Comparison of astigmatic correction after femtosecond lenticule extraction and wavefront-guided LASIK for myopic astigmatism.

PURPOSE: To compare postoperative astigmatic correction between femtosecond lenticule extraction (FLEx) and wavefront-guided LASIK in eyes with myopic astigmatism. METHODS: Fifty-eight eyes of 41 patients undergoing FLEx and 49 eyes of 29 patients undergoing wavefront-guided LASIK to correct myopic astigmatism were examined. Visual acuity, cylindrical refraction, predictability of the astigmatic correction, and astigmatic vector components were compared between groups 6 months after surgery. RESULTS: There was no statistically significant difference in manifest cylindrical refraction (P = .08) or percentage of eyes within ± 0.50 diopter (D) of its refraction (P = .11) between the surgical procedures. The index of success in FLEx was statistically significantly better than that of wavefront-guided LASIK (P = .02), although there was no significant difference between the groups in other indices (eg, surgically induced astigmatism, target-induced astigmatism, astigmatic correction index, angle of error, difference vector, and flattening index). Subgroup analysis showed that FLEx had a better index of success (P = .02) and difference vector (P = .04) than wavefront-guided LASIK in the low cylinder subgroup; the angle of error in FLEx was significantly smaller than that of wavefront-guided LASIK in the moderate cylinder subgroup (P = .03). CONCLUSIONS: Both FLEx and wavefront-guided LASIK worked well for the correction of myopic astigmatism by the 6-month follow-up visit. Although FLEx had a better index of success than wavefront-guided LASIK when using vector analysis, it appears equivalent to wavefront-guided LASIK in terms of visual acuity and the correction of astigmatism.

Association between ocular dominance and refractive asymmetry.

PURPOSE: To investigate the association between ocular dominance (sighting dominance) and refractive asymmetry in phakic patients. METHODS: This retrospective study included 3,012 patients with a mean age of 29.0 ± 5.3 years (range: 20 to 39 years). Refractive error was determined with cycloplegic refraction and axial length was determined with IOLMaster (Carl Zeiss Meditec, Dublin, CA). Ocular dominance was assessed using the hole-in-the-card test. RESULTS: The right and left eyes were dominant in 77.7% and 22.3% of the patients, respectively. In the high anisometropia group (⩾ 2.0 diopters), the non-dominant eyes had significantly higher myopic spherical equivalents and longer axial lengths than the dominant eyes (P < .05). However, there were no significant differences in these parameters in the low anisometropia group. CONCLUSION: The current study revealed that non-dominant eyes had a greater myopic refractive error and longer axial length than the dominant eyes, especially in the patients who had high amounts of anisometropia.

Aberrant GIMAP2 expression affects oral squamous cell carcinoma progression by promoting cell cycle and inhibiting apoptosis.

GTPases of immunity-associated protein 2 (GIMAP2) is a GTPase family member associated with T cell survival. However, its mechanisms of action in oral squamous cell carcinoma (OSCC) remain largely unknown. Therefore, the present study aimed to elucidate the possible role of GIMAP2 in OSCC development by investigating its expression levels and molecular mechanisms in OSCC. Reverse transcription quantitative PCR, immunoblotting and immunohistochemistry indicated that GIMAP2 expression was significantly upregulated (P<0.05) in OSCC-derived cell lines and primary OSCC specimens compared with that in their normal counterparts. GIMAP2-knockdown OSCC cells exhibited decreased cell growth, which was associated with cyclin-dependent kinase (CDK)4, CDK6 and phosphorylated Rb downregulation and p53 and p21 upregulation. In addition to cell cycle arrest, GIMAP2 affected anti-apoptotic functions in GIMAP2-knockdown cells by upregulating Bcl-2 and downregulating Bax and Bak. These findings indicated that GIMAP2 may significantly influence OSCC development and apoptosis inhibition and thus is a potential biomarker of OSCC.

Clinical outcomes of posterior chamber toric phakic intraocular lens implantation for the correction of high myopic astigmatism in eyes with keratoconus: 6-month follow-up.

