Journal of refractive surgery最新文献

Purpose: To compare the visual quality and stereopsis after bilateral implantation of the zonal refractive multifocal intraocular lens (IOL) LS-313 MF15 (Oculentis) and enhanced monofocal IOL TECNIS Eyhance ICB00 (AMO).

Methods: In this retrospective case series at The Second Hospital of Jilin University, patients underwent bilateral phacoemulsification with implantation of either enhanced monofocal (Tecnis Eyhance ICB00) or zonal refractive (LS-313 MF15) IOLs. Postoperative evaluations at 3 months included visual quality and stereopsis parameters: uncorrected distance, intermediate, and near visual acuity; corrected distance visual acuity; defocus curves; higher order aberrations; Strehl ratio; modulation transfer function; stereoacuity with correlation analysis; Visual Function Index-14 (VF-14) score; and spectacle independence rate.

Results: Sixty patients (120 eyes) were included, with 30 patients (60 eyes) per group completing follow-up assessments. At the 3-month follow-up visit, the LS-313 MF15 group showed superior near visual acuity and stereopsis versus the Eyhance ICB00, with stereopsis positively correlating with binocular near visual acuity. The LS-313 MF15 demonstrated smoother defocus curves, broader landing zones, and superior near vision performance versus the Eyhance ICB00. The LS-313 MF15 group demonstrated lower spherical aberration but higher coma, trefoil, and total higher order aberrations compared to the Eyhance ICB00 group. No statistically significant differences were observed between the two groups in SR, MTF curve area, VF-14 questionnaire scores, or spectacle independence rates.

Conclusions: For patients with intermediate-vision requirements, both IOLs represent viable options, whereas the LS-313 MF15 may be preferable for those requiring enhanced near vision and stereopsis. The Eyhance ICB00 appears more suitable for patients with suboptimal ocular conditions.

Purpose: To evaluate safety and clinical outcomes of the sutureless intrascleral one-piece intraocular lens (SSF IOL) fixation in patients with Marfan syndrome (MFS) presenting with ectopia lentis.

Methods: This retrospective, longitudinal, non-comparative case series was a multicenter study involving Ophthalmology Departments at three tertiary care centers in Italy. Fifteen eyes from 10 patients (4 males, 6 females; mean age 29.13 ± 16.96 years) diagnosed as having Marfan syndrome underwent lensectomy and implantation of the SSF one-piece IOL (FIL SSF; Soleko). Patients were followed up for 12 months postoperatively. Primary outcomes included corrected distance visual acuity (CDVA), IOL tilt (35-MHz ultrasound biomicroscopy), and endothelial cell density (ECD). Intraoperative and postoperative complications were recorded.

Results: All surgeries were performed uneventfully, and no intraoperative complications occurred. CDVA improved significantly from 0.50 to 0.09 logarithm of the minimum angle of resolution (logMAR) (P = .0001). At 12 months postoperatively, the mean IOL tilt was 2.89 ± 0.91 degrees, indicating good centration and stability. No cases of IOL dislocation were reported. ECD showed a statistically significant mean reduction of 257.4 ± 138.2 cells/mm² (P < .0001), although no corneal decompensation was observed. The postoperative complications included one case of macular edema with subsequent development of an epiretinal membrane and one case of haptic exposure.

Conclusions: The SSF implantation of a single-piece IOL appears to be a viable and reproducible option for the successful surgical management of ectopia lentis in patients with MFS.

Purpose: To evaluate the biomechanical properties of the cornea after refractive surgery using an inflation test combined with optical coherence tomography (OCT).

Methods: Nine human donor corneas were divided into two groups: healthy (control) and treated (divided into three subgroups: photorefractive keratectomy [PRK], laser in situ keratomileusis [LASIK], and small incision lenticule extraction). Refractive treatments were applied to simulate -4.00 diopters of myopia correction. The corneas were mounted on an artificial anterior chamber, and an inflation test was performed using a custom set-up. Intraocular pressure was increased from 15 to 120 mm Hg in steps of 15 mm Hg, and corneal deformation was monitored via OCT imaging. The apex displacement versus IOP relationship was analyzed to calculate corneal stiffness, expressed as Young's modulus. Corneal thickness and curvature were also measured. Statistical comparisons were performed between healthy and treated corneas.

