Buffering zone of implantable Collamer lens sizing in V4c.

BACKGROUND: The purpose of this study was to identify factors related to the unexpected vault in V4c implantable collamer lens (ICL; STAAR Surgical) implantation. METHODS: V4c ICLs were implanted in 43 eyes of 43 patients for the correction of myopia. The implanted V4c ICL sizes were determined individually with our previous V4 ICL sizing nomogram based on the sulcus-to-sulcus diameter (STS), and the V4 ICL sizes were then converted to V4c ICL sizes with a size-converting table. We defined the "normal-sizing group" as having a pre-converted ICL size larger than the STS, and the "under-sizing group" as having a pre-converted ICL size smaller than the STS. Refractive outcomes, safety and parameters related to postoperative vault were compared between the two groups. RESULTS: The value of "actual ICL size - STS" differed significantly between the normal-sizing and under-sizing groups (p < 0.001), but postoperative vault did not differ significantly (p = 0.442). The demographics, implanted ICL characteristics, effectiveness indexes, safety indexes, and parameters related to postoperative vault did not differ significantly between the two groups (p > 0.05). Two patients in the normal-sizing group exhibited over-vaulting; these patients had shallow anterior chambers and were implanted with high-dioptric-power ICLs. CONCLUSIONS: The achievement of acceptable vault in both normal-sizing and under-sizing groups indicates the existence of a buffering zone in V4c ICL sizing. The smaller size of V4c ICLs should be considered in patients susceptible to over-vaulting, such as those with shallow anterior chambers and high-dioptric-power ICLs.

Stemness characteristics of human corneal endothelial cells cultured in various media.

PURPOSE: To investigate stemness characteristics of human corneal endothelial cells (HCECs) cultured in various media. METHODS: Human corneal endothelial cells were isolated using a sphere-forming assay. Cells were allowed to attach to the bottom of culture plates and were cultured in different media designated as medium A (Opti-MEM I with 8% fetal bovine serum), medium B (DMEM/F12 with B27 supplement), medium E (DMEM/F12 with epidermal growth factor [EGF]), and medium BE (DMEM/F12 with B27 supplement and EGF), respectively. Cell morphology was evaluated with an phase-contrast inverted microscope. Immunofluorescence staining and western blotting of nestin, octamer-binding transcription factor (OCT3/4), glial fibrillary acidic protein (GFAP), zonula occludens-1 (ZO-1), collagen VIII alpha2, and Na-K ATPase was performed. Cell proliferation was assessed with a cell counting kit-8 assay. RESULTS: A few cultured cells stained with nestin. The cells cultured in medium A expressed high levels of GFAP, OCT3/4, and nestin, and higher levels of ZO-1 were expressed in the cells cultured in medium A and medium B compared with cells cultured in the other media. The cells cultured in medium A assumed a fibroblast-like shape, whereas the cells cultured in medium B and medium BE appeared as mosaics. Cell proliferation was highest in medium A compared with those cultured in the other media. CONCLUSIONS: Cultured HCECs expressed stem cell markers, including nestin, OCT3/4, and GFAP. The expression of stem cell markers differed according to the culture media and associated proliferation rate.

Fundus Image Enhancement Through Direct Diffusion Bridges.

We propose FD3, a fundus image enhancement method based on direct diffusion bridges, which can cope with a wide range of complex degradations, including haze, blur, noise, and shadow. We first propose a synthetic forward model through a human feedback loop with board-certified ophthalmologists for maximal quality improvement of low-quality in-vivo images. Using the proposed forward model, we train a robust and flexible diffusion-based image enhancement network that is highly effective as a stand-alone method, unlike previous diffusion model-based approaches which act only as a refiner on top of pre-trained models. Through extensive experiments, we show that FD3 establishes superior quality not only on synthetic degradations but also on in vivo studies with low-quality fundus photos taken from patients with cataracts or small pupils. To promote further research in this area, we open-source all our code and data used for this research at https://github.com/heeheee888/FD3.

Ethical and regulatory guidelines in clinical trials of xenocorneal transplantation in Korea; the Korean xenocorneal transplantation consensus statement.