BACKGROUND: To assess the early clinical outcomes of toric implantable collamer lenses (toric ICL™, STAAR Surgical) for the correction of high myopic astigmatism with keratoconus. METHODS: This study evaluated 27 eyes of 14 patients with spherical equivalents of -10.11 ± 2.46 D (mean ± standard deviation) and astigmatism of -3.03 ± 1.58 D who underwent toric ICL implantation for mild keratoconus. Before, and 1, 3 and 6 months after surgery, we assessed the safety, efficacy, predictability, stability, and adverse events of the surgery. RESULTS: LogMAR uncorrected visual acuity (UCVA) and LogMAR best spectacle-corrected visual acuity (BSCVA) were -0.09 ± 0.16 and -0.15 ± 0.09 respectively, 6 months after surgery. The safety and efficacy indices were 1.12 ± 0.18 and 1.01 ± 0.25. At 6 months, 85% and 96% of the eyes were within ±0.5 and ±1.0 D respectively of the targeted correction. Manifest refraction changes of 0.00 ± 0.35 D occurred from 1 week to 6 months. No vision-threatening complications occurred during the observation period. CONCLUSIONS: Toric ICL implantation was good in all measures of safety, efficacy, predictability, and stability for the correction of spherical and cylindrical errors in eyes with early keratoconus throughout the 6-month follow-up period, suggesting its viability as a surgical option for the treatment of such eyes.

One-year follow-up of posterior chamber toric phakic intraocular lens implantation for moderate to high myopic astigmatism.

OBJECTIVE: To assess the 1-year clinical outcomes of toric Visian Implantable Collamer Lens (ICL; STAAR Surgical, Nidau, Switzerland) implantation for moderate to high myopic astigmatism. DESIGN: Prospective, observational case series. PARTICIPANTS: Fifty-six eyes of 32 consecutive patients, with spherical equivalent errors of -4.00 to -17.25 diopters (D) and cylindrical errors of -0.75 to -4.00 D, who underwent toric ICL implantation. METHODS: Before and 1 week and 1, 3, 6, and 12 months after surgery, the safety, efficacy, predictability, stability, and adverse events of the surgery were assessed in eyes undergoing toric ICL implantation. Ocular higher-order aberrations (HOAs) and contrast sensitivity (CS) function also were evaluated before and 1 year after surgery. MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), safety index, efficacy index, predictability, stability, adverse events, HOAs, and CS function. RESULTS: The logarithm of the minimum angle of resolution (logMAR) UCVA and logMAR BSCVA were -0.11 (corresponding to Snellen equivalent 20/16) ± 0.12 and -0.19 (corresponding to 20/12.5) ± 0.08 1 year after surgery, respectively. The safety and efficacy indices were 1.17 ± 0.21 and 1.00 ± 0.29. At 1 year, 91% and 100% of the eyes were within 0.5 and 1.0 D, respectively, of the targeted correction. Manifest refraction changes of -0.07 ± 0.27 D occurred from 1 week to 1 year. For a 4-mm pupil, fourth-order aberrations were changed, not significantly, from 0.05 ± 0.02 µm before surgery to 0.06 ± 0.03 µm after surgery (P = 0.38, Wilcoxon signed-rank test). Similarly, for a 6-mm pupil, fourth-order aberrations were not significantly changed, merely from 0.20 ± 0.08 µm before surgery to 0.23 ± 0.11 µm after surgery (P = 0.15). The area under the log CS function was significantly increased from 1.41 ± 0.15 before surgery to 1.50 ± 0.13 after surgery (P < 0.001). No vision-threatening complications occurred during the observation period. CONCLUSIONS: In the authors' experience, the toric ICL performed well in correcting moderate to high myopic astigmatism during a 1-year observation period, suggesting its viability as a surgical option for the treatment of such eyes.

Factors affecting vaulting after implantable collamer lens implantation.

