Characteristics and influencing factors of corneal higher-order aberrations in patients with cataract.

PURPOSE: To observe the distribution characteristics of corneal higher-order aberrations (HOAs) in cataract patients, and analyze the relationship of HOAs with patients' age and ocular biometric parameters. METHODS: This retrospective study reviews the patients with cataract in Wuhan Aier Eye Department from January to August 2022. Root mean square (RMS) of the total HOA (tHOA), spherical aberration (SA), coma and trefoil aberration of the anterior cornea at central 4 and 6 mm optic zone were measured by the Wavefront Aberrometer (OPD-Scan III; Nidek Inc, Tokyo, Japan). The biometric parameters including axial length (AL), keratometry (K), central corneal thickness (CCT) and lens thickness (LT) were measured by swept-source coherence laser interferometry (OA-2000; TOMEY Corp, Aichi, Japan). Subgroup analyses and multiple linear regression analyses were used to determine whether HOAs were associated with age and ocular biometric parameters. RESULTS: A total of 976 patients (976 eyes) were included, averagely aged 65 years. At central 4 and 6 mm optic zone, the mean RMS of tHOA were respectively 0.20 and 0.65 µm, the SA were 0.06 and 0.30 µm, the coma aberration were 0.11 and 0.35 µm, and the trefoil aberration were 0.12 and 0.30 µm. The tHOA decreased with age until 60 years and then started to increase afterwards. The tHOA, coma and trefoil aberration increased with corneal astigmatism. The tHOA, SA, and coma aberration differ among different AL groups, and emmetropes had the smallest tHOA, SA, and coma aberration. CONCLUSIONS: With increasing age, the value of tHOA decrease first and started increasing at 60 years. The trends of corneal HOAs are consistent with corneal low-order aberrations. The values of tHOA, SA and coma aberration were the smallest in emmetropic eyes.

The tolerance of refractive errors of extended depth of focus intraocular lens in patients with previous corneal refractive surgery.

PURPOSE: To evaluate the tolerance for refractive errors and visual outcomes of extended depth of focus intraocular lens (EDOF IOLs) in patients with previous corneal refractive surgery for myopia. METHODS: Patients from Aier Eye Hospital of Wuhan University with previous myopia excimer laser correction underwent cataract surgery and implantation of an EDOF IOL. The follow-up period was three months. The uncorrected distance, intermediate, and near visual acuities (UDVA, UIVA, UNVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), defocus curve, optical quality, including modulation transfer functions (MTF) and Strehl ratio (SR), National Eye Institute Visual Functioning Questionnaire-14 for Chinese people (VF-14-CN), spectacle independence, and dysphotopsia were assessed. RESULTS: At the final visit, UDVA, CDVA, UIVA, and UNVA (LogMAR) were 0.06 ± 0.09, 0.01 ± 0.06, 0.11 ± 0.08, 0.20 ± 0.10, respectively. The mean spherical equivalent (SE) was - 0.57 ± 0.58D, sphere and cylinder were - 0.24 ± 0.60D, - 0.70 ± 0.58D respectively. No statistical difference in UDVA between eyes with SE in ± 0.50 D and in ± 1.0 D (p > 0.05). Corneal astigmatism > 1.00D has no significant effect on postoperative visual acuity (p > 0.05). The defocus curve showed that visual acuity could reach 0.2 in the refractive range of + 0.50D ~ - 1.50D. SR and MTF values were all higher than before the surgery. In bilateral implantation patients, the VF-14-CN questionnaire score and visual quality were quite excellent. CONCLUSION: The EDOF IOL have a certain tolerance for refractive errors and corneal astigmatism, and it's recommended for patients with prior myopia excimer laser surgery to achieve satisfactory visual performance.

Visual outcomes after vitrectomy for epiretinal membrane in pseudophakic eyes with a diffractive trifocal intraocular lens: a retrospective cohort study.

