Visual outcomes after small incision lenticule extraction and implantable collamer lens V4c for moderate myopia: 1-year results.

PURPOSE: To compare 1-year visual outcomes after implantable collamer lens V4c (EVO-ICL) implantation and small incision lenticule extraction (SMILE) for moderate myopia. METHODS: In this retrospective study, 67 eyes of 39 patients with a preoperative manifest refraction spherical equivalent between - 3.00 and - 6.00 diopters (D) were selected from a database of SMILE and ICL implantation procedures performed from April 2018 to December 2018. Thirty-two eyes of 20 patients underwent EVO-ICL implantation, and 35 eyes of 19 patients underwent SMILE. At the routine 1-year follow-up appointment, all selected patients were examined for higher-order ocular aberrations, retinal image quality, and a quality of vision (QoV) questionnaire. This data was then analyzed. RESULTS: No complications were observed. Uncorrected and corrected visual acuities at 1 year after surgery were - 0.13 ± 0.07 and - 0.15 ± 0.06 logMAR in the SMILE group, and - 0.10 ± 0.07 and - 0.16 ± 0.05 logMAR in the ICL group. Twenty-nine eyes (90.6%) which underwent ICL implantation and 34 eyes (97.1%) which underwent SMILE were within ± 0.5 D of the attempted spherical equivalent (P = 0.49). Changes in coma after ICL were significantly less than after SMILE (P = 0.002). The leading complaints after ICL and SMILE were halos (84.4%) and blurred vision (65.7%), respectively. CONCLUSIONS: Both SMILE and ICL implantation provided good safety, efficacy, and predictability in correcting moderate myopia. The subjective visual complaints consisted mainly of halos after ICL and starbursts and blurred vision after SMILE.

Optomap ultrawide field imaging for detecting peripheral retinal lesions in 1725 high myopic eyes before implantable collamer lens surgery.

IMPORTANCE: Identifying peripheral retinal lesions in high myopia patients before implantable collamer lens (ICL) surgery by nonmydriatic Optomap ultrawide field imaging. BACKGROUND: To investigate specificity and sensitivity of nonmydriatic Optomap ultrawide field imaging for detecting peripheral retinal lesions in high myopia patients before ICL surgery. DESIGN: Hospital-based, cross-sectional study. PARTICIPANTS: A total of 1725 high myopic eyes of 897 ICL surgery candidates were included in this study. METHODS: Patients with high myopia were scheduled for routine ophthalmic examination before ICL implantation. Nonmydriatic Optomap ultrawide field imaging was applied for detecting potential peripheral retinal lesions before ICL surgery. MAIN OUTCOME MEASURES: Presence of peripheral retinal lesions. RESULTS: Of 1725 eyes, 344 (19.94%) had peripheral retinal lesions in total; 75 (4.35%) eyes had holes/tears; 313 (18.14%) eyes had peripheral retinal degenerations. Sensitivity of Optomap for detecting peripheral retinal holes/tears and degenerations were 57.33% (95% confidence interval [CI]: 45.38-68.69) and 65.18% (95% CI: 59.61-70.45). Specificity for peripheral retinal holes/tears and degenerations were 99.58% (95% CI: 99.13-99.83) and 99.08% (95% CI: 98.43-99.51), respectively. A total of 22.70% (32/141) of omitted peripheral retinal lesions under Optomap needed intervention. Longer axial length (odds ratio [OR]: 1.16, P < .01), more severe refractive error (OR: 1.05, P < .01) and older age (OR: 1.03, P < .01) were proved to be risk factors for peripheral retinal degenerations in high myopes. CONCLUSIONS AND RELEVANCE: Optomap ultrawide field imaging is a reliable adjunctive tool with high specificity and moderate sensitivity for identifying and recording peripheral retinal lesions in high myopes in preoperative examination. Nonmydriatic Optomap could not entirely replace Goldmann three-mirror contact lens in detecting peripheral retinal lesions in high myopia ICL candidates.

