Retrospective Study Comparing Topography-Guided and Wavefront-Optimized LASIK Procedures in a Single Center.

Purpose: To compare visual outcomes of eyes that had laser refractive surgery with the Contoura Phorcides treatment plan and eyes that had laser refractive surgery with the wavefront-optimized treatment plan using the same laser. Methods: Retrospective chart review of clinical outcomes of eyes that had either Contoura with Phorcides (CP) or wavefront-optimized (WFO) corneal refractive procedures using the Wavelight EX500 (Alcon Vision, LLC). Data were collected and compared for uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction, change in postoperative UDVA compared to preoperative CDVA, and change in postoperative CDVA compared to preoperative CDVA. Results: Total eyes included were 348, with 227 in the CP Group and 121 in the WFO Group. Post-operatively, there was a significantly higher percentage of eyes in the CP Group that were 20/16 or better compared to the WFO Group (57%, 129 eyes, and 17%, 21 eyes, respectively; p < 0.001). The percentage of eyes that gained 1 or more Snellen lines of UDVA compared to preoperative CDVA was higher in the CP Group (47%; 107 eyes) compared to the WFO Group (12%; 14 eyes), which was statistically significant (p < 0.001). Differences in refraction were statistically significant. Conclusion: Topography-guided and wavefront-optimized treatment profiles both provided excellent refractive results. A higher percentage of eyes that were treated using Contoura with Phorcides achieved 20/16 or better unaided distance vision compared to eyes receiving a wavefront-optimized treatment plan.

Laser in situ keratomileusis (LASIK) is a common procedure performed to reshape the cornea (transparent part of the eye) and provide clear, spectacle-free vision. There are many different technologies available for surgeons to choose a treatment plan. One of the most popular is called wavefront-optimized LASIK (WFO), which takes into account the curvature of the cornea. Recently, topography-guided LASIK treatment plans that incorporate a proprietary planning software (Contoura Phorcides) have been available that can factor in the individualized surface elevation characteristics of the cornea. The purpose of this study was to compare visual outcomes in patients that had LASIK with the Contoura Phorcides treatment plan to patients that had LASIK with the WFO treatment plan. The results of this study suggest that both treatment profiles both provided excellent refractive results. In addition, a higher percentage of eyes that were treated using Contoura with Phorcides achieved 20/16 or better unaided distance vision compared to eyes receiving a WFO treatment plan.

Visual Function After Implantation of Trifocal and Trifocal Toric Intraocular Lenses Using Intraoperative Aberrometry.

Purpose: To evaluate patient outcomes and visual function following trifocal and trifocal toric intraocular lens (IOL) implantation using intraoperative aberrometry at a single site in the US. Methods: This prospective, single arm study included 21 subjects that completed 3 month follow-up. Inclusion criteria were visually significant cataract and potential post-operative visual acuity of 20/25 or better. Endpoints included postoperative prediction error, refractive outcomes, uncorrected visual acuities at distance (UDVA), intermediate (UIVA), and near (UNVA), contrast sensitivity, and subject responses on the modified Visual Function Quality of Life Questionnaire (VF-14 QOL). Results: Binocular UDVA, UIVA, and UNVA were 20/25 or better in 100% (21/21), 100% (21/21), 90% (19/21) of subjects. The absolute prediction error was 0.50 D or less in 79% (33/42) of eyes, and 81% (34/42) and 86% (36/42) of eyes achieved ≤0.5 D of residual astigmatism and manifest refraction spherical equivalent, respectively. On the modified VF-14 QOL, driving at night, reading small print, and reading a newspaper or book were the tasks that had the lowest percentages of subjects reporting no difficulty or a little difficulty. Conclusion: Implantation with trifocal and trifocal toric IOLs using intraoperative aberrometry can provide high refractive precision, leading to excellent visual performance and low visual task difficulty at all ranges (distance, intermediate, and near).