BACKGROUND: Diffractive intraocular lenses (IOLs) could affect visual acuity in patients with macular pathologies such as epiretinal membrane (ERM) and could influence the results of pars plana vitrectomy (PPV) for ERM removal in pseudophakic eyes with these IOLs. The aim of this study is to evaluate the effect on visual outcomes of a diffractive trifocal IOL in PPV for ERM peeling. METHODS: This is a retrospective cohort study on 20 eyes with a single model of trifocal IOL that underwent PPV for removal of ERM between January 2015 and September 2018 in our clinics. Follow up was at least 1 year. Primary outcome measure was mean change in visual acuity. Secondary outcome measures were mean change in central macular thickness (CMT), recovery of the external retinal layers, and change in spherical equivalent (SE). RESULTS: Mean corrected distance visual acuity (CDVA) was 0.03 ± 0.03 logMAR after phacoemulsification; this worsened to 0.23 ± 0.10 logMAR with ERM, improving to 0.10 ± 0.04 log MAR 12 months after PPV (p = 0.001). Mean uncorrected near visual acuity (UNVA) was Jaeger 2.62 ± 0.51 after lensectomy. This worsened to Jaeger 5.46 ± 1.67 with ERM and improved to the initial Jaeger 2.69 ± 0.84 after PPV (p = 0.005). CMT decreased significantly, from 380.15 ± 60.50 µm with the ERM to 313.70 ± 36.98 µm after PPV. Mean SE after lensectomy was - 0.18 ± 0.38 D, which minimally changed to - 0.18 ± 0.47 D after PPV (p = 0.99). The only complication recorded after PPV was a case of cystoid macular edema. No difficulties in visualization due to IOL design were reported during PPV. CONCLUSION: PPV for ERM in eyes with this trifocal IOL seems to be safe and effective, and allows recovery of the loss of UNVA.

Distribution of ocular biometric parameters and optimal model of anterior chamber depth regression in 28,709 adult cataract patients in China using swept-source optical biometry.

BACKGROUND: The purpose of this study was to evaluate the ocular biometric parameters in adult cataract patients from China and create an anterior chamber depth (ACD) regression model. METHODS: The ocular biometric records of 28,709 right eyes of cataract surgery candidates who were treated at Aier Eye Hospitals in nine cities from 2018 to 2019 were retrospectively analyzed. All measurements were taken with IOLMaster 700. We included patients who were at least 40 years old and were diagnosed with cataract. RESULTS: The mean age of the patients was 68.6 ± 11.0 years. The mean values recorded were as follows: axial length (AL), 24.17 ± 2.47 mm; mean keratometry (Km) value, 44.26 ± 1.70 D; corneal astigmatism (CA), 1.06 ± 0.96 D; ACD, 3.02 ± 0.45 mm; lens thickness (LT), 4.52 ± 0.45 mm; central corneal thickness (CCT), 0.534 ± 0.04 mm; and white to white (WTW) corneal diameter, 11.64 ± 0.46 mm. ACD correlated positively with AL (Spearman coefficient, 0.544) and WTW (0.300), but negatively with LT (-0.660) and age (-0.285) (all P < 0.01). In the multivariate regression analysis of ACD, which included LT, AL, WTW, sex, Km, CCT, and age, there was a reasonable prediction with adjusted R2 = 0.641. CONCLUSIONS: Cataract patients with longer AL and wider WTW have deeper ACD. With increasing age and lens thickening ACD becomes shallower. Based on the standardized coefficients of ACD multivariate regression analysis from the study, LT is the main factor that affects ACD, and is followed by AL.

Evaluating the safety and operability of asymmetric trapezoid and near-square side-port incision in cataract surgery.

PURPOSE: To compare the accuracy, safety, and consistency of asymmetric trapezoid and near-square side-port incision in cataract surgery. SETTING: Aier Eye Hospital of Wuhan University, Wuhan, Hubei Province, China. DESIGN: Prospective pilot study. METHODS: This study included patients who underwent phacoemulsification between January 2022 and August 2022. They were divided into Group A and Group B using the random number table method. Group A was given a near-square side-port incision and Group B was given an asymmetric trapezoid side-port incision. We contrasted the differences in incision length, width, and shape; surgical time; and postoperative intraocular pressure (IOP) between the 2 groups. RESULTS: 220 eyes of 220 patients were included. The mean external width of the incision in Group A was much smaller than that in Group B ( P < .01), and the consistency of the incision diameter in Group A was better than that in Group B. There was no statistically significant difference in incision length between the 2 groups ( P = .75). 1 day after surgery, there was no statistically significant difference in incision morphology between the 2 groups ( P = .72). The operating time for Group A was significantly shorter than that of Group B ( P < .01). There was no obvious incision leakage in both groups after surgery, and the IOP was generally elevated after surgery, but there was no significant statistical difference between the 2 groups ( P = .98). CONCLUSIONS: The present study suggests that a near-square side-port results in better consistency of incision width and shorter surgical time.

Phacoemulsification with implantation of a trifocal intraocular lens in eyes with asteroid hyalosis and synchysis scintillans.