Clinical characteristics and surgical outcomes of dysfunctional quadricuspid aortic valve.

BACKGROUND: Quadricuspid aortic valve (QAV) is a rare and poorly understood congenital cardiac abnormality. This study aims to evaluate the clinical features and surgical outcomes of dysfunctional QAV. METHODS: From January 2011 to May 2017, 36 (mean age 50.7 ± 11.9 y, 19 males) of a total of 3855 patients who underwent aortic valve surgery were identified as having dysfunctional QAV (frequency 0.9%). All patients presented moderate or severe aortic regurgitation, and nine patients (25.0%) had concomitant aortic stenosis. The ascending aortic diameter was over 40 mm in seven patients (19.4%) and over 45 mm in two patients (5.6%). The most common QAV morphology was type B (n = 12, 33.3%) according to the Hurwitz-Roberts classification. RESULTS: All patients underwent aortic valve replacement and two required concomitant ascending aortic replacement. The mean follow-up time was 20.6 ± 14.2 mo. There was no early or late postoperative mortality or major complications. Pathological analysis of dilated ascending aorta demonstrated a relatively normal appearance. The ascending aorta did not grow after surgery (37.3 ± 4.1 mm versus 36.1 ± 2.5 mm, P = 0.084). Both the end-diastolic (58.1 ± 7.0 mm versus 50.0 ± 6.3 mm, P < 0.001) and end-systolic (37.7 ± 6.7 mm versus 32.8 ± 6.0 mm, P < 0.001) left ventricular dimensions were significantly decreased. CONCLUSIONS: Aortic insufficiency is the predominant pathology in dysfunctional QAV patients. The incidence and extent of aortic dilation is not significant in QAV and not associated with aortic valve phenotypes. Short- and mid-term surgical outcomes were found to be satisfactory in this study.

Development and validation of a deep learning model to predict axial length from ultra-wide field images.

BACKGROUND: To validate the feasibility of building a deep learning model to predict axial length (AL) for moderate to high myopic patients from ultra-wide field (UWF) images. METHODS: This study included 6174 UWF images from 3134 myopic patients during 2014 to 2020 in Eye and ENT Hospital of Fudan University. Of 6174 images, 4939 were used for training, 617 for validation, and 618 for testing. The coefficient of determination (R2), mean absolute error (MAE), and mean squared error (MSE) were used for model performance evaluation. RESULTS: The model predicted AL with high accuracy. Evaluating performance of R2, MSE and MAE were 0.579, 1.419 and 0.9043, respectively. Prediction bias of 64.88% of the tests was under 1-mm error, 76.90% of tests was within the range of 5% error and 97.57% within 10% error. The prediction bias had a strong negative correlation with true AL values and showed significant difference between male and female (P < 0.001). Generated heatmaps demonstrated that the model focused on posterior atrophy changes in pathological fundus and peri-optic zone in normal fundus. In sex-specific models, R2, MSE, and MAE results of the female AL model were 0.411, 1.357, and 0.911 in female dataset and 0.343, 2.428, and 1.264 in male dataset. The corresponding metrics of male AL models were 0.216, 2.900, and 1.352 in male dataset and 0.083, 2.112, and 1.154 in female dataset. CONCLUSIONS: It is feasible to utilize deep learning models to predict AL for moderate to high myopic patients with UWF images.

Spectacle Lenses With Highly Aspherical Lenslets for Slowing Axial Elongation and Refractive Change in Low-Hyperopic Chinese Children: A Randomized Controlled Trial.