PURPOSE: To evaluate the vaulting of the STAAR Implantable Collamer Lens (ICL) over the crystalline lens after implantation. METHODS: One hundred twenty-three eyes of 68 patients with myopic refractive errors of -3.25 to -22.75 diopters undergoing ICL implantation were examined retrospectively. The magnitude of the central vaulting of the ICL was assessed quantitatively using slit-lamp microscopy at 3 months after surgery. Multiple regression analysis was used to assess the factors affecting the amount of vaulting. RESULTS: The mean central vaulting 3 months after surgery was 603.6 +/- 259.6 microm. Explanatory variables relevant to the vaulting were, in order of influence, the horizontal white-to-white distance (partial regression coefficient B = 0.268, P = .0002) and patient age (B = -0.007, P = .011). CONCLUSIONS: Although the majority of the variance remains unexplained, younger patients' eyes and eyes with greater white-to-white distances are more predisposed to have higher ICL vaulting over the crystalline lens.

Effects of antiglaucoma drugs on refractive outcomes in eyes with myopic regression after laser in situ keratomileusis.

PURPOSE: To assess effects of antiglaucoma drugs on refractive outcomes in eyes with myopic regression after laser in situ keratomileusis (LASIK). DESIGN: Prospective, nonrandomized clinical trial. METHODS: We examined 27 eyes with mean myopic regression +/- standard deviation of -1.26 +/- 0.48 diopters (D; range, -0.50 to -2.25 D) after LASIK. Nipradilol 2.5% was administered topically twice daily to these regressive eyes. We obtained the refraction (spherical equivalent, astigmatism), intraocular pressure (IOP) measurements, pachymetry, geometry, and refractive power of the cornea before and three months after treatment. RESULTS: Mean manifest refraction was improved significantly from -1.02 +/- 0.52 D to -0.44 +/- 0.39 D (P < .001). However, mean manifest astigmatism was changed from -0.55 +/- 0.30 D to -0.49 +/- 0.22 D, but the difference was not significant (P = .23). The IOP was decreased significantly from 11.4 +/- 2.4 mm Hg to 9.4 +/- 1.3 mm Hg (P < .001). Central corneal thickness was not changed significantly from 505.2 +/- 39.3 microm to 503.6 +/- 38.7 microm (P = .61). The posterior corneal surface was shifted posteriorly by 9.1 +/- 8.2 microm, and the total refractive power of the cornea was decreased significantly, by 0.63 +/- 0.62 D (P < .001), at three months after application. CONCLUSIONS: The preliminary data show that antiglaucoma drugs are effective for the reduction of the refractive regression, especially of the spherical errors, after LASIK. It is suggested that backward movement of the cornea may occur, possibly flattening the corneal curvature by lowering the IOP. Reduction of the IOP may contribute to improving regression after keratorefractive surgery.

Comparison of Collamer toric implantable [corrected] contact lens implantation and wavefront-guided laser in situ keratomileusis for high myopic astigmatism.

PURPOSE: To compare the postoperative visual outcomes after implantation of a Collamer toric implantable contact lens (ICL) and after wavefront-guided laser in situ keratomileusis in high myopic astigmatism. SETTING: Department of Ophthalmology, Kitasato University, Kanagawa, Japan. METHODS: This study comprised 30 eyes (18 patients) having toric ICL implantation and 24 eyes (17 patients) having wavefront-guided LASIK (Technolas 217z) to correct high myopic astigmatism (manifest spherical equivalent [SE] or=1.0 D). The safety, efficacy, predictability, stability, and adverse events were assessed preoperatively and 1 week and 1, 3, and 6 months postoperatively. RESULTS: At 6 months, the mean safety index was 1.28+/-0.25 (SD) in the ICL group and 1.01+/-0.16 in the LASIK group and the mean efficacy index, 0.87+/-0.15 and 0.83+/-0.23, respectively. All eyes in the ICL group and 71% of eyes in the LASIK group were within +/-1.00 D of the targeted SE correction at 6 months. The mean change in manifest refraction from 1 week to 6 months was -0.04+/-0.24 D in the ICL group and -0.60+/-0.49 D in the LASIK group. There were no significant complications in the ICL group; 2 eyes (8.3%) in the LASIK group required enhancement ablations. CONCLUSION: Toric ICL implantation was better than wavefront-guided LASIK in eyes with high myopic astigmatism in almost all measures of safety, efficacy, predictability, and stability, suggesting that toric ICL implantation may become a viable surgical option to treat high myopic astigmatism.

[Long-term clinical course of laser in situ keratomileusis--two year follow-up].