BACKGROUND: To establish the consensus about the conditions for undertaking clinical trials in xenocorneal transplantation in Korea, specific issues regarding the xenocorneal transplantation on ethical and regulatory aspects are addressed, and the guidelines to conduct clinical trial of the xenocorneal transplantation are proposed. METHOD AND RESULTS: Chapter 1 reviews the key ethical requirements and progress of a Korean regulatory framework for clinical trials of xenocorneal transplantation. Chapters 2-7 provide recommendations on source pigs, quality control of porcine corneal procurement, preclinical efficacy required to justify a clinical trial, strategies to prevent transmission of porcine endogenous retrovirus (PERV), patient selection for clinical trials, and informed consent in xenocorneal transplantation using either cellularized or decellularized porcine graft, which are essentially based on the International Xenotransplantation Association (IXA) islet xenotransplantation consensus statement. The consensus statement of the inclusion criteria for the patients' selection has been made by the executive board members in Korean External Eye Disease Society. CONCLUSIONS: This consensus statement will be a good initiative for Korean Food and Drug Administration to discuss final regulatory guidelines in conducting clinical trials of xenocorneal transplantation in Korea and for International Xenotransplantation Association to develop International Consensus Standards of Xenocorneal Transplantation.

Factors affecting near vision after monofocal intraocular lens implantation.

PURPOSE: To identify factors that influence near vision after monofocal intraocular lens (IOL) implantation for distance vision. METHODS: A retrospective review was conducted of patients who underwent cataract surgery with monofocal IOL implantation from October 2009 to April 2010 at Samsung Medical Center. Eyes were classified as having good (⩾ J4) or poor (< J4) near vision. Factors analyzed included age, sex, intraocular lens (IOL) movement, axial length, pupil size, degree and type of astigmatism, IOL type, total aberration, and higher-order aberrations. Binary logistic regression and odds ratios with 95% confidence intervals were determined. RESULTS: This retrospective study involved 84 eyes of 84 patients. Thirty-four eyes were classified as having good near vision and 50 eyes as having poor near vision. All groups had a postoperative uncorrected visual acuity greater than 0.2 logMAR (Snellen 20/32) and a refractive error within ± 0.5 diopter of spherical equivalent. Pupil size and axial length were inversely associated with good near vision (P = .034 and .039, respectively). A pupil size smaller than 2.6 mm and an axial length less than 23.0 mm resulted in better near vision than larger measurements after monofocal IOL implantation for distant target. CONCLUSIONS: Among the factors analyzed, small pupil size and short axial length predicted good near vision after phacoemulsification and monofocal IOL implantation.

Prospective contralateral eye study to compare 80- and 120-µm flap LASIK using the VisuMax femtosecond laser.

PURPOSE: To compare visual outcomes and flap stability of LASIK with ultrathin 80- and 120-µm flaps created with a VisuMax femtosecond laser (Carl Zeiss Meditec, Jena, Germany) for moderate to high myopia and to evaluate the effect of corneal flap thickness on outcomes. METHODS: In a prospective contralateral eye study, 36 consecutive patients (72 eyes) underwent bilateral LASIK for myopia ranging from -2.00 to -10.00 diopters using the VisuMax femtosecond laser and MEL-80 excimer laser (Carl Zeiss Meditec). One eye of each patient was randomized to have the 80-µm flap and the other to the 120-µm flap created with 200-kHz VisuMax femtosecond laser. Preoperative and postoperative tests included visual acuity, manifest refraction, contrast sensitivity, and flap thickness measured by anterior segment optical coherence tomography. Main outcomes and complications were checked at postoperative 1 week and 1, 3, and 6 months. RESULTS: There were no differences in visual outcome, residual refractive error, or contrast sensitivity between groups during follow-up, except for better uncorrected visual acuity at postoperative 1 day in the 120-µm group. Mean standard deviations of measured flap thickness during follow-up ranged from 3.16 to 3.80 µm in both groups. Opaque bubble layer, a unique complication in femtosecond LASIK, was more frequent in the 80-µm group (7 of 36: 19%) than in the 120-µm flap group (3 of 36: 8%) without a statistically significant difference (P = .301) and was related to thicker central cornea and steeper keratometric value, although it did not influence clinical results. Comparison of the intended versus achieved correction showed no significant differences between groups. CONCLUSIONS: LASIK using the VisuMax femtosecond laser supplied good clinical results and flap reproducibility in both the 80- and 120-µm flap groups. Patients with relatively thin cornea may benefit from 80-µm flap LASIK.