PURPOSE: Spectacle lenses with highly aspherical lenslets (HAL) have been shown to effectively retard myopia progression in myopic children. This study aimed to investigate the impact of spectacle lenses with HAL on refractive and axial length (AL) changes in Chinese children with low amount of hyperopia. DESIGN: Randomized controlled trial. METHODS: A total of 108 Chinese children aged 6.0 to 9.9 years and spherical equivalent refractive error (SERE) from 0.00 to +2.00 D were randomly allocated into two groups: the HAL group and the single vision spectacle lens (SVL) group. Cycloplegic refraction, AL, and uncorrected visual acuity were measured at baseline, 6 and 12 months after lens dispensing. The duration of spectacle lens wear was monitored using a wearable device attached to the spectacle frame and by questionnaire logs provided by participants at each follow-up visit. RESULTS: The 1-year SERE change was -0.19 (-0.32, 0.03) D and -0.23 (-0.36, 0.05) D in the SVL and HAL groups (P = .883). The 1-year AL elongation was 0.24 (0.18, 0.34) mm and 0.19 (0.12, 0.27) mm in the SVL and HAL groups (P = .057). In the HAL group, changes in AL and SERE were significantly correlated to lens wearing time (P < .001 and P = .024, respectively). Participants in the HAL group who wore their lenses for more than 30 hours per week had significantly slower AL elongation (0.11 [0.05, 0.17] mm) compared to their SVL counterparts (0.27 [0.21, 0.33] mm) (P < .001). CONCLUSIONS: Spectacle lenses with HAL significantly reduced AL elongation in low hyperopic children who wore lenses for over 30 hours per week. A dose-response relationship was evident with longer lens wearing time associated with less AL change.

Application of mydriasis and eye steering in ultrawide field imaging for detecting peripheral retinal lesions in myopic patients.

PURPOSE: To compare mydriatic and eye-steering ultrawide field imaging (UWFI) with standard non-mydriatic UWFI examination in detecting peripheral retinal lesions in myopic patients. METHODS: Cross-sectional, observational study. 220 eyes of 110 myopic patients with known peripheral retinal lesions in at least one eye under Goldmann three mirror contact lens examination were recruited. Non-mydriatic standard and eye-steering UWFI images were taken centrally and with eye-steering technique in upper, lower, nasal and temporal gazes under Optomap UWFI (Daytona, Optos, UK). Mydriatic standard and eye-steering UWFI was captured in central gaze and four different peripheral gazes. Sensitivity of detecting peripheral retinal lesions under different UWFI settings was compared. RESULTS: 141 (64.09%) eyes were with peripheral retinal lesions. The sensitivity for detecting peripheral lesions from low to high was 41.84% (95% CI 33.62% to 50.54%) under non-mydriatic standard UWFI setting, 52.48% (95% CI 44.08% to 60.75%) under mydriatic standard setting, 75.18% (95% CI 67.21% to 82.06%) under non-mydriatic eye-steering setting and 86.52% (95% CI 79.76% to 91.69%) under mydriatic eye-steering setting. Both mydriasis and eye-steering technique increased sensitivity of detecting peripheral lesions with statistical significance (p<0.001). By applying eye-steering technique, sensitivity of detecting lesions located in superior and inferior quadrants witnessed a greater increase compared with other two quadrants (p<0.05). Neither spherical equivalence (p>0.05) nor axial length (p>0.05) was an independent influence factor for detecting peripheral lesions. CONCLUSIONS: Eye-steering technique and mydriasis could both efficiently improve the sensitivity of detecting peripheral retinal lesions in myopic patients. Lesions of superior and inferior quadrants benefited more from eye-steering technique.

Prediction of Refractive Error Based on Ultrawide Field Images With Deep Learning Models in Myopia Patients.

