVCS) compared to CENTURION® Vision System with ACTIVE SENTRY™ (CAS) using slit side view (SSV) technique during simulated occlusion break event.

Setting: Zengyo Suzuki Eye Clinic, Kanagawa, Japan.

Design: Experimental study.

Methods: Ten porcine eyes underwent testing with UVCS and CAS at intraocular pressures (IOPs) of 20, 30, and 40 mmHg, vacuum limits of 550, 600, 650 mmHg, and aspiration flow rate of 40 mL/min. Eyes with 2.4 mm incision were transferred to slit lamp. Continuous irrigation stabilized IOP before occlusion break which was simulated thrice. IOP changes and SSV images were recorded determining AC depth (ACD) changes, surge duration, and volume during an occlusion break event.

Results: ACD change was significantly less with UVCS compared to CAS (0.15 ± 0.06 vs 0.43 ± 0.14 mm, p < 0.001). During occlusion break, minimum IOP was closer to baseline with UVCS vs CAS (19.1 ± 5.9 vs 26.9 ± 6.3 mmHg, p < 0.001). Post-occlusion break surge volume, duration were minimal with UVCS vs CAS (p < 0.001), with mean recovery time ≤ 0.17 seconds with UVCS.

Conclusion: UVCS maintained AC stability better than CAS during simulated occlusion break testing which may improve clinical outcomes, surgeon confidence to operate at lower IOP. Recovering from post-occlusion break surge faster than reported human reaction times suggested UVCS compensated for fluctuations faster than the surgeon can react.

Purpose: To assess if differences in straylight can be detected in patients implanted with multifocal intraocular lenses (IOL) using a standard and modified clinical straylight measurement.

Setting: A tertiary care university eye clinic.

Design: Comparative cross-sectional study.

Methods: Straylight was measured at 7 and 2.5 degrees using the standard and modified C-Quant (Oculus Optikgeräte) devices. Two measurements per eye and angle were obtained. Logarithm of the straylight parameter (s) at both angles and its increase between 7 and 2.5 degrees were compared between study groups.

Results: Thirty-eight patients (67 eyes) were included in total: 12 patients (24 eyes) implanted with Tecnis Synergy (Johnson & Johnson Vision), 13 patients (25 eyes) with Clareon PanOptix (Alcon), and 13 patients (18 eyes) with monofocal lenses. The mean (±standard deviation) straylight values at 7 degrees were 0.98±0.16 log(s) with Synergy, 1.03±0.14 log(s) with PanOptix, and 1.05±0.22 log(s) with monofocal controls (p=0.864). At 2.5 degrees, they were 1.55±0.09 log(s) with Synergy, 1.34±0.10 log(s) with PanOptix, and 1.29±0.21 log(s) with monofocal IOLs (p<0.001). The increase in straylight at 2.5 degrees was 0.57±0.13 log(s) for Synergy, 0.31±0.11 log(s) for PanOptix, and 0.25±0.10 log(s) for monofocal controls (p<0.001).

Conclusions: Straylight measurements at 2.5 degrees using the modified technique showed higher straylight levels with Synergy when compared to PanOptix and monofocal IOLs, while the standard technique did not detect differences between IOLs. Straylight testing at smaller angles emerges as a sensitive measure to identify multifocal designs posing an increased risk of inducing photic phenomena in pseudophakic patients.

Abstract: Recent advancements in the treatment of keratoconus and ectasia indicate a new era in managing these conditions, with promising innovations aimed at delaying or potentially preventing the need for invasive corneal transplantation. This review evaluates contemporary treatment modalities by analysing recent literature on innovative techniques including Corneal Allogenic Intrastromal Ring Segment (CAIRS) insertion using both surgeon-prepared and technician-prepared donor corneas; lenticular insertion techniques such as implantation of Keratorefractive lenticule extraction (KLEx) and xenograft implants, and Bowman Layer transplantation. A comprehensive review of 83 articles published between January 2017 and April 2024 was conducted. This review aims to elucidate these emerging techniques for better understanding and adoption, providing detailed descriptions and assessing clinical outcomes and complications associated with each approach. By consolidating current knowledge, this review seeks to guide clinicians in selecting appropriate interventions and optimizing patient care for those affected by Keratoconus and ectasia.

Abstract: In patients with iris deficiencies, surgical placement of a custom, artificial iris improves cosmesis and photic symptoms. When patients have existing intraocular lenses (IOLs) within the capsular bag, iris devices also placed within the capsular bag might change the IOL's effectivity; previous reports suggest a hyperopic shift, but data is limited. This retrospective chart review studied 13 eyes receiving a custom, flexible iris prosthesis fixated into an existing intact capsular bag, separate from prior phacoemulsification. Biometry, IOL data, and pre- and post-operative refraction were collected. For iris prosthesis placement without concomitant procedures, the average change in spherical equivalent was +0.49D; For an aphakic eye receiving a secondary IOL, post-operative refraction was +0.79D more hyperopic than expected. For eyes undergoing concomitant IOL exchange, average post-operative refraction was 1.22D less myopic than predicted. This study confirms a hyperopic refractive shift when both IOLs and iris prostheses are placed into the capsular bag.