An intraocular lens (IOL) is a clear artificial lens that can be used to replace the natural lens in the eye when the natural lens becomes opaque (develops a cataract). Monofocal IOLs are designed to provide good vision to see distant objects; however, spectacles may still be needed to see objects clearly up close (such as reading a book or using a digital device). Trifocal IOLs are designed to provide good vision to see objects at distance and up close, however, the power of the IOL must be accurately determined for the best visual outcomes. Devices called biometers are used by cataract surgeons to measure the eye and determine the most appropriate lens power to implant. Most biometers are used prior to surgery, however one type, intraoperative aberrometry (IA), can be used during surgery to measure the eye and determine the most appropriate lens power. The purpose of this study was to evaluate patient outcomes and visual function following trifocal IOL implantation using IA. The results of this study suggest that implantation with trifocal IOLs using IA can provide high refractive accuracy and excellent visual outcomes.

Biometric Indicators for Maximizing Intermediate Vision with a Monofocal IOL.

Purpose: To determine refractive or biometric variables that might be predictive of increased intermediate vision in patients receiving an Eyhance monofocal intraocular lens (IOL). Methods: This prospective, single-center, bilateral, non-randomized, open-label, observational study included a total of 110 subjects (220 eyes). Subjects had been previously bilaterally implanted with an Eyhance monofocal IOL (Johnson & Johnson Vision Care, Inc.) and were later divided into 2 groups based on their postoperative visual acuity. Subjects that had binocular distance corrected intermediate visual acuity (DCIVA) of 0.2 logMAR or better were classified into the Enhanced Group, and the remaining subjects were classified into the Non-Enhanced Group. Refractive outcomes and biometric measurements were compared between groups. Results: The number of subjects in each group was 61 for the Enhanced Group, and 49 for the Non-Enhanced Group. There were significant differences in pupil size between groups, with pupil sizes in the Enhanced Group significantly smaller than in the Non-Enhanced Group (p < 0.01). Subjects also reported significantly more dysphotopsias in the Non-Enhanced Group compared to the Enhanced Group (p = 0.03). Multiple regression analysis identified pupil size and axial length as significant predictors of increased monocular intermediate vision. Conclusion: The results of this study suggest that pupil size could be a predictor of increased intermediate vision in a patient receiving an Eyhance monofocal IOL.

The Accuracy of Flap Thickness and Diameter in LASIK Using a Femtosecond Laser.

Purpose: To evaluate the resultant thickness of the WaveLight FS200 (Alcon Vision, LLC) created LASIK flap compared to intended thickness at the surgical visit, using the WaveLight EX500 (Alcon Vision, LLC) pachymeter and the resultant flap diameter compared to intended diameter. Methods: This single arm, prospective, single surgeon study assessed the accuracy of the intended flap thickness and diameter, after successful bilateral LASIK surgery. The WaveLight FS200 femtosecond laser was used to create all flaps with an intended thickness of 120 µm. Flap thickness was calculated by subtracting the stromal bed thickness after flap lift from the preoperative corneal thickness using the WaveLight EX500 on-board optical pachymeter. Flap diameter was determined using digital analysis. Results: A total of 58 subjects (116 eyes) completed the study. The calculated mean flap thickness was 120.6 ± 9.0 µm (range 102 to 143 µm) using the EX500 pre- and post-flap pachymetry measurements. There was no statistically significant difference between the planned and achieved flap thickness (p > 0.05). The mean difference in flap diameter between planned and actual was 0.02 ± 0.05 mm. Corneal thickness measured by Pentacam at up to 2 months preoperatively versus EX500 just prior to surgery was similar, with EX500 measuring 2 µm less on average than the Pentacam. Conclusion: The results suggest that the WaveLight FS200 laser is reliable for LASIK flap thickness and diameter and accurately created flaps at the intended thickness and the intended diameter.

Head-to-Head Comparison of Intermediate Vision of Two Monofocal Intraocular Lenses.