Summary: Ultrawide field fundus images could be applied in deep learning models to predict the refractive error of myopic patients. The predicted error was related to the older age and greater spherical power. Purpose: To explore the possibility of predicting the refractive error of myopic patients by applying deep learning models trained with ultrawide field (UWF) images. Methods: UWF fundus images were collected from left eyes of 987 myopia patients of Eye and ENT Hospital, Fudan University between November 2015 and January 2019. The fundus images were all captured with Optomap Daytona, a 200° UWF imaging device. Three deep learning models (ResNet-50, Inception-v3, Inception-ResNet-v2) were trained with the UWF images for predicting refractive error. 133 UWF fundus images were also collected after January 2021 as an the external validation data set. The predicted refractive error was compared with the "true value" measured by subjective refraction. Mean absolute error (MAE), mean absolute percentage error (MAPE) and coefficient (R 2) value were calculated in the test set. The Spearman rank correlation test was applied for univariate analysis and multivariate linear regression analysis on variables affecting MAE. The weighted heat map was generated by averaging the predicted weight of each pixel. Results: ResNet-50, Inception-v3 and Inception-ResNet-v2 models were trained with the UWF images for refractive error prediction with R 2 of 0.9562, 0.9555, 0.9563 and MAE of 1.72(95%CI: 1.62-1.82), 1.75(95%CI: 1.65-1.86) and 1.76(95%CI: 1.66-1.86), respectively. 29.95%, 31.47% and 29.44% of the test set were within the predictive error of 0.75D in the three models. 64.97%, 64.97%, and 64.47% was within 2.00D predictive error. The predicted MAE was related to older age (P < 0.01) and greater spherical power(P < 0.01). The optic papilla and macular region had significant predictive power in the weighted heat map. Conclusions: It was feasible to predict refractive error in myopic patients with deep learning models trained by UWF images with the accuracy to be improved.

Impact of ablation ratio on 5-year postoperative posterior corneal stability after refractive surgery: SMILE and FS-LASIK.

BACKGROUND: To investigate the impact of the ablation ratio on 5-year postoperative posterior corneal stability in myopic eyes after small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) surgery. METHODS: A prospective, nonrandomized, cohort study: 80 eyes of 43 patients underwent SMILE surgery and 63 eyes of 32 patients underwent FS-LASIK surgery at the EYE & ENT Hospital, Fudan University. Ablation ratio was defined as lenticule thickness (SMILE cases) or ablation depth (FS-LASIK cases) divided by central corneal thickness (CCT). Posterior corneal elevation changes were recorded as posterior central elevation (PCE), posterior corneal surface at thinnest point (PTE) and posterior corneal mean elevation (PME). Patients were followed up at 6-month and 5-year interval to investigate the impact of the ablation ratio on posterior corneal elevation after SMILE and FS-LASIK surgery. RESULTS: PCE dropped at the 6-month follow-up for both SMILE (decreased by -1.11 ± 2.93 µm, P < 0.05) and FS-LASIK groups (decreased by -0.46 ± 3.72 µm, P < 0.05). PTE also dropped in SMILE (reduced by -2.04 ± 3.02 µm, P < 0.05) and FS-LASIK group (reduced by -1.28 ± 4.21 µm, P < 0.05) at the 6-month follow-up. Stable PCE (elevation change: SMILE -0.28 ± 4.03 µm; FS-LASIK 0.79 ± 4.13 µm, P > 0.05) and PTE (elevation change: SMILE -0.08 ± 4.28 µm; FS-LASIK 1.42 ± 3.85 µm, P > 0.05) for both groups were recorded at the 5-year follow-up compared to the 6-month visit. Ablation ratio was strongly correlated with 5-year postoperative PCE (ß = 2.68 ± 1.05, P < 0.01) and PTE (ß = 2.35 ± 1.17, P < 0.05). Cut-off value for 5-year postoperative raised PCE and PTE was 27.3 and 27.1%, respectively. CONCLUSIONS: Ablation ratio was strongly correlated with postoperative posterior corneal elevation in a 5-year follow-up in both SMILE and FS-LASIK groups. PCE and PTE underwent slight backward displacement 6-month postoperatively and remain stable at the 5-year follow-up. Threshold of the ablation ratio for resisting forward displacement of posterior corneal surface was 27.3 and 27.1% for SMILE and FS-LASIK groups, respectively.