Journal of refractive surgery最新文献

英文中文

Repeatability of a Combined Adaptive Optics Visual Simulator and Hartman-Shack Aberrometer in Pseudophakic Eyes With and Without Previous Corneal Refractive Surgery. 自适应光学视觉模拟器和哈特曼-沙克像差仪在接受过角膜屈光手术和未接受过角膜屈光手术的假性角膜病眼中的重复性。

IF 2.4 3区医学 Q1 OPHTHALMOLOGY

Journal of refractive surgery

Pub Date : 2024-09-01 DOI: 10.3928/1081597x-20240718-02

Dylan McBee,Karim Kozhaya,Li Wang,Mitchell P Weikert,Douglas D Koch

PURPOSETo evaluate the intrasession repeatability of wavefront aberrations obtained by a combined adaptive optics visual simulator and Hartman-Shack aberrometer in pseudophakic eyes with and without previous corneal refractive surgery.METHODSThree consecutive measurements were performed in one eye of each individual. Total ocular aberrations were recorded up to the 5th Zernike order for a 4.5-mm pupil. Repeatability was assessed by calculating the within-subject standard deviation (Sw), the repeatability limit (R), and the intraclass correlation coefficient (ICC). Vector analysis was performed to assess astigmatism variability between scans.RESULTSThe study enrolled 32 normal individuals and 24 individuals with a history of refractive surgery. In normal and eyes that had previous refractive surgery, respectively, the Sw values were 0.155 and 0.176 diopters (D) for sphere and 0.184 and 0.265 D for cylinder. The Sw values for all 3rd order terms ranged from 0.037 to 0.047 µm in normal eyes and 0.044 to 0.063 µm in eyes that had previous refractive surgery. The Sw for primary spherical aberration was 0.020 µm in normal eyes and 0.026 µm in eyes that had previous refractive surgery. ICC values for measurements of astigmatism yielded larger variability (ICC = 0.751 and 0.879). However, both groups demonstrated excellent repeatability (ICC > 0.9) for root mean square higher order aberrations (RMS-HOA) and total RMS values.CONCLUSIONSIn pseudophakic eyes, the adaptive optics Hartmann-Shack device demonstrated acceptable repeatability for measurement of sphere and 3rd and 4th order HOAs with higher variability for astigmatism measurements, especially in eyes with a prior history of corneal refractive surgery. [J Refract Surg. 2024;40(9):e645-e653.].

目的评估自适应光学视觉模拟器和哈特曼-沙克像差仪在曾接受过角膜屈光手术和未接受过角膜屈光手术的假性角膜病眼中获得的波前像差的会内重复性。在 4.5 毫米的瞳孔中记录眼球总像差，直至第 5 Zernike 阶。重复性通过计算受试者内标准偏差 (Sw)、重复性极限 (R) 和类内相关系数 (ICC) 进行评估。该研究招募了 32 名正常人和 24 名有屈光手术史的人。在正常人和曾接受过屈光手术的人眼中，球面的 Sw 值分别为 0.155 和 0.176 迪普特 (D)，柱面的 Sw 值分别为 0.184 和 0.265 迪普特。正常眼球中所有三阶项的 Sw 值介于 0.037 至 0.047 微米之间，曾接受屈光手术的眼球中 Sw 值介于 0.044 至 0.063 微米之间。在正常眼睛中，一次球差的 Sw 值为 0.020 µm，而在接受过屈光手术的眼睛中，一次球差的 Sw 值为 0.026 µm。散光测量的 ICC 值变异较大（ICC = 0.751 和 0.879）。结论在假性角膜眼中，自适应光学哈特曼-沙克设备在测量球面和三阶、四阶 HOA 方面表现出可接受的可重复性，而在散光测量方面的变异性较高，尤其是在曾接受过角膜屈光手术的眼睛中。[J Refract Surg. 2024;40（9）：e645-e653]。

