Trifocal IOL Implantation in Eyes With Previous Laser Corneal Refractive Surgery: The Impact of Corneal Spherical Aberration on Postoperative Visual Outcomes.

PURPOSE: To analyze corneal aberrations and factors affecting visual outcomes after implantation of a trifocal intraocular lens (IOL) in eyes previously treated with laser corneal refractive surgery. METHODS: This retrospective case series included 222 consecutive eyes implanted with the trifocal FineVision Micro-F IOL (PhysIOL) after laser corneal refractive surgery. The series was divided into two groups according to safety outcomes after lensectomy: eyes with loss of one or more lines of corrected distance visual acuity (CDVA) [n = 59, 26.5%]) (failed eyes group) and eyes with no loss or gain in CDVA lines (n = 163, 73.4%]) (successful eyes group). Distribution of tomographic corneal aberrations (spherical aberration [Z40], comatic and root mean square of higher order aberrations [RMS-HOA]), laser corneal refractive surgery error, kappa angle, and CDVA after laser corneal refractive surgery were compared among both groups. RESULTS: Mean CDVA after lensectomy was 0.15 ± 0.07 logMAR (range: 0.05 to 0.30 logMAR) versus 0.03 ± 0.04 logMAR (range: 0.00 to 0.15 logMAR) in the failed and successful eyes groups, respectively (P < .001). Comparison of both groups showed that failed eyes had a statistically significantly higher grade of hyperopic laser corneal refractive surgery than successful eyes measured as mean sphere (+0.71 ± 3.10 diopters [D] [range: -7.75 to +6.00 D] vs -0.46 ± 3.70 D [range: -10.75 to +6.00 D], P < .01), spherical equivalent (+0.27 ± 3.10 D [range: -8.00 to +5.50 D] vs -0.97 ± 3.60 D [range: -12.50 to +4.90 D], P < .05), and percentage of hyperopic laser corneal refractive surgery (64% vs 43.5%, P < .05). Corneal aberration analysis showed that mean Z40 values were significantly more negative in the failed eyes group than in the successful eyes group (+0.07 ± 0.40 mm [range: -0.82 to +0.65 mm] vs +0.18 ± 0.37 mm [range: -0.79 to +0.87 mm], P < .05). Laser corneal refractive surgery cylinder was distributed homogeneously between both groups, as well as coma and RMS-HOA, kappa angle, and CDVA after laser corneal refractive surgery that were not statistically significant. CONCLUSIONS: Surgeons should consider tomographic corneal spherical aberration after implantation of a trifocal IOL in eyes after keratorefractive surgery, particularly in eyes previously treated with hyperopic laser corneal refractive surgery, to prevent loss of lines of visual acuity after lensectomy. [J Refract Surg. 2022:38(4):222-228.].

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.

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.

Long-term assessment of crystalline lens transparency in eyes implanted with a central-hole phakic collamer lens developing low postoperative vault.

PURPOSE: To assess long-term crystalline lens transparency in eyes implanted with phakic collamer intraocular lens (pIOL) with a central port and low postoperative vault for correction of myopia. SETTING: Clinica Baviera, Madrid, Spain. DESIGN: Retrospective cross-sectional single-center study. METHODS: Using a noninvasive Fourier-domain swept-source anterior segment optical coherence tomography system, shifts in myopic and astigmatic myopic eyes implanted with a pIOL with vaulting lower than 100 µm in miosis and more than 4 years of follow-up were dynamically evaluated. Main outcome measures were pIOL dynamic vault (vault interval and vault range [VR]), crystalline lens density, and anterior subcapsular lens opacities. Crystalline lenses were examined under slitlamp microscopy, and lens density was evaluated using quantitative Scheimpflug images. Scheimpflug images were compared with those of a control group comprising eyes that were candidates for pIOL implantation. RESULTS: The study population comprised 24 eyes from 16 patients previously implanted with a pIOL (5.82 ± 0.9 years) with central vault lower than 100 µm under photopically induced miosis. The mean vault value was 52 ± 19 µm under photopic light conditions and 113 ± 37 µm under scotopic conditions. The mean VR was 58 ± 24 µm. Anterior subcapsular lens opacities were found in only 1 eye (4.17%). The mean lens density was 7.94 ± 0.43, and no statistically significant differences were observed compared with the control group. CONCLUSIONS: Long-term low vaulting in eyes implanted with a pIOL with a central port for correction of myopia was associated with a low risk for developing anterior crystalline lens opacities.

