Comparison of Femto-LASIK With Combined Accelerated Cross-linking to Femto-LASIK in High Myopic Eyes: A Prospective Randomized Trial.

PURPOSE: To evaluate the safety and efficacy of femtosecond (fs) laser-assisted in situ keratomileusis (LASIK) combined with accelerated corneal cross-linking (LASIK Xtra) compared to conventional fs-LASIK (convLASIK) in high myopic patients. DESIGN: Prospective, randomized, fellow-eye controlled clinical trial. METHODS: Setting: Department of Ophthalmology, Goethe University, Frankfurt/Germany. StudyPopulation: Twenty-six patients with high myopia and/or myopic astigmatism received randomized treatment with LASIK Xtra (30 mW/cm2, 90 seconds with continuous ultraviolet-A) in 1 eye and convLASIK in the other eye. MainOutcomeMeasures: Uncorrected distance visual acuity (UDVA), best spectacle-corrected VA (BSCVA), manifest refractive spherical equivalent (MRSE), endothelial cell count (ECC), and corneal thickness. RESULTS: The UDVA improved from 1.26 ± 0.13 logMAR preoperative to -0.02 ± 0.15logMAR in LASIK Xtra eyes and from 1.27 ± 0.12 logMAR to 0.01 ± 0.15 logMAR in the convLASIK eyes (P > .05). The MRSE changed from -7.35 ± 1.15 diopters (D) and -7.5 ± 1.12 D to -0.17 ± 0.43 D and -0.25 ± 0.46 D, respectively. There was no significant difference in outcomes between both groups during the 12 months follow-up except for the convLASIK eyes' showing slightly better BSCVA after 1 week (P < .05). ConvLASIK eyes revealed a nonsignificant trend toward myopic regression from 3 to 12 months postoperative with a change in MRSE of -0.15 D compared to -0.1 D in LASIK Xtra eyes. Topography showed stability of corneal curvature with no signs of keratectasia in both groups at 12 months. CONCLUSION: While apparently safe, LASIK Xtra showed no advantages over conventional LASIK. At 12 months, both groups showed no difference regarding UDVA and refractive stability, and no signs of keratectasia.

Comparison of a panfocal and trifocal diffractive intraocular lens after femtosecond laser-assisted lens surgery.

PURPOSE: To compare the visual outcomes of 2 diffractive intraocular lenses (IOLs), a panfocal model and a trifocal model, after femtosecond laser-assisted lens surgery. SETTING: Department of Ophthalmology, Goethe University, Frankfurt, Germany. DESIGN: Prospective comparative case series. METHODS: This study comprised patients who had bilateral implantation of a Panoptix (panfocal) or AT LISA (trifocal) IOL. Exclusion criteria were previous ocular surgery, corneal astigmatism greater than 1.50 diopters, ocular pathology, and corneal abnormalities. Postoperative examinations included visual acuity at 4 m, 40 cm, 60 cm (panfocal), and 80 cm (trifocal); monocular distance-corrected defocus testing; and contrast sensitivity. A quality-of-vision questionnaire was also administered. RESULTS: The study comprised 80 patients. There was no significant difference in visual acuity (>0.1 logarithm of the minimum angle of resolution [logMAR]) at any distance between the 2 IOLs (P > .05). The defocus curve of the panfocal IOL (0.01 logMAR) showed significantly better visual acuity at 50 cm compared with the trifocal IOL (0.16 logMAR) (P < .001). There was no significant between-group difference in the defocus curve at other distances (P > .05). The contrast sensitivity under photopic, mesopic, and mesopic conditions with glare was similar between groups (P > .05). CONCLUSIONS: Both IOLs provided excellent distance, intermediate, and near vision. The lenses appear to be equally good options for patients with intermediate vision needs at their preferred foci, while the panfocal IOL might be better for patients with closer vision requirements at 60 cm compared to the trifocal IOL at 80 cm. Both yielded high spectacle independence with comparable contrast sensitivity and high patient satisfaction, despite some optical phenomena.