PURPOSE: To evaluate the cases that were treated with laser in situ keratomileusis (LASIK) and who were follwed up for a full 2-year period without fail. MATERIALS AND METHODS: LASIK was performed in 62 eyes of 35 patients between June 1997 and March 1999. Mean age was 29.1 years and the preoperative mean spherical equivalent refraction was -6.90 +/- 2.49 (mean +/- standard deviation) diopter (D). Five aspects were studied as follows. RESULTS: 1. SAFETY: 26 eyes (41.9%) gained 1 line or more in best corrected visual acuity. Twenty eyes (32.3%) were unchanged. Sixteen eyes(25.8%) lost 1 line. No eye lost 2 lines or more. The safety index was 1.04. 2. EFFICACY: The efficacy index was 0.85. 3. Predictability: Forty-eight eyes (77.4%) were predictable within +/- 0.5 D, and 55 eyes (88.7%) were within +/- 1.0 D. 4. Stability: Manifest refraction was relatively stable after 3 months. 5. Complication: No complications were experienced. CONCLUSIONS: Our 2-year follow-up showed that postoperatively LASIK was safe and effective.

Demographics of patients having cataract surgery after laser in situ keratomileusis.

PURPOSE: To retrospectively assess the demographics of patients having cataract surgery in eyes with previous laser in situ keratomileusis (LASIK). SETTING: Department of Ophthalmology, Kitasato University, Kanagawa, and Sanno Hospital, Tokyo, Japan. DESIGN: Retrospective case series. METHODS: This study evaluated eyes of consecutive patients scheduled for cataract surgery after previous LASIK (Group 1). The control groups comprised eyes with axial lengths (ALs) matched with ALS in Group 1 (Group 2) and all eyes scheduled for cataract surgery (Group 3). Assessed were age, sex, corrected distance visual acuity, manifest refraction, keratometry (K) readings, corneal astigmatism, and corneal higher-order aberrations (HOAs). RESULTS: Group 1 comprised 40 eyes of 40 patients; Group 2, 606 eyes of 606 patients; and Group 3, 3642 eyes of 3642 patients. The mean age at cataract surgery of patients in Group 1 was 54.6 years ± 8.1 (SD), which was significantly younger than in Group 2 (by approximately 10 years) and Group 3 (by approximately 15 years) (P < .001, Student t test). In Group 1, 70.0% of patients were men, a significantly higher percentage than in Groups 2 and 3 (P < .05, Fisher exact test). The rate of corneal HOAs was significantly higher in Group 1 than in Groups 2 and 3 (P < .05, Student t test). There were no significant differences in other demographics except in K readings. CONCLUSION: A long AL and an increase in corneal HOAs might contribute to a tendency for cataract surgery to be performed earlier in eyes in which LASIK has been performed. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Three-year follow-up of posterior chamber toric phakic intraocular lens implantation for the correction of high myopic astigmatism in eyes with keratoconus.

AIM: To assess the clinical outcomes following the use of toric implantable collamer lenses (toric ICL, STAAR Surgical) for the correction of high myopic astigmatism with keratoconus. METHODS: This retrospective study evaluated 21 eyes of 11 patients with spherical equivalents of -9.70±2.33 D (mean±SD) and astigmatism of -3.21±1.56 D who underwent toric ICL implantation for keratoconus. Preoperatively, and at 1, 3 and 6 months and 1, 2 and 3 years postoperatively, we assessed the safety, efficacy, predictability, stability and adverse events of the surgery. RESULTS: The logarithm of the minimum angle of resolution (logMAR) uncorrected distance visual acuity (UDVA) and the logMAR corrected distance visual acuity (CDVA) were -0.06±0.11 and -0.12±0.09, respectively, at 3 years postoperatively. At 3 years, 67% and 86% of the eyes were within ±0.5 and ±1.0 D, respectively, of the targeted correction. Manifest refraction changes of 0.04±0.33 D occurred from 1 month to 3 years postoperatively. No significant change in manifest refraction (analysis of variance, p=0.989) or keratometry (p=0.951), or vision-threatening complications occurred during the observation period. CONCLUSIONS: Toric ICL implantation is beneficial according to measures of safety, efficacy, predictability and stability for the correction of refractive errors for keratoconus during a 3-year observation period. The disease did not progress even in the late-postoperative period, suggesting the viability of this procedure as a surgical option for the treatment of such eyes.