PURPOSE: To compare the visual outcomes in both eyes of patients who undergo phacoemulsification and trifocal intraocular lens (IOL) implantation and have asteroid hyalosis (AH) or synchysis scintillans (SS) in only one eye. METHODS: A retrospective comparative case series was performed. We evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), predictability, safety, efficacy, and satisfaction after implantation of the same model of trifocal IOL in both eyes (PhysIOL FineVision Pod-F and Micro-F and Rayner RayOne Trifocal). RESULTS: A total of 164 eyes of 82 patients (41 females, 50%) met the inclusion criteria. There were no statistically significant differences in sphere, cylinder, spherical equivalent, UDVA, UIVA, or UNVA between the groups. Postoperative CDVA was slightly better in the control group (logMAR 0.03) than in the AH/SS group (logMAR 0.04) (P: 0.014). There were no statistically significant differences in predictability, safety index, or efficacy index between the groups. Overall subjective satisfaction was good (98.2%). CONCLUSIONS: Visual outcomes and satisfaction are good after implantation of trifocal IOLs in eyes with AH or SS. Therefore, trifocal IOLs should not be ruled out in these patients when no other vitreoretinal disorder is present.

Visual Outcomes and Patient Satisfaction After Bilateral Refractive Lens Exchange With a Trifocal Intraocular Lens in 5,226 Patients With Presbyopia.

PURPOSE: To assess visual and refractive outcomes and visual function after bilateral RayOne Trifocal toric and nontoric intraocular lens (IOL) (Rayner) implantation in patients with presbyopia. METHODS: Charts of patients with presbyopia who underwent refractive lens exchange with bilateral implantation of the RayOne Trifocal IOL (toric and non-toric) were retrospectively reviewed. Visual and refractive outcomes were evaluated at 3 months. Patient satisfaction, spectacle independence, and visual disturbance profile were assessed by questionnaires. RESULTS: A total of 5,226 patients were assigned to one of two groups: 1,010 patients had toric IOL implantation (toric group) and 4,216 patients received the non-toric model (non-toric group). Mean ± standard deviation visual acuity at 3 months for the toric group was binocular uncorrected distance visual acuity (UDVA) of 0.07 ± 0.11 logMAR, monocular corrected distance visual acuity (CDVA) of 0.05 ± 0.07 logMAR, binocular uncorrected near visual acuity (UNVA) at 40 cm of 0.10 ± 0.09 logMAR, binocular uncorrected intermediate visual acuity (UIVA) at 40 cm of 0.13 ± 0.12 logMAR, postoperative spherical equivalent (SE) of -0.21 ± 0.47 diopters (D), and cylinder of -0.34 ± 0.40 D. The non-toric group had binocular UDVA of 0.04 ± 0.08 logMAR, monocular CDVA of 0.05 ± 0.07 logMAR, binocular UNVA of 0.10 ± 0.08 logMAR, binocular UIVA of 0.13 ± 0.11 logMAR, SE of -0.08 ± 0.38 D, and cylinder of -0.28 ± 0.34 D. No statistically significant differences were found in achieving spectacle independence and there were high levels of satisfaction in both groups. CONCLUSIONS: In this retrospective analysis with more than 5,000 patients, both the toric and non-toric RayOne Trifocal IOL models provided good visual performance at all distances, resulting in excellent levels of spectacle independence and patient satisfaction. [J Refract Surg. 2024;40(7):e468-e479.].

Trifocal versus monofocal intraocular lens implantation in eyes previously treated with laser in situ keratomileusis (LASIK) for myopia.

PURPOSE: To assess visual and refractive outcomes of trifocal intraocular lens (IOL) implantation in eyes that had previously undergone laser in situ keratomileusis (LASIK) for myopia and to compare them with those recorded after implantation of a monofocal IOL. DESIGN: Retrospective comparative cases series. METHODS: This study evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), safety, and efficacy after the implantation of two comparable trifocal IOL models and one monofocal IOL model in patients who had previously undergone myopic LASIK. Patients were classified according to the implanted IOL (monofocal or trifocal). RESULTS: A total of 211 eyes from 170 patients received a monofocal IOL, and 211 eyes from 161 patients received a trifocal IOL. At the end of the study, after lensectomy, there was a higher myopic residual spherical equivalent in the monofocal group because some eyes had been targeted for slight myopia to achieve monovision; therefore, UDVA was better in the trifocal group. CDVA was comparable in both groups. As expected, both monocular and binocular UNVA were significantly better in the trifocal group. Although the percentage of eyes that lost ≥1 line of CDVA did not differ between the groups, the safety index was slightly better in the monofocal group. CONCLUSION: Although implantation of monofocal and trifocal IOLs after myopic LASIK yielded excellent distance visual outcomes, UNVA was significantly better for the trifocal IOL, with a minimally worse safety profile. Trifocal IOLs can be considered after previous LASIK for myopia, with an appropriate patient selection.

