Journal of refractive surgery最新文献

Purpose: To evaluate the efficacy, predictability, safety, and complication profile associated with the latest posterior chamber phakic Implantable Collamer Lenses (ICLs) featuring a central port (models V4c and V5; STAAR Surgical).

Methods: This PROSPERO-registered systematic review and single-arm meta-analysis included prospective ICL V4c or V5 implantation studies in adults without ocular comorbidities. Databases searched included PubMed, Embase, and the Cochrane Library through May 2025. Primary outcomes were efficacy, predictability, and safety; secondary outcomes included intraocular pressure, endothelial cell density, and complications.

Results: Twenty-seven studies comprising 2,204 myopic eyes were included, with a mean follow-up of 13.84 months. Final uncorrected distance visual acuity (UDVA) averaged 0.057 ± 0.022 logarithm of the minimum angle of resolution (logMAR), with 80.23% achieving 20/20 or better. The mean efficacy index was 1.103 ± 0.019. Predictability was high: 87.45% of eyes were within ±0.50 diopters (D) of the intended refraction. The mean corrected distance visual acuity (CDVA) was 0.014 ± 0.020 logMAR, and the safety index averaged 1.185 ± 0.021. Intraocular pressure remained stable postoperatively (15.98 ± 0.531 mm Hg), and endothelial cell density showed a statistically significant but clinically acceptable decrease. Complications were infrequent, with no vision-threatening events reported.

Conclusions: This meta-analysis of ICLs with a central port (V4c and V5) demonstrates high levels of efficacy, refractive predictability, and safety for correcting moderate to high myopia. The incidence of serious adverse events was low, and results were consistent across a broad range of prospective studies. Continued long-term follow-up and geographically diverse populations are warranted to further validate these findings.

Purpose: To compare the posterior keratometry (PK) values obtained with three instruments based on optical coherence tomography (Anterion [Heidelberg Engineering], IOLMaster 700 [Carl Zeiss Meditec AG], and MS-39 [CSO]), and one Scheimpflug camera biometer (Pentacam AXL Wave; Oculus Optikgeräte GmbH). The average keratometry (Kave), total corneal power (TCP), anterior-to-posterior ratio (A/P ratio), and posterior corneal astigmatism (PCA) were also compared.

Methods: Measurements by the four instruments, expressed in diopters (D), were compared using repeated measures analysis of variance, when they were normally distributed, or Friedman's test, when they were not.

Results: One hundred eyes (100 consecutive patients) scheduled to undergo cataract surgery were prospectively enrolled. Statistically significant differences among the Anterion, IOLMaster 700, MS-39, and Pentacam AXL Wave were detected for PK: Anterion: -6.08 ± 0.23 D, IOLMaster 700: -5.77 ± 0.23 D, MS-39: -6.15 ± 0.26 D, and Pentacam AXL Wave: -6.26 ± 0.26 D (P < .0001); for Kave: Anterion: 43.19 ± 1.50 D, IOLMaster 700: 43.35 ± 1.49 D, MS-39: 43.36 ± 1.53 D, and Pentacam AXL Wave: 43.22 ± 1.55 D (P < .0001); for the A/P ratio: Anterion: 1.19 ± 0.02, IOLMaster 700: 1.12 ± 0.02, MS-39: 1.20 ± 0.03, Pentacam AXL Wave: 1.22 ± 0.03 (P < .0001); and for TCP: Anterion: 42.69 ± 1.51 D, IOLMaster 700: 43.36 ± 1.49 D, MS-39: 42.92 ± 1.52 D, and Pentacam AXL Wave: 42.35 ± 1.55 D (P < .0001). PCA revealed significant differences for the KP(45) and KP(0) vectors (P < .0001).

Conclusions: The four instruments showed different PK values. The largest difference was observed with the IOL-Master 700, which provided the flattest PK and the lowest A/P ratio. The measurements cannot be considered interchangeable, and this should be considered when entering PK values into calculators using this parameter for IOL power.

Purpose: To develop a novel intraocular lens (IOL) power calculation formula by predicting the actual lens position (ALP) in patients with Marfan syndrome who have ectopia lentis undergoing IOL implantation.

Methods: Patients with Marfan syndrome undergoing in-the-bag IOL implantation or scleral-fixated IOL (SF-IOL) implantation were prospectively recruited. ALP was calculated by adding anterior chamber depth to half of the IOL thickness, measured using the IOLMaster 700 (Carl Zeiss Meditec). A generalized linear model was developed to predict the ALP and integrated into effective lens position (ELP) predictions. A supplementary strategy was adjusting axial length (AL). The proposed formulas were evaluated by refraction prediction error (PE) and its absolute value (AE) and compared with both classic and state-of-the-art formulas.

Results: A total of 408 patients (408 eyes) were divided into a training set and a validation set. ALP was significantly correlated with ELP, but the discrepancy increased with longer AL. A significant anterior shift of ALP was observed in the SF-IOL procedure compared to in-the-bag IOL implantation. The ALP prediction model, stratified by AL and surgical procedure, was constructed in the training set. In the validation set, the ALP-based formula demonstrated the highest proportion of AE within 1.00 diopter (D) (83.78% for AL ≤ 24 mm; 92.50% for AL > 24 mm) and significantly reduced extreme PE compared to other formulas. For SF-IOL implantation, the AL-adjusted formula was the most accurate. An online calculator was developed to facilitate its application.

Conclusions: The proposed formulas demonstrated superior accuracy for IOL power calculation in patients with Marfan syndrome compared to existing formulas.

Purpose: To compare the accuracy of formulas for intraocular lens (IOL) power calculation in eyes needing myopic targets between -2.50 and -3.00 diopters (D).

