Bilateral Refractive Lens Exchange With Trifocal Intraocular Lens for Hyperopia in Patients Younger Than 40 Years: A Case-Control Study.

PURPOSE: To evaluate visual outcomes, satisfaction, and spectacle independence in non-presbyopic hyperopic patients who underwent bilateral refractive lens exchange with a trifocal intraocular lens (IOL) and to compare them with presbyopic hyperopic patients. METHODS: In this retrospective study, patients younger than 40 years underwent bilateral refractive lens exchange with a diffractive trifocal IOL (FineVision Micro F; PhysIOL SA) for hyperopia with at least 3 months of follow-up. A control group of patients older than 50 years was matched by axial length, sex, and follow-up. Safety, efficacy, predictability, patient satisfaction, and spectacle independence were evaluated. RESULTS: One hundred thirty-three patients (average age = 36.94 ± 2.91 years; range = 21.50 to 40 years) were included in this study. After a mean follow-up of 8.83 ± 5.69 months (range = 2.75 to 77.63 months), the safety and efficacy indexes and predictability within ±1.00 diopters (D) were 1.02%, 0.98%, and 99.62%, respectively, which was not different from the control group (P > .05). No intraoperative complications were recorded. The only postoperative complication was posterior capsule opacification in 21 eyes (7.89%), which was similar to the control group (P > .05). Ninety-seven percent of patients in each group expressed that they were satisfied and all of them in each group reported that they did not use spectacles for distance, intermediate, or near vision. CONCLUSIONS: Refractive lens exchange and trifocal IOL implantation for hyperopia in patients without presbyopia provided the same good visual outcomes as in presbyopic patients with a high rate of patient satisfaction and spectacle independence. [J Refract Surg. 2021;37(8):524-531.].

Outcomes of Laser In Situ Keratomileusis and Photorefractive Keratectomy in Patients Taking Isotretinoin.

PURPOSE: To determine the functional outcomes of laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) in patients taking isotretinoin, which is contraindicated for these procedures. DESIGN: Multicenter, retrospective, interventional case series. METHODS: All patients taking isotretinoin who underwent LASIK or PRK from January 2003 to September 2017 were included (Group 1). Patients were compared with those undergoing LASIK or PRK who had taken isotretinoin previously but not in the previous 6 months (Group 2). Patients were included consecutively. RESULTS: A total of 113 patients (219 eyes) were included. No significant intraoperative or postoperative complications were found. There were no significant differences between the groups in terms of visual acuity, postoperative spherical equivalent, efficacy index, predictability, or safety index. When only PRK patients were taken into account, the efficacy index (P = .017), postoperative sphere (P = .041), and postoperative astigmatism (P < .001) were better in Group 2, although the difference was not clinically relevant. CONCLUSIONS: In our experience, LASIK and PRK can be performed effectively and safely in selected patients taking isotretinoin. The absolute exclusion of certain systemic medications should be reconsidered.

Long-term evaluation of eyes with central corneal thickness <400 µm following laser in situ keratomileusis.

PURPOSE: To study long-term refractive and visual outcomes of laser in situ keratomileusis (LASIK) in eyes with a postoperative thin central cornea. METHODS: In this retrospective observational case series, we studied 282 myopic eyes with a normal preoperative topographic pattern and postoperative thin corneas (<400 µm) that had at least 3 years of follow-up after LASIK in three private clinics. The main outcome measures were safety, efficacy, predictability, percent tissue altered, and complications. RESULTS: The mean postoperative central corneal thickness was 392.05 µm (range: 363.00-399.00 µm). After a mean follow-up of 6.89±2.35 years (standard deviation), the safety index was 1.17, the efficacy index was 0.94, and predictability (±1.00 diopter [D]) was 73.49. The mean residual stromal bed thickness was 317.34±13.75 µm (range: 275-356 µm), the mean flap thickness was 74.76±13.57 µm (range: 55-124 µm), and the mean percent tissue altered was 37.12%±3.62% (range: 27.25%-49.26%). No major complications were recorded. CONCLUSION: LASIK with a resultant central cornea thickness <400 µm seems to be effective, safe, and predictable provided that preoperative topography is normal and the residual stromal bed thickness is >275 µm.

Incidence of corneal infections after laser in situ keratomileusis and surface ablation when moxifloxacin and tobramycin are used as postoperative treatment.

