Journal of refractive surgery最新文献

Purpose: To evaluate the effect of eyelid laxity on the structure of the cornea.

Methods: This was a retrospective study performed in one institution. Patients with and without upper and lower eyelid laxity, which were determined using the snap-back test (SBT) and the upper eyelid distraction test (LDT), were evaluated for corneal structural changes with Scheimpflug imaging corneal tomography for the keratometric readings, and cor-neal spectral domain optical coherence tomography for the epithelial thickness (ET) measurements. The ET values were obtained using the statistics report for the superior quadrant (SET), the inferior quadrant (IET) within the 2- to 7-mm region, and central thickness (CET) within the 2-mm region. The minimum corneal thickness values within the central 5-mm region (MinCT) were also included in the study. Keratometric readings (in diopters), horizontal white-to-white (HWTW) measurements, pachymetry, and ET measurements were assessed along with the presence or absence of eyelid laxity.

Results: A total of 170 eyes from 85 patients were evaluated (50.6% with eyelid laxity, and 49.4% without eyelid laxity). There was no significant difference between the mean keratometric readings, HWTW, and the mean IET and CET values (P > .05); however, the difference was significant for the MinCT and SET (P < .05). A statistically significant negative correlation was found between the SET values and age, LDT, and SBT measurements (P < .05).

Conclusions: A strong association was found between decreased SET and MinCT values and eyelid laxity. The possible reason for these decreases may be inflammation, which plays a role in the pathophysiology of eyelid laxity. [J Refract Surg. 2024;40(11):e783-e791.].

Purpose: To assess the visual quality, patient satisfaction, and photic phenomena 3 and 12 months after the implantation of two similar diffractive intraocular lenses (IOLs) manufactured with different materials.

Methods: This retrospective observational study included patients with the AcrySof PanOptix IOL or the Clareon Pan-Optix IOL (both Alcon Laboratories, Inc). Three and 12 months after the surgery, binocular contrast sensitivity under photopic conditions was measured. The presence of dysphotopsias and difficulties when driving in dim light conditions was also reported. Patient satisfaction was assessed through the Catquest 9-SF questionnaire and patients also reported the need for additional spectacles at different distances. Twelve months after the surgery, the presence of posterior capsule opacification and glistening was reported.

Results: The study included 59 patients. Contrast sensitivity was stable in both groups 12 months after the surgery, the proportion of patients that always perceived halos decreased approximately 15%, and difficulties when driving at night were minimized. Both groups showed high and similar rates of satisfaction with their vision and achieved spectacle independence rates greater than 85% at the two visits. The presence of posterior capsule opacification was similar for both groups, whereas 64% and 90% of the eyes were free of glistening in the AcrySof and Clareon groups, respectively.

Conclusions: Both diffractive IOLs offer consistent visual outcomes and high rates of patient satisfaction during the initial 12 months after surgery. The results also suggest that the novel material may better preserve the transparency of the IOL in the long term. [J Refract Surg. 2024;40(11):e877-e883.].

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.].