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引用次数: 0

Further Back. 再往后

IF 2.9 3区医学 Q1 OPHTHALMOLOGY

Journal of refractive surgery

Pub Date : 2024-09-01 DOI: 10.3928/1081597X-20240806-01

Alejandro Martinez Garcia

引用次数: 0

The Impact of Corneal Higher Order Aberrations on the Discrepancy Between Manifest Refractive Astigmatism and Topography-Measured Anterior Corneal Astigmatism in Healthy Candidates. 角膜高阶像差对健康候选者明显屈光性散光与地形图测量的角膜前散光之间差异的影响》（The Impact of Corneal Higher Order Aberrations on Discrepancy Between Manifestive Refractive Astigmatism and Topography-Measured Anterior Corneal Astigmatism in Healthy Candidate）。

IF 2.4 3区医学 Q1 OPHTHALMOLOGY

Journal of refractive surgery

Pub Date : 2024-09-01 DOI: 10.3928/1081597x-20240723-05

Avi Wallerstein,Chelsea Ridgway,Mathieu Gauvin

引用次数: 0

Misclassification of Eyes With Progressive Keratoconus Using the KISA% Index. 使用 KISA% 指数对渐进性角膜病眼球进行错误分类。

IF 2.4 3区医学 Q1 OPHTHALMOLOGY

Journal of refractive surgery

Pub Date : 2024-09-01 DOI: 10.3928/1081597x-20240726-01

Bassel Hammoud,William J Dupps,Giuliano Scarcelli,J Bradley Randleman

PURPOSETo determine the misclassification rate of the keratoconus percentage (KISA%) index efficacy in eyes with progressive keratoconus.METHODSThis was a retrospective case-control study of consecutive patients with confirmed progressive keratoconus and a contemporaneous normal control group with 1.00 diopters or greater regular astigmatism. Scheimpflug imaging (Pentacam HR) was obtained for all patients. KISA% index and inferior-superior (IS) values were obtained from the Pentacam topometric/keratoconus staging map. Receiver operating characteristic curves were generated to determine the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity values.RESULTSThere were 160 eyes from 160 patients evaluated, including 80 eyes from 80 patients with progressive keratoconus and 80 eyes from 80 control patients. There were 20 eyes (25%) with progressive keratoconus misclassified by the KISA% index, with 16 eyes (20%) of the progressive keratoconus cohort classified as normal (ie, KISA% < 60). There were 4 eyes (5%) with progressive keratoconus that would classify as having "normal topography" using the published criteria for very asymmetric ectasia with normal topography of KISA% less than 60 and IS value less than 1.45. All controls had a KISA% index value of less than 15. The optimal cut-off value to distinguish cohorts was 15.31 (AUROC = 0.972, 93.75% sensitivity). KISA% index values of 60 and 100 achieved low sensitivity (80% and 73.75%, respectively).CONCLUSIONSThe KISA% index misclassified a significant proportion of eyes with progressive keratoconus as normal. Although highly specific for clinical keratoconus, the KISA% index lacks sensitivity, does not effectively discriminate between normal and abnormal topography, and thus should not be used in large data analysis or artificial intelligence-based modeling. [J Refract Surg. 2024;40(9):e614-e624.].

目的确定渐进性角膜炎患者角膜屈光度百分比（KISA%）指数疗效的误判率。方法这是一项回顾性病例对照研究，研究对象是确诊为渐进性角膜炎的连续患者，以及同时具有 1.00 斜度或更大规则散光的正常对照组。所有患者均获得了 Scheimpflug 成像（Pentacam HR）。从 Pentacam 地形测量/角膜病分期图中获得 KISA% 指数和下-上 (IS) 值。结果共评估了 160 名患者的 160 只眼睛，包括 80 名进行性角膜病患者的 80 只眼睛和 80 名对照组患者的 80 只眼睛。有 20 只眼睛（25%）的进行性角膜病被 KISA% 指数错误分类，16 只眼睛（20%）的进行性角膜病被分类为正常（即 KISA% < 60）。有 4 只（5%）渐进性角膜病患者的 KISA% 指数小于 60 且 IS 值小于 1.45，根据已公布的 KISA% 指数小于 60 且 IS 值小于 1.45 的极不对称异位正常地形图标准，这 4 只眼会被归类为 "正常地形图"。所有对照组的 KISA% 指数值均小于 15。区分组群的最佳临界值为 15.31（AUROC = 0.972，灵敏度为 93.75%）。KISA% 指数值为 60 和 100 时，灵敏度较低（分别为 80% 和 73.75%）。虽然 KISA% 指数对临床角膜病具有高度特异性，但它缺乏灵敏度，不能有效区分正常和异常地形图，因此不应在大数据分析或基于人工智能的建模中使用。[J Refract Surg. 2024;40（9）：e614-e624]。