Correlation between preoperative biometry and posterior chamber phakic Visian Implantable Collamer Lens vaulting.

OBJECTIVE: To evaluate (1) the effect of preoperative biometric factors on vault error and (2) the difference in achieved vault (AV) and expected vault (EV) after Visian Implantable Collamer Lens (ICL) implantation. DESIGN: Retrospective, comparative, interventional case series. PARTICIPANTS: A total of 129 eyes of 75 myopic patients treated with ICL. METHODS: On the basis of the hypothesis that ICL vaulting is due mainly to an inequality between ICL size and the horizontal sulcus-to-sulcus distance (STS) or horizontal white-to-white distance (WTW), we assumed that EV would linearly correlate with ICL horizontal compression, as demonstrated in an ex vivo experiment. Expected vault was defined as follows: EV(WTW[or STS]) = (ICL size - WTW[or STS]) × 1100 µm. With the use of preoperative data as independent variables (including age, anterior chamber depth measured from the central corneal endothelium to the anterior lens capsule, STS, WTW, ICL size, ICL size - STS, ICL size - WTW, STS - WTW, ICL diopter, and mean K-reading), a multiple regression analysis was performed to evaluate meaningful factors affecting AV. MAIN OUTCOME MEASURES: Preoperative ICL EV and postoperative ICL AV. RESULTS: Mean AV was 518.6 (standard deviation [SD] 258.4 µm). The EV(WTW) was 626.6 (SD 220.9 µm), and EV was 242.8 (SD 364.2 µm). Higher ICL compression tended to result in a lower AV than EV, whereas lower ICL compression tended to result in a higher AV than EV. The ICL size - STS was more highly correlated with AV than the ICL size - WTW (Pearson correlation coefficient 0.425 vs. 0.247). Stepwise multivariate regression showed that, in order of the strength of the contribution, ICL size - STS, ICL size, age, and K-reading were significant factors associated with AV (adjusted R(2)=0.369), but ICL size - WTW was not. Among the meaningful factors, ICL size - STS, ICL size, and K-reading were positively correlated with AV, whereas age was negatively correlated. CONCLUSIONS: The ICL vaulting based on only the horizontal compression could not be quantitatively predicted. Additional factors, such as vertical compression by the iris, dampening effect of the ciliary sulcus structure, or innate ICL vault, should be considered to avoid unexpected vaulting after ICL implantation.

Factors affecting prediction error after cataract surgery with implantation of various multifocal IOLs in patients with previous refractive laser surgery.

BACKGROUND: This study aimed to compare the clinical outcomes of implantation of various multifocal intraocular lenses (mIOLs) and the prediction accuracy of two intraocular lens (IOL) power calculation formulas for eyes that underwent previous corneal refractive surgery. METHODS: Four types of mIOLs [TECNIS Symfony (Group I), AcrySof IQ PanOptix (Group II), LENTIS Mplus (Group III), and TECNIS ZLB00 (Group IV)] were used and the IOL power was calculated with the two no-history methods, Shammas-PL and Barrett True-K. Visual acuity and refractive outcomes including manifest refraction, prediction error (PE), absolute error (AE), and median absolute error (MedAE) were evaluated at three months after the cataract surgery. RESULTS: For all groups the Barrett True-K formula produced a narrower range of PEs and lower MedAE than Shammas-PL. Eyes of lower predictive accuracy (group B, AE >0.5D) showed weak uncorrected distance visual acuity resulting from myopic refractive error and target refraction when compared to that of higher predictive accuracy (group A, AE ≤0.5 D). CONCLUSIONS: Targeting emmetropia using the Barrett True-K, which considers both anterior and posterior corneal curvature is recommended in patients undergoing mIOL implantation with prior corneal refractive surgery. Additionally, history of prior large amount of laser ablation seems to be an important factor related to low predictive accuracy.

Contribution of macrophages to angiogenesis induced by vascular endothelial growth factor receptor-3-specific ligands.

