Journal of refractive surgery最新文献

Purpose: To compare the clinical outcomes, surgical workflow, and patient satisfaction following small incision lenticule extraction (SMILE) performed with the VisuMax 800 in one eye and the VisuMax 500 in the contralateral eye (both Carl Zeiss Meditec).

Methods: This was a prospective, single-site clinical study of patients undergoing SMILE for myopia and myopic astigmatism between February 2022 and August 2023. Each patient underwent bilateral treatment using the VisuMax 800 (VM800 group) in one eye and the VisuMax 500 (VM500 group) in the contralateral eye. Intraoperative docking time, suction time, laser time, and surgical time were noted. Patient satisfaction and laser preference was evaluated immediately after treatment. Visual and refractive outcomes, contrast sensitivity, and quality of vision were assessed at the 3-month postoperative visit.

Results: A total of 30 patients undergoing bilateral SMILE were included. The mean docking time and surgical time were significantly lower in the VM800 group (46.53 ± 11 sec and 4.52 ± 2.33 min, respectively) compared to the VM500 group (68.25 ± 15 sec and 6.22 ± 2.04 min, respectively) (P < .001). No significant differences were observed at the 1-day or 3-month visit for uncorrected distance visual acuity, corrected distance visual acuity, spherical equivalent, higher order aberrations, Objective Scatter Index, modulation transfer function, and contrast sensitivity. Patient scores regarding subjective symptoms were comparable. However, overall satisfaction with the surgical experience was rated significantly better in the VM800 group, with 80% of patients preferring the VM800 eye. No complications occurred for eyes in either group.

Conclusions: No significant differences were observed in clinical outcomes between the two laser systems. However, the surgical workflow and patient-reported intraoperative experience favored the VisuMax 800. [J Refract Surg. 2025;41(1):e14-e21.].

Purpose: To evaluate dynamic changes in ciliary parameters and Implantable Collamer Lens V4C (ICL) (STAAR Surgical) haptic position using mydriatic and miotic agents and their effects on the central and peripheral vault.

Methods: This study involved 80 eyes from 40 consecutive patients (mean age: 28.05 years; range: 19 to 42 years) examined 3 months after ICL implantation. Patients were randomly assigned to either a mydriasis group or a miosis group. Ultrasound biomicroscopy was used to measure the following parameters at baseline and after pharmacological induction with tropicamide or pilocarpine: ciliary process length (CPL), iris ciliary angle (ICA), final tip point of the ICL haptic (ftICL haptic), central vault (c-vault), mid-peripheral vault (m-vault), and peripheral vault (p-vault).

Results: In the mydriatic group, the proportion of eyes with all ICL haptics in the ciliary sulcus increased from 70.0% to 77.5% after tropicamide administration, whereas in the miotic group, this proportion decreased from 67.5% to 57.5% after pilocarpine administration. The CPL and ftICL haptic increased significantly in the mydriatic group (all P < .01) but decreased in the miotic group (all P < 0.01). Conversely, the ICA decreased significantly in the mydriatic group and increased in the miotic group (all P < .01). The correlation analysis showed no significant relationship between changes in c-vault, m-vault, and p-vault with alterations in CPL, ICA, and ftICL haptic in both groups.

Conclusions: Haptic position contributes to the movement of the ICL optical zone during accommodation, but changes in haptic position were not significantly correlated with changes in the vault. [J Refract Surg. 2025;41(1):e22-e28.].

Purpose: To evaluate the clinical outcome of laser-assisted surgical correction of high hyperopic or mixed astigmatism using small incision intrastromal lenticule rotation (SMILERO) alone or combined with photorefractive keratectomy (PRK).

Methods: This retrospective case series enrolled 25 eyes with high astigmatism that underwent SMILERO surgery. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), manifest refraction, central corneal thickness, and corneal higher order aberrations were analyzed before surgery and after 3, 6, and 12 months of follow-up. The postoperative residual refractive errors were fine-tuned using PRK.