Visual outcomes of combined use of implantable collamer lens implantation and laser corneal visual correction for myopia over -18.00 diopters.

PURPOSE: To explore visual outcomes in patients with extreme myopia receiving an implantable collamer lens (ICL) at -18.00 diopters (D), with central port, followed by bioptics by laser vision correction (laser in situ keratomileusis [LASIK] or photorefractive keratectomy [PRK]) to address residual myopia or myopic astigmatism. SETTING: Clínica Baviera (Aier Eye Hospital Group), Bilbao, Spain. DESIGN: Retrospective analysis of cases. METHODS: The study assessed uncorrected distance visual acuity, corrected distance visual acuity (CDVA), predictability, safety, efficacy, and patient satisfaction after implantation of the ICL and bioptics. The model implanted was V4c and EVO, with a correction of -18.00 D. Bioptics were performed at least 3 months after implantation, and patients were followed up for at least 3 months after LASIK or PRK. RESULTS: The analysis included 125 eyes from 90 patients. Of these, 51.2% underwent LASIK and 48.8% PRK. Mean time from implantation to bioptics was 5.9 ± 9.4 months. Patients were followed up for a mean of 40.2 ± 37.9 months after bioptics. Median manifest refractive spherical equivalent was -2.89 D before bioptics and -0.49 D after. Median CDVA was 0.18 logMAR before bioptics and 0.17 after. The mean safety and efficacy indices were 2.22 ± 1.88 and 2.06 ± 1.85, respectively. CONCLUSIONS: Visual outcomes and safety indices after ICL implantation and subsequent LASIK or PRK in patients with extreme myopia are excellent.

Four-Point Flange Intrascleral Fixation With Double Suture Through the Dislocated Plate-Haptic Trifocal Intraocular Lens.

PURPOSE: To describe a technique for the replacement of dislocation of plate-haptic trifocal intraocular lens (IOL) through double-suture 4-point flange intrascleral fixation. DESIGN: Retrospective, interventional, noncomparative, case series. METHODS: A total of 7 eyes of 7 patients with a dislocated plate-haptic trifocal IOL were enrolled for 4-point flange intrascleral fixation with double 7-0 polypropylene suture. Preoperative and postoperative visual acuity, operating time, refractive results, postoperative IOL tilt and decentration, and intraoperative and postoperative complications were recorded. RESULTS: The mean postoperative uncorrected distance visual acuity (UDVA) was 0.05 ± 0.06 logarithm of the minimum angle of resolution (logMAR). The mean postoperative uncorrected intermediate visual acuity (UIVA) at 80 cm was 0.09 ± 0.06 logMAR and the mean postoperative uncorrected near visual acuity (UNVA) at 40 cm was 0.06 ± 0.07 logMAR. The mean postoperative residual spherical equivalent values were -0.27 ± 0.39 diopters. The visual function index-14 questionnaire showed that no difficulty was found in >80% of subjects for all tasks. The mean surgical time was 16.23 ± 5.64 min. The mean tilt of IOL was 3.74° ± 1.31° and the mean decentration of the IOL was 0.18 ± 0.09 mm. No important complications appeared. CONCLUSION: We have described the technique of 4-point flange intrascleral fixation for plate-haptic trifocal IOL.

Comparison of Patients With Emmetropia and Presbyopia and Different Accommodation Who Undergo Unilateral or Bilateral Implantation of a Trifocal IOL.

