Journal of refractive surgery最新文献

Purpose: To investigate the effect of corneal flap margin space width after femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) on corneal nerve regeneration using in vivo confocal microscopy (IVCM).

Methods: This study assessed 46 consecutive patients who underwent FS-LASIK surgery. Routine examinations after myopic laser surgery were performed. IVCM was performed before and after surgery to observe the flap margin space and regeneration of the corneal subbasal nerve. The average of corneal flap margin space was calculated. Patients were divided into two groups: the wide-space group (> 20 µm) and the narrow-space group (⩽ 20 µm). Central and peripheral (average of 3-, 6-, and 9-o'clock positions) corneal sensitivity was tested by the Cochet-Bonnet esthesiometer and corneal subbasal nerve regeneration was quantitatively analyzed.

Results: Postoperatively at days 1 to 90, the incision edge of the narrow-space group showed a high-density linear structure without obvious epithelial cells filling in the space, and the corneal nerve gradually grew from the outside of the flap through the incision edge to the inside of the flap. In the wide-space group, obvious epithelial cells filling in the space were observed from 1 day postoperatively, and the corneal nerve grew less from the outside of the flap through the incision edge to the inside of the flap. There was no significant intergroup difference in the central corneal nerve fiber length. However, the peripheral corneal nerve fiber length in the narrow-space group was significantly higher at both 30 and 90 days postoperatively. No statistically significant differences were observed between groups in central and peripheral corneal sensitivity. There was no significant difference in spherical equivalent between groups at each time point.

Conclusions: Although the postoperative flap margin space significantly affects corneal nerve regeneration, it does not influence corneal sensitivity or the refractive outcome after FS-LASIK.

Purpose: To evaluate the effect of total laser fluence on early and mid-term visual outcomes after keratorefractive lenticule extraction performed with a femtosecond laser. The setting was a single-surgeon, single-center refractive surgery clinic. The design was a retrospective comparative cohort analysis of prospectively collected data.

Methods: This retrospective comparative case series included 112 eyes of 112 patients. Eyes were stratified into four quartiles (Q1 to Q4, n = 28 each) based on total fluence (range: 290 to 767 mJ/cm²). Outcomes included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest spherical equivalent, and higher order aberrations (HOAs) measured by corneal and ocular wavefront at 4 and 6 mm. Assessments were performed at postoperative day 1 (POD1) and month 6 (POM6). Statistical analyses used Kruskal-Wallis and Mann-Whitney U tests with Holm step-down correction.

Results: At POD1, lower fluence groups showed faster UDVA recovery (Q1: -0.11 ± 0.07 vs Q4: -0.01 ± 0.10 logMAR), but these differences were not significant after Holm correction. By POM6, UDVA was excellent across all quartiles. CDVA line gains were significantly more frequent in Q1 and Q2 (79% and 54% gained ⩾ one line) compared with Q3 and Q4 (7% each, Holm-adjusted P < .005). Predictability remained high, with 82% to 93% of eyes within ±0.50 diopters at 6 months. HOA induction was slightly greater with higher fluence at POD1 but converged by POM6, except spherical aberration at 6 mm, which differed significantly (P = .006).

Conclusions: Lower total fluence was associated with non-significant trends toward faster recovery and greater mid-term CDVA gains, whereas refractive accuracy and safety were not compromised. Fluence optimization may enhance early visual quality without sacrificing predictability.

Purpose: To present the first case of a pupillary block that was successfully managed with neodymium:YAG (Nd:YAG) laser to eliminate the obstruction of the central port in patients with Implantable Collamer Lens (ICL) implantation.

Methods: Case report and literature review.

Results: A V4c ICL (STAAR Surgical) was implanted in a 25-year-old woman, and the intraocular pressure was 47 mm Hg 2 months later. Anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) indicated that this patient underwent pupillary block, and a membranous structure was found in the ICL hole. Nd:YAG laser was uneventfully applied to the membranous structure to eliminate the pupillary block.

Conclusions: This is the first case of direct Nd:YAG over the occluded phakic IOL port to manage pupillary occlusion, which broadens the experience of ophthalmologists. Nd:YAG laser treatment is one of the effective options for pupillary block in patients with ICL implantation.

Purpose: To identify factors predicting a two-line (0.2 logarithm of the minimum angle of resolution [logMAR]) improvement in corrected distance visual acuity (CDVA) following laser vision correction surgery in patients with amblyopia.

Methods: Consecutive patients with amblyopia undergoing primary laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) between 2013 and 2024 were included. Inclusion criteria were age older than 18 years, stable refraction for 12 months or more, myopia of -12.00 diopters (D) or less, hyperopia of +6.00 D or less, and cylinder of 6.00 D or less. Amblyopia was classified as mild (CDVA better than 20/40) or moderate (CDVA worse than or equal to 20/40 and better than 20/80). Patients were grouped by CDVA improvement (⩾ 2 lines vs < 2 lines). Binary logistic regression identified predictors of CDVA improvement, including variables with P < .15 in univariate analysis.