Vascular endothelial growth factor receptor (VEGFR)-2 is a major stimulator of hemangiogenesis (HA), whereas VEGFR-3 stimulates lymphangiogenesis (LA). Contrary to this understanding, we demonstrate that implantation of pellets containing VEGFR-3-specific ligands (VEGF-C156S and recombinant murine VEGF-D) into the corneal stroma induce not only LA but also robust HA characterized by blood vessels that are positive for VEGFR-3 expression. The implantation of pellets containing VEGFR-3-specific ligands also leads to the recruitment of VEGF-A-secreting macrophages. Depletion of these infiltrating macrophages using clodronate-liposome administration shows a significant reduction in HA as well as LA. Blockade of either VEGFR-2 or VEGFR-3 signaling reduces both HA and LA; however, the percent reduction of HA is greater in the VEGFR-2 blockade group. In addition, in the VEGFR-3 blockade group, the percent reduction of HA is significantly greater with VEGFR-3-specific ligands than that by VEGF-A or VEGF-C. Collectively, our data suggest that VEGFR-3-specific signaling can induce new blood vessels, to which macrophages contribute a major role, and signify its potential as an additional therapeutic target to the existing VEGF-A/VEGFR-2 signaling-based antiangiogenesis strategies.

Postoperative astigmatism and axis stability after implantation of the STAAR Toric Implantable Collamer Lens.

PURPOSE: To evaluate the efficacy, safety, and rotational and footplate stability of the STAAR Toric Implantable Collamer Lens (TICL; STAAR Surgical Co) for correction of myopic astigmatism. METHODS: In this prospective, consecutive, interventional case series, a TICL was implanted uneventfully in 30 consecutive eyes of 20 patients with myopia and astigmatism. The uncorrected visual acuity, best spectacle-corrected visual acuity, refraction, and astigmatism were measured preoperatively and at last follow-up. To evaluate postoperative axis deviation from the intended axis and footplate displacement, a digital anterior segment photograph was taken after full mydriasis and ultrasound biomicroscopy for the four footplates of the TICL in each eye at last follow-up. Possible risk factors for TICL rotation were analyzed through correlation analysis. RESULTS: After mean follow-up of 7.6 months, the mean refractive astigmatism decreased from 2.43 +/- 1.24 diopters (D) preoperatively to 0.73 +/- 0.47 D postoperatively, and the mean difference between intended and achieved TICL axes was 4.03 +/- 3.39 degrees. The absolute value of TICL rotation had significant correlation with the spherical power of the TICL (P = .037). The footplates of all TICLs were in situ in the ciliary sulcus except for one case in which one of the four footplates was located below the ciliary sulcus. CONCLUSIONS: Implantation of the STAAR TICL appears to be an effective and safe method for correction of myopic astigmatism. No clinically significant rotation or footplate displacement of the TICLs was detected postoperatively during mean follow-up of 7.6 months.

Changes in iridocorneal angle structure and trabecular pigmentation with STAAR implantable collamer lens during 2 years.

PURPOSE: To evaluate the changes in iridocorneal angle structure and trabecular pigmentation after implantation with the STAAR Implantable Collamer Lens (ICL), as potential risk factors of secondary glaucoma. METHODS: An ICL was implanted in 48 eyes of 29 patients with high myopia. Angle opening distance (distance between trabecular meshwork and iris) measured at 500 microm from the scleral spur and trabecular-iris angle were assessed preoperatively and at 1, 6, 12, and 24 months postoperatively by ultrasound biomicroscopy, and trabecular pigmentation was evaluated preoperatively and at 1, 12, and 24 months postoperatively by standardized gonioscopic photography. RESULTS: Mean follow-up was 33.2 +/- 7.3 months. One-month postoperative trabecular-iris angle and angle opening distance values were significantly smaller than preoperative values by 41.5% and 31.8%, respectively (P < .001), but no significant progressive changes were observed thereafter. The mean trabecular pigmentation of four quadrants did not change significantly during the first month after ICL implantation (P = .317), but significantly decreased at 1 and 2 years postoperatively compared with the preoperative value (P = .039 and .047, respectively). Intraocular pressure (IOP) remained stable in all eyes throughout follow-up except in one eye, which showed elevated IOP and significantly increased trabecular pigmentation requiring antiglaucoma medications. CONCLUSIONS: No ongoing narrowing of iridocorneal angle was noted after approximately 40% narrowing at 1 month postoperatively. There was no general increase in trabecular pigmentation or IOP over a mean follow-up of 33.2 months. Considering significant initial angle crowding and one eye with increased trabecular pigmentation and IOP, careful monitoring of iridocorneal angle and IOP is required during the early postoperative period, especially for 1 month.