Purpose: To validate the Catquest-9SF survey in a US Veteran population while assessing how cataract surgery impacts quality of life from the patient's perspective.

Setting: Edward Hines Jr. VA Hospital. Hines, IL, USA.

Design: A prospective survey study of Veteran patients undergoing cataract surgery, gauging pre- and post-operative responses to questions regarding vision-related daily tasks.

Methods: Recruitment selected for all Veteran patients undergoing routine cataract surgery without a second simultaneous ophthalmic surgery. Patients who experienced complications during surgery were excluded. Outcomes were measured using the Catquest-9SF questionnaire and post-operative visual acuity.

Results: A total of 257 Veterans were included in this study. Rasch person-measure estimates improved from -1.37 to -4.22 logits (Δ 2.85 logits), indicating higher visual functioning after cataract surgery. The Catquest-9SF demonstrated satisfactory Rasch performance (ordered thresholds; person reliability 0.83; person-separation 2.25; first contrast eigenvalue 1.65). Mean LogMAR visual acuity improved from 0.41 ± 0.34 to 0.18 ± 0.22 (mean change: -0.23; p < 0.01).

Conclusions: To our knowledge, this is the first use of the Catquest-9SF questionnaire as a PROM tool to investigate cataract surgery outcomes among US Veterans. This study found that the Catquest-9SF satisfied validation criteria in a US Veteran population and found cataract surgery to improve patient reported outcomes, regardless of comorbidity.

Purpose: To analyse the halo formation of several intraocular lenses (IOLs) in the optical bench.

Setting: University of Murcia (Murcia, Spain).

Design: In vitro study.

Methods: Light from a green LED passed through a pinhole and was collimated. Each IOL was placed within a realistic model eye having a PMMA cornea with a physiological amount of spherical aberration and a 4.5 mm aperture. A CMOS sensor acted as the retina and a focus tunable lens was used to change the object's vergence (range ±4 D). Series of images were captured with different exposure times and fused to get a high dynamic range (HDR) image. Performance was assessed by analysing the corresponding halo brightness and size. The tested lenses, that included biconvex and inverted meniscus IOLs, were: monofocals, extended depth-of-focus (EDOF), and diffractive trifocals.

Results: Monofocal lenses produced halos with a radius close to 0.4 degrees. The halo radii of the non-diffractive EDOF lenses ranged between 0.45 and 0.63 degrees, whereas diffractive lenses had radii ranging from 0.84 to 1.22 degrees. The halo was generally dimmer for the refractive lenses and brighter for the diffractive. The through-focus images show that the halo size was larger at any defocus position for the diffractive lenses than for the rest of the tested IOLs.

Conclusions: The diffractive IOLs exhibited a characteristic halo structure. Performance of the inverted meniscus and other non-diffractive lenses (Vivity and Eyhance) was comparable to a monofocal lens. This on-bench test can serve as an indication of the potential impact of photic phenomena on patient satisfaction.

Purpose: To assess visual and subjective outcomes in eyes with low to moderate irregular astigmatism following extended-depth-of-focus (EDOF) IOL implantation.

Setting: Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.

Design: Single-center, prospective, clinical trial.

Methods: This study assessed patients with low to moderate irregular astigmatism who received bilateral cataract surgery using the non-toric/toric AcrySof IQ Vivity IOL (Alcon Labs, Fort Worth, USA). At the 4-months examination, monocular and binocular CDVA and DCIVA, monocular 5% low contrast CDVA and DCIVA, monocular DCNVA and CNVA, monocular defocus curve from +0.5D to -2.5D, wavefront aberrometry and subjective outcome (VF-7) were evaluated.

Results: In total, 28 patients presenting low to moderate irregular astigmatism with mean 1.27±0.83D cylinder and 0.04±0.01μm/mm2 RMS/A were analyzed. At the follow-up visit, mean logMAR results were the following: monocular CDVA was -0.01±0.08, binocular CDVA was -0.08±0.07, monocular DCIVA was 0.18±0.11, binocular DCIVA was 0.08±0.08, monocular 5% low contrast CDVA was 0.40±0.12 and DCIVA was 0.38±0.11, monocular DCNVA was 0.38±0.09 and CNVA was 0.09±0.09. Monocular defocus curves demonstrated 0.16±0.09 logMAR at -1.5D of defocus and ≤0.2 logMAR visual acuity up to -1.66D of defocus. Difficulties during daily life activities (VF-7 questionnaire) were low.

Conclusions: In eyes with low to moderate irregular astigmatism, the AcrySof IQ Vivity IOL provided very good monocular and binocular visual performance at far and intermediate distance following bilateral cataract surgery. These findings suggest that low to moderate irregular astigmatism does not substantially worsen visual outcome after bilateral EDOF IOL implantation.