PURPOSE: To compare visual outcomes and satisfaction in patients with emmetropia, presbyopia, and greater or lesser residual accommodation who undergo unilateral or bilateral implantation of a trifocal diffractive intraocular lens (IOL). METHODS: A multicenter, multisurgeon study was performed to evaluate outcomes in patients with emmetropia and presbyopia who underwent refractive lens exchange followed by implantation of a FineVision trifocal IOL (PhysIOL). The inclusion criteria were as follows: emmetropia, sphere -0.25 to +0.50 diopters (D), cylinder less than 0.75 D, and manifest refractive spherical equivalent (MRSE) of -0.25 to +0.25 D. All patients also had to have an uncorrected distance visual acuity (UDVA) of Snellen 0.9 or better in each eye. The sample was divided into different clusters based on two variables: eyes operated on (monocular or binocular) and age either younger than 55 years or 55 years or older. Thus, four possible groups were created. Visual and refractive performance, patient satisfaction, and spectacle independence were assessed. RESULTS: A total of 690 eyes from 431 patients were evaluated. There was no difference in postoperative uncorrected (UDVA) and corrected (CDVA) distance visual acuity between the groups. Binocular uncorrected near vision (UNVA) was better in patients who underwent surgery on both eyes regardless of age (median [interquartile range]: 0.00 [0.00; 0.10] vs 0.10 [0.00; 0.10] logMAR; P < .001). Binocular uncorrected intermediate vision (UIVA) was better in patients who underwent surgery on both eyes aged younger than 55 years than in those who underwent surgery in one eye aged 55 years or older (median [interquartile range]: 0.18 [0.10; 0.18] vs 0.30 [0.18; 0.30] logMAR; P < .001). The efficacy and safety indexes were 0.98 ± 0.09 and 1.01 ± 0.06, respectively. A total of 93.3% of eyes were within the 0.50 D range in postoperative MRSE. Visual dysphotopsia was worse in patients with both eyes operated on, although the differences were not statistically significant. CONCLUSIONS: The study shows that after refractive lens exchange, patients with emmetropia and presbyopia who received a trifocal IOL in one or both eyes achieved good UNVA, UIVA, and UDVA. Regarding near binocular visual acuity, results were better for patients who underwent surgery on both eyes than for those who underwent surgery on one eye. Regarding binocular intermediate visual acuity, patients aged younger than 55 years with both lenses replaced had better results than those 55 years or older with only one lens replaced. However, no significant differences were observed in UDVA or patient satisfaction. [J Refract Surg. 2023;39(12):817-824.].

Visual and refractive outcomes after implantation of two models of trifocal intraocular lenses in eyes with previous corneal ablation to treat hyperopia.

BACKGROUND: To assess whether a trifocal intraocular lens (IOL) with neutral spherical aberration (SA) provides better visual and refractive outcomes than a trifocal IOL with negative SA after hyperopic corneal laser ablation. METHODS: This is a retrospective comparative study. Patients were classified according to the IOL implanted after cataract or clear lens phacoemulsification [group 1, PhysIOL FineVision Pod-F (negative SA); group 2, Rayner RayOne Trifocal (neutral SA)]. We evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), predictability, safety, efficacy, and satisfaction. RESULTS: 198 eyes of 119 patients met the inclusion criteria. Group 1 comprised 120 eyes and group 2 comprised 78 eyes. At completion, the refractive and predictability results were significantly better in group 1 than in group 2 for manifest refraction spherical equivalent (MRSE) (P < 0.001). Differences were not significant for UDVA (P = 0.647), CDVA (P = 0.343), UIVA (P = 0.059), UNVA (P = 0.382), binocular UIVA (P = 0.157), or binocular UNVA (P = 0.527). Safety and efficacy indices in refractive lens exchange (RLE) eyes were 0.96 and 0.91, and 0.89 and 0.93 in groups 1 and 2, respectively (P = 0.254 and 0.168). Patient satisfaction was similar in both groups (P > 0.05, all items). CONCLUSION: In eyes previously treated with hyperopic corneal ablation, implantation of a trifocal IOL with neutral SA provided better efficacy and safety outcomes but worse predictability outcomes than those obtained with a trifocal model with negative SA.

Clinical presentation of acute primary angle closure during the COVID-19 epidemic lockdown.

Purpose: This study aimed to investigate the clinical presentation of acute primary angle closure (APAC) during the COVID-19 epidemic lockdown in Wuhan. Methods: Consecutive patients seeking APAC treatment at the Wuhan Aier Eye Hospital during the 76 days (January 23-April 8, 2020) when the lockdown policy was implemented due to the COVID-19 pandemic were compared to those during the same period the following year (January 23-April 8, 2021), when the lockdown policy was not implemented. The cohorts were compared to assess demographic variables and clinical presentations. Results: A total of 54 patients (64 eyes) were included in the 2020, compared with 46 patients (51 eyes) in the 2021. Demographic factors were similar between the groups. Significantly more patients developed blindness in the 2020 cohort (21.87%) than in the 2021 cohort (7.84%). Patients in the 2020 showed a longer time from symptom to treatment (241.84 ± 211.95 h in 2020 vs. 121.53 ± 96.12 h in 2021; P = 0.001), higher intraocular pressure at presentation (52.63 ± 12.45 mmHg in 2020 vs. 45.16 ± 9.79 mmHg in 2021; P = 0.001), larger pupil diameter (5.47 ± 1.62 mm in 2020 vs. 4.33 ± 1.27 mm in 2021; P = 0.001), and more glaucomatous optic neuropathy diagnoses [20/64 eyes (31.25%) in 2020 vs. 7/51 eyes (13.73%) in 2021; P = 0.03]. Conclusion: The time between the onset of APAC symptoms and its treatment during the COVID-19 epidemic lockdown was significantly prolonged, which increased the blindness rate of APAC patients.