Methods: Patients who underwent phacoemulsification needing a myopic target were enrolled in a single-center retrospective study. IOL power was calculated with newer formulas (Barrett Universal II [BUII], Cooke K6, EVO 2.0, Hoffer QST, and Kane) and older ones (Haigis, Hoffer Q, Holladay 1 and 2, and SRK/T). Trueness, precision, and accuracy of the prediction error (PE) and the percentages of eyes within certain PE thresholds were compared. Patients were grouped based on the implanted IOL (iSert255 [Hoya] or SN60WF [Alcon Laboratories, Inc]).

Results: One hundred thirty eyes were enrolled in the iSert 255 group and 105 eyes in the SN60WF group. No statistically significant difference was observed in trueness among formulas, due to constant optimization. In the iSert 255 group, the accuracy of the Holladay 1 formula was lower (P < .05) compared to the Cooke K6, EVO 2.0, and Kane formulas. In the SN60WF group, the accuracy of the Holladay 1 formula was lower (P < .005) compared to the BUII, EVO 2.0, Hoffer QST, and Kane formulas. The percentage of eyes with an absolute PE less than 0.50 D was highest with newer formulas (77% to 81% in the iSert 255 group and 83% to 85% in the SN60WF group) and lowest with the Holladay 1 formula (58 and 69%, respectively).

Conclusions: Newer formulas have good accuracy in eyes with intentional myopic targets, whereas the use of older formulas, especially the Holladay 1, is not recommended.

Purpose: To assess the clinical outcomes and postoperative complications of the EVO Toric Implantable Collamer Lens (TICL) (STAAR Surgical) with a central port correction over a 5-year follow-up in patients with low and normal vault.

Methods: This retrospective study included 240 eyes from 120 patients divided in two groups based on early postoperative vault: low (< 250 μm; n = 77) and normal (⩾ 250 μm; n = 163). Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, refraction, astigmatism vectorial analysis, complications, and secondary surgeries were assessed at 1 month, 12 months, and 5 years postoperatively.

Results: At 5 years, both groups showed significant improvement in UDVA and CDVA (P < .001), with no intergroup differences. The safety index was 1.17 ± 0.25 in the low vault group and 1.18 ± 0.32 in the normal vault group (P = .634); efficacy index was 1.02 ± 0.24 and 1.00 ± 0.29, respectively (P = .542). Manifest cylinder at 5 years was similar between groups: -0.41 ± 0.56 and -0.48 ± 0.61 diopters (P = .526). Both groups demonstrate a similar tendency for undercorrection, with target induced astigmatism values higher than surgically induced astigmatism values, at 1 (P = .813) and 5 (P = .466) years. The mean deviation vector and correction index was statistically similar between groups (P > .05). The absolute mean angle of error was also similar between groups (P = .128). TICL axis repositioning occurred in 4 cases (5.19%) in the low vault group and in 5 cases (3.08%) in the normal vault group.

Conclusions: TICL implantation provides excellent long-term refractive and rotational stability regardless of vault height. Low vault was not associated with significant safety concerns, supporting TICL efficacy across a broad range of postoperative vault values.

Purpose: To conduct a critical review of the peer-reviewed literature on the use of an implantable collamer lens (ICL) for the correction of pseudophakic ametropia.

Methods: A scoping review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the National Library of Medicine (PubMed), EMBASE, and Web of Science as the primary source of information. Articles were selected based on predefined inclusion and exclusion criteria for this review, ultimately resulting in the selection of 17 articles for the current scoping review.

Results: Data from 170 eyes of 147 patients were analyzed. Most of the reviewed studies exhibited short follow-up periods and had suboptimal designs, including case reports and case series with lack of clinical trials. However, most authors report that visual performance and refractive outcomes were significantly improved for all patients undergoing surgery, leading to enhanced postoperative uncorrected distance visual acuity with a very low complication rate.

Conclusions: The use of the ICL, both spherical and toric, as a supplementary intraocular lens for correcting pseudophakic ametropia represents a viable option for enhancing vision and improving patient satisfaction, with minimal associated complications. Nevertheless, further research with more robust study designs is necessary to validate these findings.

Purpose: To describe a new surgical technique to treat corneal allogenic ring segments (CAIRS) shaped by a femto-second laser with extracorporeal ultra-high-fluence corneal cross-linking (CXL) before insertion into the corneal stroma (ECO-CAIRS).

Methods: Four eyes from four patients with stable keratoconus and maximum keratometry readings between 58.00 and 69.80 diopters (D) were analyzed. Each patient had a corneal thickness of at least 400 μm at 5 mm from the pupil center. CAIRS were prepared from donor corneas using a femtosecond laser. The segments were cross-linked with 30 and 60 J/cm² ultraviolet (UV) light fluences, and inserted without air-drying or extended dehydration.

Results: Insertion was uneventful in all cases. CAIRS subjected to ultra-high-fluence CXL remained stiff during the entire insertion process and showed no tendency to soften. The initial ring segment thickness was approximately halved immediately after the high-fluence CXL treatment compared to pre-CXL levels; thickness levels increased within days after insertion.

Conclusions: This new technique may provide multiple advantages over unmodified or air-dried CAIRS, including an easier insertion due to greater stiffness and resistance to re-swelling during insertion. The high UV fluences used should eliminate viable keratocytes, essentially transforming the segment into an acellular collagen scaffold. Finally, the marked transitory decrease in thickness may allow for the insertion of ring segments with greater overall volume, potentially increasing the corneal topographical effect. Further clinical research is required to assess the extent to which the effect on corneal topography is driven by the CAIRS volume and/or by its intrinsic stiffness.