Clinical outcomes of wavefront-guided laser in situ keratomileusis: 6-month follow-up.

PURPOSE: To evaluate the clinical outcomes 6 months after wavefront-guided laser in situ keratomileusis (LASIK) for myopia in Japan. SETTING: Department of Ophthalmology, Sanno Hospital, Tokyo, Japan. METHODS: This prospective study comprised 22 eyes of 12 patients treated with wavefront-guided LASIK who were available for evaluation at 6 months. The mean patient age was 31.2 years +/- 8.4 (SD) (range 23 to 50 years), and the mean preoperative spherical equivalent refraction was -7.30 +/- 2.72 diopters (D) (range -2.75 to -11.88 D). In all cases, preoperative wavefront analysis was performed with a Hartmann-Shack aberrometer and the Technolas 217z flying-spot excimer laser system (Bausch & Lomb) was used with 1.0 mm and 2.0 mm spot sizes and an active eye tracker with a 120 Hz tracking rate. The clinical outcomes of wavefront-guided LASIK were evaluated in terms of safety, efficacy, predictability, stability, complications, and preoperative and postoperative aberrations. RESULTS: At 6 months, 10 eyes had no change in best spectacle-correct visual acuity and 10 gained 1 or more lines. The safety index was 1.11 and the efficacy index, 0.82. Slight undercorrections were observed in highly myopic eyes. In all eyes, the postoperative refraction tended slightly toward myopia for 3 months and stabilized after that. No complication such as epithelial ingrowth, diffuse lamellar keratitis, or infection was observed. Comparison of the preoperative and postoperative aberrations showed that 2nd-order aberrations decreased and higher-order aberrations increased. In the 3rd order, aberrations increased in the high-myopia group (-6.0 D or worse) and decreased in the low to moderate-myopia group (better than -6.0 D). CONCLUSION: Wavefront-guided LASIK was a good option for refractive surgery, although a longer follow-up in a larger study is required.

Late-onset diffuse lamellar keratitis.

BACKGROUND: Diffuse lamellar keratitis (DLK) is marked by the presence of diffuse or multifocal infiltrates confined to the laser in situ keratomileusis (LASIK) interface. These infiltrates are culture-negative, and the etiology is thought to be noninfectious. Most cases of DLK occur within the first week or 2 following surgery. CASES: We described 2 cases of DLK that occurred 3 months after LASIK. These patients were treated with intensive topical corticosteroids. RESULTS: Treatment with topical corticosteroid was instituted, with rapid improvement in patient symptoms, visual acuity, and slit-lamp biomicroscopic findings. CONCLUSION: DLK may occur as late as 3 months after LASIK.

[Late onset diffuse lamellar keratitis].

BACKGROUND: Diffuse lamellar keratitis (DLK) is marked by the presence of diffuse or multifocal infiltrates confined to the laser in situ keratomileusis(LASIK) interface. These infiltrates are culture-negative, and the etiology is thought to be noninfectious. Most cases of DLK occur within the first week or two following surgery. CASE: We describe two cases of diffuse lamellar keratitis that occurred 3 months after LASIK. These patients were treated with intensive topical corticosteroids. RESULTS: We treated the patients with topical corticosteroids, with rapid improvement in patient symptoms, visual acuity, and slit-lamp biomicroscopy. CONCLUSION: DLK may occur three months after LASIK.

Long-term quality of life after posterior chamber phakic intraocular lens implantation and after wavefront-guided laser in situ keratomileusis for myopia.