Purpose: To compare intermediate visual outcomes in patients previously implanted with bilateral Clareon monofocal IOLs versus bilateral Eyhance IOLs. Methods: This was a non-interventional, single-center, examiner-masked, comparative study. Participants were cataract patients presenting at least 3 months after uncomplicated, bilateral implantation of either Clareon or Eyhance non-toric and toric IOLs. Outcomes measures included binocular distance-corrected intermediate visual acuity (DCIVA), binocular corrected distance visual acuity (CDVA), binocular best-corrected defocus curve, postoperative mean residual spherical equivalent (MRSE), and residual astigmatism. Results: A total of 620 eyes of 310 subjects (155 subjects per group) were evaluated. The mean difference in DCIVA was 0.05 logMAR between the Eyhance and Clareon IOLs which was significant (p < 0.01), but within the 0.1 logMAR non-inferiority margin. Mean CDVA of the Clareon group was 0.01 ± 0.03 logMAR compared to 0.02 ± 0.03 logMAR of the Eyhance Group (p > 0.05). Defocus curves from +1.0 D to -3.0 D were not clinically nor statistically different between the Clareon and Eyhance groups (p > 0.05). Conclusion: The results of this study show that bilateral implantation of Clareon monofocal IOLs and Eyhance monofocal IOLs lead to similar distance and intermediate visual outcomes.

Comfort After Refitting Symptomatic Habitual Reusable Toric Lens Wearers with a New Daily Disposable Contact Lens for Astigmatism.

Purpose: To subjectively evaluate comfort with a daily disposable (delefilcon A for astigmatism) contact lens compared to other common weekly/monthly soft toric contact lenses in symptomatic wearers. Methods: This open-label, single arm study enrolled current reusable soft toric lens wearers with minimum score of 12 on the contact lens dry eye (CLDEQ-8) questionnaire. Subjects were also administered the CLDEQ-8 after 1 replacement schedule of their optimized habitual toric lenses (2 to 4 weeks), and after 2 weeks of wear with delefilcon A toric daily disposable lenses (Dailies Total1 for Astigmatism; Alcon Vision LLC, Fort Worth, Texas). Results: A total of 85 subjects completed the study. Mean total CLDEQ-8 score was 16.8 ± 8.1 for subjects refit with their optimized habitual toric lenses and 12.4 ± 7.5 for subjects refit with delefilcon A toric lenses, a difference of 4.3 ± 10.4 (p < 0.001). With delefilcon A toric lenses, 78.9% of subjects reported little to no intensity of eye discomfort, compared to 51.7% for the habitual toric lenses (p = 0.005). In addition, 77.7% of subjects reported little to no intensity of dryness for delefilcon A toric lenses, compared to 50.6% for the habitual toric lenses (p = 0.001). Conclusion: The subjective comfort in symptomatic habitual reusable toric contact lens wearers was improved by refitting with delefilcon A toric lenses.

Refractive Predictability of a Swept Source Optical Coherence Tomography Biometer in Long and Short Eyes Implanted with Extended Depth of Focus Intraocular Lenses.

Purpose: To determine the refractive predictability of Argos (Movu, a Santec company) measurements and the Barrett Universal II formula in long and short eyes implanted with an extended depth of focus (EDOF) intraocular lens (IOL). Methods: This retrospective, non-interventional study included 86 eyes (55 long and 31 short) of 55 patients. Preoperative biometry was performed using the Argos. Preoperative IOL power formulas were the preprogrammed Barrett Universal II (BUII). Data were collected for refractive outcomes, postoperative prediction error (directional and absolute), and monocular corrected distance visual acuity (CDVA, Snellen). Results: The mean absolute prediction error for BUII was 0.27 ± 0.26 D overall, 0.24 ± 0.20 D in long eyes, and 0.33 ± 0.33 D in short eyes. Overall, the percentage of eyes with ≤ 0.5 D prediction error was 84% for BUII. In long eyes, the percentage of eyes with ≤ 0.5 D prediction error was 90% for BUII. In short eyes, the percentage of eyes with ≤ 0.5 D prediction error was 74% for BUII. The percentage of eyes with ≤ 0.5 D of MRSE was 89% for long eyes and 94% for short eyes. Visual acuities were excellent in both long and short eyes, with > 90% of eyes 20/25 or better in each group. Conclusion: The prediction error of Argos using BUII was low in long and short eyes at one month after EDOF IOL implantation.