Comparison of 9 modern intraocular lens power calculation formulas for a quadrifocal intraocular lens.

PURPOSE: To evaluate the accuracy of 9 formulas (Barrett Universal II, Haigis, Hill-Radial Basis Function [RBF], Hoffer Q, Holladay 1, Holladay 2, Olsen, Sanders-Retzlaff-Kraff/theoretical [SRK/T], and T2) calculating the power of the quadrifocal Acrysof IQ Panoptix TFNT00 intraocular lens (IOL). SETTING: Department of Ophthalmology, Goethe University, Frankfurt, Germany. DESIGN: Retrospective case series. METHODS: The study included patients having cataract surgery with insertion of a quadrifocal IOL over 15 months. Preoperative biometry measurements were obtained from an IOLMaster 500. Optimized IOL constants were calculated to reduce the mean refractive prediction error. The primary outcomes were differences in mean absolute prediction error between the formulas. Median and maximum absolute prediction errors were evaluated as well as percentages of eyes within prediction errors of ±0.25 diopters (D), ±0.50 D, ±1.00 D, and ±2.00 D. RESULTS: The study comprised 75 eyes of 38 patients. The formulas were ranked by the mean absolute refractive prediction error as follows: Barrett Universal II (0.294 D), Hill-RBF (0.332 D), Olsen (0.339 D), T2 (0.351 D), Holladay 1 (0.381 D), Haigis (0.382 D), SRK/T (0.393 D), Holladay 2 (0.399 D), and Hoffer Q (0.410 D). The differences in absolute errors between the formulas were significant (P < .001). The lowest maximum absolute prediction error was obtained with the Barrett Universal II. CONCLUSION: The most accurate predictions of actual postoperative refraction were achieved using the Barrett Universal II, Hill-RBF, Olsen, or T2 formula. Thus, one of these formulas should be used for IOL power calculation of the quadrifocal IOL.

Visual Performance of a Quadrifocal (Trifocal) Intraocular Lens Following Removal of the Crystalline Lens.

PURPOSE: To evaluate visual performance after implantation of a quadrifocal intraocular lens (IOL). METHODS: Setting: Department of Ophthalmology, Goethe University, Frankfurt, Germany. STUDY POPULATION: Twenty-seven patients (54 eyes) received bilateral implantation of the PanOptix IOL (AcrySof IQ PanOptixTM; Alcon Research, Fort Worth, Texas, USA) pre-enrollment. Exclusion criteria were previous ocular surgeries, corneal astigmatism of >1.5 diopter (D), ocular pathologies, or corneal abnormalities. Intervention or Observational Procedure(s): Postoperative examination at 3 months including manifest refraction; uncorrected visual acuity (UCVA) and distance-corrected visual acuity (DCVA) in 4 m, 80 cm, 60 cm, and 40 cm slit-lamp examination; defocus testing; contrast sensitivity (CS) under photopic and mesopic conditions; and a questionnaire on subjective quality of vision, optical phenomena, and spectacle independence was performed. MAIN OUTCOME MEASURE(S): At 3 months postoperatively, UCVA and DCVA in 4 m, 80 cm, 60 cm, and 40 cm (logMAR), defocus curves, CS, and quality-of-vision questionnaire results. RESULTS: Mean spherical equivalent was -0.04 ± 0.321 D 3 months postoperatively. Binocular UCVA at distance, intermediate (80 cm, 60 cm), and near was 0.00 ± 0.094 logMAR, 0.09 ± 0.107 logMAR, 0.00 ± 0.111 logMAR, and 0.01 ± 0.087 logMAR, respectively. Binocular defocus curve showed peaks with best visual acuity (VA) at 0.00 D (-0.07 logMAR) and -2.00 D (-0.02 logMAR). CONCLUSION: Visual performance of the PanOptix IOL showed good VA at all distances; particularly good intermediate VA (logMAR > 0.1), with best VA at 60 cm; and high patient satisfaction and spectacle independence 3 months postoperatively.