Comparison of the actual diameter of capsulotomy and predicted diameter of capsulotomy after femtosecond laser-assisted capsulotomy.

PURPOSE: To compare the consistency between the actual diameter of capsulotomy (ADC) and the predicted diameter of capsulotomy (PDC) in femtosecond laser-assisted cataract surgery (FLACS) and analyze the factors that influence the deviation of the diameter of capsulotomy (DDC) between the actual and predicted. SETTING: Aier Eye Hospital of Wuhan University, China. DESIGN: Retrospective observational case series. METHODS: Patients who underwent FLACS from March 2020 to March 2021 were reviewed. The ADC in FLACS was measured and compared with the PDC. The effects of age, sex, and biometrics on DDC were analyzed. RESULTS: 412 eyes of 336 patients were included. The mean age was 53.0 ± 0.91 years (range 3 to 91 years). When the PDC was set to 4.50 mm, the results showed that the ADC was 5.21 ± 0.21 mm with a significant difference between them ( P &lt; .05). However, when the PDC was set to 5.2 mm, the ADC was 5.10 ± 0.38 mm without a significant difference between them ( P &gt; .05). No correlation ( P &gt; .05) was found between the DDC and the axial length, the DDC and the anterior chamber depth (ACD), and the DDC and the mean keratometry (Km), but a negative correlation was found between the DDC and the lens thickness (LT) ( r = -0.21; P &lt; .05) and the DDC with age ( r = -0.70; P &lt; .05). Using curvilinear regression analysis, a development of an age-depending correction formula was predicted: ADC = PDC + 1.23 - 0.30 ln (x) (x = age ≥3) ( R2 = 0.65; F = 752.39; P = .00). CONCLUSIONS: The consistency of the ADC and PDC was influenced by age and LT. For patients aged 40 years or younger, the younger the patient, the wider the DDC; for patients older than 40 years, the DDC was small. The thicker the LT, the smaller the DDC.

Efficacy and Safety of Surgically Managed Late Traumatic LASIK Flap Displacements in a Study of 66 Cases.

PURPOSE: To evaluate safety and efficacy in the management of flap displacement after laser in situ keratomileusis (LASIK) and subsequent complications. METHODS: This was a retrospective study performed using data recorded at the center's database from October 2002 to August 2021. Efficacy and safety were both converted to binary outcomes (loss of one or more lines and no change or gain in lines of visual acuity). The effects of time from surgery to complication and from complication to repair were assessed and the odds ratios and probabilities were calculated. The same procedure was applied to investigate the effect of these temporal variables on complications. RESULTS: A total of 66 eyes with late traumatic LASIK flap displacements were studied. Efficacy remained unchanged in 48 patients (64 eyes, 75%), and safety remained unchanged in 53 patients (59 eyes, 90%). Sixty-six patients (64 eyes, 100%) achieved visual acuity values of 20/40 and 45 patients (64 eyes, 70.3%) achieved values of 20/20. The flap displacement was resolved in the first 24 hours (SD ± 0.1 days). Surgery was performed in 58 patients (65 eyes, 90%). Epithelial ingrowth was the most frequent complication. Patients who underwent surgery tended not to lose lines (P = .05). The risk of developing epithelial ingrowth increases with time after LASIK surgery until traumatic flap displacement (odds ratio: 1.001; P < .001). The prevalence of dislocation during the study period was 0.012%. CONCLUSIONS: Visual safety values were favorable after resolution of the flap complication. Immediate surgical management leads to better visual efficacy, and the time between LASIK and trauma increases the risk of epithelial ingrowth after flap displacement. [J Refract Surg. 2022;38(4):270-276.].

Laser corneal enhancement after trifocal intraocular lens implantation in eyes that previously had photoablative corneal refractive surgery.