Results: All treated corneas exhibited significant reductions in thickness and Young's modulus compared to the healthy group. The mean corneal thickness was 552.0 ± 5.9 µm in the healthy group and 486.9 ± 14.0 µm in the treated group (P < .05). Young's modulus was significantly lower in treated corneas (14.2 ± 4.9 MPa) compared to healthy corneas (22.9 ± 0.5 MPa, P = .02). Among surgical techniques, LASIK resulted in the greatest reduction in corneal stiffness, whereas PRK showed the least impact.

Conclusions: Inflation testing combined with OCT imaging allows for precise assessment of biomechanical alterations following refractive surgery. These findings highlight the importance of considering biomechanical consequences when selecting refractive procedures.

Purpose: To compare the visual outcomes and patient-reported symptoms of volunteers with myopia and myopic astigmatism who had topography-guided laser in situ keratomileusis (TG-LASIK) in one eye and keratorefractive lenticule extraction (KLEx) in the other eye.

Methods: This was a prospective, randomized, contralateral study. Participants aged 21 to 50 years underwent TG-LASIK and KLEx contralaterally. Participants included had myopia between -2.00 and -8.00 diopters (D) with astigmatism of 3.00 D or greater. Postoperative month 6 (POM6) visual and refractive outcomes and patient-reported symptoms were reported for 49 participants (98 eyes).

Results: TG-LASIK [L] resulted in more eyes achieving uncorrected distance visual acuity (UDVA) of 20/16 or better than KLEx [K] eyes at POM6 (L = 43%, K = 29%; P = .038). TG-LASIK outperformed KLEx in mean UDVA (L = -0.08 ± 0.05 logMAR [Snellen 20/17], K = -0.05 ± 0.09 logMAR [Snellen 20/18]; P = .013; Cohen's d = 0.41), corrected distance visual acuity (CDVA) (L = -0.12 ± 0.05 logMAR [Snellen 20/15], K = -0.10 ± 0.04 logMAR [Snellen 20/16]; P = .001), residual manifest cylinder (L = 0.16 ± 0.17 D, K = 0.31 ± 0.34 D; P = .012; Cohen's d = 0.56), low contrast (LC) UDVA (L = 0.24 ± 0.10 logMAR [Snellen 20/32], K = 0.28 ± 0.12 logMAR [Snellen 20/38]; P = .006), and LC CDVA (L = 0.21 ± 0.08 logMAR [Snellen 20/32], K = 0.22 ± 0.08 logMAR [Snellen 20/33]; P = .026). TG-LASIK induced fewer total higher order aberrations (HOAs) (L = 0.49 ± 0.22 µm, K = 0.57 ± 0.21 µm; P < .0006), vertical coma (L = -0.10 ± 0.31 µm, K = -0.17 ± 0.33 µm; P = .011; Cohen's d = 0.09), and vertical trefoil (L = 0.03 ± 0.11 µm, K = -0.03 ± 0.17 µm; P = .020; Cohen's d = 0.43) and resulted in better patient vision satisfaction score than KLEx (L = 1.25 ± 0.48, K = 1.41 ± 0.64; P = .044).

Conclusions: At POM6, TG-LASIK provided superior UDVA, CDVA, LC UDVA, LC CDVA, and lower HOAs and residual manifest cylinder compared to KLEx. Patients reported greater vision satisfaction with TG-LASIK.

Purpose: To assess the tolerance to simulated astigmatism and patient-reported outcomes in pseudophakic eyes implanted with a violet light-filtering diffractive full visual range intraocular lens (VLF FVR IOL).

Methods: This prospective, observational study included 30 patients who had cataract surgery with the implantation of a VLF FVR IOL (Tecnis Odyssey, DXR00V & DRT models; Johnson & Johnson Vision). Visual outcomes were assessed 1 to 3 months postoperatively. Cylindrical defocus was induced using +0.50 to +2.00 diopters (D) cylinder lenses in 0.50-D increments for with-the-rule (WTR), oblique, and against-the-rule (ATR) orientation over the patient's corrected distance refraction. The tolerance to simulated astigmatism was evaluated by calculating the difference between distance visual acuity at each defocus and corrected distance visual acuity without defocus. The patient's reported outcomes were analyzed using the Assessment of IOL Implant Symptoms (AIOLIS) questionnaire.