Randomized Trial Comparing Prediction Accuracy of Two Swept Source Optical Coherence Tomography Biometers.

Purpose: To compare the prediction accuracy of the Argos biometer using standard keratometry to the prediction accuracy of the IOLMaster 700 biometer using Total Keratometry. Methods: This was a randomized, prospective, single surgeon study of 80 right eyes of 80 patients that had preoperative biometry with both the Argos and IOLMaster 700 devices, followed by cataract surgery and intraocular lens (IOL) implantation. Prediction errors (directional and absolute) for each device were determined from the 1 month postoperative manifest refraction. Results: The directional prediction error was 0.07 ± 0.32 D for the Argos and 0.08 ± 0.34 D for the IOLMaster 700. The mean of the difference in prediction error (directional) was 0.02 D, which was not statistically significant (p > 0.05). The absolute prediction error was 0.21 ± 0.25 D for the Argos and 0.25 ± 0.24 D for the IOLMaster 700. The mean of the difference in absolute prediction error was 0.04 D, which was statistically significant (p < 0.004) but not clinically significant. The percentage of eyes with absolute prediction error ≤ 0.5 D was 91% (73 eyes) for the Argos and 88% (70 eyes) for the IOLMaster 700. This difference was not statistically significant. Conclusion: The prediction accuracies were similar between the Argos and IOLMaster 700 in eyes with normal axial length. There was a significant difference in mean absolute prediction error between devices; however, this was not clinically meaningful.

Evaluation of Visual Outcomes and 3-Month Refractive Stability of a New Hydrophobic Acrylic Intraocular Lens.

Purpose: To determine the refractive stability of a new hydrophobic acrylic intraocular lens (IOL) when implanted bilaterally. Methods: This was a prospective, evaluator masked, single surgeon study of 58 eyes of 29 patients. Patients were bilaterally implanted with the Clareon monofocal IOL (CNA0T0, Alcon Vision LLC). Refractive stability was evaluated between 1 and 3 months postoperatively. At 3 months postoperatively, data were also collected for binocular uncorrected and distance corrected visual acuities at distance (4 m) and intermediate (80 cm and 66 cm) and binocular defocus curve. Results: Postoperative refraction was statistically equivalent between 1 and 3 months postoperatively (p < 0.001). Mean postoperative uncorrected distance visual acuity was -0.01 ± 0.10 logMAR, and mean corrected distance visual acuity was -0.04 ± 0.06 logMAR. Mean postoperative uncorrected intermediate visual acuity was 0.16 ± 0.13 logMAR and 0.24 ± 0.14 logMAR at 80 cm and 66 cm, respectively. With distance correction in place, mean visual acuity at 80cm and 60cm was 0.16 ± 0.13 logMAR and 0.23 ± 0.14 logMAR, respectively. Conclusion: The Clareon monofocal IOL can provide stable refraction, excellent distance vision, and functional intermediate vision postoperatively.

Comparing Predictive Accuracy of a Swept Source Optical Coherence Tomography Biometer and an Optical Low Coherence Reflectometry Biometer.

Purpose: To compare the refractive accuracy resulting from calculations based on measurements with a swept-source optical coherence tomography (SS-OCT) biometer compared to calculations based on measurements with an optical low coherence reflectometry (OLCR) biometer at one month postoperatively. Methods: This was a retrospective comparative non-interventional study of preoperative biometry and postoperative refraction and visual acuity of 200 eyes. All eyes had preoperative biometry with both the Argos (Movu, a Santec company) and Lenstar LS900 (Haag-Streit AG) devices. Data were collected for mean postoperative prediction error (directional and absolute), preoperative mean K, delta K (corneal astigmatism), axial length, and anterior chamber depth. Results: The mean directional prediction error was -0.15 ± 0.47 D for Argos and -0.31 ± 0.50 D for Lenstar LS900, and there was a statistically significant mean of the differences (0.16 ± 0.24 D; p < 0.001). The mean absolute prediction error was 0.35 ± 0.34 D for Argos and 0.42 ± 0.41 D for Lenstar LS900, and there was a statistically significant mean of the differences (-0.07 ± 0.24 D; p < 0.001). Neither the differences in directional prediction error nor the differences in absolute prediction error were clinically significant. Conclusion: The directional and absolute prediction accuracies were statistically significant, but not clinically different between the Argos and Lenstar LS900 devices. In addition, differences between preoperative K, AL, and ACD measurements were not clinically significant.