PURPOSE: To evaluate the visual and refractive outcomes of laser corneal enhancement after trifocal intraocular lens (IOL) implantation in eyes previously treated with myopic/hyperopic laser corneal refractive surgery (LCRS). SETTING: Clinica Baviera-AIER-Eye Group, Spain. DESIGN: Retrospective comparative case series. METHODS: Patients were divided by primary LCRS into myopic and hyperopic groups. The outcomes evaluated were uncorrected distance (UDVA), corrected distance (CDVA), uncorrected intermediate (UIVA), and uncorrected near visual acuity (UNVA), and predictability, safety, efficacy, and satisfaction after implantation of 2 trifocal IOL models (Physiol-FineVision and Zeiss-ATLisa 839) and subsequent laser enhancement. RESULTS: 186 eyes (89 myopic and 97 hyperopic eyes) from 146 patients were assessed. At the last visit, refractive outcomes were better in myopic than those in hyperopic eyes, with statistically significant differences for sphere ( P < .001), cylinder ( P < .001), manifest refraction spherical equivalent (MRSE) ( P = .003), CDVA ( P = .005), UDVA ( P = .047), and UNVA ( P = .003) but not for UIVA ( P = .580), binocular UIVA ( P = .660), or binocular UNVA ( P = .836). Predictability differences were nonsignificant between groups for a final MRSE of ±0.5 diopters (D) and ±1.0 D (P = .167 and .502, respectively). Efficacy and safety were similar in both groups ( P = .235 and P = .080). A greater myopic MRSE was present after trifocal implantation in myopic than in hyperopic eyes (MRSE = -0.93 vs -0.69 D, P = .013), and the statistically significant differences were maintained after enhancement between both groups (MRSE -0.00 vs 0.00 D, P = .003). Overall satisfaction was similar in both groups ( P > .05 all items). CONCLUSIONS: Corneal laser enhancement after implantation of a trifocal IOL in eyes previously treated for myopia or hyperopia with LCRS was safe, effective, predictable, and highly satisfactory.

Myopic LASIK and LASEK in patients with preoperative mean central keratometry ≥47.50 D.

PURPOSE: To evaluate whether patients who undergo myopic LASIK or laser epithelial keratomileusis (LASEK) with preoperative central keratometry ≥47.50 diopters (D) are at higher risk for developing corneal ectasia postoperatively. METHODS: Records of 32 patients (54 eyes) who underwent myopic LASIK or LASEK between May 2002 and July 2005 with preoperative mean central keratometry ≥47.50 D were retrospectively reviewed. Patients eligible for the study were offered free follow-up. Last follow-up was at least 3 years after surgery. All procedures were performed with the Technolas Keracor 217z excimer laser (Bausch & Lomb). RESULTS: Twenty-four patients (40 eyes) had LASIK and 8 patients (14 eyes) had LASEK. At last follow-up, no patient had developed ectasia. CONCLUSIONS: This study suggests that patients with preoperative central keratometry ≥47.50 D as the only parameter evaluated should not be excluded from corneal refractive surgery due to increased risk of postoperative ectasia. However, when this preoperative finding is accompanied by other topographic abnormalities, treatment options should be carefully evaluated.

Analysis of Lens Thickness Distribution Based on Swept-Source Optical Coherence Tomography (SS-OCT).

OBJECTIVE: This study aimed to analyze the distribution of lens thickness (LT) and its associations in age-related cataract patients based on swept-source optical coherence tomography (SS-OCT). METHODS: This cross-sectional study included 59,726 Chinese age-related cataract patients. Only right-eye data were included in the study. Repeated measures of ocular parameters were performed using an IOL Master 700 device. The distributions of ocular biometric data including anterior chamber depth (ACD), LT, axial length (AL), central corneal thickness (CCT), white-to-white (WTW), and mean keratometry (MK) and their associations with age were assessed. The anterior segment (AS) was measured as the sum of CCT, ACD, and LT, while the vitreous chamber depth (VCD) was calculated as the difference between AL and AS. The values of LT : AL, AS : AL, and VCD : AL in different AL groups and their changes are the main outcome measures used to observe the proportion of the anterior and posterior segments of the eye. RESULTS: Biometric data were available for 59,726 individuals. The mean age was 68.81 years (range = 40-100); 40.62% were male and 59.38% were female. Mean anterior chamber depth (ACD) was 3.02 ± 0.44 mm, mean LT was 4.51 ± 0.44 mm, mean axial length (AL) was 23.89 ± 1.92 mm, mean central corneal thickness (CCT) was 0.53 ± 0.03 mm, mean white-to-white (WTW) was 11.64 ± 0.44 mm, and mean keratometry (MK) was 44.27 ± 1.65 diopter. Female patients had shorter AL, shallower ACD, smaller CCT and WTW, decreased LT, and steeper corneas (p < 0.005). ACD revealed the strongest negative correlation (p ≤ 0.001, r = -0.682) with LT. Age (p ≤ 0.001, r = 0.348) showed a moderate positive correlation, whereas MK (p ＜ 0.05, r = 0.011), CCT (p ≤ 0.001, r = 0.041) had a weak positive correlation and WTW (p ≤ 0.001, r = -0.034) had a weak negative correlation with LT. A nonlinear correlation was found between LT and AL. LT increased with age in both males and females. LT changed variably in eyes with AL less than 27 mm, LT decreased as AL increased, then LT gradually increased as AL increased in extremely long and extra-long eyes (p ≤ 0.001). LT : AL and AS : AL decreased as AL increased, VCD : AL gradually increased as AL increased in highly myopic eyes, and VCD : AL increased by about 0.01 for every 1 mm increase in AL. CONCLUSIONS: Among Chinese age-related cataract patients, we found LT to have the strongest relation with ACD. The lens was thicker in elderly patients and women. The correlation between LT and AL is not a simple negative correlation; with the increase of age, LT decreases first and then increases. The proportion of VCD is constantly rising with the elongation of AL.

