Journal of refractive surgery最新文献

Purpose: To investigate the reasons for the removal and/or exchange of posterior chamber phakic intraocular lenses (PCPIOLs) and the outcomes of these procedures.

Methods: In this retrospective study, PCPIOL implantations performed between January 2015 and June 2023 in a single center were reviewed. The study group consisted of the files of eyes with removed and/or exchanged PCPIOL. Visual acuities, refraction errors, endothelial cell counts, and measurements of the vault before and after exchanges were recorded. Reasons for removal and/or exchange were evaluated. The tuck-and-pull technique was used in all explantations.

Results: Twenty-three of 1,490 eyes with PCPIOL implantation required removal and/or exchange. Of the explanted eyes, 17 were implanted with PCPIOLs for myopia (1.21% of all myopic corrections) and 6 were implanted with PCPIOLs for hyperopia (6.59% of all hyperopic corrections). The most common reason for removal and/or exchanges after implantation was inappropriate vault (10 of the 23 total removals and/or exchanges), followed by cataract development (7 of the 23 total removals and/or exchanges). A comparison of the biometric characteristics of eyes with PCPIOL removal and/or exchange due to inappropriate vault with other PCPIOL implantations showed that anterior chamber depth, PCPIOL length, and white-to-white distance were significantly higher in the group of explanted eyes (P < .05). All eyes with high vault in myopic patients had a 13.2- or 13.7-mm length PCPIOL.

Conclusions: The main reason for PCPIOL removal and/or exchange is vault values outside the ideal limits and cataract development. Before ordering 13.2- and 13.7-mm long PCPIOLs, biometric data of both eyes and recommended PCPIOL sizes should be carefully reviewed. [J Refract Surg. 2024;40(11):e797-e803.].

Purpose: To compare the effect of superior and temporal clear corneal incisions, regardless of the steep axis, on postoperative changes in corneal higher order aberrations (HOAs) in patients with healthy corneas and mild preoperative corneal astigmatism.

Methods: In this prospective cohort study, the right eyes of study participants were randomly assigned to one of two groups prior to cataract surgery: temporal incision (TI) and superior incision (SI). Preoperatively and 6 weeks after surgery, measurements were taken of corneal HOAs over a 6-mm optical zone.

Results: The study included 102 eyes (50 eyes in the TI group and 52 eyes in the SI group) that underwent routine phacoemulsification using a 2.4-mm clear corneal incision. Significant changes in vertical coma (P = .019), horizontal coma (P = .042), and vertical trefoil (P = .001) were observed in the SI group. In the subgroup analysis of the SI group, significant changes in vertical coma (P = .025) and vertical trefoil (P = .047) were observed in the eyes with preoperative with-the-rule corneal astigmatism, and significant changes in horizontal coma (P = .038) were observed in eyes with preoperative against-the-rule corneal astigmatism. The TI group showed no significant difference between the preoperative and postoperative periods.

Conclusions: The SI induced vertical and horizontal coma in accordance with the preoperative axis of the steep meridian. These alterations in corneal HOAs may affect the quality of vision after surgery. TI may potentially provide an advantage over SI in terms of corneal HOAs. [J Refract Surg. 2024;40(11):e792-e796.].

Purpose: To compare the subjective refraction and Innov-Eyes (Alcon Laboratories, Inc) wavefront-measured refraction in patients with myopia and astigmatism before refractive surgery.

Methods: Consecutive myopic patients planning to receive refractive surgery with ages between 18 and 50 years old were retrospectively enrolled. The subjective and wavefront-measured refraction (InnovEyes platform) were compared, and the influential factors for the measurement difference were analyzed.

Results: Of the 500 eyes enrolled, the mean age was 29.3 ± 6.8 years. Mean wavefront-measured refraction was 0.58 ± 0.62 diopters (D) more myopic and 0.10 ± 0.27 D more astigmatic than subjective refraction (P < .001). Wavefront-measured refraction exhibited excellent consistency and significant correlation with subjective refraction. Linear regression demonstrated that age (P = .008) and wavefront-measured sphere standard deviation (P < .001) were positively correlated with spherical measurement difference, and total quality score (P < .001) and accommodative response (binocular cross-cylinder) (P = .011) demonstrated a negative correlation with spherical and cylindrical measurement difference. The patients with low wavefront measurement quality had significantly greater spherical differences than those with high-quality measurement (P < .001). The patients with accommodative lead had greater spherical equivalent differences than other participants (P = .047).