Ten-year clinical outcomes after implantation of a posterior chamber phakic intraocular lens for myopia.

PURPOSE: To report the long-term clinical outcomes, including efficacy and safety, of implantable collamer lens (ICL) implantation to treat myopia. SETTING: Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. DESIGN: Retrospective case series. METHODS: Medical records of patients who had ICL implantation were reviewed. The preoperative and postoperative visual acuity, spherical equivalent (SE), endothelial cell density (ECD), and intraocular pressure (IOP) were analyzed. The postoperative vault and complication rate, including cataract and glaucoma, were evaluated. Patients were placed in the lens opacity group or clear lens group based on whether lens opacity developed postoperatively. RESULTS: One hundred ten eyes (60 patients) were analyzed. The mean preoperative age was 30.3 years ± 8.3 (SD). The mean SE was -12.01 ± 3.70 diopters (D) preoperatively and -0.65 ± 1.09 D 10 years postoperatively. The mean vault height was 562.4 ± 175.9 µm 6 months postoperatively, decreasing to 352.9 ± 171.8 µm at 10 years. There were no significant changes in the ECD and IOP at any timepoint. Lens opacities developed in 21 eyes (12.1%) during the 10-year follow-up. The mean vault in the lens opacity group was significantly lower than in the clear lens group after 4 years. No patient who had ICL implantation when they were 30 years or younger developed lens opacity or required phacoemulsification. CONCLUSIONS: The results indicate that ICL implantation provided long-term stability and good refractive outcomes. Performing this surgery in young patients, especially those 30 years or younger, may be safe in terms of long-term cataract formation.

Incidence and Risk Factors of Opaque Bubble Layer Formation According to Flap Thickness During 500-kHz FS-LASIK.

PURPOSE: To present the incidence, risk factors, and effect of opaque bubble layer (OBL) formation during flap creation in laser-assisted in situ keratomileusis (LASIK) with a 500-kHz femtosecond laser on visual performance. METHODS: In this retrospective study, preoperative characteristics (age, sex, keratometric value, spherical equivalent, and central corneal thickness) and intraoperative surgical factors (used energy, docking type, and flap thickness) were compared between eyes with and without OBL formation during flap creation. Possible risk factors for specific types of OBLs were analyzed. RESULTS: One hundred thirty-five eyes of 71 patients underwent LASIK, and OBL developed in 98 eyes (72.59%). In the univariate analysis, the greater than 80-µm flap group was associated with a lower OBL occurrence than the 80-µm flap group (P = .0424, odds ratio [OR] = 0.481) and hard docking was associated with increased OBL formation (P = .0001, OR = 6.859). In the multivariate analysis, hard docking was a risk factor for OBL development (P = .0003, OR = 6.329). In the subgroup analysis, hard docking had a marginal effect on OBL occurrence in the 80-µm flap group (P = .086, OR = 3.564), but it had a strong effect in the greater than 80-µm flap group (P = .0018, OR = 10.210). CONCLUSIONS: Hard docking is a risk factor for OBL development. However, hard docking had a small effect on OBL occurrence in the 80-µm flap group during LASIK. OBL formation did not affect visual performance. [J Refract Surg. 2019;35(9):583-589.].

Case report: femtosecond laser-assisted small incision deep lamellar endothelial keratoplasty.

PURPOSE: To report two cases of femtosecond laser-assisted small incision deep lamellar endothelial keratoplasty (DLEK) for patients with corneal endothelial decompensation by Fuchs dystrophy and glaucoma METHODS: Femtosecond laser (IntraLase; IntraLase Corp., Irvine, CA) with 15 kHz of repetition rate, was used for a 9.5 mm diameter by 400 micrometer thickness donor corneal lamellar dissection. RESULTS: In Case 1, the graft was clear and compact without interface haze, Orbscan showed smooth and regular corneal surface, specular microscopy was unremarkable without sign of corneal endothelial damage, and Optical coherence tomography showed uniform graft well attached to recipient stroma with minimal interface reflection at 2 months postoperation. In Case 2, the graft was clear and compact with minimal interface haze at 1 month postoperation. Femtosecond laser-assisted small incision DLEK was safe and technically feasible in our cases; however, further evaluation is required to determine long-term effects.