Results: The median absolute preoperative cylinder of 4.50 diopters (D) decreased to 1.25 D at 3 months postoperatively. The lenticule rotation improved UDVA (0.80 vs 0.45 logMAR) due to a noticeable myopic shift. Regarding UNVA, 14 of 24 eyes were capable of reading Jaeger number 1 chart postoperatively in comparison to one eye preoperatively. The lenticule rotation led to successful correction of both astigmatic and spherical components in 13 of 25 eyes. The residual refractive errors in 12 of 25 eyes were fine-tuned postoperatively by PRK. The SMILERO and PRK combination led to a satisfactory refractive outcome with median absolute cylinder of 0.75 D, median spherical equivalent of -0.25 D, and median UDVA of 20/40 Snellen equivalent at 12 months postoperatively.

Conclusions: This study demonstrates that SMILERO is capable of correcting both corneal and refractive astigmatism with mid-term corneal stability. The residual refractive errors were further minimized with subsequent PRK fine-tuning. [J Refract Surg. 2025;41(1):e5-e13.].

Purpose: To investigate long-term corneal biomechanical changes in thin corneas after small incision lenticule extraction (SMILE).

Methods: Patients with indications for SMILE were enrolled in this study between November 2017 and March 2018. Patients were matched for age, spherical diopter, cylinder, spherical equivalent (SE), and lenticule thickness (LT), and then categorized into the thin cornea group (preoperative thinnest central corneal thickness [CCT] of 500 µm or less, 32 eyes) or normal cornea group (CCT of greater than 500 µm, 32 eyes). Corneal biomechanical properties were measured using the Corvis ST system. Data were collected at 1 day, 3 weeks, 3 months, and 3 years postoperatively.

Results: At 3 years postoperatively, the safety indexes were 1.06 ± 0.12 and 1.09 ± 0.12 (P = .23) in the thin cornea and normal groups, respectively; the respective effective indexes were 0.89 ± 0.23 and 0.98 ± 0.18 (P = .12). Recovery of overall corneal stiffness was observed in both groups. Comparative analysis of biomechanical parameters revealed that the change between preoperative and 3-year postoperative values was smaller in the thin cornea than in the normal group, without statistical significance. Correlation analysis showed that SE, LT, and CCT were the main parameters affecting changes in corneal biomechanical properties in the normal group. No significant correlations were found between the stress-strain index, Corvis biomechanical index for laser vision correction, and preoperative CCT or age.

Conclusions: With rigorous preoperative screening and appropriate surgical design, thin corneas are biomechanically stable in the long term after SMILE. Moreover, postoperative biomechanical strength increases over time. [J Refract Surg. 2025;41(1):e39-e49.].

Purpose: To observe and explore the correlation between visual outcomes and intraocular lens (IOL) stability after tri-focal IOL implantation in eyes with high myopia.

Methods: Patients with highly myopic cataract (axial length > 26 mm) were enrolled in this prospective study. Thirty-one eyes (31 patients) received implantation of a trifocal IOL (AcrySof IQ PanOptix TFNT00). Uncorrected distance, intermediate, and near visual acuity (UDVA 5 m, UIVA 60 cm, UNVA 40 cm) and refractive status were evaluated at 1 day, 1 week, 4 weeks, and 3 months postoperatively. The defocus curve was plotted 3 months postoperatively. The IOL tilt, IOL decentration, postoperative aqueous depth, and adhesion of the capsule with IOL were evaluated at 2 hours, 1 week, 4 weeks, and 3 months postoperatively. The correlation between postoperative visual outcomes and dynamic changes in IOL positioning was analyzed.