PURPOSE: To compare the vision-related quality of life 5 years after Implantable Collamer Lens phakic intraocular lens (pIOL) implantation and after wavefront-guided laser in situ keratomileusis (LASIK) for myopia. SETTING: Department of Ophthalmology, Kitasato University, Kanagawa, Japan. DESIGN: Retrospective case series. METHODS: Quality of life was measured with the National Eye Institute Refractive Error Quality of Life instrument in consecutive patients 5 years after pIOL implantation or wavefront-guided LASIK to correct myopia. RESULTS: Phakic IOL implantation was performed in 48 patients and LASIK in 55 patients. The scores for activity limitations, symptoms, appearance, and satisfaction with correction were significantly higher in the pIOL group than in the LASIK group (P<.05, Mann-Whitney U test). No significant differences in other scores were observed between the 2 groups (P ≥.05). The scores for near vision and dependence on correction were significantly higher in the younger subgroup than in the older subgroup with both techniques. CONCLUSIONS: Phakic IOL implantation may offer significant vision-related quality-of-life advantages (eg, fewer activity limitations and symptoms and better appearance and satisfaction with correction) over wavefront-guided LASIK for myopia in the long term. Moreover, refractive surgery may provide a better quality of life in younger patients.

Three-year follow-up of posterior chamber toric phakic intraocular lens implantation for moderate to high myopic astigmatism.

PURPOSE: To assess the 3-year clinical outcomes of toric phakic intraocular lens (Visian ICL™; STAAR Surgical) implantation for moderate to high myopic astigmatism. METHODS: This retrospective study evaluated fifty eyes of 28 patients who underwent toric ICL implantation for the correction of moderate to high myopic astigmatism and who regularly returned for postoperative examination. Before, and 1, 3, and 6 months after, and 1, 2, and 3 years after surgery, we assessed the safety, efficacy, predictability, stability, and adverse events of the surgery in eyes undergoing toric ICL implantation. RESULTS: The logarithm of the minimal angle of resolution (LogMAR) uncorrected visual acuity and LogMAR best spectacle-corrected visual acuity were -0.10 (corresponding to Snellen equivalents 20/16) ± 0.16 and -0.20 (corresponding to 20/12.5) ± 0.07, 3 years postoperatively, respectively. The safety and efficacy indices were 1.16 ± 0.20 and 0.94 ± 0.28. At 3 year, 82% and 98% of the eyes were within 0.5 and 1.0 D, respectively, of the targeted correction. Manifest refraction changes of -0.15 ± 0.31 D occurred from 1 month to 3 year. No vision-threatening complications occurred during the observation period. CONCLUSIONS: On the basis of the clinical results of this study, toric ICL implantation was good in all measures of safety, efficacy, predictability, and stability for the correction of moderate to high myopic astigmatism throughout a 3-year observation period.

Comparison of visual acuity, higher-order aberrations and corneal asphericity after refractive lenticule extraction and wavefront-guided laser-assisted in situ keratomileusis for myopia.

AIM: To compare postoperative visual acuity, higher-order aberrations (HOAs) and corneal asphericity after femtosecond lenticule extraction (FLEx) and after wavefront-guided laser-assisted in situ keratomileusis (wfg-LASIK) in myopic eyes. METHODS: We examined 43 eyes of 23 patients undergoing FLEx and 34 eyes of 19 patients undergoing wfg-LASIK to correct myopia. Ocular HOAs were measured by Hartmann-Shack aberrometry and corneal asphericity was measured by a rotating Scheimpflug imaging system before and 3 months after surgery. RESULTS: There was no statistically significant difference in uncorrected (p=0.66 Mann-Whitney U-test) or corrected distance visual acuity (p=0.14) after two surgical procedures. For a 6-mm pupil, the changes in fourth-order aberrations after FLEx were statistically significantly less than those after wfg-LASIK (p<0.001). On the other hand, there were no statistically significant differences in the changes in third-order aberrations (p=0.24) and total HOAs (p=0.13). Similar results were obtained for a 4-mm pupil. The positive changes in the Q value after FLEx were statistically significantly less than those after wfg-LASIK (p=0.001). CONCLUSIONS: In myopic eyes, FLEx induces significantly fewer ocular fourth-order aberrations than wfg-LASIK, possibly because it causes less oblation in the corneal shape, but there was no statistically significant difference in visual acuity or in the induction of third-order aberrations and total HOAs. It is suggested that FLEx is essentially equivalent to wfg-LASIK in terms of visual acuity and total HOA induction, although the characteristics of HOA induction are different.

Time course of refractive and corneal astigmatism after laser in situ keratomileusis for moderate to high astigmatism.