Conclusions: Wavefront-measured refraction had excellent consistency with subjective refraction, although it measured more myopia and astigmatism than subjective refraction. The spherical measurement difference was greater in older patients and those with accommodative lead. More stable and higher quality repeated measurements will yield closer results between wavefront-measured and subjective refraction. [J Refract Surg. 2024;40(11):e836-e844.].

Purpose: To assess visual outcomes and stability of lens alignment more than 3 years after implanting either the AT Lisa Tri Toric (Carl Zeiss Meditec) or the Acrysof IQ Restor Toric (Alcon Laboratories, Inc) intraocular lens (IOL).

Methods: Patients who had received either the AT Lisa Tri Toric or the Acrysof IQ Restor Toric IOL were included in the study. The average follow-up period was 5.4 years for the AT Lisa Tri Toric group and 7.9 years for the Acrysof IQ Restor group. The examinations covered included: subjective refraction, monocular and binocular corrected and uncorrected visual acuity at far (4 m), intermediate (75 cm), and near (40 cm) distances, binocular best-corrected defocus curve analysis (4 m), contrast sensitivity evaluation, assessment of IOL axial position, and presence of positive dysphotopsia.

Results: A total of 42 eyes were evaluated. Both groups exhibited good long-term lens axial stability. The AT Lisa Tri Toric group had a mean misalignment of 4.8 ± 3.2° from the preoperatively determined axis, whereas the Acrysof IQ Restor Toric group had an average misalignment of 5.4 ± 4.5° (no statistically significant difference, P = .578). Mean achieved spherical equivalent was -0.19 ± 0.36 diopters (D) for the AT Lisa Tri Toric group and 0.15 ± 0.39 D for the Acrysof IQ Restor Toric group. In the AT Lisa Tri Toric group, 18 eyes (72%) achieved an uncorrected distance visual acuity of 0.10 logarithm of the minimum angle of resolution (20/25 Snellen) or better, compared to 15 eyes (88%) in the Acrysof IQ Restor Toric group. Overall, 21 eyes (84%) in the AT Lisa Tri Toric group and 14 eyes (83%) in the Acrysof IQ Restor Toric group achieved a postoperative spherical equivalent refraction between -0.50 and +0.50 D.

Conclusions: Both the AT Lisa Tri Toric and the Acrysof IQ Restor Toric IOLs showed good long-term stability and functional outcomes. They proved to be effective options for restoring vision at far, intermediate, and near distances, providing a viable solution for presbyopia correction even several years after implantation. [J Refract Surg. 2024;40(11):e845-e853.].

Purpose: To describe Light Adjustable Lens (RxSight, Inc) (LAL) visual and refractive outcomes in a Japanese patient population with and without prior refractive surgery.

Methods: In this retrospective chart review of patients with cataract in a private eye clinic, 34 eyes from 21 patients underwent cataract surgery with LAL implantation. Eyes underwent light treatment to adjust the patients' refraction after implantation to meet individual visual goals. Standard visual and refractive outcomes were collected. Contrast sensitivity (to assess quality of vision), clinical defocus and vergence curves (to assess range of vision), and patient satisfaction were also collected.

Results: The mean prediction error of the light adjustment was -0.04 ± -0.48. Thirty-one eyes (91%) and 33 eyes (97%) were within ±0.25 and ±0.50 diopters (D) of manifest spherical equivalent target, respectively. Thirty-two eyes (94%) had residual refractive cylinder of 0.50 D or less. The full depth of focus was 3.68 D. Monocular contrast sensitivity shows frequencies equivalent to a normal population aged 50 to 60 years. The mean satisfaction score was 8.8 (scale: 1 to 10). There were no adverse events and no eyes lost corrected distance visual acuity from the light treatment.

Conclusions: LALs in cataract refractive surgery hold great promise, including for the Japanese population, which have unique ocular biometrics. By providing a safe procedure and the ability for postoperative adjustments, the LAL provided a tailored approach to vision correction, ultimately improving patient outcomes and satisfaction. [J Refract Surg. 2024;40(11):e854-e862.].

Purpose: To assess objective reading performance at intermediate and near distances using the Salzberg Reading Desk (SRD) (SRD Vision) in patients with cataract who underwent the implantation of a diffractive extended depth of focus intraocular lens (EDOF IOL) in the dominant eye and a hybrid multifocal EDOF IOL in the non-dominant eye.