Results: In total, 29 eyes of 29 patients were available for analysis. UDVA, UIVA, and UNVA were 0.03 ± 0.01, 0.03 ± 0.01, and 0.02 ± 0.01 logarithm of the minimum angle of resolution (logMAR) at 3 months postoperatively (mean spherical equivalent [SE]: -0.10 ± 0.04 D). From 1 to 7 days postoperatively, UIVA (P = .031) and UNVA (P = .02) improved, SE shifted to myopic (P = .001), and the IOL moved forward (P < .001). A bimodal defocus curve showed that the visual acuity achieved 0.2 logMAR from +0.50 to -2.50 D, and the peaks were at plano and -2.50 D, reaching 0.04 ± 0.01 and 0.08 ± 0.01 logMAR. The capsular bend index reached 3.35 ± 0.06 at 3 months postoperatively. There were no significant changes in tilt and decentration during the postoperative follow-up period.

Conclusions: This trifocal IOL provides excellent visual acuity at far, intermediate, and near distance in high myopia eyes. The postoperative position of the IOL was relatively stable in eyes with highly myopic cataracts. [J Refract Surg. 2025;41(1):e56-e64.].

Purpose: To evaluate residual refractive errors after intraocular lens (IOL) extraction and the safety and effectiveness of refractive correction procedures.

Methods: The eligibility criteria for this systematic review were patients who had undergone cataract or clear lens extraction and had experienced residual refractive error. All study designs were considered for inclusion and non-English publications, non-peer reviewed articles, books, and systematic reviews were excluded. A comprehensive electronic search strategy was employed on PubMed, Scopus, Web of Science, Cochrane, and Embase databases from January 1, 1950, to August 1, 2023.

Results: This review examined 55 articles with 2,223 eyes. Piggyback IOL and IOL exchange are highly effective in correcting both myopia and hyperopia, showing significant improvements in spherical and cylindrical errors. Among corneal-based procedures, laser in situ keratomileusis offers a strong balance, with substantial reductions in both spherical and cylindrical errors, along with a favorable safety profile. Small incision lenticule extraction improves uncorrected distance visual acuity (UDVA), particularly in hyperopic patients, whereas photorefractive keratectomy is effective for both UDVA and astigmatism correction, although it has less impact on corrected distance visual acuity (CDVA). Conductive keratoplasty is effective but has greater variability and a higher incidence of complications.

Conclusions: Significant improvements in spherical equivalent were consistently observed after treatment across the different procedures. Both UDVA and CDVA demonstrated notable enhancements, suggesting an overall efficacy in improving visual function. Although complications were reported, they were generally low in incidence and varied across procedure types. [J Refract Surg. 2025;41(1):e73-e87.].

Purpose: To evaluate the 12-month rotational stability and outcomes of V4c toric Implantable Collamer Lenses (TICLs) (STAAR Surgical) located at two different lens orientations (horizontal or oblique).

Methods: This retrospective study included a total of 403 eyes with TICL implantation, enrolled between January 2021 and December 2022, that were divided into two groups based on the minimum intended angle off the horizontal axis: horizontal with 263 eyes at an angle ±22.5 degrees or less and oblique with 140 eyes at a minimum intended angle of greater than ±22.5 degrees. A comparison was made of the preoperative characteristics, surgical outcomes, secondary surgical interventions, footplate positions, and adverse events at 1, 6, and 12 months postoperatively. The rotation-related factors were analyzed.

Results: At 12 months, there were 243 eyes (92%) in the horizontal group and 130 eyes (93%) in the oblique group that were within ±0.50 diopters (D) of emmetropia. Their rotation proportion was 5.3 % and 5.7%, respectively, and their rotation angle was 9.11 ± 2.84 and 9.96 ± 2.42 degrees, respectively (P = .086). TICL footplates were mostly positioned on the ciliary body. No correlation was observed of lens placement axis, vault, or manifest refraction with rotation in both groups (P > .05). During the follow-up, no vision-threatening complications were observed in both groups. Rotation cases were successfully addressed via alignment or lens exchange.

Conclusions: TICLs, when implanted across a range of lens orientations, demonstrated favorable rotational stability and postoperative outcomes. The postoperative rotational stability is independent of the placement angle of the TICL. [J Refract Surg. 2025;41(1):e29-e38.].