Emergence of fentanyl-related deaths in Travis County, Texas and surrounding areas: A retrospective review of postmortem fentanyl-related drug toxicities from 2020 to 2022.

The opioid epidemic has affected the United States (US) for decades with fentanyl and its analogs accounting for a recent surge in morbidity and mortality. Currently, there is a relative lack of information characterizing fentanyl-related fatalities specifically in the Southern US. A retrospective study was conducted to examine all postmortem fentanyl-related drug toxicities in Travis County, Texas, encompassing Austin (one of the fastest-growing cities in the US), from 2020 to 2022. Fentanyl contributed to 2.6% and 12.2% of deaths submitted for toxicology between 2020 and 2022, respectively, representing a 375% increase in fentanyl-related deaths over this 3-year period (n = 517). Fentanyl-related fatalities primarily occurred in males in their mid-30s. Fentanyl and norfentanyl concentrations ranged from 0.58 to 320 ng/mL and 0.53 to 140 ng/mL with mean (median) concentrations of 17.2 ± 25.0 (11.0) and 5.6 ± 10.9 (2.9) ng/mL, respectively. Polydrug use was present in 88% of cases, with methamphetamine (or other amphetamines) (25%), benzodiazepines (21%), and cocaine (17%) representing the most frequently identified concurrent substances. Co-positivity rates of various drugs and drug classes widely varied over time. Scene investigations reported illicit powder(s) (n = 141) and/or illicit pill(s) (n = 154) in 48% (n = 247) of fentanyl-related deaths. Illicit oxycodone (44%, n = 67) and illicit "Xanax" (38%, n = 59) pills were frequently reported on scene; however, toxicology only identified oxycodone and alprazolam in 2 and 24 of these cases, respectively. The results of this study provide a better understanding of the fentanyl epidemic in this region creating an opportunity to promote increased awareness, shift focus to harm reduction, and aid in minimizing public health risks.

Comparative Study Between Non-Diffractive Extended Depth of Focus and Monofocal Intraocular Lenses.

Purpose: To evaluate the visual acuity and quality of vision in bilaterally implanted ZCBOO/ZCTx monofocal (Johnson & Johnson Vision) intraocular lens (IOL) and bilaterally implanted DATx15 extended depth of focus (EDOF) IOL (Alcon Vision, LLC). Methods: A single site, non-interventional study comparing ZCBOO/ZCTx monofocal IOL patients implanted with DATx15 IOL toric or non-toric versions in both eyes. A total of 30 patients (60 eyes) completed the study in the monofocal group, 32 (64 eyes) in the EDOF group, and all were targeted for emmetropia. Binocular uncorrected distance, intermediate (66cm), and near (40cm) visual acuities and distance corrected distance, intermediate (66cm) and near (40cm) visual acuities were assessed. Binocular distance corrected defocus curve testing was from -3.5 D to +3 D. Patient reported visual disturbances (QUVID) and IOL satisfaction (IOLSAT) questionnaires were administered. Results: The DATx15 group mean uncorrected visual acuity was 0.15 ± 0.10 logMAR at 66cm and 0.36 ± 0.14 logMAR at 40cm, compared to 0.24 ± 0.15 logMAR and 0.59 ± 0.17 logMAR respectively for the ZCBOO/ZCTx group. The DATx15 group (23 respondents, 74%) also reported significantly more spectacle independence at near with the IOLSAT (p < 0.01), compared to the ZCBOO/ZCTx group (13 respondents, 43%). Glare, halos, starbursts, and blur reported on the QUVID questionnaire were similar in the two groups. Conclusion: The DATx15 group had improved near and intermediate vision and increased spectacle independence compared to the ZCBOO/ZCTx group.