Methods: This prospective, non-comparative, interventional study included 46 eyes of 23 patients with cataract who underwent bilateral cataract surgery with implantation of the DFR00V Tecnis Synergy IOL (Johnson & Johnson Surgical Vision) in the non-dominant eye and the DXR00V Tecnis Symfony OptiBlue IOL (Johnson & Johnson Surgical Vision) in the dominant eye. At postoperative 6 months, the Salzburg Reading Desk was used to assess distance-corrected reading performance at near and intermediate distances.

Results: Although the monocular reading acuity at the preferred intermediate distance was statistically significantly better in the eyes implanted with the DXR00V IOL, it was better with the DFR00V IOL at preferred near distances. The mean binocular distance-corrected preferred intermediate and near reading acuity was 0.07 ± 0.09 (20/23) and 0.13 ± 0.09 (20/27) logarithm of the minimum angle of resolution, respectively. Other parameters of reading performance, such as reading speed, reading distance, reading time, and smallest scale log print size, were similar between the two IOL groups when assessed monocularly.

Conclusions: Implanting a DFR00V IOL in the non-dominant eye and a diffractive DXR00V IOL in the dominant eye resulted in excellent binocular reading acuity and speed at intermediate and near distances. [J Refract Surg. 2024;40(11):e778-e782.].

Purpose: To compare variance of manifest refraction (MR) measurement and variance of refractive outcomes after keratorefractive lenticule extraction (KLEx) in the same cohort.

Methods: This was a retrospective study of consecutive patients attending at least three preoperative refractions before undergoing KLEx. All manifest refractions were performed according to a standard protocol. Additionally, automated refraction, spectacles prescription, wavefront refraction, and tomography/topography were also considered when determining the treatment refraction. Variance of postoperative outcomes was compared to variance of MR measurement.

Results: The difference in MR of 153 eyes between the first and last preoperative visit showed a mean pairwise absolute difference of 0.22 ± 0.22 diopters (D) (range: 0.00 to 1.25 D) in spherical equivalent (SE). The 95% limit of agreement (LoA) was within 0.73 D for sphere, 0.60 D for cylinder, and 0.61 D for SE. Standard deviation (SD) for corrected distance visual acuity (CDVA) was 0.06 logarithm of the minimum angle of resolution (logMAR) and the 95% LoA was within 1.3 Snellen lines. The differences between reproducibility of the two last preoperative MR and the variance of postoperative outcomes after KLEx (ie, the isolated repeatability of corneal lenticule extraction) was SD of 0.13 D for sphere, cylinder, and SE, and 11 degrees in axis, respectively.

Conclusions: Predictability of KLEx was equal to variance of refraction measurement. Isolated repeatability of the laser treatment was better than the reproducibility of MR. Thus, the authors have shown for the first time that precision of KLEx has reached such a level today that further improvement is limited by MR measurements. [J Refract Surg. 2024;40(11):e814-e823.].

Purpose: To evaluate range of visual acuity, visual quality, and safety of the IC-8 small-aperture (SA) intraocular lens (IOL) (Apthera; Bausch & Lomb, Inc) in patients with cataract.

Methods: This was a prospective, multicenter, open-label, parallel-group, non-randomized, examiner-masked, 12-month clinical study conducted at 21 sites in the United States. Included patients (N = 453) received either the SA IOL (targeted to -0.75 diopters) in one eye and a monofocal or monofocal toric IOL (targeted to plano) in the fellow eye (SA IOL group, n = 343) or bilateral monofocal/monofocal toric IOLs (control group, n = 110).

Results: At 6 months, the SA IOL group achieved superior binocular uncorrected intermediate and near visual acuity (P < .0001) and equivalent binocular uncorrected distance visual acuity versus the control group. In SA IOL eyes, 99.1% achieved monocular corrected distance visual acuity of 0.3 logarithm of the minimum angle of resolution or better. The SA IOL and control groups had comparable binocular photopic and mesopic contrast sensitivities at 6 months both with and without glare. The SA IOL group reported few visual symptoms overall, although at higher rates than in the control group.

Conclusions: The SA IOL group exhibited improved intermediate and near vision, comparable distance vision and binocular contrast sensitivities, and few visual symptoms or adverse events versus the bilateral monofocal/monofocal toric IOL group, suggesting that the SA IOL is an effective option for presbyopia correction at the time of cataract surgery. [J Refract Surg. 2024;40(11):e824-e835.].