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引用次数: 0

Reply: Intraoperative Factors Affecting Visual Recovery Following Hyperopic LASIK. 回复：影响远视 LASIK 术后视力恢复的术中因素。

IF 2.4 3区医学 Q1 OPHTHALMOLOGY

Journal of refractive surgery

Pub Date : 2024-09-01 DOI: 10.3928/1081597x-20240815-01

Margarita Safir

引用次数: 0

Comparing the Postoperative Outcomes of Intrastromal Corneal Ring Segments in Three Different Topographic Patterns of Eccentric Keratoconus. 比较偏心性角膜炎三种不同地形模式下角膜环内节段的术后效果

IF 2.4 3区医学 Q1 OPHTHALMOLOGY

Journal of refractive surgery

Pub Date : 2024-09-01 DOI: 10.3928/1081597x-20240716-02

Mohamed Omar Yousif,Rania Serag Elkitkat,Ahmed Elmassry,Mohamed Nabil Hamza,Noha Abdelsadek Alaarag

PURPOSETo compare the postoperative outcomes following implantation of KERATACx ring segments (Imperial Medical Technologies Europe GmbH) in patients having eccentric keratoconus with three different topographic patterns.METHODSThis retrospective cohort study was conducted at Maadi Eye Subspeciality Center, Cairo, Egypt. The study included patients with keratoconus who had implantation of KERATACx ring segments. Three groups were segregated based on topographic keratoconus patterns using the Sirius CSO Topographer (CSO Italia): type I ectasia where the cone coincides with the corneal flat axis, type II ectasia in which the cone coincides with neither the steep nor the flat axis and lies between the two axes, and type II ectasia for cones coinciding with the corneal steep axis. The visual and topographic outcomes were compared preoperatively and postoperatively for the three enrolled groups.RESULTSThis study enrolled 92 eyes of 92 patients and had a mean ± standard deviation follow-up of 16.9 ± 9.2 months. The patients' medical records revealed that night vision complaints and halos around the light were experienced the most by the type III ectasia group (31.25%). For the type III ectasia group, four topographic indices and one visual parameter did not show statistically significant differences between the preoperative and postoperative data (inferior-superior difference at 2- and 4-mm diameter, coma aberration, higher order aberrations, and uncorrected distance visual acuity), contrary to the type I and II ectasia groups, which showed significant improvements in all evaluated parameters.CONCLUSIONSThe type III morphological pattern of ectasia is the least likely to benefit from KERATACx ring segments implantation. [J Refract Surg. 2024;40(9):e625-e634.].

目的比较三种不同地形模式的偏心角膜病患者植入 KERATACx 环状节段（Imperial Medical Technologies Europe GmbH）后的术后效果。研究对象包括植入 KERATACx 环段的角膜炎患者。根据使用 Sirius CSO 角膜地形图仪（意大利 CSO 公司）进行的角膜地形图模式分为三组：圆锥体与角膜平轴重合的 I 型异位；圆锥体既不与陡轴重合也不与平轴重合且位于两轴之间的 II 型异位；圆锥体与角膜陡轴重合的 II 型异位。该研究共纳入 92 名患者的 92 只眼睛，平均随访时间为 16.9±9.2 个月，平均±标准差为 16.9±9.2 个月。患者的病历显示，III 型眼球外翻组（31.25%）患者的夜视症状和光晕最多。对于 III 型外生殖器组，术前和术后数据（2 毫米和 4 毫米直径的上下差、昏迷像差、高阶像差和未矫正的远距离视力）之间的四项地形学指数和一项视觉参数没有显示出统计学意义上的显著差异，而 I 型和 II 型外生殖器组则相反，所有评估参数均有显著改善。[J Refract Surg. 2024;40（9）：e625-e634]。