PURPOSE: To assess the incidence, culture results, and visual outcomes of infectious keratitis after laser in situ keratomileusis (LASIK) and surface ablation when topical moxifloxacin was added to postoperative prophylaxis with tobramycin. SETTING: Clínica Baviera, Instituto Oftalmológico Europeo, Bilbao, Spain. DESIGN: Retrospective case series review. METHODS: The medical records of 55 255 patients (108 014 eyes) who had LASIK and surface ablation were reviewed to identify cases of infectious keratitis. The incidence, risk factors, clinical course, days to diagnosis, treatment, and final visual outcomes were recorded. These data were compared with previously published data of 221 437 eyes that received postoperative tobramycin alone. RESULTS: Post-LASIK infectious keratitis was diagnosed in 10 eyes (9 patients) and post-surface ablation infectious keratitis in 11 eyes (10 patients). The onset of infection was early in 40.00% of cases after LASIK and in 36.36% after surface ablation. Cultures were positive in 2 cases after surface ablation. Immediate flap lifting and irrigation with antibiotics were performed in all eyes after LASIK. The final corrected distance visual acuity was 20/20 or better in 7 cases after LASIK (70.00%) and 7 cases after surface ablation (63.64%) and 20/40 or better in all cases after LASIK or surface ablation. CONCLUSIONS: The incidence of infectious keratitis decreased from 0.025% to 0.011% (P < .001) per procedure after LASIK and from 0.200% to 0.066% (P < .001) after surface ablation. Infectious keratitis was less frequent after LASIK than after surface ablation. The frequency of infection, mainly early-onset infection, was lower when the postoperative treatment was tobramycin and moxifloxacin rather than tobramycin alone. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Intraocular pressure during the early postoperative period after 100 consecutive implantations of posterior chamber phakic intraocular lenses with a central hole.

PURPOSE: To study changes in intraocular pressure (IOP) during the early postoperative period in eyes having implantation of a posterior chamber phakic intraocular lens (pIOL) (Visian Implantable Collamer Lens V4c). SETTING: Clínica Baviera, Instituto Oftalmológico Europeo, Madrid, Spain. DESIGN: Case series. METHODS: This retrospective review included the first consecutive eyes having implantation of a spherical or toric myopic pIOL with a central hole at Clínica Baviera from December 2011 to June 2012 by the same experienced surgeon. The IOP was evaluated preoperatively and 1 day, 1 week, and 1 month postoperatively. RESULTS: The study comprised 100 eyes. The mean IOP changed from 14.6 mm Hg ± 3.4 (SD) (range 8 to 26 mm Hg) preoperatively to 14.5 ± 4.6 mm Hg (range 6 to 30 mm Hg) 1 day postoperatively, 14.2 ± 4.2 mm Hg (range 6 to 29 mm Hg) at 1 week, and 12.3 ± 3.4 mm Hg (range 9 to 24 mm Hg) at 1 month. No statistically significant changes were detected over time postoperatively (P>.2). No perioperative complications associated with the implantation of the pIOL were recorded. No pIOLs were explanted, no toric pIOL rotation was detected, and no pupillary block or acute angle closure was observed. CONCLUSION: The short-term clinical data for the new pIOL model with the central hole (KS-Aquaport) suggest that it is a safe and effective means for controlling postoperative IOP.

Long-term comparison of laser in situ keratomileusis versus laser surface ablation in corneas thinner than 470 µm.

PURPOSE: To compare long-term refractive and visual outcomes of laser in situ keratomileusis (LASIK) and laser surface ablation in eyes with corneas thinner than 470 µm. SETTING: Private clinics, Spain. DESIGN: Comparative case series. METHODS: The study comprised eyes with myopic error and corneas thinner than 470 µm that had at least 2.9 years of postoperative follow-up between September 2001 and June 2007. The main outcome measures were safety, efficacy, predictability, and complications. RESULTS: The mean central corneal thickness was 462.0 µm (range 440 to 469 µm) in the LASIK group (n = 40) and 458.1 µm (range 420 to 469 µm) in the laser surface ablation group (n = 88). All eyes had normal preoperative topography. In the LASIK group after a mean follow-up of 5.1 years ± 1.5 (SD), the safety index was 1.07, efficacy was 0.99, and predictability (± 1.00 diopter [D]) was 0.93. In the laser surface ablation group after a mean follow-up of 4.8 ± 1.3 years, the safety index was 1.01, efficacy was 0.93, and predictability (± 1.00 D) was 0.92. The mean residual corneal bed thickness in all eyes was 345 ± 25 µm (range 270 to 399 µm). No major complications occurred. The safety index was better in the LASIK group than in the laser surface ablation group. CONCLUSION: Both techniques were effective, safe, and predictable in eyes with corneas thinner than 470 µm, normal preoperative topography, and a residual corneal bed thickness greater than 250 µm.