PURPOSE: To assess the time course of refractive and corneal astigmatism after laser in situ keratomileusis (LASIK) in eyes with moderate to high astigmatism. SETTING: Department of Ophthalmology, Kitasato University, Kanagawa, Japan. DESIGN: Retrospective case series. METHODS: Keratometric readings and corneal astigmatism were determined with an autokeratometer in consecutive patients who had LASIK for moderate to high astigmatism (≥2.00 diopters [D]). RESULTS: The study enrolled 48 eyes of 35 patients with a mean age of 34.0 years ± 8.1 (SD), a mean spherical error of -5.10 ± 2.11 D, and a mean cylindrical error of -2.74 ± 0.99 D. Postoperatively, the mean spherical refraction changed significantly from 0.38 ± 0.80 D at 1 week to -0.13 ± 0.90 D at 1 year (P<.001, Wilcoxon signed-rank test). The mean cylindrical refraction showed no significant change (-0.67 ± 0.54 D at 1 week to -0.63 ± 0.63 D at 1 year) (P=.54). There were significant increases in the flattest and steepest keratometry readings at 1 week and at 1 year. However, no significant change in corneal astigmatism was found at either time point (P=.10). CONCLUSIONS: After LASIK, there was significant refractive regression in the spherical component but not in the cylindrical component. This suggests that refractive regression occurs by corneal steepening in the spherical component and that astigmatic regression does not occur, even in moderately to highly astigmatic eyes. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Visual performance after posterior chamber phakic intraocular lens implantation and wavefront-guided laser in situ keratomileusis for low to moderate myopia.

PURPOSE: To compare postoperative visual function after implantable collamer lens (ICL) implantation and after wavefront-guided laser in situ keratomileusis (LASIK) in eyes with low to moderate myopia. DESIGN: Retrospective observational case study. PATIENTS AND METHODS: We investigated 30 eyes of 20 patients undergoing ICL implantation and 64 eyes of 38 patients undergoing wavefront-guided LASIK for the correction of low to moderate myopia (manifest spherical equivalent: -3.00 to -5.88 diopters [D]). Ocular higher-order aberrations (HOAs) and contrast sensitivity (CS) function were measured by Hartmann-Shack aberrometry and a contrast sensitivity unit before and 3 months after surgery, respectively. From the contrast sensitivity, the area under the log contrast sensitivity function was calculated. RESULTS: For 4-mm and 6-mm pupils, the changes in ocular third-order aberrations, fourth-order aberrations, and total HOAs after ICL implantation were significantly less than those after wavefront-guided LASIK (P < .05, Mann-Whitney U test). The postoperative area under the log contrast sensitivity function was significantly increased after ICL implantation (P < .001), whereas, after wavefront-guided LASIK, it was not significantly changed (P = .11). CONCLUSIONS: ICL implantation induces significantly fewer ocular HOAs than wavefront-guided LASIK. Moreover, CS was significantly improved after ICL implantation but unchanged after wavefront-guided LASIK in eyes with low to moderate myopia. Thus, even in the correction of low to moderate myopia, ICL implantation appears to be superior in visual performance to wavefront-guided LASIK, suggesting that it may be a viable surgical option for the treatment of such eyes.

Implantable Collamer Lens implantation and limbal relaxing incisions for the correction of hyperopic astigmatism after laser in situ keratomileusis.

PURPOSE: To report on a patient in whom hyperopic Implantable Collamer Lenses (ICL, STAAR Surgical, Nidau, Switzerland) and limbal relaxing incisions have been beneficial for the correction of hyperopic astigmatism after laser in situ keratomileusis (LASIK). METHODS: The 48-year-old man had undergone LASIK to correct high myopia 5 years earlier. Preoperatively, the manifest refraction was +2.25, -1.00 x 160, with an uncorrected visual acuity of 0.15 and a best spectacle-corrected visual acuity of 1.5. RESULTS: Postoperatively, the manifest refraction was +0.50, -0.5 x 165, with an uncorrected visual acuity of 1.0 and a best spectacle-corrected visual acuity of 1.2. No serious complications were observed during the 10-month observation period. CONCLUSION: Hyperopic Implantable Collamer Lenses implantation combined with limbal relaxing incisions may be an alternative for the treatment of hyperopic astigmatism after overcorrected myopic LASIK.