Randomized and double-blind comparison of clinical visual outcomes of 2 EDOF intraocular lenses.

PURPOSE: To assess and compare the visual disturbance profiles of 2 extended depth-of-focus (EDOF) intraocular lenses (IOLs). SETTING: Private practice (West Kootenays, British Columbia, Canada). DESIGN: Prospective, randomized, single-surgeon study. METHODS: This was a double-blind prospective study of 138 eyes (69 patients) that underwent bilateral implantation of 1 of 2 EDOF IOLs. Participants were randomized to either the Symfony group or the Vivity group. Outcome measures included Questionnaire for Visual Disturbances; binocular corrected distance visual acuities at distance (6 m), intermediate (66 cm), and near (40 cm); and refractive outcomes. RESULTS: At 3 months postoperatively, 21 patients (60%) reported not experiencing glare in the Symfony group compared with 30 (88%) in the Vivity group, a difference of 28% (P = .008). Reports of experiencing starbursts were also significantly different between the Symfony and Vivity groups (23 participants [66%] Symfony and 30 participants [88%] Vivity; P = .027). In addition, 12 participants (34%) reported "moderate" or "severe" starbursts in the Symfony group compared with 3 (9%) in the Vivity group, a difference of 25% (P = .019). Visual acuities and refractive outcomes were similar between groups. CONCLUSIONS: Both EDOF lenses provide good visual outcomes at distance and intermediate with acceptable near vision. The Symfony group had increased reports of some visual disturbances, notably the frequency, severity, and bothersomeness of starbursts and glare.

Clinical outcomes of a trifocal compared with an extended depth of focus IOL following bilateral cataract surgery.

OBJECTIVE: To compare the visual and patient reported outcomes of 2 presbyopia-correcting intraocular lenses (IOLs). METHODS: A total of 134 eyes (67 patients) that underwent cataract surgery with either a trifocal IOL or an extended depth of focus (EDOF) IOL bilaterally and were assessed 3 months after surgery. Outcome measures were binocular distance-corrected visual acuity at near (40 cm), intermediate (60 cm), and distance (6 m); Akman modified Quality of Life (QOL) Questionnaire-14; and 10% contrast visual acuity at distance and near, with and without glare. RESULTS: Mean binocular logMAR visual acuity (VA) for the PanOptix compared with the Symfony lenses: distance-corrected near VA, 0.054 versus 0.228; distance-corrected intermediate VA, 0.019 versus 0.063; and distance-corrected distance VA, -0.016 versus -0.021. The QOL questionnaire showed that 62% of the PanOptix group and 48% of the Symfony group had little or no difficulty with all QOL-related tasks. In a multivariable model controlling for pupil size and angle kappa (chord mu distance, right eyes), the differences were -0.005 (range, -0.03-0.02) and 0.165 (range, 0.12-0.21), respectively. Also, 10% contrast acuity was comparable in the 2 different lenses and was unaffected by glare. CONCLUSIONS: Binocular distance-corrected near VA was significantly better in the PanOptix group (p < 0.0001). This result remained statistically significant after controlling for pupil size and chord mu distance (p < 0.001). Intermediate and distance VAs were similar between the 2 groups. QOL scores were higher in the PanOptix group.

Refractive outcomes following bilateral implantation of a diffractive toric intraocular lens in a multisurgeon hospital setting.