Clinical evaluation of accommodative intraocular lens implantation in high myopic eyes.

PURPOSE: To compare the clinical outcome of AT-45 implantation between high myopic eyes and non-high myopic eyes. METHODS: Retrospective, non-randomized, comparative trial. The medical charts of 28 patients with 35 eyes who had phacoemulsification and AT-45 implantation were retrospectively reviewed. 13 eyes of 10 patients were included in the high myopic group (axial length > or = 26.0 mm) and 22 eyes of 18 patients were included in the non-high myopic group. The clinical data included unilateral best-corrected visual acuity (BCVA) and distance-corrected near visual acuity (DCNVA) at 6 months follow-up after the surgery. The results were compared between the two groups. RESULTS: In the non-high myopic group, 22 eyes (100%) and 19 eyes (86.4%) achieved a BCVA of 20/25 and 20/20 or better respectively. For the high myopic group, the results were 13 eyes (100%) and 12 eyes (92.3%) respectively, at 6 months after the surgery. In the non-high myopic group, 21 (95.4%) and 7 eyes (31.8%) achieved a DCNVA of 20/40 and 20/25 or better. For the high myopic group, the results were 13 (100%) and 4 eyes (30.8%) respectively, at 6 months after the surgery, the differences between the two groups for a BCVA of 20/25 or better and 20/20 or better and a DCNVA 20/40 or better and 20/25 or better were not statistically significant. CONCLUSIONS: Six months clinical outcome of cataract surgery with an AT-45 for the high myopic eyes was satisfactory; it was not significantly different from that of the non-high myopic eyes.

Clinical outcomes of surgical techniques in congenital cataracts.

PURPOSE: To investigate the general clinical features of congenital cataracts and to determine their relationship to visual prognosis and surgical complications according to age at operation and surgical procedure adopted. METHOD: We retrospectively evaluated 92 eyes in 61 patients with congenital cataracts who underwent cataract surgery between January 1996 and December 2006. The demographic data, surgical technique, post-operative complications, and final visual prognosis were evaluated. RESULTS: The average age at surgery was 3.17 years (range 1 month to 11 years), and the mean follow-up was 40.02 months (range 6 to 46 months). Of the 56 eyes that could be checked for visual acuity after cataract extraction, 29 (51.7%) had a BCVA of > or = 0.5 at last visit. Unilateral congenital cataracts (p=0.025) and congenital cataracts with strabismus (p=0.019) showed significantly poorer visual outcomes. Patients with nystagmus also experienced a poor visual outcome; 6 patients (67%) had a BCVA of <0.1. Posterior cataracts had the worst visual prognosis (p=0.004). No statistically significant differences in posterior capsular opacity (p=0.901) or synechia formation (p=0.449) were observed between surgical techniques, but children younger than one year showed a higher tendency for PCO and synechia formation. CONCLUSIONS: Anterior vitrectomy did not reduce postoperative complications. Higher rates of complications (PCO, posterior synechia) developed in children younger than one year of age.

Visual quality assessment after presbyopic laser in-situ keratomileusis.

AIM: To assess visual quality after presbyopia correction using an aspheric ablation profile and a micro-monovision protocol. METHODS: This is a retrospective interventional study. Fifty-four eyes of 27 patients (mean age, 50.2±7.5y) who underwent presbyopia correction with an aspheric micro-monovision protocol were enrolled. The values of modulation transfer function (MTF) cutoff frequency, Strehl ratio, objective scattering index (OSI) and accommodation range were quantitatively assessed using the HD analyzer. Preoperative and postoperative contrast sensitivity (CS) at far (2.5 m) and near (40 cm) distance and higher-order aberrations (HOAs) were analyzed. Subjective visual satisfaction was evaluated by self-reported questionnaire regarding optical visual symptoms. RESULTS: One year after presbyopia correction, no significant differences were found in the MTF cutoff frequency, Strehl ratio and OSI, however, the HD analyzer accommodation range significantly differed postoperatively (P=0.004). Postoperative CS at 12 and 18 cpd at near showed statistically significant improvement (P=0.020 and 0.008, respectively). Visual performance by self-reported questionnaire revealed satisfactory results in terms of subjective visual quality improvement. CONCLUSION: Objective optical quality parameters show good visual outcomes. Subjective visual quality assessed by self-reported questionnaire in the presbyopia correction group show satisfactory results.