Dynamic assessment of variations in pupil diameter using swept-source anterior segment optical coherence tomography after phakic collamer lens implantation.

PURPOSE: To dynamically assess variations in pupil diameter induced by changes in brightness in myopic eyes implanted with an implantable collamer lens (ICL, STAAR Surgical) with a central port. METHODS: This prospective, observational single-center case series study comprised 65 eyes from 65 consecutive patients undergoing ICL implant. A modified commercially available swept-source Fourier-domain anterior segment optical coherence tomography (AS-OCT) device was used for imaging and performing dynamic pupillometry under changing light conditions before and after a mean follow-up interval of four months after surgery. RESULTS: Preoperative mean pupil size under photopic conditions was 3.38 ± 0.64 mm; after surgery, this increased to 3.48 ± 0.61 mm. Mean pupil size under scotopic light conditions was 5.72 ± 0.79 mm before surgery and 5.84 ± 0.77 mm postoperatively. The differences between preoperative and postoperative pupil diameter in miosis and mydriasis were 0.10 ± 0.44 mm (P = 0.078) and 0.12 ± 0.58 mm (P = 0.098), respectively. The scotopic pupil exceeded the optic zone of the implanted lens in 39 eyes (60%). The mean central vault value was 412 ± 177 µm under maximum miosis and 506 ± 190 µm under maximum mydriasis. We found a positive correlation between vault and differences in pupil diameter under all light conditions (P < 0.05). CONCLUSION: Dynamic AS-OCT enables a very precise determination of the pupillary diameter in the iris plane. The changes in the pupil diameter under different light conditions after the implantation of an ICL are related to the postoperative vault.

Trifocal intraocular lens implantation in eyes with previous corneal refractive surgery for myopia and hyperopia.

PURPOSE: To evaluate the visual and refractive outcomes of trifocal intraocular lens (IOL) implantation in eyes previously treated with myopic and hyperopic corneal refractive laser surgery. SETTING: Clinica Baviera-AIER-Eye group, Spain. DESIGN: Retrospective comparative case series. METHODS: The series was divided into 2 groups according to the type of corneal laser refraction (myopic and hyperopic). The main visual and refractive outcome measures included corrected distance visual acuity (CDVA) and uncorrected distance and near visual acuity, safety, efficacy, and predictability. The secondary outcome measures were percentage of enhancement and Nd:YAG capsulotomy and influence of prelaser magnitude of myopia and hyperopia on the outcome of trifocal IOL implantation. RESULTS: The sample comprised 868 eyes (543 patients): myopic, n = 319 eyes (36.7%); and hyperopic, n = 549 eyes (63.2%). Three months postoperatively, visual outcomes were poorer in the hyperopic group than those in the myopic group for mean CDVA (0.06 ± 0.05 vs 0.04 ± 0.04, P < .01) and safety (21% vs 12% of CDVA line loss, P < .05) outcomes. However, precision outcomes were worse in the myopic group than those in the hyperopic group, with a mean spherical equivalent of -0.38 ± 0.3 vs -0.17 ± 0.3 (P < .01). Stratification by magnitude of primary laser treatment revealed poorer visual and safety results in the high hyperopia subgroup (>+3.0 diopters [D]) and poorer precision in the high myopia subgroup (<-5.0 D). CONCLUSIONS: Trifocal IOL implantation after photorefractive surgery in eyes previously treated with myopic ablation achieved good visual outcomes but less predictability in the high myopia subgroup. However, eyes with a previous hyperopic corneal ablation achieved excellent precision but worse visual and safety outcomes in the high hyperopia subgroup.