OBJECTIVE: To assess residual postoperative refractive astigmatism following bilateral implantation of a trifocal toric intraocular lens (IOL) in a real-world multisurgeon setting. DESIGN: Prospective multisurgeon study (6 surgeons at 2 sites). METHODS: Bilateral implantation of a trifocal toric IOL (AcrySof PanOptix IOL; Alcon Vision LLC, Fort Worth, TX, USA) was performed in 140 eyes of 70 patients. Patients were assessed on day 1 and 3 months postoperatively. The primary outcome measure was residual astigmatism. Secondary endpoints included absolute prediction error, IOL rotation, binocular uncorrected and distance-corrected visual acuities at near (40 cm), intermediate (60 cm), and distance (6 m) and spectacle independence evaluated with the validated Intraocular Lens Satisfaction questionnaire. RESULTS: Mean preoperative cylinder was 1.25 ± 0.72 D and was 0.39 ± 0.28 D at 3 months postoperatively. At 3 months postoperatively, mean residual astigmatism was 0.39 ± 0.28 D (range, 0-1.25 D), and 118 eyes (84.3%) had postoperative astigmatism of 0.5 D or less. Mean absolute prediction error was 0.25 ± 0.21 D (range, 0-1.13 D), and 124 eyes (88.6%) had absolute prediction error of 0.5 D or less. At 3 months postoperatively, mean absolute rotation was 2.0 ± 2.7 degrees compared with baseline (range, 0-15 degrees), and 133 IOLs (95.0%) were within 5 degrees of the implanted axis. Additionally, 55 patients (79%) reported never or rarely using spectacles at near, 66 (94%) at intermediate, and 67 (96%) at distance. CONCLUSIONS: The results of this study demonstrate that implantation with the PanOptix toric IOL can provide excellent refractive and visual outcomes with minimal residual astigmatism.

Comparison of Astigmatism Prediction Accuracy for Toric Lens Implantation from Two Swept-Source Optical Coherence Tomography Devices.

Purpose: To compare the astigmatism prediction accuracy for toric intraocular lens (IOL) implantation between two swept-source optical coherence tomography (SS-OCT) devices: Argos (Movu, a Santec Company) and the IOLMaster 700 (Carl Zeiss Meditec). Methods: This was a retrospective chart review of 59 eyes (44 patients) with corneal astigmatism and cataract that underwent cataract surgery or refractive lens exchange surgery with a toric IOL. Biometry was performed on all patients prior to cataract surgery and the Barrett toric IOL calculator was used. Visual acuity was measured postoperatively. Manifest refraction was measured at 1 month and compared to the predicted postoperative residual refraction. Preoperative K measurements between devices were also compared. Results: Mean cylinder prediction error was -0.17 ± 0.43 for Argos and 0.12 ± 0.56 for IOLMaster 700. The cylinder prediction error 0.5 D or less was not significantly different between the devices, with 83.1% (49 eyes) for Argos and 76.3% (45 eyes) for IOLMaster 700 (p = 0.206). Spherical equivalent prediction error was 0.13 ± 0.39 for Argos and 0.25 ± 0.50 for IOLMaster 700. The mean spherical equivalent prediction error 0.5 D or less was significantly different between the devices, with 79.7% (47 eyes) for Argos and 61.0% (36 eyes) for IOLMaster 700 (p = 0.016). Conclusion: The prediction accuracies were similar between the devices, except for spherical equivalent, where a higher percentage of eyes were 0.5 D or less of the prediction with the Argos compared to the IOLMaster.

Refractive Outcomes Following Trifocal Intraocular Lens Implantation in Post-Myopic LASIK and PRK Eyes.

Purpose: To assess refractive outcomes of a trifocal intraocular lens (IOL) in post-myopic laser refractive surgery eyes. Methods: This was a retrospective chart review of 35 eyes (21 patients), with history of laser refractive surgery, who were implanted with a trifocal IOL. Surgeon's standard procedure included femtosecond laser (FLACS), digital registration, and intraoperative aberrometry (IA). The primary outcome measure was absolute prediction error. Secondary measures were refractive outcomes, postoperative residual astigmatism (PRA), monocular uncorrected visual acuity at distance (UDVA; 4m), intermediate (UIVA; 60cm), and near (UNVA; 40cm), and monocular best-corrected visual acuity at distance (BCVA; 4m). Results: At 3 months postoperatively, 71% and 68% of eyes had absolute prediction error 0.5 D or less with IA and preoperative planning respectively, which was not statistically significant (p > 0.05). The PRA was 0.5 D or less in 91% of eyes with IA and 56% of eyes with preoperative planning. The PRA differences between IA and preoperative planning were statistically significant (p < 0.002). The percentage of eyes 20/20 or better for monocular UCVA, BCVA, UIVA, and UNVA was 29%, 77%, 78%, and 66%, respectively. Absolute prediction error 0.5 D or less was significantly higher in post-LASIK eyes versus post-PRK eyes (p < 0.003), at 85% and 56% of eyes, respectively. Conclusion: Implantation with a trifocal IOL can provide acceptable refractive and visual outcomes with minimal residual astigmatism in post-myopic LASIK and PRK eyes.