Temporary Piggyback Intraocular Lens Implantation Versus Single Intraocular Lens Implantation in Congenital Cataracts: Long-Term Clinical Outcomes.

Purpose: To report the long-term results of temporary piggyback IOL implantation in congenital cataract and to compare the clinical outcomes of temporary piggyback IOL with those of single IOL implantation. Methods: This is a retrospective, comparative, interventional study. The medical records of all consecutive patients who underwent cataract extraction and single or temporary piggyback IOL implantation within the first 3 years of life from 1999 to 2013 at Samsung Medical Center were reviewed. Twenty-eight eyes from 18 patients underwent single IOL implantation (monopseudophakia group), and 32 eyes of 20 patients underwent temporary piggyback IOL implantation in congenital cataract surgery (polypseudophakia group). Results: The mean age at initial cataract surgery was 15.8 months in the monopseudophakia group and 11.1 months in the polypseudophakia group (P = 0.144). The average follow-up duration was 133 months in the monopseudophakia group and 120 months in the polypseudophakia group (P = 0.391). The best-corrected visual acuity at the last visit was 0.36 logMAR in the monopseudophakia group and 0.55 logMAR in the polypseudophakia group (P = 0.044). Four (14%) and 14 (44%) reoperations for complications within the anterior segment were performed in the monopseudophakia group and polypseudophakia group, respectively (P = 0.042). Four cases (14.3%) in the monopseudophakia group and 13 cases (40.6%) in the polypseudophakia group had a glaucoma-related adverse event (P = 0.086). Conclusions: Compared with primary single IOL implantation in congenital cataract, temporary piggyback IOL implantation produced worse visual acuity, higher reoperation rate, and higher risk of secondary glaucoma. Temporary piggyback IOL implantation does not have benefit in congenital cataract.

Comparison of Intraocular Lens Power Calculation Methods Following Myopic Laser Refractive Surgery: New Options Using a Rotating Scheimpflug Camera.

PURPOSE: To evaluate and compare published methods of calculating intraocular lens (IOL) power following myopic laser refractive surgery. METHODS: We performed a retrospective review of the medical records of 69 patients (69 eyes) who had undergone myopic laser refractive surgery previously and subsequently underwent cataract surgery at Samsung Medical Center in Seoul, South Korea from January 2010 to June 2016. None of the patients had pre-refractive surgery biometric data available. The Haigis-L, Shammas, Barrett True-K (no history), Wang-Koch-Maloney, Scheimpflug total corneal refractive power (TCRP) 3 and 4 mm (SRK-T and Haigis), Scheimpflug true net power, and Scheimpflug true refractive power (TRP) 3 mm, 4 mm, and 5 mm (SRK-T and Haigis) methods were employed. IOL power required for target refraction was back-calculated using stable post-cataract surgery manifest refraction, and implanted IOL power and formula accuracy were subsequently compared among calculation methods. RESULTS: Haigis-L, Shammas, Barrett True-K (no history), Wang-Koch-Maloney, Scheimpflug TCRP 4 mm (Haigis), Scheimpflug true net power 4 mm (Haigis), and Scheimpflug TRP 4 mm (Haigis) formulae showed high predictability, with mean arithmetic prediction errors and standard deviations of -0.25 ± 0.59, -0.05 ± 1.19, 0.00 ± 0.88, -0.26 ± 1.17, 0.00 ± 1.09, -0.71 ± 1.20, and 0.03 ± 1.25 diopters, respectively. CONCLUSIONS: Visual outcomes within 1.0 diopter of target refraction were achieved in 85% of eyes using the calculation methods listed above. Haigis-L, Barrett True-K (no history), and Scheimpflug TCRP 4 mm (Haigis) and TRP 4 mm (Haigis) methods showed comparably low prediction errors, despite the absence of historical patient information.