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引用次数: 0

Reply: Astigmatism: Using Correct Analysis Methods and Terminology. 答复：散光：使用正确的分析方法和术语。

IF 2.9 3区医学 Q1 OPHTHALMOLOGY

Journal of refractive surgery

Pub Date : 2024-09-01 DOI: 10.3928/1081597X-20240805-01

Jun Zhang, Jie Shao, Xinfang Cao, Yonggang Zhang, Li Zheng

引用次数: 0

Refractive Outcomes After Scleral Fixation of the Carlevale Intraocular Lens. 巩膜固定 Carlevale 眼内透镜后的屈光效果。

IF 2.9 3区医学 Q1 OPHTHALMOLOGY

Journal of refractive surgery

Pub Date : 2024-08-01 DOI: 10.3928/1081597X-20240611-04

Nathan Courat, Frédéric Gobert, Thibault Naudin, Alexandre Ducloux, Camille Alleyrat, Nicolas Leveziel

Purpose: To assess the refractive predictability of the Carlevale sutureless scleral fixation intraocular lens (IOL) (Sole-ko IOL Division) power calculation.

Methods: This retrospective, non-comparative, interventional case series included patients without a capsular support having undergone sutureless scleral fixation IOL implantation in two French hospitals between October 2019 and April 2022. IOL calculation was performed with the Barrett Universal II, Hoffer Q, Holladay 1, and SRK/T formulas with constant optimization to achieve a mean arithmetic prediction error equal to zero. The main outcomes were prediction error (PE) and its standard deviation (SD-PE), the median absolute error (MedAE), the mean absolute error (MAE), and the percentage of eyes with PE within ±0.50, ±1.00 and ±2.00 diopters (D) 6 months after surgery.

Results: Thirty eyes of 30 patients were included in the study. The mean age was 66.6 years, the mean axial length was 24.31 mm, and the mean keratometry was 43.07 D. SDPE ranged from 0.73 to 0.87 D depending on the formula. MedAE ranged from 0.38 to 0.61 D, and MAE from 0.52 to 0.68 D. Between 46.7% and 56.7% of eyes were within ±0.50 D, 76.7% and 90.0% were within ±1.00 D, and 96.7% were within ±2.00 D of target equivalent. No statistically significant difference was observed between the four formulas for any outcomes.

Conclusions: This study confirmed that the design of the Carlevale sutureless scleral fixation IOL provides satisfactory refractive results. [J Refract Surg. 2024;40(8):e527-e532.].

目的：评估Carlevale无缝线巩膜固定人工晶体（IOL）（Sole-ko IOL Division）功率计算的屈光预测性：该回顾性、非比较性、介入性病例系列包括2019年10月至2022年4月期间在两家法国医院接受无缝线巩膜固定人工晶体植入术的无囊支持患者。人工晶体计算采用 Barrett Universal II、Hoffer Q、Holladay 1 和 SRK/T 公式，并不断进行优化，以实现平均算术预测误差等于零。主要结果是预测误差（PE）及其标准差（SD-PE）、绝对误差中位数（MedAE）、平均绝对误差（MAE）以及术后 6 个月后 PE 在±0.50、±1.00 和 ±2.00 屈光度（D）以内的眼睛的百分比：研究共纳入了 30 名患者的 30 只眼睛。平均年龄为 66.6 岁，平均轴长为 24.31 mm，平均角膜度数为 43.07 D。46.7%到56.7%的眼睛在±0.50 D以内，76.7%到90.0%的眼睛在±1.00 D以内，96.7%的眼睛在±2.00 D以内。在任何结果上，四种公式之间都没有统计学意义上的差异：本研究证实，Carlevale 无缝线巩膜固定人工晶体的设计可提供令人满意的屈光效果。[J Refract Surg. 2024;40(8):e527-e532.]。

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引用次数: 0

Reply: Improving Second-Eye Vaulting in Deferred Bilateral Implantable Collamer Lens Surgery. 回复：改善延迟双侧植入式人工晶体手术中的第二眼拱起。