Comparative hemostatic efficacy of 4F-PCC in patients with intracranial hemorrhage on factor Xa inhibitors versus warfarin.

OBJECTIVE: Patients experiencing an intracranial hemorrhage (ICH) on oral anticoagulants often require rapid reversal. This study evaluated patients taking factor Xa inhibitors or warfarin that received reversal with 4-factor prothrombin complex concentrate (4F-PCC) for an ICH. The objective of the study was to determine if the efficacy of 4F-PCC for the reversal of factor Xa inhibitors is noninferior to its use in warfarin reversal in patients with ICH. METHODS: This was a retrospective, single center, noninferiority trial. Patients presenting to the emergency department with ICH were divided into two cohorts: those taking factor Xa inhibitors versus those taking warfarin. In each cohort, patients received anticoagulation reversal with weight-based 4F-PCC. The primary endpoint was hemostatic efficacy defined as ≤20% expansion in hematoma volume on repeat computed tomography imaging. A pre-specified noninferiority margin of -10% was selected to evaluate the difference between groups for the primary endpoint. RESULTS: A total of 221 patients were included in the study (factor Xa inhibitors, n = 87; warfarin, n = 134). Effective hemostasis was achieved in 70 patients (81%) on factor Xa inhibitors compared to 111 patients (83%) on warfarin, (-2.4% difference, [95% confidence interval, -12.87 to 8.12]; p = 0.654). There was no statistically significant difference between groups with regards to the primary outcome; however, the use of 4F-PCC in factor Xa inhibitor reversal was not noninferior when compared to 4F-PCC use for warfarin reversal. Hospital length of stay and discharge disposition were similar between cohorts. CONCLUSIONS: The efficacy of 4F-PCC in reversing factor Xa inhibitor-related ICH compared to warfarin-related ICH was not significantly different between groups; however, these results did not prove noninferiority. Further study is warranted to delineate 4F-PCC's role in reversing factor Xa inhibitors in patients with ICH.

Clinical outcomes of a diffractive trifocal intraocular lens with femtosecond laser, digital tracking, and intraoperative aberrometry.

OBJECTIVE: To evaluate clinical outcomes of a trifocal intraocular lens using femtosecond laser-assisted cataract surgery (FLACS), digital tracking (DT), and intraoperative aberrometry (IA). SETTING: One site (Abbotsford, B.C., Canada) DESIGN: Retrospective, single-surgeon study. METHODS: This was a retrospective, single-surgeon study examining 200 eyes of 100 bilaterally implanted patients. Eligible participants were those presenting with visually significant cataracts or as a candidate for clear lens extraction who were interested in implantation of a diffractive toric or non-toric intraocular lens. Preoperative and postoperative data were collected for manifest refraction spherical equivalent (MRSE), refractive astigmatism (RA), and monocular uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA). RESULTS: Mean postoperative manifest refraction spherical equivalent (MRSE) was 0.006 ± 0.27 D. The absolute prediction error was 0.50 D or less in 88.0% (176/200) of eyes. Postoperative RA was 0.50 D or less in 98.5% (197/200) of eyes. Postoperative UDVA was 0.10 logMAR or better in 86% (172/200) of eyes, and 66.0% (132/200) of eyes were 0.00 logMAR or better. Postoperative UIVA was 0.10 logMAR or better in 99.5% (199/200) of eyes, and 95.0% (190/200) of eyes were 0.00 logMAR or better. Postoperative UNVA was 0.10 logMAR or better in 91.5% (183/200) of eyes, and 73.5% (147/200) of eyes were 0.00 logMAR or better. CONCLUSION: The results demonstrate that trifocal implantation with FLACS, DT, and IA can provide excellent refractive and visual outcomes.