Results: More than 90% of patients achieved visual acuity of 20/40 or better with 1.50 D WTR and 1.00 D oblique/ATR astigmatism. WTR astigmatism resulted in visual acuity within one line for up to 1.00 D and two lines for 1.50 D, outperforming ATR, which achieved it for 0.50 and 1.50 D, followed by oblique, which resulted in 0.50 and 1.00 D, respectively. Induced 1.00 D WTR astigmatism demonstrated better visual acuity than ATR (P = .04) and oblique (P = .03). Starbursts, halos, and snowballs were reported as severe in 3% of patients, whereas 7% experienced glare at night. Notably, 96.6% of patients reported spectacle independence.

Conclusions: The VLF FVR IOL showed good tolerance to induced astigmatism for distance vision, with WTR astigmatism being better tolerated than oblique and ATR orientations. The AIOLIS questionnaire showed a strong level of patient satisfaction and optical phenomena.

Purpose: To evaluate the long-term safety and efficacy of simultaneous total corneal wavefront-guided transepithelial photorefractive keratectomy (TCWG-TransPRK) with accelerated corneal cross-linking (CXL) in mild to moderate keratoconus, incorporating corneal biomechanics as objective markers of structural stability.

Methods: This prospective, interventional, single-center study included patients with mild to moderate keratoconus. All underwent TCWG-TransPRK (maximum planned stromal ablation: 55 µm) followed by accelerated CXL (30 mW/cm² for 3 minutes; total fluence: 5.4 J/cm²). Follow-up was conducted at 24 hours, 1 week, and 1, 3, 6, and 12 months. Primary outcomes were safety and efficacy, with stress-strain index version 2 (SSI v2) proposed as a key objective marker of biomechanical stability. Additionally, refractive accuracy, tomography, and epithelial remodeling were evaluated.

Results: Thirty-eight eyes from 19 patients were analyzed. At 12 months, uncorrected distance visual acuity improved from 0.80 ± 0.36 to -0.03 ± 0.10 logarithm of the minimum angle of resolution (P < .0001), with 87% achieving 20/20 and all 20/40 or better. Corrected distance visual acuity improved (P < .0001), with no Snellen line loss. Refractive accuracy was high (89% within ±1.00 diopter). SSI v2 increased significantly (P < .0001), indicating enhanced intrinsic stiffness. No keratoconus progression was observed. Epithelial thickness increased nasally and temporally, correlating with changes in spherical aberration and vertical trefoil.

Conclusions: Despite the use of accelerated CXL parameters, TCWG-TransPRK with CXL improved vision and enhanced biomechanical stability, as evidenced by a significant increase in SSI v2. This provides an objective structural marker for monitoring and customizing keratoconus care. These findings support the procedure as a safe and effective option for non-progressive mild to moderate keratoconus.

Purpose: To systematically evaluate the effect of different centration methods on postoperative visual quality in patients with refractive error undergoing corneal refractive surgery.

Methods: Overall, 3,140 eyes from 65,604 records were retrieved through a comprehensive search of eight databases. Thirteen studies were included in the meta-analysis to evaluate the impact of centration methods on visual quality outcomes.

Results: Postoperative decentration was significantly lower in the coaxially sighted corneal light reflex (CSCLR)-centered group than in the entrance pupil center (EPC)-centered group (P < .05). The proportion of spherical equivalent (SE) within ±0.50 diopters (D) were significantly better in the CSCLR-centered group (P = .001). However, no significant differences were found in postoperative uncorrected distance visual acuity (UDVA), postoperative corrected distance visual acuity (CDVA), the proportion of eyes achieving 20/20 or better UDVA, loss of two or more lines of CDVA, or astigmatism (all P > .05). Induced coma was significantly lower in the CSCLR-centered group (P < .00001), with no significant difference in sphere or other higher order aberrations (HOAs). Significant differences in HOAs were observed between angle kappa of 0.2 mm or greater and angle kappa less than 0.2 mm groups (P = .03), although no significant differences were found in postoperative UDVA, SE, sphere, or horizontal coma/vertical coma (all P > .05).

Conclusions: CSCLR centration ablation might have a potential advantage over EPC centration in achieving better postoperative outcomes (SE residuals, and induced coma) after corneal refractive surgery according to the currently available low-quality evidence. When the preoperative angle kappa is large, an angle kappa adjustment is suggested. More high-quality trials are required in future research.