IF 2.9 3区医学 Q1 OPHTHALMOLOGY

Journal of refractive surgery

Pub Date : 2024-08-01 DOI: 10.3928/1081597X-20240723-01

Andrea Russo, Ottavia Filini, Erik Mertens, Sheraz M Daya, Luigi Conti, Francesco Carones, Giulia Festa, Alessandro Boldini, Giacomo Savini

引用次数: 0

Impact and Correction of an Anterior Phakic Intraocular Lens on Swept-Source Optical Coherence Tomography Biometry. 前置法康眼内透镜对扫源光学相干断层成像生物测量的影响和校正。

IF 2.9 3区医学 Q1 OPHTHALMOLOGY

Journal of refractive surgery

Pub Date : 2024-08-01 DOI: 10.3928/1081597X-20240716-01

Bruno Barbosa Ribeiro, Sílvia Monteiro, João Heitor Marques, Ana Carolina Abreu, Maria do Céu Pinto

Purpose: To evaluate the impact of anterior chamber phakic intraocular lens (pIOL) on swept-source optical coherence tomography (SS-OCT) biometric measurements and IOL power calculation.

Methods: This retrospective analysis of 67 eyes of 49 patients with previous anterior chamber pIOL implantation analyzed the accuracy of automatic segmentation of the anterior surface of the crystalline lens and its impact on anterior chamber depth (ACD, measured from epithelium to lens), lens thickness measurements, and IOL power calculation. The sample was divided into two groups: correct detection of the anterior surface of the crystalline lens and inaccurate detection. Segmentation of eyes from the inaccurate detection group was manually corrected and ACD and lens thickness were calculated using ImageJ software. IOL power was calculated using 7 formulas for both measurements.

Results: The anterior surface of the crystalline lens was mis-identified in 13 (19.4%) eyes. ACD was underestimated (Δ -0.85 ± 0.33 mm, P < .001) and lens thickness was overestimated (Δ +0.81 ± 0.25 mm, P < .001). Manual correction changed the target spherical equivalent only in the Haigis formula (P = .009). After correction for segmentation bias, the Pearl DGS, Cooke K6, and EVO 2.0 formulas showed the lowest prediction error, with the Pearl DGS showing greatest accuracy within ±1.00 diopters of prediction error range (81.0%).

Conclusions: SS-OCT biometry misidentifies the anterior surface of the crystalline lens in a significant proportion, resulting in significant IOL power calculation error in the Haigis formula. Manual proofing of segmentation is mandatory in every patient with anterior chamber pIOL implantation. After correct segmentation, the Pearl DGS, Cooke K6, and EVO seem to be the best formulas. [J Refract Surg. 2024;40(8):e562-e568.].

目的：评估前房人工晶体（pIOL）对扫源光学相干断层扫描（SS-OCT）生物测量和人工晶体功率计算的影响：该回顾性分析对 49 名曾植入前房人工晶体的患者的 67 只眼睛进行了分析，分析了晶状体前表面自动分割的准确性及其对前房深度（ACD，从上皮到晶状体的测量值）、晶状体厚度测量和人工晶体功率计算的影响。样本分为两组：晶状体前表面检测正确组和检测不准确组。对检测不准确组的眼睛进行人工校正分割，并使用 ImageJ 软件计算 ACD 和晶状体厚度。两种测量结果均使用 7 种公式计算人工晶体功率：结果：13 只眼睛（19.4%）的晶状体前表面识别错误。ACD被低估（Δ -0.85 ± 0.33 mm，P < .001），晶状体厚度被高估（Δ +0.81 ± 0.25 mm，P < .001）。手动校正只改变了海吉斯公式中的目标球面等值（P = .009）。修正分割偏差后，Pearl DGS、Cooke K6 和 EVO 2.0 公式的预测误差最小，其中 Pearl DGS 在 ±1.00 斜度的预测误差范围内（81.0%）的准确度最高：SS-OCT 生物测量法错误识别晶状体前表面的比例很高，导致海吉斯公式中 IOL 功率计算出现重大误差。对每一位接受前房人工晶体植入术的患者，都必须进行人工晶体分割校对。在正确分割后，Pearl DGS、Cooke K6 和 EVO 似乎是最好的公式。[J Refract Surg. 2024;40（8）：e562-e568]。

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