Journal of refractive surgery最新文献

Purpose: To correlate personality traits (Big Five Inventory) of patients undergoing refractive surgery with postoperative patient satisfaction and visual quality.

Methods: This was a prospective interventional study of 46 patients undergoing corneal refractive surgeries (laser in situ keratomileusis/keratorefractive lenticule extraction) at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi. Personality traits were evaluated using the Big Five Inventory questionnaire preoperatively. Three questionnaires (Quality of Life Impact of Refractive Correction [QIRC], Quality of Vision [QoV], and Quality of Life Enjoyment and Satisfaction Questionnaire [QLESQ]) were administered to assess the quality of life and vision preoperatively and at 3 months. The primary outcome was to correlate the personality type with quality of life and quality of vision in patients undergoing refractive surgery. Secondary outcomes were to assess the change in the quality of life and visual quality after refractive surgery.

Results: Agreeableness (36.90%, 17/46) was the most common personality trait, and neuroticism (8.70%, 4/46) was the least common. At 3 months, there was a significant improvement in the mean QIRC score (P < .001), QLESQ score for physical health (P < .001), and QoV scores for blurred vision (P = .004) and distortion (P = .023). At 3 months, conscientiousness and extraversion traits correlated positively with the QLESQ and QIRC and negatively with the QoV (P < .05). Neuroticism trait had negative correlation with the QLESQ and QIRC and positive correlation with the QoV (P < .05). Agreeableness and openness to experience traits had no correlation with quality of life measures. Visual acuity was comparable between all personality subgroups.

Conclusions: Postoperative visual quality and patient satisfaction were least in neurotic personalities and higher with conscientiousness and extraversion traits. Targeted personality-specific counseling may help achieve optimal patient satisfaction.

Purpose: To assess the efficacy of the AcrySof IQ Vivity non-diffractive extended depth of focus intraocular lens (EDOF IOL) (Alcon Laboratories, Inc) in patients with Fuchs' endothelial dystrophy undergoing Descemet membrane endothelial keratoplasty (DMEK), comparing visual outcomes between staged and simultaneous surgical approaches.

Methods: This was a prospective, descriptive, single-center, non-randomized, comparative clinical study. Twenty-nine eyes from 29 patients with Fuchs' endothelial dystrophy were divided into the staged (n = 14) and simultaneous (n = 15) groups. Uncorrected and corrected distance, intermediate at 66 cm, and near at 40 cm visual acuity, refractive accuracy, corneal topography, and endothelial cell density were assessed preoperatively and at 12 weeks after cataract surgery. Patients also completed the Quality of Vision (QoV) questionnaire.

Results: After 12 weeks, the staged group exhibited significantly better uncorrected and corrected visual acuity at distance, intermediate, and near (P < .05). Refractive accuracy was similar between groups, with 72% of the staged and 60% of the simultaneous group within ±0.50 diopters of the target. The simultaneous group had higher endothelial cell density (P < .001). QoV scores were comparable, indicating no significant differences in visual symptoms between groups.

Conclusions: The AcrySof IQ Vivity EDOF IOL implantation during DMEK and cataract surgery yields favorable visual outcomes with minimal visual disturbances. Although the staged approach showed better visual acuity, both surgical strategies are viable options; patient-specific factors should guide the choice of surgical sequence.

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.