Changes in the total corneal refractive power after insertion of intrastromal rings in patients with keratoconus in short, medium and long term / Mudanças no poder refrativo total da córnea após a inserção de anéis intrastromais em pacientes com ceratocone a curto, médio e longo prazo

ABSTRACT Objective To analyze the short, medium and long-term efficacy and stability in 46 eyes with keratoconus, operated with Ferrara intrastromal corneal ring segments. Methods The primary endpoint was the mean keratometry of total corneal refractive power. We also studied the effects of age, degree of keratoconus and clinical phenotype on the results, as well as the following keratometry variations and aberrometry variations: flattest, most curved, mean, maximum, astigmatism, root mean square of primary coma aberration and root mean square of secondary coma aberration. Results The immediate postoperative reduction in mean keratometry of total corneal refractive power was 3.08±1.51 diopters (D) (p<0.001). At 4 years, the mean keratometry of total corneal refractive power increased to 0.57±0.96D (p=0.005). Between 4 and 7 years, there was no change in mean keratometry of total corneal refractive power (p=0.727). The degree of keratoconus was a factor affecting the efficacy of the intrastromal corneal ring segments, achieving a greater effect in those with a greater degree of keratoconus (p=0.012 between groups). The immediate postoperative reduction was 1.77±1.88D for the flattest, 3.91±2.30D for the most curved, 2.76±1.63D for the mean, 4.42±3.26D for the maximum, 2.15±2.68D for astigmatism, 1.03±0.83µm for root mean square of primary coma aberration and root mean square of secondary coma aberration (p<.001 in all cases). At 4 years, most curved increased by 0.42±0.78D (p=0.001), mean increased by 0.54±0.64 (p<0.001) and root mean square of primary coma aberration decreased 0.14±0.27µm (p=0.020). Conclusion Ferrara intrastromal corneal ring segment implantation is an effective and stable long-term treatment for patients with keratoconus. There is, however, partial regression in the medium term.

RESUMO Objetivo Analisar a eficácia e a estabilidade a curto, médio e longo prazo em 46 olhos com ceratocone, operados com segmentos de anel intrastromal corneano de Ferrara. Métodos A meta primária foi a ceratometria média de poder refrativo total da córnea. Também estudamos os efeitos da idade, grau de ceratocone e fenótipo clínico nos resultados, bem como as seguintes variações de ceratometria e variações de aberrometria: mais plana, mais curva, média, máxima, astigmatismo, raiz quadrada média da aberração comática primária e raiz quadrada média da aberração comática secundária. Resultados A redução pós-operatória imediata da ceratometria média do poder refrativo total da córnea foi de 3,08±1,51 dioptrias (D) (p<0,001). Aos 4 anos, a ceratometria média do poder refrativo total da córnea aumentou para 0,57±0,96D (p=0,005). Entre 4 e 7 anos, não houve mudança na ceratometria média da potência refrativa total da córnea (p=0,727). O grau de ceratocone foi um fator que afetou a eficácia dos segmentos do anel intrastromal da córnea, alcançando um efeito maior naqueles com maior grau de ceratocone (p=0,012 entre grupos). A redução pós-operatória imediata foi de 1,77±1,88D para a mais plana, 3,91±2,30D para a mais curva, 2,76±1,63D para a média, 4,42±3,26D para a máxima, 2,15±2,68D para o astigmatismo, 1,03±0,83µm para a raiz quadrada média da aberração comática primária e raiz quadrada média da aberração comática secundária (p<0,001 em todos os casos). Aos 4 anos, a maioria das curvas aumentou 0,42±0,78D (p=0,001), a média aumentou 0,54±0,64 (p<0,001) e a raiz quadrada média da aberração comática primária diminuiu 0,14±0,27µm (p=0,020). Conclusão O implante de anel intrastromal corneano Ferrara é um tratamento eficaz e estável a longo prazo para pacientes com ceratocone. Há, no entanto, uma regressão parcial a médio prazo.