Results: Of 1,894 amblyopic eyes reviewed, 1,007 eyes met inclusion criteria. Two-line CDVA improvement was observed in 22.8% (n = 230). Predictors of improvement included younger age (odds ratio [OR]: 0.96 per year, P < .001), male gender (OR: 1.38, P = .04), and worse preoperative CDVA (OR: 1.67 per 0.1 logMAR unit, P < .001). Higher preoperative cylinder values were inversely associated with improvement (OR: 0.88 per diopter, P = .03). Patients in the improvement group were younger (27.3 ± 8.4 vs 30.9 ± 10.5 years, P < .001) and more likely to have moderate amblyopia (28.7% vs 21.5%, P = .03).

Conclusion: Younger age, male gender, worse preoperative CDVA, and lower cylinder values are significant predictors of a two-line improvement in CDVA in patients with amblyopia undergoing LASIK or PRK. These findings can guide preoperative counseling and help set realistic expectations for this subset of patients.

Purpose: To assess a new method for measuring optical zone decentration after corneal laser surgery using postoperative topography with ImageJ software (National Institutes of Health).

Methods: Postoperative topographies from 40 eyes that underwent keratorefractive lenticule extraction (KLEx) surgery were analyzed twice in a randomized manner by three different operators to assess the repeatability and reproducibility of the new centration method for the treatment zone. For each topography, the ablation zone was identified, and the distance between the vertex (the visual axis defined on the topography) and the center of the optical zone was measured using ImageJ software.

Results: The analysis demonstrated good repeatability. The inter-operator reliability of decentration measurements ranged from moderate to good (0.689 to 0.901), with no significant bias (< 0.02 mm) and concordance limits remaining within acceptable ranges for this measurement method (-0.15 to 0.21 mm). The results indicate good reproducibility of the method, with no significant inter-operator bias, high intraclass correlation coefficient values (0.811), and agreement limits within acceptable ranges (-0.12 to -0.27), supporting its overall reliability and a good agreement. The mean total decentration was 0.18 ± 0.08 mm (0.05 to 0.41).

Conclusions: This study demonstrates the repeatability and reproducibility of a new centration assessment method in corneal refractive surgery, paving the way for the development of artificial intelligence-driven automated solutions.

Purpose: To evaluate the effect of implantation of two sizes of capsular tension rings (CTRs) on intraocular lens (IOL) stability in patients with cataract who have an axial length (AL) of 30 mm or greater.

Methods: This prospective randomized controlled study included 120 eyes (AL ⩾ 30 mm) undergoing phacoemulsification and IOL implantation, randomized into three groups (n = 40 each): large group (CTR1311 [Eyebright Medical Technology]: 13 × 11 mm), small group (CTR1210 [Eyebright Medical Technology]: 12 × 10 mm), and control group (no CTR). Postoperative assessments (1 day and 1, 3, and 6 months) included uncorrected and corrected distance visual acuity (UDVA/CDVA), area of continuous curvilinear capsulorhexis (ACCC), IOL tilt/decentration, intraocular pressure (IOP), and corneal endothelial cell (CEC) counts.

Results: All groups had improved UDVA/CDVA postoperatively (P > .05). At 3 and 6 months, horizontal IOL tilt/decentration differed significantly among groups (P < .05). The control group had greater tilt at 3 and 6 months versus 1 week (P < .05) and the small group at 3 months versus 1 week (P < .05). All groups had lower ACCC at 6 months versus baseline (P < .05). The large group had the highest posterior capsule-IOL attachment rate (85%) and the lowest posterior capsular opacity rate (5% vs 12.5% in the small group and 22.5% in the control group). Postoperative IOP/CEC showed no intergroup differences (P > .05).

Conclusions: In eyes with AL of 30 mm of greater, the CTR1311 more fully supports the lens sac, reduces its shrinkage, stabilizes the IOL, and thus obtains better visual quality. However, the study had limited power (61%) due to the smaller sample size. Therefore, although selecting a large CTR in such patients is recommended based on our findings, further validation in larger studies is warranted.

Purpose: To investigate the incidence, presentation, and outcomes of sterile anterior segment inflammation following sulcus-supported phakic IOL implantation (SASI-pIOL).

Methods: The retrospective case series included consecutive patients diagnosed as having SASI-pIOL (early-onset: ⩽ 7 days; late-onset: > 7 days postoperatively) between July 2023 and July 2024 at two tertiary centers in China. All patients were followed up for at least 6 months after diagnosis.

Results: SASI-pIOL occurred in 39 eyes (0.26%) out of 15,209 pIOL surgeries. Early-onset cases accounted for 26 eyes (66.7%), and late-onset for 13 eyes (33.3%). Anterior chamber inflammation and pIOL surface white deposits resolved completely with topical steroids. No eye lost one or more Snellen lines in corrected distance visual acuity. No significant changes were observed in intraocular pressure or endothelial cell density compared to baseline. Recurrence of white deposits on the pIOL occurred in 11 eyes (42.3%) in the early-onset group and 6 eyes (54.5%) in the late-onset group. A significant difference was observed in the proportion of early-onset versus late-onset SASI-pIOL cases relative to ophthalmic viscosurgical device use (P < .001, Fisher's exact test).

Conclusions: SASI-pIOL is uncommon, responds well to topical corticosteroids, and is associated with favorable visual outcomes, yet requires long-term monitoring due to a notable recurrence rate.